Study Guide Flashcards
1
Q
What are the intrinsic cardiac Pacemakers and their rates?
A
- SA node (intrinsic rate 60-100)
- AV node (Intrinsic rate 40-60)
- Bundle branches (Intrinsic rate (20-40)
2
Q
What is the SA nodes intrinsic rate?
A
60-100 BPM
3
Q
What is the AV nodes intrinsic rate?
A
40-60 BPM
4
Q
What is the intrinsic rate of the Bundle branches?
A
20-40 BPM
5
Q
What is the normal path of cardiac conduction?
A
- Originates in the SA Node
- AV Node causing atrial depolarization
- AV Node slightly delays impulse
- Bundle of HIS
- Bundle Branches
- Purkinje Fibers causing ventricular depolarization
6
Q
What part of the EKG represents the absence of electrical activity/base line?
A
The Isoelectric Line
7
Q
What does the P-Wave represent?
A
atrial depolarization
8
Q
What does the QRS complex represent?
A
ventricular depolarization
9
Q
What do the ST segment and T-Wave represent?
A
ventricular repolarization
10
Q
hat part of the EKG represents the absolute and relative refractory periods?
A
1) QRS to peak of T-wave
2) the rest of the T-wave
11
Q
Which part of the ECG represents ventricular depol and repol?
A
QT Interval
12
Q
What is the normal length of the QT Interval?
A
- normally less than half the length of the R-R interval
- 360 - 440 ms
13
Q
The small box of the ECG measures how many seconds?
A
0.04 secs along the horizontal axis
14
Q
The small box of the ECG measures how many mV?
A
1 mV along the vertical axis
15
Q
The large box of the ECG measures how many seconds?
A
0.20 secs along the horizontal axis
16
Q
How many small boxes make up one large box on an ECG strip?
A
5 small = 1 large box
17
Q
A six second strip has how many large boxes?
A
30 boxes
18
Q
Five big boxes is how many seconds?
A
1 sec
19
Q
How do you measure the PRI and what its the normal length?
A
- beginning of the P-wave to the beginning of the QRS complex
- normal = 0.12-0.20 secs or 3-5 sm boxes
20
Q
What is the normal length of the QRS complex?
A
0.04 - 0.10 secs or 1-2.5 sm boxes
21
Q
How do you calculate the HR on an irregular rhythm on an ECG?
A
count the # of P and R waves in a six second strip and x10
22
Q
What is the 1500 rule for calculating the HR on an ECG?
A
- 1500 / # of small boxes b/t two consecutive P or R-waves
23
Q
What is the 300 rule for calculating the HR on an ECG?
A
- 300 / # of large boxes b/t two consecutive P or R-waves
24
Q
How do you calculate the HR on an ECG using the standard rule?
A
- use for regular rhythms only
- count and label 6 consecutive lg boxes
- 1 = 300
- 2 = 150
- 3 = 100
- 4 = 75
- 5 = 60
- 6 = 50
25
Criteria for NSR?
```
Impulse starts in SA node
Rate: A and V = 60-100
Rhythm: A and V regular
P-Wave: normal, 1:1 P-QRS
PRI: 0.12 - 0.20 secs
QRS: 0.04 - 0.10 secs
```
26
Criteria for Sinus Bradycardia?
```
Impulse starts in SA node
Rate: A and V = < 60
Rhythm: A and V regular
P-Wave: normal, 1:1 P-QRS
PRI: 0.12 - 0.20 secs
QRS: 0.04 - 0.10 secs
```
27
Criteria for Sinus Tachycardia?
```
Impulse starts in SA node
Rate: A and V = 100 - 150
Rhythm: A and V regular
P-Wave: normal, 1:1 P-QRS
PRI: 0.12 - 0.20 secs
QRS: 0.04 - 0.10 secs
```
28
Criteria for Sinus Arrythmias
Impulse starts in SA node but activity varies with respiration
Rate: A and V = 100 - 150, but varies
Rhythm: A and V irregular (P-P and R-R irregular)
P-Wave: normal, 1:1 P-QRS
PRI: 0.12 - 0.20 secs
QRS: 0.04 - 0.10 secs
29
How is the HR of a Sinus Arrhythmia affected by respiration?
rate slows with expiration and increases with inspiration
30
What is happening during a sinus pause/arrest?
The SA node fails to fire, creating a pause on the ECG strip. The underlying rhythm is a sinus rhythm except for the pause.
31
How do you treat a patient with sinus pause/arrest that is symptomatic?
- symptomatic if the patient is experiencing frequent/prolonged (>3 secs) episodes or other symptoms
- pt may require a pacer
32
What are the effects of the parasympathetic nervous system on the HR?
slows the HR through the release of acetylcholine and stimulation of the vagus nerve (vagal maneuvers)
33
What are the effects of the sympathetic nervous system on the HR?
- speeds up the HR through the release of Epi and NE
| - fight or flight system
34
A deep, wide QRS is indicative of?
an MI or intraventricular conduction delay (IVCD)
35
Notched R-waves are indicative of?
BBB
36
What is the normal length of the QT Interval for a male?
- normal is 0.036 - 0.044 secs
| - males: 0.039 - 0.041 secs
37
What is the normal length of the QT Interval for a female?
- normal is 0.036 - 0.044 secs
| - males: 0.036 - 0.044 secs
38
What is the normal length of the QTc for a female?
< 0.44 secs
39
What is the normal length of the QT Interval for a male?
< 0.42 secs
40
Criteria for a P-wave that indicates origination of the impulse from the SA node?
Shape: round, upright
Height: 2 - 3 mm
Time: 0.06 - 0.12 secs
41
Notched or pointy P-wave(s) are indicative of?
atrial enlargement r/t to:
- COPD
- pulmonary emboli
- valvular disease
- CHF
42
The following PRI values are indicative of:
1) > 0.20 secs
2) < 0.12 secs
1) conduction delay
| 2) impulse originated outside of the SA node
43
An elevated ST segment is indicative of?
an MI
44
A depressed ST segment is indicative of?
acute ischemia
45
Tall or peaked T- waves are indicative of ___1___ while an inverted T-wave indicates ___2___?
1) potassium (k+) abnormality
| 2) myocardial ischemia
46
An inverted U-wave is indicative of?
HTN
47
What is the treatment for a patient with Sinus Bradycardia and is symptomatic?
- assess the pt (CAB, BP)
- give O2
- start IV
- atropine: 0.5 mg quick IV push
- epi or dopamine continuous IV infusion
- transcutaneous pacine
48
Dosing, administration and considerations for atropine?
- 0.5 mg quick IV push
| - can worsen MI if present, need to closely monitor the patient
49
What happens when atropine is given to slowly?
may cause paradoxical bradycardia, needs to be given quickly (IV push)
50
What is the treatment for Sinus Tachycardia?
- assess the patient,
- treat the symptoms
- treat the source last
51
Sinus Arrythmias are common in what patient demographic?
- ventilated patients
- with MI
- infants, children and the elderly
- with medications
52
What is the 1st step when identifying an ectopic beat/rhythm?
identify the underlying rhythm
53
What are escape beats?
beats that appear after they are expected
54
What is the key indentifier of a premature atrial complex (PAC)?
an early p-wave which may look different from the others
55
Criteria for an Aberantly Conducted PAC?
- early P-wave and Wide QRS (> 0.10 secs)
| - ventricles are not fully repolarized so are late to fire
56
Criteria for a Nonconducted or Blocked PAC?
- early P wave with NO following QRS
| - atria fires to early, no time for ventricles to fire
57
Treatment for PAC's?
- infrequent PAC's do not require treatment
| - frequent: reduce/eliminate causes (stress, smoke, caffeine)
58
Criteria for Atrial Flutter?
```
Rate:
- A = 250 - 400 BPM
- V = Controlled < 100
uncontrolled > 100
Rhythm: A = regular, V = regular or irregular
P-Waves: absent/replace with SAW TOOTH waves
PRI: not measureable
QRS: 0.04 - 0.10 secs
```
59
What is the treatment for A-Flutter?
1) assess the pt
2) control the ventricular rate if > 100 (meds then cardioversion)
4) try to convert the rhythm
60
What medications are used for A-Flutter with an uncontrolled ventricular rate?
CCB, Beta-Blockers, or Digoxin to reduce/control the rate
61
What is the most effective treatment for an uncontrolled/unstable A-Flutter?
Cardioversion
62
What methods can be used to convert an atrial ectopic rhythm?
antiarrhythmics, cardioversion, ablation, or overdrive pacing
63
Criteria for Atrial Fibrillation?
```
Rate:
- A = > 300 or not measurable
- V = controlled < 100, uncontrolled > 100
Rhythm: ventricular usually regular
P-Waves: none
PRI: not measurable
QRS: 0.04 - 0.10 secs
```
64
What is the treatment for controlled A-Fib?
anticoagulants and antiarrhythmics
65
What is the treatment for uncontrolled and stable A-Fib?
CCB, Beta Blockers and digoxin to slow the HR
66
What is the treatment for unstable A-Fib?
cardioversion
67
What is the primary concern with A-flutter and A-Fib?
the ventricular rate
68
Criteria for Junctional Rhythms?
Rate: 40 - 60
Rhythm: ventricular is regular (pacing occurs at the av junction)
P-Waves:
- inverted
- may come B4, after or be hidden in the QRS
PRI: < 0.12 secs
QRS: 0.04 - 0.10 secs
