EKG and Irregular Atrial Rhythms

Question 1

What does the EKG measure?

Answer 1

The electrical activity of a heart beat
- each beat sends an electrical wave through the heart tissue

Question 2

What does an EKG determine?

Answer 2

heart rate and rhythm
needs interpretation

Question 3

Phase 0 of EKG

Answer 3

Depolarization and rapid entry of Na+

Question 4

Phase 1 of electrophysiological principles

Answer 4

Early depolarization
K+ slowly enters

Question 5

Phase 2 of electrophysiological principles

Answer 5

Plateu continues
slower entry of Ca++

Question 6

Phase 3 of electrophysiological principles

Answer 6

K+ moves out of the cell

Question 7

Phase 4 of electrophysiological principles

Answer 7

Resting phase

Question 8

What ability is indicated with automaticity?

Answer 8

Pacemaker ability

Question 9

What does rhythmicity indicate?

Answer 9

systematic pattern

Question 10

What does conductivity indicate?

Answer 10

spreads impulses

Question 11

What does contractility indicate?

Answer 11

the contraction ability

Question 12

What are the 4 electrophysiological principles?

Answer 12

Automaticity
Rhythmicity
Conductivity
Contractility

Question 13

What is activated with the SA node?

Answer 13

the atria

Question 14

What is the intrinsic rate of the SA node?

Answer 14

60-100 bpm

Question 15

What is activated with the AV node?

Answer 15

ventricles

Question 16

What is the intrinsic rate of the AV node?

Answer 16

40-60 bpm

Question 17

What is the intrinsic rate of the bundle of HIS and purkinje fibers?

Answer 17

30-40 bpm

Question 18

What happens during the P wave?

Answer 18

atrial depolarization
- impulses spread to the left atrium via the bachmann bundle

Question 19

What happens during the P-R interval?

Answer 19

depolarization reaches the AV node causing that slight delay

Question 20

What happens during the QRS complex?

Answer 20

Ventricular depolarization
- the electric impulse reaches the purkinje fibers

Question 21

How many seconds in an EKG strip?

Answer 21

6 second intervals

Question 22

How many seconds are in a small square?

Answer 22

0.04 seconds

Question 23

How many seconds in a large square?

Answer 23

0.20

Question 24

How many leads are there?

Answer 24

6

Question 25

Where is V1 and V2 placed?

Answer 25

Near the sternal border

Question 26

Where is V3 placed?

Answer 26

Midway between V2 and V4

Question 27

Where is V4 placed?

Answer 27

5th intercostal space @ L midclavicular line

Question 28

Where is V5 placed?

Answer 28

Left anterior axillary line at V4 level

Question 29

Where is V6 placed?

Answer 29

Left mid axillary line at V4/V5 level

Question 30

How do you count the HR on an EKG?

Answer 30

count the QRS in a 6-second intervals then x10 which gives the HR for 1 minute

Question 31

When does the PR interval start and end?

Answer 31

start of P wave to start of R wave

Question 32

What does the P-R interval measure?

Answer 32

the time beween the start of atrial depolarization and ventricular depolarization

Question 33

What is normal PR interval?

Answer 33

3-5 small squares or 0.12-0.20 seconds

Question 34

When does the QRS start and end?

Answer 34

starts of Q wave to end of S wave

Question 35

Describe the QRS complex in an EKG strip

Answer 35

Q - first downward deflection R - first upward deflection S - second downward deflection

Question 36

The QRS complex measures what?

Answer 36

the depolarization of ventricles

Question 37

What is normal QRS complex interval?

Answer 37

0.06-0.10 seconds (1 1/2 - 3 small boxes)

Question 38

What is an abnormal QRS complex interval?

Answer 38

>0.12 seconds

Question 39

What is the systematic approach of an EKG?

Answer 39

1. P wave 2. PR interval 3. QRS complex 4. QRS interval 5. T wave 6. Look at the R to R wave 7. How is the HR 8. Observe the pt and sx

Question 40

What are the causes for PAC?

Answer 40

- when isolated = benign finding (non-lethal) - associated with underlying cardiac conditions (early sign of CVD) - HTN, caffeine - Pregnant - COPD, asthma - Metabolic - hyperthyroid disease - stress or extreme fatigue - medications for asthma or hayfever

Question 41

What are the symptoms of PAC?

Answer 41

Skipped beat fatigue or SOB Exercise intolerance Chest pain (advanced PAC)

Question 42

How do you decrease PAC symptoms?

Answer 42

reduce intensity monitor vitals report to a team

Question 43

What is atrial tachycardia (supraventricular)?

Answer 43

Atrial depolarization is happening so fast P wave isnt seen and hidden in the QRS/ventricular activity

Question 44

What are the causes of atrial tachycardia?

Answer 44

- stretching of the atria via HTN and cardiomyopathy - MI hx - excessive alchohol or stimulants - irritable focus Sometimes idiopathic

Question 45

What is irritable focus?

Answer 45

cell outside the sinus node starts generating an electical impulse automatically on their own

Question 46

What are the sx of atrial tachycardia?

Answer 46

palpitations fainting chest pain SOB fatigue exercise intolerance

Question 47

How do you reduce atrial tachycardia?

Answer 47

Reduce intensity monitor vitals alert the team

Question 48

What is the characteristic of atrial fibrillation?

Answer 48

A very common arrhythmias - Has no waves before QRS and very irregular HR - jagged baseline

Question 49

What is the characteristics of atrial flutter?

Answer 49

"saw-tooth" appearance that represents multiple P waves for each QRS complex

Question 50

What causes a-fib and a-flutter?

Answer 50

- interferance of electrical conductivity - age - heart diseases - alchohol - endocrine disorders - neurologic disorders - hemodynamic stress - sleep apnea - inflammation

Question 51

What are the sx of a-fib and flutter?

Answer 51

- tachycardia - SOB - dizziness - syncope - fatigue - exercise intolerance - chest pain - anxiety - night sweats or waking up with palpitations

Question 52

How do you decrease sx of a-fib and flutter?

Answer 52

- stopping activity then calling the team to monitor patient - Use RPE for beta blockers - Deep breathing to slow down HR

Question 53

What happens with the electrical impulses of atrial impulses?

Answer 53

The impulses don't travel in a straight line - move in a circle inside the atria = regular tachycardia

Question 54

How is the speed of an electrical signals in a-fib?

Answer 54

travel through the atria - fast and disorderly = heart quivers instead of squeezing strongly = tachycardia in an irregular rhythm and reduced atrial kick

Question 55

Why is a-fib more dangerous?

Answer 55

Irregular atrial contractions in fib = **increasing the risk of clot** formation higher risk of CVA