EKG Flashcards by Madeline Peters

A dysrhythmia originating in an ectopic site in the ventricles causing the QRS complexes to appear abnormally wide and bizarre

Ventricular Tachycardia

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Rate of VT

110-250 bpm

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Characterized by rapid, chaotic firing of numerous ectopic sites in the ventricles causing the ventricles to quiver; grossly irregular rhythm.

Ventricular Fibrillation

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No QRS complexes are present; no cardiac output and no pulse present! (=DEAD)

Ventricular Fibrillation

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Bizarre

Tachycardia

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Chaotic

Fibrillation

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Chaotic QRS complexes

V fib

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Bizarre QRS complexes

V tach

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AV node pulse

40-60 bpm

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SA node pulse

60-100 bpm

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purkinje fibers pulse

20-40 bpm

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P wave

atrial contraction or depolarization

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normal QRS interval

0.04-0.12 seconds

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T wave

ventricular relaxation or repolarization

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The normal PR interval

0.12-0.20 seconds

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Normal QT interval

0.36-0.44 seconds (adjusted for HR)

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One small box

0.04 seconds

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One large box

0.20 seconds

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Wide, irregular QRS with prolonged intervals.

Idioventricular

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Absence of all electrical activity within the ventricles.

No HR, no pulse, no rhythm (“flat line”); or if P waves are present but no QRSs, there is no output from the heart- no pulse.

Aystsole/ Ventricular standstill

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Prolonged PR interval- greater than 0.20 seconds

1st Degree Heart Block

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a. Progressing lengthening of the PR Interval, until a P wave is conducted with no QRS following it.
b. Cycle of lengthening PR Intervals will repeat, causing “groups” of the same pattern.
c. Rate is normal.
d. R to R interval is irregular- due to dropped QRSs.

2nd Degree Heart Block- Type I

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a. You will see “grouped beating”—groups of ECG complexes, then a pause with one or more P waves and no QRS following them.
b. This “grouped beating pattern” then repeats itself- This makes the rhythm
irregular (the QRSs are irregular—because one or more QRS is “missing” after
the extra P waves between groups).
c. The PR Interval is “fixed” or “consistent” across the ECG rhythm strip (except
where no QRS follows the extra P wave/ waves).

2nd Degree Heart Block- Type II

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a. Also known as Complete Heart Block.
b. AV Dissociation- is like a “divorce” between the atria and ventricles- they have nothing to do with each other any longer.
c. Will see regular, independent “P” waves (rate usually 60- 100) and regular, independent QRS complexes (rate usually 20 - 40).
d. Waves “march” regularly down the baseline-there is no association between the P waves and QRSs.

Study These Flashcards

Third Degree Heart Block

Normal SpO2 readings

94% to 100%.

QT high limit in our monitors is

500ms

prolonged QT may lead to

ventricular dysrthymias

Several medications may prolong the QT interval:

Tikosyn, Amiodarone, Haldol are examples.

The QT interval is defined as

the time between the beginning of the Q wave and end of the T wave, it measures the total duration of depolarization and repolarization phases

The relationship between QT and HR is...

inverse- the higher the HR, the shorter the QT interval:

the monitor uses _______ formula to determine the QTc, which is the QT corrected for HR

Bazett’s

QT alarm/value

Uncorrected QT

QTc alarm/value

Corrected QT

QTc HR

the HR used to calculate QTc

dQTc

delta QTC or the change in QTc from baseline

CANNOT ANALYZE QT

Monitor will say this if QT morphology is too varied to get an accurate measurement

In some situations it may be difficult to obtain reliable QT measurements, therefore it is appropriate to discontinue QT monitoring: (6)

i. Very flat T-wave ii. Atrial flutter or fibrillation where the T-wave may not be well defined iii. U-waves obscuring the end of the T-wave iv. Tachycardia where the P-wave encroaches on the end of the previous T-wave v. Noise or high QRS morphology variation vi. Physician order.

The ST segment is an important early indicator of...

cardiac ischemia

all telemetry monitored patients will receive ST segment monitoring unless they meet exclusionary criteria (5)

a. 100% paced b. Intermittent (not continuous) Right Bundle Branch Block c. Left Bundle Branch Block with frequent change in heart rate d. Atrial fibrillation/flutter with very coarse baseline e. Noisy signal due to restlessness or confusion

You can find type of pacing wires and programmed mode information by:

a. Looking in the patient’s chart – find documentation from the physician or pacemaker clinic for lead placement information b. Asking the patient or looking at his/her wallet card (if available) c. Checking a recent chest-x-ray for lead placement

Dual Chamber pacing

when a patient has an atrial and ventricular pacemaker

Pacing modes are determined by a sequence of letters.

1st letter: indicates which chamber will be “paced” 2nd letter: indicates which chamber is “sensed” by the pacemaker 3rd letter: pacemakers response to sensing the patient’s natural heart activity

AOO

This pacemaker mode paces in the atria 100% of the time; it has NO sensing capability 1. Post-op cardiac surgery in the presence of A-V block, especially after valvular surgery (due to the operative site being close to the AV node and bundle of His)

AAI

This pacemaker mode paces the atria, senses natural atrial activity, and inhibits pacing if natural activity occurs 1. Sinus node dysfunction with good AV function (i.e. sinus bradycardia, sinus arrest, sinoatrial block) 2. Atrial arrhythmias suppressed by chronic atrial pacing (i.e. atrial fibrillation with slow ventricular response)

- Erratic impulses from ectopic atrial sites - No discernible P wave ("squiggles") - R-waves not regular

Atrial Fibrillation

- Classic “sawtooth” pattern | - Ventricular rate may be regular or irregular depending on how many flutter waves are conducted through AV node

Atrial Flutter

- Atria activated by ectopic site instead of SA - Different shaped P wave - Early P in T wave (double hump)

Premature Atrial Contraction

SVT

- 150-250 bpm - ectopic focus in atria - Paroxysmal (PSVT): rhythm starts then stops

Atrial tachycardia

- Rapid rhythm 150-250 bpm - Ectopic focus in atria - 1:1 conduction (ventricle responds to every atrial impulse)

varies with respirations

sinus arrhythmia

sinus arrest

(sinus pause) - SA node fails to fire - HR normal or slow - caused by vagal, hiccups

Inverted P wave/ no P wave/ after QRS P wave

Premature Junctional Contraction

AV node takes over as primary pacemaker - 40-60 bpm - P-wave: absent, inverted, or burried

Junctional Rhythm

AV node takes over as primary pacemaker - 60-100 bpm - NO or inverted P wave

Accelerated junctional rhythm

AV node takes over as primary pacemaker - rate over 100 bpm - NO or inverted P wave

Junctional tachycardia

An IVR of less than 20 is

an agonal rhythm

An IVR of 41 to 100 BPM is

an accelerated idioventricular rhythm

A ventricular rhythm with a rate of 20-40 bpm.

ventricular Escape Rhythm

EKG Flashcards

(58 cards)