ECG Rules Flashcards
(72 cards)
1
Q
Tall, peaked T wave
A
K+ is too high or myocardial ischemia is present
2
Q
U wave may represent
A
- low K+
- abnormal Mg+ levels
- normal repolarization of purkinje fibers
3
Q
Slowed conduction (>0.20) in the PR interval is indicative of…
A
1st degree AVB (AV block)
4
Q
QRS complex >0.12 represents
A
-R or L bundle branch block and a slowing of normal conduction through the ventricles
5
Q
a deep Q wave signifies…
A
myocardial infarct
6
Q
what creates a slight variance in normal RR intervals?
A
respiration
7
Q
Normal QT interval
A
less than one-half the RR interval and should not vary from one complex to another
8
Q
problem with a long QT interval
A
it presents an extended opportunity for stray irritable impulses to excite the muscle and may trigger dangerous ventricular rhythms
9
Q
medications that prolong the QT interval
A
quinidine and pronestyl
10
Q
elevated ST segment
A
- more than 1mm above baseline
- indicates myocardial ischemia: lack of oxygen to cardiac muscle (STEMI)
11
Q
normal sinus rhythm (NSR)
A
- regular rhythm
- 60-100 bpm
- each complex is complete
- intervals are within normal limits
- nothing looks off
12
Q
treatment of sinus bradycardia if pt is symptomatic
A
atropine
13
Q
significance of sinus tachycardia
A
- depends on pt’s tolerance of increased HR- some have dizziness and hypotension
- increased HR = increased myocardial O2 consumption
- MI pts with consistent tachy have increased risk for angina and increased infarct size
14
Q
treatment of sinus tachycardia
A
- treat underlying cause
- beta blockers (Inderal)
15
Q
sinus arrhythmia
A
- RR intervals vary; rate changes with respirations
- usually no significance and no treatment
16
Q
Premature atrial contractions (PAC)
A
- early complex
- atrial because it still has a p-wave
- t-wave might be bigger because p-wave is sitting on top of it
17
Q
PAC associations
A
- usually from stress, caffeine, tobacco, alcohol
- could be infection, inflammation, hyperthyroidism, COPD, heart disease, valvular disease
- enlarged atrium
18
Q
treatment of PAC
A
- start with getting rid of caffeine, tobacco, alcohol
- meds: dig, quinidine, procainamide, beta-blockers
19
Q
atrial flutter
A
- p-waves have saw-tooth appearance
- SA node constantly firing
- if >100 bpm, significantly decreased CO and could go into HF
20
Q
problems with atrial flutter
A
- decreased CO because atria can’t refill with blood (decreased preload)
- at risk for clots because of sitting blood… they’ll be on an anticoagulant
21
Q
treatment of atrial flutter
A
- cardioversion: reads QRS so it shocks when its supposed to
- meds: verapamil, diltizem, dig, quinidine, procainamide, beta-blockers
22
Q
atrial fibrillation
A
- *hallmark sign is regularly irregular QRS complexes
- syncope is often caused by an otherwise healthy person going into AFib
23
Q
significance of AFib
A
- decreased CO because lose “atrial kick”
- thrombi
- stroke
24
Q
treatment of AFib
A
- will need to be on anticoagulants
- if fast: digoxin
- if slow: pacemaker
- emergency situations: cardioversion
- other meds: verapamil, diltizem, quinidine, beta-blockers
25
atrial tachycardia
- R-R is constant and rate is regular
- rate is 150-250 bpm
- patient will say "my heart is racing" or "pounding out of my chest"
26
atrial tachycardia associations
- overexertion and emotional stress
- DIG TOXICITY
- changes in position, deep insporation, caffeine and tobacco
- Will Parkinson Wright
- RDH
27
treatment of atrial tachycardia
- Adenosine doesn't treat, just slows HR so you can see rhythm and have paddles ready
- vagal stimulation
- Meds: adenosine, verapamil, diltiazem, digitalis, propanolol
28
premature junctional contraction (PJC)
- premature beat (irregular rhythm)
- no p-wave
- fired from the AV node
- QRS
29
treatment of PJC
- rarely causes s/s
| - MAY medicate with procainamide or quinidine
30
treatment of junctional escape rhythm
- only medicate if symptomatic
| - if symptomatic, give atropine
31
associations of accelerated junctional rhythm
- acute inferior MI
- Dig toxicity
- acute rheumatic fever
- open heart surgery
32
treatment of accelerated junctional rhythm
- if Dig tox: hold Dig
| - atrial pacemaker
33
junctional tachycardia
- no p-wave
- regular rate and rhythm
- rate >100 bpm (usually 100-180)
- QRS
34
junctional tachycardia associations
-*ACUTE INFERIOR MI
-Dig tix
acute rheumatic fever
-open heart surgery
(rapid HR can cause s/s of low CO)
35
treatment of junctional tachycardia
- vagal stimulation
- verapamil
- cardioversion
36
premature ventricular contractions (PVC)
- ectopic beat
- no p-wave
- wide QRS >.12
- associated with irregular pulse
37
bigeminy
every other beat is early
38
trigeminy
every 3rd beat is early
39
couplet vs run
- couplet is a PVC that comes in pairs
| - run is a PVC that is 3 or more in a row
40
clinical associations of PVCs
- **HYPOKALEMIA
- hypoxia (could happen during suctioning)
- stimulants
- MI, mitral valve prolapse, CHF, CAD
41
significance of PVCs
- could cause Vtach
- usually benign is pts with normal hearts
- may reduce CO- angina and HF (heart will enlarge to compensate and cause hypertrophy)
42
indications for treatment of PVCs
- six or more in one minute
- ventricular couplets or triplets
- multifocal PVCs
- R on T phenomenon
43
treatment of PVCs
- amiodarone is drug of choice
- lidocaine: initial bolus - 0.5-1.5 mg/kg and continuous infusion of 2-4 mg/min
- procainamide
44
ventricular tachycardia
- regular rate/rhythm
- rate of 150-250 bpm
- QRS >.12
45
treatment of ventricular tachycardia
- if pulseless: defibrillate
- if they have a pulse: drug of choice is amiodarone
- also lidocaine, pronestyl
46
torsades de pointes
- type of vtach - "twisting of the points"
| - crescendo-decrescendo
47
treatment of torsades de pointes
-magnesium sulfate
48
ventricular fibrillation and treatment
- no waves or complexes that can be measured or analyzed
| - defibrillate immediately, CPR
49
idioventricular rhythm
- 20-40 bpm
- no p-wave
- wide QRS and often bizarre looking
50
treatment of idioventrivular rhythm
- atropine, isuprel (DO NOT GIVE LIDOCAINE)
| - pacemaker
51
asystole and treatment
- flatline, no pulse
- always check leads first
- CPR, ACLS with early intubation and IV epi and atropine
52
pulseless electrical activity (PEA)
- electrical activity can be observed but there is no mechanical activity and NO pulse
- prognosis is poor unless underlying cause is corrected immediately
53
causes of PEA
```
PATCHHH
Pulmonary emolus
Acidosis
Tension pneumothorax
Cardiac tamponade
Hypovolemia
Hypoxemia
Hypothermia
```
54
treatment of PEA
- treat underlying cause
| - CPR with early intubation and IV epi
55
first degree heart block
- "if the R is far from the P, then you have first degree"
- PR interval will be constant but greater than .20
- AV node is always the one thats blocking it
56
treatment of first degree
none
57
wenckebach (second degree heart block type 1)
- "longer, longer, longer, drop, then you have Wenchebach!"
| - hallmark: PR is long, next on is longer, longer, then complex is dropped
58
treatment of wenckebach
if symptomatic: atropine (always start with .5 mg) or pacemaker
59
classical second degree heart block (Mobitz II)
- "if some p's don't get through, then you have Mobitz II"
| - some p's don't have a QRS, but the ones that do are fixed and regular, they are close to the QRS
60
treatment of classical 2nd degree heart block
- pacing
| - can try atropine, epi, dopamine
61
complete or 3rd degree heart block
- "if Ps and Qs don't agree, then you have 3rd degree"
- R-R is regular
- P to P is regular
- But no relationship between P and QRS... complex is all jacked up
62
treatment of 3rd degree heart block
- priority pt for pacemaker
| - may use atropine, epi, dopamine
63
indications for a pacemaker
- symptomatic sinus bradycardia
- chronic atrial fib with a slow ventricular response
- idioventricular rhythm
- 2nd degree heart block type 2
- 3rd degree heart block
- sick sinus syndrome
64
failure to pace
- there is no pacemaker spike when there should be one
- pacemaker fails to initiate an electrical impulse when needed
- check battery or MD reposition pacing electrode
65
failure to capture
- there is a spike and no immediate p wave or QRS
- pacemaker initiates a pulse but fails to get a response (contraction)
- caused by: pacer lead fracture, battery failure, electrode movement, or fibrosis at electrode tip
- may need to increase coltage
66
failure to sense
- there is a pacemaker pike after a contraction
- pacemaker fails to sense pts heartbeat and initiates an electrical pulse
- caused by: pacer lead fracture, battery failure, movement of electrode
- need to increase the sensitivity of the external pulse generator
67
Atropine
- increases HR
| - always start with 0.5 mg; increase and repeat q 3-5 min in ACLS
68
digoxin
- slows ventricular rate, increased CO
- give in AFib and AFlutter
- paroxysmal atrial tachycardia
69
amiodarone
- slows the sinus rate, increases PR and QT intervals, causes vasodilation
- life-threatening ventricular arrhythmias unresponsive to less toxic agents
- VFib and VTach
- supraventricular tachyarrhythmias
70
adenosine
- slows conduction through the AV node
| - conversion of paroxysmal supraventricular tachycardia to NSR when vagal maneuvers are unsuccessful
71
lidocaine
- suppresses automaticity and spontaneous depolarization of ventricles
- for ventricular arrhythmias
72
magnesium sulfate
-torsades de pointes
