EKG Flashcards
(113 cards)
1
Q
What is an EKG?
A
A graphic representation of the electrical impulses of the heart
2
Q
EKG are used to
A
identify irregularities in heart rhythm
3
Q
How is EKG recorded from the body surface?
A
Electrodes
4
Q
Where do impulses in the heart start?
A
SA node (pacemaker of the heart )
5
Q
Flow of conduction in the heart
A
SA Node –> AV (junctional) node –> Bundle of His –> Left and Right bundle branches –> purkinje fibers
6
Q
what part of the heart delays conduction?
A
AV node
7
Q
AV Node allows for
A
mechanical contraction of the atria to eject blood into ventricles
8
Q
what are the bundle of his branches responsible for?
A
depolarizing respective ventricles
9
Q
What do the purkinje fibers do?
A
Penetrate myocardium and stimulate muscle contraction from the bottom the heart upwards…. VENTRICLE CONTRACTION
10
Q
P wave represents
A
atrial depolarization
11
Q
P-R interval
A
represents the slowing of conduction through the AV node
12
Q
QRS complex
A
ventricular depolarization and normally followed closely by ventricle contraction
13
Q
when does depolarization begins
A
ventricular contraction ends
14
Q
ST segment
A
- isoelectric (straight line) pause.
- ventricle is initiating depolarization
15
Q
When is repolarization complete?
A
end of the T-wave
16
Q
single-lead EKG can help practictitoners determine what?
A
- safety of pursing interventions in the light of abnormalities
- good indicator to stop treatment or continue
17
Q
most common practice in step-downs, ICUs, and CPPT rehab programs
A
Single-lead monitoring via telemetry
18
Q
Single-lead monitoring via telemetry are used to
A
detect rate and rhythm disturbances
19
Q
what can Single-lead monitoring via telemetry NOT detect
A
ischemia
20
Q
Ischemia
A
decreased blood flow to cardiac tissue
21
Q
Ischemia can lead to
A
disturbance in heart rhythm or infraction
22
Q
Infarction
A
interruption of blood flow that leads to death of cardiac muscle tissue
23
Q
Twelve- lead EKG is used to determine
A
ischemia or infarction
24
Q
when is a 12 lead EKG ordered
A
with change in patient condition or when ischemia is suspected
25
important info from a 12 lead EKG
- Ventricular hypertrophy
- myocardial ischemia
- Myocadial infarction
26
Ventricular hypertrophy
indicated by increased height (R wave) and depth (S wave) in QRS complex
27
Myocardial ischemia
indicated by ST segment depression or T-wave inversion when present with angina
28
Myocardial infarction
ST segment elevation
29
ST elevation is seen on EKG in conjunction with acute onset chest pain is what?
MEDICAL EMERGENCY
30
What is another term for ST segment elevation ?
tombstone Ts
31
Besides myocardial ischemia what are other causes for ST depression?
- Digitalis toxicity
| - Ischemic response to exercise if happens with activity
32
voltage or amplitude is measure where on the graph paper?
y-axis
33
Time is measured on where on the graph paper?
x-axis
34
how many seconds are 1 tick?
3 seconds
35
Square counting method is ideal for
regular rhythms
36
during a normal sinus rhythm rate is
60-100 bpm
37
During normal sinus rhythm QRST should be followed by what?
P
38
During normal sinus rhythm, P is followed by ?
QRST
39
During normal sinus rhythm, PR interval is constant at?
0.12 -0.20 seconds
40
Q waves are a sign of what?
Previous MI (absence in electrical activity)
41
do Q waves go away?
usually there to stay
42
Widened QT interval/ syndrome ?
inherited or medication induced
43
Widened QT interval/ syndrome are often misdiagnosed as what?
seizure
44
what type of drug is a patient on for a Widened QT interval/ syndrome?
Methadone
45
why can Widened QT interval/ syndrome be dangerous ?
they can lead to ventricular arrhythmias
46
U Waves represent repolarization if what?
purkinje fibers or papillary muscles
47
Patient who may present with U waves ?
hypokalemia or hypercalcemia, digitalis toxicity, and is a possible indicator for myocardial ischemia
48
dysrhythmia or arrhythmia
any rhythm other than NSR Arrhythmias
49
Tachyarrythmia
rhythm with a rate >100 bpm
50
Bradyarrythmia
rhythm with a rate < 60 bpm
51
Ectopy
electrical activity outside of the normal pathways
52
Junctional
premature impulses that arise from AV node or junctional tissue
53
Ventricular
Very dangerous and can alter cardiac output
54
ectopic focus
activity is originating or from a spot it is not supposed to
55
causes of sinus tachycardia
increase in sympathetic stimulation (exercise, emotions(fear, anxiety), stimulants (caffeine, atropine, nicotine, amphetamines), increase in O2 demands)
56
What do we do for tachycardia?
- Attempt to eliminate the cause
| - Initiation of beta-blocker therapy
57
Causes of sinus bradycardia
- super fit folks
- Beta blockers
- Increased vagal stimulation
58
symptoms of bradycardia
syncope, dizziness, angina or diaphoresis
59
what do we do for bradycardia?
Nothing, unless patients are sypmtomic
| -atropine, temp pacemaker
60
Sinus Arrhythmia
Quickening and slowing of impulse formation
61
Most common cause for Sinus Arrhythmia
respiratory cycle
62
Sinus Arrhythmia during expiration? & Inspiration ?
Expiration: slowing
Inspiration: speeding
63
What is it called when there is no true P wave, but flutters
Atrial flutter (flutter waves)
64
Is the ventricular rate effected during atrial flutter?
Not typically
65
Causes for atrial flutter?
Rheumatic heart disease, mitral valve disease, hypoxemia
66
treatment for atrial flutter
meds (digoxin, verapamil, beta-blockers)
| Cardioversion
67
Atrial rate during atrial flutter
250-300 times per minute
68
what is it called when there is no true Pwave and SA node is no longer the pacemaker?
Atrial fibrillation
69
during atrial fib there are multiple ectopic foci in where?
atria
70
During atrial fibrillation, ventricular rate depends on what?
AV node responsiveness
71
what is a classic sign of a fib?
highly irregular pulse
72
causes of a fib?
Advanced age, ischemia/infarction, CHF, stress, and renal failure
73
why is a fib a problem
- Decreased cardiac output
- Becomes very dangerous in the presence of tachycardia
- Stagnant blood.... excess coagulation.... clot formation
74
when should you terminate/ hold exercises with someone with Afib?
when ventricular rate is > 120-130 bpm at rest
75
what is the treatment of Afib
Pharmacological control, anticoagulation, radiofrequency ablation
76
when do heart blocks occur?
when cardiac electrical impulse is either delayed or blocked within the AV node, bundle of HIS, or Purkinje system
77
Is 1st degree heart block , a block or a delay?
Delay
78
2st degree heart block/ Moritz I is caused by?
conduction delay at AV node or bundle of his
79
What will be longer than normal in 2st degree heart block: Moritz I
PR interval
80
what is almost always a disease of the AV node?
2nd degree heart block : mobitz I
81
2nd degree heart block can also be known as
Moritz I or wenckebach
82
what do you see on an ECG during 2nd degree heart block/ mobitz I
progressive elongation of PR interval followed by a “dropped” or missing QRS complex
83
2nd degree. Moritz II is almost always a conduction disorder involving what?
bundle of his or purkinje system
84
What do you see during a 2nd degree/ Moritz II
- PR interval stays the same but "dropped" beats will be visible
- Intermirrent non-conducted P waves
85
Clinical significance of 2nd degree heart block/ mobitz II
- Can rapidly progress to complete heart block
| - Can lead to cardiac arrest
86
Definitive treatment for 2nd degree heart block/ Moritz II
implanted pacemaker
87
during 3rd degree or complete heart block impulses are generated where? and not conducted where?
- generated in SA node
| - NO conducted to ventricles
88
3rd degree heart block is categorized by?
complete lack of relationship between P waves and QRS complexes
89
what happens during a 3rd degree heart block?
A new or “accessory” pacemaker will generate “escape rhythms”, usually in the ventricles
90
what are the two independent rhythms on the ECG?
- P waves with a regular P to P interval (aka normal sinus rhythm)
- The QRS complexes with regular R to R interval. PR interval is variable here.
91
what causes 3rd degree or complete heart block?
- Coronary ischemia
- inferior wall MI (can damage AV node)
- Anterior wall MI (can cause damage to distal conduction system of heart)
92
Symptoms of 3rd deg heart block
severe bradycardia, hypotension, hemodynamic instability
93
Treatment of 3rd degree heart block
- Electrical pacing, either temporary or permanent
| - Definitive treatment is dual chamber artificial pacemaker
94
What are Premature ventricular contractions (PVC)
- Ectopic focus generating an impulse from somewhere in the ventricles
- Can be an individual event or occur in a predictable pattern
- Can be unifocal or multifocal
95
When should you be concern during PVC?
- 3 PVC in a row
| - 6 PVC in a minute
96
PVC can lead to
Ventricular Tachycardia
97
causes of PVC?
If isolated, possibly due to stress, caffeine or nicotine sensitivity, electrolyte imbalance
Ischemia, cardiac disease, irritation of myocardium
98
Symptoms of PVC ?
Feeling of a “skipped beat”, possible feelings of anxiety, SOB, dizziness
99
treatment of PVC?
Treat underlying cause
In patients with lung disease, PVCs may indicate hypoxemia. Patient should be placed on supplemental O2
Antiarrhythmic medication
100
Ventricular tachycardia or tech is defined as?
3 or more PVCs in a row
| -Rate 100-250 bpm
101
sustained v-tach
run of v-tach> 30 s, even if it self terminates
102
non-sustained v-tach
Self-termination in < 30 seconds
103
v-tach can lead to?
ventricular fibrillation
104
why does v-tach occur?
rapid firing by a single ventricular focus
105
causes of v-tach?
- Ischemia or acute infarction, CAD, heart disease
- Medication reactions (digoxin or qunidine toxicity)
- Athletes during exercise due to electrolyte imbalance
106
Symptoms of v-tach?
- Dizziness and syncope
- Disorientation
- Weak, thready pulse
107
Treatment of v-tach?
Immediate pharmacological intervention, cardioversion or defibrillation
108
What is Torsade de pointes
- Unique configuration of v-tach
- “Twisting of the points” around the isoelectric line
- Often associated with prolonged Q-T interval
- Occurs at a rapid rate and terminate spontaneously
109
Torsade de pointes is a what?
MEDICAL EMERGENCY
110
Torsade de pointes is treated with?
cardioversion
111
what is ventricular fibrillation?
erratic quivering of ventricular musculature
112
V fib is caused by?
multiple ectopic foci firing at the same time ..... no cardiac output
113
What do you always associate V fib with?
cardiac arrest
