ECG interpretation Flashcards by Alyssa Samayoa

How many little boxes does one big box contains?

5 little boxes

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Each little box represents ____ seconds

0.04s

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Multiply 0.04 by ___ small boxes to make up __ large box

5 small boxes to make up 1 large box

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How many seconds does each large box make up?

0.20 seconds

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What does P wave mean?

atrial depolarization

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What does a good P wave look like?

smooth, round and upright

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What to look for with the P wave…..

if there are no P waves
if a P wave is present, but not followed by a QRS complex
can give clues to pacemaker site
P waves that vary in size and configuration
Upright or inverse

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What is the PR interval? How is it measured?

amount of time it tasks atria to DEPOLARIZE and for impulse to travel through the AV node
measured from the start of the P wave to the point at which the QRS complex begins

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How long is the PR interval supposed to be?

<0.20s (one bigger box, 5 little ones)

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What does the QRS complex supposed to look like?

Narrow, with sharply pointed waves and has a duration of less than 0.12s (3 small boxes or less)

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What does the QRS complex represent?

Ventricular depolarization

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What does a wide QRS mean?

a BLOCK somewhere

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Do T waves really matter in reading a lead II ECG?

NOPE

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What is the 1st step in reading an ECG rhythm?

Measure the heart rate
- 6 sec strip
- 300 rule

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What is the 2nd step in reading an ECG rhythm?

Identify the P waves.
- upright? contoured? retrogade? inverted?
- do they all look the same?

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What is the 3rd step in reading an ECG rhythm?

Measure the PI interval.
- should be less than 0.20s (one bigger box, 5 little ones)

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What is the 4th step in reading an ECG rhythm?

Determine the relationship of the P waves with QRS.
- should be 1:1 ratio

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What is the 5th step in reading an ECG rhythm?

Determine if the QRS complex is wide or narrow.
- wide means there is a block
- narrow=normal, <0.12s, 3 little boxes

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What is the 6th step in reading an ECG rhythm?

Determine rhythm regularity.
- are the QRS’s equally distance from each other?
- is it regularly irregular? irregularly irregular?

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What is the number sequence for the 300 rule?

300, 150, 100, 75, 60, 50, 43, 38, 33, 30

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What are the 3 different categories of dysrhythmias?

disorder of impulse formation
- SA node failure, other pacemakers and ectopic focuses
Disorders of impulse conduction
- Delayed or blocked in the heart
Artifact
- 60 cycle inference, poor contact, damaged cable

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Rate: 60-100 bpm
P waves: present/ upright
PRI: <0.20s
QRS: <0.12s
Ratio: 1:1
Rhythm: regular

Normal Sinus Rhythm

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Rate: 60-100 bpm, but sometimes below rates of 60bpm, the rate slightly increases and decreases with expiration and inspiration
P waves: present/ upright
PRI: <0.20s
QRS: <0.12s
Ratio: 1:1
Rhythm: regular irregular, it coincides w breathing patterns

Heart rate varies slightly with respiratory pattern

Sinus Arrhythmia

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Rate: <60bpm
P waves: present/ upright
PRI: <0.20s
QRS: <0.12s
Ratio: 1:1
Rhythm: regular

Sinus Bradycardia

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Rate: >100bpm P waves: present/ upright PRI: <0.20s QRS: <0.12s Ratio: 1:1 Rhythm: regular

Sinus Tachycardia

Rate: 140-250bpm P waves: buried under the preceding T wave PRI: N/A QRS: narrow <0.12s Ratio: N/A Rhythm: regular

Supra ventricular Tachycardia

Rate: rate change is sudden and unexpected (120-230bpm) P waves: may be seen during slower phase PRI: N/A during fast rate QRS: narrow Ratio:1:1(during slower rhythm) Rhythm: each section has regular rhythm

Paroxysmal Supraventricular Tachycardia (PSVT)

What is RE ENTRY syndrome?

when conduction is abnormally slow in some area (ex. heart damage) the myocardial cells are unable to activate the fast sodium channel part of impulse will arrive late and potentially be treated as a new impulse series of beats, sudden onset

What is pre excitation syndrome?

occurs because there exists muscle fibre that penetrates the AV ring that normally isolates the 2

What are types of pre excitation syndromes?

WPW- (kent bundle): pathway through the AV ring that bypasses the Av node MANHEIM FIBERS: from the AV node, bundle of His or branches LGL- bypass the AV node and goes directly to the bundle of His

Rate: generally slow-normal P waves: present and upright, the FOLLOWING beat will have a different morphology from the other P waves PRI: interval normal QRS: narrow Ratio: 1:1 Rhythm: regular, expect where disrupted by the pause

sinus arrest

Rate: slow-normal P waves: present except when dropped (after dropped, returns to normal) PRI: normal QRS: narrow Ratio: 1:1 Rhythm: regular except where disrupted by dropped beats

Sinus exit block / SA block

- Ectopic beat from somewhere in the atria - Contraction ahead of the regular P wave - similar OR diff morphology - PRI can be normal or long - SA node is firing normally and the atrium decided to shoot a single off

Premature Atrial Complex (PAC)

When the P wave must be upright during a PAC, if it is inverted/ retrograde, what is it called? - coming from the AV node

Premature Junctional Complex (PJC)

Rate: 40-60bpm P waves: absent, inverted or retrograde (after T) PRI: is normal or short or N/A QRS: usually narrow Ratio: 1:1 Rhythm: regular

Junctional

Rate: >100bpm P waves: retrograde PRI: short QRS: narrow Ratio: 1:1 Rhythm: regular

Junctional tachycardia

- waves with NO organization or regularity - indication of random electrical activity - can be atrial or ventricular - wavy line

Fibrillation

Rate: will vary P waves: not discernible PRI: N/A QRS: usually narrow Ratio: N/A Rhythm: irregularly irregular= the HALLMARK...

A-Fib (Atrial fibrillation)

What should we give to pt's who are in A FIB?

blood thinners

Rate: 200-350bpm P waves: saw tooth appearances PRI: n/a QRS: usually narrow Ratio: 2:1, 3:1, 4:1 Rhythm: usually regular

Atrial Flutter

Ventricular Rhythms: What are the different types of AV blocks?

1st degree (long PRI) 2nd degree: type I & II 3rd degree

Rate: depends on the underlying rhythm P waves: normal PRI: >0.20s QRS: narrow Ratio: 1:1 Rhythm: regualr

1st degree AV block

Rate: generally slow-normal P waves: present, stand alone PRI: becomes increasingly longer until a beat is dropped (hint: the PRI before dropped beat will be longer the one after) LONG before---> SHORT after QRS: narrow Ratio: 1:1 Rhythm: regularly irregular

2nd degree- type I

Rate: generally slow P waves: present, stand alone PRI: when there are P waves associated with QRS the PRI will be CONSTANT QRS: narrow Ratio: FIXED ratio Rhythm: usually regular

2nd degree, type II

Rate: slow 45 or below, atrial rate is normal P waves: present, stand alone PRI: N/A QRS: wide Ratio: N/A Rhythm: regular - No connection between the atrium and ventricles - Pt will obviously be SICK

3rd degree (complete block)

Rate: 20-40bpm P waves: absent PRI: N/A QRS: >0.12 and BIZARRE looking Ratio: N/A Rhythm: regular

Idioventricular

Rate: >40 less than 100bpm P waves: absent PRI: N/A QRS: wide >0.12 and BIZARRE Ratio: N/A Rhythm: regular

Accelerated Idioventricular- AIVR

Rate: 120-250bpm P waves: N/A PRI: N/A QRS: always wide >0.12s (usually >0.14s) Ratio: N/A Rhythm: usually regular unless polymorphic

Ventricular Tachycardia

What is monomorphic V Tach?

All QRS complexes have the same morphology

What is polymorphic V Tach?

When the QRS complexes vary in size/shape!

What is torsades de pointes?

axis of the QRS complex changes from positive to negative in a haphazard fashion "twisting of points" can convert to NSR or V FIB

- caused by premature firing of the ventricular cell - ventricular pacer fires before the SA node - underlying pacing rhythm schedule is not altered, so the beat after the PVC on arrive on time - ectopic complexes - occurs EARLY than expected

Premature Ventricular Complex

What does multifocal mean?

arising from 2 or more ectopic foci - results in multiple QRS morphologies

What does unifocal mean?

arising from a single ectopic foci - results in each PVC looking identical

Two consecutive PVCs?

couplet

Every other beat is a PVC?

Bigeminy

Every third beat is a PVC?

Trigeminy

Every fourth beat is a PVC?

Quadrigeminy

- Rhythm most commonly seen in cardiac arrests - Responds well to defibrillation - CPR compressions help make heart more susceptible to defibrillation - can be coarse or fine

Ventricular Fibrillation (V FiB)

V fib pts are clinically _______ !!

DEAD

2 types of V FIB:

coarse and fine

- Flatline - Entire heart is no longer contracting - Generally confirmation of death

ASYSTOLE

- clinically dead or VSA (no pulse) - presence of some form of electrical activity and a rhythm but the pt is apenic and pulseless - CPR is indicated - can be any heart rhythm

Pulseless Electrical Activity (PEA)

What are the 6 H's of causes of PEA:

Hyperkalemia Hypoxia Hydrogen Ion Access Hypoglycemia Hypothermia Hypovolemic

What are the 6 T's of causes of PEA:

Tamponade Toxins Thrombosis (MI) Thrombosis (PE) Trauma Tension pneumothorax

What is artifact?

- somatic tremors from skeletal muscle contraction - alternating current - disrupt the baseline as well as the clarity of the tracing

ECG interpretation Flashcards

(66 cards)