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Flashcards in EKG Deck (120):
1

Normal PR Interval

0.12 - 0.2 seconds (5 small squares)

2

Where is the electrical impulse generated from if the EKG is showing normal sinus rhythm?

SA node

3

PR interval for sinus bradycardia

Normal (0.12 - 0.2 seconds)

4

Where is the electrical impulse generated from in the EKG is showing normal sinus rhythm?

Could possibly be the AV node but could also be the SA node

5

Sinus Bradycardia Treatments

If patient is symptomatic:
1. Atropine 0.5 mg IVP every 3-5 minutes with maximum total dose of 3 mg
2. Transcutaneous pacing

6

Possible Symptoms a Bradycardic Patient might experience

1. Hypotension
2. Diaphoretic
3. Drowsiness
4. Cyanotic/Dusky

7

Causes of Sinus Bradycardia

1. Lower metabolic needs
2. Vagal stimulation
3. Medications
4. Increased ICP
5. MI
6. Hypovolemia
7. Hypoxia
8. Hypo/hyperkalemia
9. Hypothermia
10. Toxins
11. Cardiac tamponade
12. Tension pneumothorax
13. Thrombosis
14. Trauma

8

HR range for sinus tachycardia

More than 100 but less than 120

9

PR interval for sinus tachycardia

Normal (0.12 - 0.20 seconds)

10

Causes of Sinus Tachycardia

1. Physiologic or psychological stress
2. Medications
3. Stimulants
4. Illicit Drugs
5. Autonomic dysfunction

11

Physiologic or Psychological Stress that can Cause Sinus Tachycardia

1. Acute blood loss
2. Shock
3. Fever
4. Exercise
5. Anxiety
6. Fluid overload

12

Medications that can cause Sinus Tachycardia

1. Catecholamine's
2. Aminophylline
3. Atropine

13

Stimulants that can cause Sinus Tachycardia

1. Caffeine
2. Nicotine

14

Illicit drugs that can cause Sinus Tachycardia

1. Cocaine
2. Ecstacy

15

Treatment for Sinus Tachycardia

1. Correct the cause
2. Beta-blockers
3. Calcium-channel blockers

16

What does Atrial Flutter look like on an EKG?

Saw tooth or picket fence appearance

17

Is the rhythm regular or irregular for atrial flutter?

Regular

18

Atrial Flutter Rate

1. Atrial rate ranges from 250 to 400
2. Ventricular rate ranges from 75 to 150

19

PR interval for Atrial Flutter

Not measurable

20

Causes of Atrial Flutter

1. COPD
2. Valvular disease
3. Thyrotoxicosis (thyroid storm)
4. S/P Cardiac Surgery

21

Treatment of Atrial Flutter

1. Vagal maneuvers
2. Adenosine
3. Electrical cardioversion
4. Catheter ablation

22

S/Sx of Atrial Flutter

1. Patient may or may not be symptomatic
2. Chest pain
3. SOB
4. Decreased BP
* If a patient is asymptomatic, they might just put them on an anticoagulant but possibly no other therapy

23

Atrial Fibrillation Rhythm

Irregularly irregular

24

Atrial Fibrillation Rate

1. Atrial rate from 300 to 600
2. Ventricular rate from 120 to 200

25

PR interval for atrial fibrillation

Not measurable

26

Causes of Atrial Fibrillation

1. Valvular heart disease
2. Inflammatory or infiltrative disease
3. CAD
4. HTN
5. Heart failure
6. Hyperthyroidism
7. Pulmonary HTN
8. Pulmonary embolism
9. Obstructive sleep apnea
10. S/P cardiac or pulmonary surgery

27

Treatment of Atrial Fibrillation

1. Electrical cardioversion
2. Amiodarone
3. Flecainide
4. Propafenone
5. Ibutilide
6. Catheter ablation
7. Antithrombotic therapy

28

Special Consideration for a patient with Atrial Fibrillation

First obtain an H/P, how long has the patient been in this rhythm or is it new onset?

29

Supraventricular Tachycardia Rhythm

Regular

30

Supraventricular Tachycardia Rate

140 - 220

31

PR interval for Supraventricular Tachycardia

Depends on site of supraventricular pacemaker (where is the impulse coming from)

32

Where is the electrical impulse coming from in a patient with SVT

Impulses stimulating the heart are not being generated by the SA node, but instead are coming from a collection of tissue around and involving the AV node

33

Causes of SVT

1. Caffeine
2. Nicotine
3. Hypoxemia
4. Stress
5. CAD
6. Cardiomyopathy

34

Treatment of SVT

1. Vagal maneuvers
2. Adenosine (6 mg, then 12 mg)
3. Calcium channel blockers
4. Cardioversion

35

Premature Ventricular Complex Rhythm

Depends on the underlying rhythm

36

Premature Ventricular Complex Rate

Irregular due to early QRS

37

PR interval for Premature Ventricular Complex

Normal (0.12 - 0.20 seconds)

38

Causes of Premature Ventricular Complex (PVC)

1. Caffeine
2. Nicotine
3. Alcohol
4. Cardiac ischemia or infarction
5. Heart failure
6. Digitalis toxicity
7. Hypoxia
8. Acidosis
9. Electrolyte imbalances

39

Treatment for PVC

1. If the patient has no underlying disease or infrequent changes, no treatment is required
2. Amiodarone
3. Lidocaine
* if not treated, they can progress to V-tach

40

PVC's can cause problems if...

1. More than 6 per minute
2. Multifocal/polymorphic
3. Occur 2 in a row
4. Occur on the T wave

41

Ventricular Tachycardia Rhythm

Regular

42

Ventricular Tachycardia Rate

Range from 100 to 200

43

Causes of Ventricular Tachycardia

1. CNS disease
2. Hypokalemia
3. Hypocalcemia
4. Hypomagnesemia

44

Treatment of Ventricular Tachycardia

1. Cardioversion if patient has a pulse
2. Defibrillation if patient is pulseless
3. Replace electrolytes
4. Amiodarone
5. Isuprel

45

Ventricular Fibrillation Rhythm

Extremely Irregular

46

Ventricular Fibrillation Rate

Greater than 300

47

Causes of Ventricular Fibrillation

1. CAD
2. MI
3. Untreated V-tach
4. Cardiomyopathy
5. Vavlular heart disease
6. Acid-base imbalance
7. Electrolyte imbalance
8. Electrical shock

48

Treatment of Ventricular Fibrillation

Defibrillation

49

Causes of Asystole

1. Hypoxia
2. Acidosis
3. Severe electrolyte imbalance
4. Drug overdose
5. Hypovolemia
6. Cardiac tamponade
7. Tension pneumothorax
8. Coronary/pulmonary thrombosis
9. Trauma
10. Hypothermia

50

Treatment of Asystole

CPR

51

Third Degree AV Block Rhythm

Regular

52

Third Degree AV Block Rate

Varies

53

PR interval for 3rd Degree AV Block

Irregular

54

3rd Degree AV Block is also called what?

Complete Heart Block

55

Treatment of 3rd Degree Heart Block

Pacing
* This patient will have decreased cardiac output

56

Potential Complications of Dysrhythmias

1. Cardiac Arrest
2. Heart Failure
3. Thromboembolic Event

57

Defibrillation

Shocking the patient is depolarizing the patient. It resets polarization so that the SA node picks up and starts

58

Defibrillation is the treatment for what arrhythmias?

1. Pulseless V-tach
2. V-fib

59

Nursing Responsibilities for Defibrillation

1. Start CPR before defibrillation
2. Turn device on (apply gel if needed)
3. Ensure device in defibrillation mode
4. Select electric charge 300-360 joules (or follow MD order)
5. If using paddles, apply 20 lbs of pressure
6. Ensure all personnel are clear of patient/bed prior to shocking the patient
7. After defibrillation, check the patient an monitor

60

Cardioversion is the treatment for which arrhythmias?

1. SVT
2. A-Fib
3. A-Flutter
4. Stable V-tach (pulse is present)

61

Cardioversion

- The shock is synchronized with the rhythm
- The MD can control the amount of joules
- Synchronized hits in the QRS complex during ventricle depolarization
- Even if the pads are pushed a little too early, it's ok, it will wait until the QRS complex

62

Nursing Responsibilities for Cardioversion

1. Consent may be obtained if not emergent
2. Patient may be given a sedative: diazepam or midazolam
3. Usually try 3-4 times

63

Pacemaker Therapy

- Used to treat conduction defects or dysrhythmias
- Uses a pulse generator to provide an electrical stimulus to the heart when the heart fails to conduct its own at a rate that maintains cardiac output

64

Fixed (Asynchronus) Pacemaker

Pacemaker is set at a rate determined by the MD

65

Demand (Synchronus) Pacemaker

Pacemaker fires when rate falls below set rate determined by MD

66

Temporary Pacemaker

Uses an external pulse generator attached to a lead threaded intravenously into the right ventricle

67

Types of Temporary Pacemakers

1. Epicardial - directly in the heart
2. Endocardial - threaded through a central vein

68

Permanent Pacemakers

Use an internal pulse generator placed in a subcutaneous pocket in the subclavian space or abdominal wall

69

What kind of arrhythmias would require a pacemaker?

1. 3rd degree AV Block
2. Sick Sinus Syndrome
3. Asystole

70

S/Sx of Low Cardiac Output

1. Dizziness
2. Bradycardia
3. Restlessness
4. Hypotension

71

Potential Complications after Pacemaker Placement

1. Infection
2. Pneumothorax
3. Arrhythmias

72

Patient Care of Pacemaker

1. Monitor incision
2. Avoid large magnetic fields
3. Avoid heavy lifting for 2 weeks
4. Medical identification

73

Pacemaker on an EKG

- Pacing is detected on ECG by sharp spike noted before the P wave with atrial pacing or before the QRS with ventricular pacing
- If nurse caring for patient does not see pacer spikes, the voltage must be increased so that spikes are seen

74

Implantable Cardioverter Defibrillator

- Detects life threatening changes in the rhythm (tachycardia, fibrillation)
- Automatically delivers an electrical shock to convert the dysrhythmia
- Life vest are used until a patient can have an AICD placed

75

Electrophysiological Studies

- An electrophysiology study (EPS) is one of the most accurate and reliable methods of evaluating heart rhythms
- The procedure is performed by an electrophysiologist who will attempt to reproduce dysrhythmias to determine the type and location

76

Cardiac Conduction Surgery

- Maze procedure is performed to treat atrial fibrillation (refractory)
- Catheter ablation therapy is a curative procedure that involves the application of energy through a catheter tip to cauterize electrical tissue causing the dysrhythmias

77

P Wave

Atrial Depolarization (atrial contraction)

78

QRS Complex

Depolarization of ventricles (contraction of ventricles)

79

What does the SA node do?

- It is the primary pacemakers
- Highest degree of automaticity, causes depolarization

80

What does the AV node do?

- It is the backup pacemaker in the 40-60 bpm range
- Atrial junction, slower to allow the ventricle chamber to fill more completely

81

Purkinje Fibers

Could take over as pacemaker if HR gets to 20-30 bpm range if needed

82

Bundle of His

Ventricle sends blood to pulmonary artery and the aorta

83

Stroke Volume

Injected blood into the system circulation in one beat

84

Contractility

The ability of the cells to shorten when depolarized by an electrical impulse

85

Automaticity

The ability of the cell to spontaneously generate and discharge an electrical impulse

86

Excitability

The ability of the cell to respond by depolarization. The response can be influenced by: hormones, electrolytes, meds, O2, nutrition

87

Refractory

The period which the cells resist stimulation
- Relative refractory
- Absolute refractory

88

Relative Refractory

A greater than normal stimulus is required to generate another action potential

89

Absolute Refractory

Depolarization will not occur no matter how strong the stimulus

90

What is the PR interval?

Measures the amount of time it takes for impulse to travel from atrial depolarization to the beginning of ventricle depolarization (0.12-0.20 seconds); SA node to AV node

91

Normal length of QRS interval

Complex is normally less than 0.12 seconds in duration

92

ST segment

End of ventricle depolarization to the beginning of ventricle repolarization
- Isoelectric or flat
- Elevated or depressed may indicate disease or injury of ventricle muscle

93

T Wave

Repolarization of ventricles (return to resting state) and are most vulnerable to dangerous stimuli

* Should be up, if downward displacement = injury, ischemia, or infarction

94

QT interval

The amount of time for ventricle to depolarize and repolarize (usually 0.32-0.40 seconds)

95

Conditions that can change the shape and size of PR interval

1. Digitalis
2. Beta-blockers
3. Age and conduction disease
4. Atrial enlargement
5. Valvular heart disease

96

Conditions or medications that change the QRS

1. Ventricle enlargement
2. Dysrhythmic meds, Quinidine, Procainamide, Flocainidine
3. Ventricle electrical conduction defects
4. COPD
5. Hyperkalemia
6. Hypokalemia

97

Conditions that cause the QT interval to prolong

1. Low HR
2. Hypocalcemia
3. Hypokalemia
4. Ischemia
5. Infarction

98

P Wave for Normal Sinus Rhythm

Visible before each QRS complex

99

QRS Duration for Normal Sinus Rhythm

Normal (< 0.12 seconds)

100

QRS Duration for Sinus Bradycardia

Normal (< 0.12 seconds)

101

P Wave for Sinus Bradycardia

Visible before each QRS complex

102

QRS Duration for Sinus Tachycardia

Normal (< 0.12 seconds)

103

P Wave for Sinus Tachycardia

Visible before each QRS complex

104

QRS Duration for Atrial Flutter

Usually normal (< 0.12 seconds)

105

P Wave for Atrial Flutter

Saw-tooth shape (referred to as F waves)

106

P Wave Rate for Atrial Flutter

300 beats per minute

107

QRS Duration for Atrial Fibrillation

Usually normal (< 0.12 seconds)

108

P Wave for Atrial Fibrillation

Not distinguishable as the atria are firing off all over

109

QRS Duration for SVT

Usually normal (< 0.12 seconds)

110

P Wave for SVT

Cannot be seen

111

QRS Shape for PVC

Bizarre and abnormal

112

P Wave for PVC

Ratio 1:1

113

P Wave Rate for PVC

Normal and same as QRS rate

114

QRS Duration for V-tach

Prolonged with a bizarre abnormal shape

115

P Wave for V-tach

Not seen

116

QRS Duration for V-fib

Not recognizable

117

P Wave for V-fib

Not seen

118

QRS Duration for 3rd Degree Block

Usually abnormal

119

P Wave for 3rd Degree AV Block

Unrelated to QRS complex

120

P Wave Rate for 3rd Degree AV Block

Normal but faster than QRS rate