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ECG Workout
Exercises in Arrhythmia Interpretation
| Question | Answer |
|---|---|
| Electrocardiogram | Graphic representation of electrical activity of the heart |
| Parts of the conduction system of the heart | 1) SA Node, 2) Internodal Tracts, 3) AV Node, 4) Bundle of His, 5) Right / Left Bundle Branch, 5) Purkinje Fibers |
| Accelerates the heart rate through the AV node and increases the force of ventricular contraction | Stimulation of the sympathetic nervous system |
| Decreases conduction through the AV node and causes a small decrease in the force of ventricular contraction | Stimulation of the parasympathetic nervous system |
| Parasympathetic | Slows down |
| Sympathetic | Speeds up |
| Depolarization | Inside of cell becomes more positive than negative (Potassium leaves the cell, Sodium rushes in) |
| Repolarized | Inside of cell becomes more negative than positive and returns to resting state (Sodium leaves cell, Potassium rushes in) |
| Dysrhythmia | Any rhythm that isn't normal |
| What does the T Wave represent | Ventricular repolarization |
| What does the U Wave represent | Late ventricular repolarization |
| What does the QRS Complex represent | Ventricular depolarization or the spread of the impulse throughout the ventricles |
| Normal duration of the QRS Complex | .10 seconds or less |
| Is the Q Wave negative or positive | negative |
| Is the R Wave negative or positive | positive |
| How is the QRS Complex measured | From the beginning of the QRS Complex to the end of the QRS Complex |
| Resting Cardiac Cell | More negative ions inside the cell than outside the cell |
| The left ventricle is the ____________ ____________ of the heart. | Largest Chamber |
| The P wave represents | Atrial Depolarization (or depolarization of the right & left atria) |
| The P wave originates in the ___________ ___________, travels thru the __________, resulting in normal ________________. | sinus node, atria |
| What does the Q wave represent | Repolarization |
| Polarized | No electrical activity occurring and a straight line is recorded on the ECG |
| Two kinds of cardiac cells | 1) Myocardial cells (Working cells) 2) Pacemaker cells |
| What do horizontal lines on ECG Graph paper measure | the duration of the waveform in seconds of time |
| What do vertical lines on ECG Graph paper measure | the voltage or amplitude of the waveform in millimeters (mm) |
| Five steps to systematic evaluation of an EKG | 1) Determine regularity 2) Calculate the rate 3) Examine the P waves 4) Measure the PR Interval 5) Measure the QRS Complex |
| Normal duration of the PR Interval | .12 to .20 seconds |
| How is the PR Interval measured | From the beginning of the P wave to the beginning of the QRS Complex |
| What does the QT interval represent | Total ventricular activity (the time from the onset of ventricular depolarization to the end of ventricular repolarization |
| What does the ST segment represent | early ventricular repolarization |
| A cardiac cycle consists of one ______________ or one __________ sequence. | heartbeat or one PQRST sequence |
| Why is the QRS complex normally larger than the P wave | depolarization of the larger muscle mass of the ventricles generates more voltage than does depolarization of the smaller muscle mass of the atria |
| What is the first deflection of the cardiac cycle | the P wave |
| Where does a normal sinus P wave originate | in the sinus node and travels through normal atria, resulting in normal depolarization |
| What do normal P waves look like | smooth and round, positive in lead II, .5 to 2.5mm in height, .10 seconds or less in width, one P wave to each QRS complex |
| What does more than one P wave before each QRS complex indicate | a conduction disturbance, such as that which occurs in second and third-degree heart block |
| What are two types of abnormal P waves | 1) Abnormal Sinus P wave 2) Ectopic P wave |
| What does the PR Interval represent | the time from the onset of atrial depolarization to the onset of ventricular depolarization |
| What does the normal PR Interval look like | includes a P wave and the short isoelectric line that follows it |
| Is the S wave negative or positive | negative |
| What is the J point (Junction point) | The point where the QRS complex meets the ST segment |
| Where does the QRS complex end | at the point where the straight line of the ST segment begins, even though the straight line may be above or below baseline |
| What term is used if the entire complex is negative | QS complex (not a negative R wave because R waves are always positive) |
| What is a notch | a wave that changes direction but doesn't cross the baseline |
| Describe the normal ST segment | a flat line between the QRS complex and the T wave |
| Describe the normal T wave | rounded and slightly asymmetrical (with the first p art of the T wave gradually sloping to the peak and returning more abruptly to baseline, positive in lead II, with an amplitude less than 5mm |
| The T wave always follows the... | QRS Complex ( repolarization always follows depolarization) |
| How is the QT interval measured | from the beginning of the QRS complex to the end of the T wave |
| How is duration of the QT interval determined | by multiplying the number of small squares in the QT interval by 0.04 seconds |
| Describe the normal U wave | small, rounded, and symmetrical, positive in lead II and 2 mm or less in amplitude (always smaller than the preceding T wave) |
| When is the U wave seen best | when the heart rate is slow |
| What determines if the rhythm is irregular | Variation of 0.12 seconds or more between the shortest and longest R wave |
| Rhythm: Regular Rate: 60 to 100 beats/minute P waves: Normal in size, shape and direction; positive in lead II; one P wave precedes each QRS complex PR interval: Normal (0.12 to 0.20 seconds) QRS Complex: Normal (0.10 seconds or less) | Normal sinus rhythm |
| What is the rate for normal sinus rhythm | 60 to 100 beats/minute |
| What is the rate for sinus tachycardia | 100 to 160 beats/minute |
| Rhythm: Regular Rate: 100 to 160 beats/minute P waves: Normal in size, shape and direction; positive in lead II; one P wave precedes each QRS complex PR interval: Normal (0.12 to 0.20 seconds) QRS Complex: Normal (0.10 seconds or less) | Sinus Tachycardia |
| What is the rate for sinus bradycardia | 40 to 60 beats/minute |
| Rhythm: Regular Rate: 40 to 60 beats/minute P waves: Normal in size, shape and direction; positive in lead II; one P wave precedes each QRS complex PR interval: Normal (0.12 to 0.20 seconds) QRS Complex: Normal (0.10 seconds or less) | Sinus Bradycardia |
| Sinus arrhythmia | Rhythm: irregular Rate: Normal or Slow P waves: Normal in size, shape and direction; positive in lead II; one P wave precedes each QRS complex PR interval: Normal (0.12 to 0.20 seconds) QRS Complex: Normal (0.10 seconds or less) |
| Sinus block | Basic rhythm resumes on time after pause |
| Sinus arrest | Basic rhythm does not resume on time after pause |
| If the basic rhythm is irregular (sinus arrhythmia) sinus arrest can't be differentiated from sinus block so how is the rhythm interpreted | as sinus arrhythmia with sinus pause |
| How is the PR Interval measured | from the beginning of the P wave as it leaves baseline to the beginning of the QRS complex |
| How is the PR interval calculated | count the number of small squares contained in the interval and multiply by 0.04 seconds |
| How is the QRS complex measured | from the beginning of the QRS complex as it leaves baseline until the end of the QRS complex when the ST segment begins. |
| How is the QRS complex calculated | count the number of small squares in the QRS complex measurement and multiply by 0.04 seconds |
| What is sinus pause | a broad term used to describe rhythms in which there is a sudden failure of the SA node to initiate or conduct an impulse |
| This sinus rhythm is common among trained athletes | Sinus Bradycardia |
| What causes sinus arrest | a failure of the SA node to initiate an impulse and is therefore a disorder of automaticity. |
| What causes sinus exit block | an electrical impulse is initiated by the SA node but is blocked as it exits the sinus node preventing conduction of the impulse to the atria |
| What is sinus exit block | a disorder of conductivity |
| What is sinus arrest | an arrhythmia caused by a failure of the SA node to initiate an impulse. The ECG will show a sudden pause in the sinus rhythm in which one or more beats are missing. The underlying rhythm does not resume on time following the pause. |
| The Sinus node is the ___________ ___________ of the heart | dominant pacemaker |
| R wave | Positive wave in the QRS complex |
| Sinus Arrhythmia | an arrhythmia originating in the SA node that occurs when the SA node discharges impulses irregularly. |
| Sinus Bradycardia | an arrhythmia originating in the sinus node characterized by a regular rhythm; normal p waves, pr interval, and qrs duration, and a rate between 40 and 60/beats per minute |
| Sinus tachycardia | an arrhythmia originating in the sinus node characterized by a regular rhythm; normal p waves, pr interval, and qrs duration; and rate between 100 and 160 beats/per minute |
| S wave | the negative deflection of the QRS complex that follows the R wave |
| Sympathetic Nervous System | a part of the autonomic nervous system. stimulation increases heart rate, speeds conduction thru the AV node, increases the force of ventricular contraction and causes increase in BP |
| t wave | a wave that follows the ST segment. represents ventricular repolarization |
| u wave | a wave that sometimes follows the t wave. represents the ventricular repolarization. |
| qt interval | the portion of the ecg between the onset of the qrs complex and the end of the t wave representing ventricular depolarization and repolarization |
| q wave | the negative deflection of the qrs complex that precedes the r wave |
| p wave | the waveform representing depolarization of the right and left atria |
| purkinje fibers | a network of fibers that carry electrical impulses directly to ventricular muscle cells |
| parasympathetic nervous system | a part of the autonomic nervous system. stimulation decreases the heart rate, slows conduction thru the av node, decreases the force of ventricular contraction and causes a drop in bp |
| normal sinus rhythm | the normal rhythm of the heart originating in the sa node characterized by a regular rhythm; normal p waves, pr interval, and qrs duration; rate between 60 and 100 beats/minute |
| mitral valve | one of two atrioventricular vales located between the left atrium and left ventricle, only has two cusps |
| myocardium | the middle and thickest layer of the heart, composed primarily of cardiac muscle cells and responsible for the heart's ability to contract |
| negative deflection | a waveform that is below baseline |
| j point | the point where the qrs complex and th st segment meet |
| intraventricular septum | the wall separating the right and left ventricles |
| intermodal atrial conduction tracts | part of the electrical conduction system. consists of three pathways of specialized conducting tissue located in the walls of the right atrium. conducts impulses from the sa node to the av node |
| heart rate | the number of heartbeats or qrs complexes per minute |
| depolarization | electrical activation of a cardiac cell due to movement of ions across a cell membrane causing the inside of the cell to become more positive depolarization is an electrical event expected to result in muscle contraction. |
| what produces the p wave | depolarization of the atria |
| what produces the qrs complex | depolarization of the ventricles |
| dysrhythmia | any rhythm other than a sinus rhythm. used interchangeably with arrhythmia |
| diastole | the period of atrial or ventricular relaxation |
| conductivity | the ability of a cardiac cell to receive an electrical impulse and conduct that impulse to an adjacent cardiac cell |
| contractility | the ability of cardiac cells to cause cardiac muscle contraction in response to an electrical stimulus |
| bundle branches | a part of the electrical conduction system consisting of the right and left bundle branches that conducts the electrical impulses from the bundle of his to the purkinje network |
| bundle of his | a part of the electrical conduction system that connects the av node to the bundle branches |
| autonomic nervous system | regulates functions of the body that are involuntary (not under conscious control) includes the sympathetic and parasympathetic nervous systems each producing opposite effects when stimulated |
| base of the heart | top of the heart located at approximately the level of the second intercostal space |
| bradycardia | an arrhythmia with a rate of less than 60 beats/minute |
| atrioventricular block | a delay or failure of conduction of electrical impulses through the av node |
| atria | the two thin-walled upper chambers of the heart. the right and left atria are separated from the ventricles by the mitral and tricuspid valves |
| apex of the heart | the bottom of the heart formed by the tip of the left ventricle; located to the left of the sternum at approximately the fifth intercostal space, midclavicular line |
| absolute refractory period | the period of time during ventricular depolarization and most of repolarization when cardiac cells cannot be stimulated to conduct an electrical impulse. this period begins with the onset of the qrs complex and ends at the peak of the t wave. |
Created by:
dawncherie
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