EKG

Question 1

What is the function of the SA node?

Answer 1

Sinoatrial (SA) Node

“Pacemaker of the heart”

Rate of 60-100 bpm (intrinsic rate)

Begins atrial systole, and transmits electrical impulse to AV node

Question 2

What is the function of the AV node?

Answer 2

Atrioventricular (AV) Node
Slows conduction to ventricles
Delay allows for “Atrial Kick”
completes ventriclular filling
~20% of Cardiac Output
Back-up pacemaker in case of SA conduction failure
Rate of 40-60 bpm (intrinsic rate)

Question 3

How is blood transported into the Ventricles?

Answer 3

2 ways

80% from pressure gradient 20% from atrial kick

Question 4

What is the Intrinsic rate of the AV node?

Answer 4

40 - 60 bpm

Question 5

Bundle branches can have what rate?

Answer 5

20 - 40

Question 6

What happens in Diastole?

Answer 6

Ventricles are filling and relaxed as tricuspid and mitral valves are open

Semilunar valves are closed.

Coronary Arteries are passively filled with blood that is past the Aortic valve

Question 7

What happens during Atrial Systole (P-wave)?

Answer 7

Atrial Kick that give the last 20% of blood from atria

Greater pressure in ventricles than atria closes AV valve

Question 8

What Happens in Isovolumetric Ventricular Contraction?

Answer 8

Ventricles contract, all valves closed rapidly increasing pressure.
Volume not changing in left and right ventricle

Question 9

What Happens in ventricular systole?

Answer 9

Incresed pressure from ventricle contraction opens semilunar valves to release blood into arteries.

Question 10

What is a heart Murmur?

Answer 10

regurgitation of blood back to original chamber due to valve weakening.

Question 11

What Happens in Isovolumetric Relaxation?

Answer 11

Vents repolarize

Ventricle pressure decreased, AV valves open

Question 12

What is the P-wave on an EKG?

Answer 12

Atrial depolarization, contraction

Question 13

When reading an EKG, a small box represents what length of time?
A big box represents what length of time?

Answer 13

Small box = .04 secs

Big box = .20 secs

Question 14

When reading a rate, if an R-wave peaks on every other line, what is the rate?

Answer 14

150
Remember: on every line = 300
if it skips 2 lines then beats = 100
if its skips 3 lines then beats = 75
if its skips 4 lines then beats = 50

Question 15

What is the normal height and length of a P-wave?

Answer 15

less then 2.5 mm high

less .12 seconds or (3 sm boxes)

Question 16

What is the normal length of a PR interval?

Answer 16

.12-.20 seconds (or 3-5 sm boxes)

Question 17

What is the normal length of a QRS wave?

Answer 17

.06-.12 seconds (or 1 ½ to 3 sm boxes)

Question 18

What is the ST segment and what conditions can it show?

Answer 18

It is normally an isoelectric line that happens after the QRS wave and right before the T wave.
An elevated ST segment may mean M.I. (code STEMI)
A depressed ST segment can occur in Angina

Question 19

What is a T-wave?

Answer 19

repolarization of the muscles

T wave is typically larger than P wave and asymmetric, elevated with electrolyte imbalances

Question 20

What is the process in reading an EKG?

6 things

Answer 20

• Is the rhythm regular?
• Determine the rate
• Norm 60-100
• P waves: are they normal? Is there a QRS after every one?
• PR interval: normal length?
• QRS normal?
• ST segment isoelectric and T waves normal?

Question 21

What is a bi or tri gemini?

Answer 21

Its a term used in regularly irregular beats.
bi are irregular beats that happen ever other beat
tri are irregular beats that happen every 3rd beat

Question 22

What is a couplet or a triplet?

Answer 22

Its a term used for irregular beats.
Couplet are 2 irregular beats that occur but then return
Triplets are 3 irregular beats

Question 23

What are the 3 types of T waves?

Answer 23

Normal
Peaked
Inverted

Question 24

What is a normal HR?

Answer 24

60-100

Question 25

What are the characteristics of a Normal Sinus Rhythm?

Answer 25

``` HR - 60 - 100 Regular rhythm There is a P wave before every QRS PR interval of .12-.20 secs QRS of less than .12 ```

Question 26

What are the characteristics of Sinus Brady? | What is the treatment?

Answer 26

``` HR - Less than 60 Regular rhythm There is a P wave before every QRS PR interval of .12-.20 secs QRS of less than .12 ``` Treatment: Atropine

Question 27

What are the characteristics of Sinus Tachycardia? | Treatment?

Answer 27

``` HR - greater than 100 Regular rhythm There is a P wave before every QRS PR interval of .12-.20 secs QRS of less than .12 ``` Treatment: Need to find underlying cause. Can use oxygen Pain meds

Question 28

What is a PAC?

Answer 28

Premature Atrial Contraction Ectopic focus, atrial fires before SA node impulse Can be Multifocal or Unifocal

Question 29

What does unifocal and Multifocal mean?

Answer 29

It describes the origin of the ectopic beat outside of the normal electrical pathways. Unifocal means the beat comes from one place multifocal comes from multiple parts of the heart.

Question 30

What are the causes for a PAC?

Answer 30

Atrial hypoxia, irritability COPD due to dilated, hypertrophied atria which are more irritable Digitalis toxicity Stress

Question 31

What is the treatment for a PAC?

Answer 31

Rarely needs treatment

Question 32

What is PSVT and a PAT?

Answer 32

Paroxsymal Supraventicular tachycardia Paroxsymal Atrial Tachycardia dysrhythmias that correct itself. Coughing or bearing down can bring rhythm back

Question 33

What is an Atrial Flutter?

Answer 33

Very irritated focus – atrial contraction 250-400 AV node doesn’t (can’t) pass all impulses; ventricular rate is controlled Atrial kick diminished Characteristic sawtooth pattern

Question 34

What are the causes of A-flutter? | 4 causes

Answer 34

AMI, Cardiac Surgery, hypoxemia, PE

Question 35

How do you treat A-flutter?

Answer 35

Goal to control rate Drugs: amiodarone, digoxin Symptomatic (palpatations, angina, hemodynamic compromise) = cardioversion

Question 36

What is the difference of Cardioversion and D-Fib?

Answer 36

Cardioversion is timed to send a shock at an R-wave | while D-fib is not synchronized.

Question 37

What is A-fib? | at least 5 things

Answer 37

Multiple ectopic impulses Erratic quivering of atria NO effective atrial contractions occur Conduction thru AV node is slow or fast Atrial rates can be 350-650

Question 38

What are some risks of A-fib?

Answer 38

CVA PE risk Hemodynamic effect depends on patient tolerance of decreased CO

Question 39

What is the treatment of A-fib?

Answer 39

``` anticoagulation (if patient has been in A-fib for an unknown time) dixgoxin, esmolol, amiodarone. If symptomatic cardioversion. ```

Question 40

What is a first degree Heart block? What is the treatment?

Answer 40

Normal SA impulse Delayed at AV node (PR interval longer than 0.2 seconds ( 5 boxes) No treatment

Question 41

What is second degree heart block TYPE 1? What is the treatment?

Answer 41

PR interval gets longer with each beat until transmission to ventricle is dropped P wave is seen without QRS No treatment

Question 42

What is second degree heart block TYPE 2? What is the treatment?

Answer 42

PR intervals remain Constant Impulses are intermittently blocked at Bundle of His or Bundle branch More P waves than QRS Atropine then pacemaker

Question 43

What is 3rd degree heart block? Complete heart block What is the treatment?

Answer 43

No Beats conducted to ventricle from atria Atria and ventricles depolarize independently SA node depolarizes atria, Bundle of His or Bundle branches depolarize ventricles Normal QRS if Bundle of his, wide complex if below due to slower conduction rates Pacemaker

Question 44

what is a Idioventricular Rhythm?

Answer 44

ventricles take over if Atria aren’t firing Rate : 20-40 also called Ventricular escape rhythm Do NOT try to abolish this rhythm Lidocaine contraindicated permanent pacing may be required, this is not a reliable rhythm

Question 45

What is ventricular tachycardia?

Answer 45

Rhythm usually regular Rate is 100-250 P waves not usually present Wide QRS three PVCs in a row = V-Tach

Question 46

What is the difference between an Idioventricular rhythm and a Junctional Rhythm?

Answer 46

An Idioventricular Rhythm occurs when SA node doesnt set pace for ventricular rate and an ectopic focus is use to set the pace. Junctional Rhythm is controlled by the AV node and appears to be have a normal QRS. P wave may be present but can look inverted.