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Cardio
BC3- Cardio - EKG
| Question | Answer |
|---|---|
| SA Node location | base of the right atrium |
| SA Node | normal pacemaker of the heart |
| SA Node rate | 60-100 |
| How is the SA node connected to the AV node | by internodal pathways |
| AV Node location | apex of the right atrium |
| AV node rate | slows the impulse down to 40-60 |
| What is the back-up with the SA node doesn't work? | AV |
| Conduction system of the heart | SA Node - AV Node - Bundle of HIS - Bundle Branches - Perkinje Fibers |
| Ventricle Rate | 20-40 |
| Juctional Rate | 40-60 |
| Parasympathetic | slows down |
| Sympathetic | fight or flight |
| 1 small box on EKG strip = | .04 seconds |
| 1 large box on EKG strip = | .20 seconds |
| 15 large boxes on EKG strip = | 3 seconds |
| P wave measures | produced as impusle from SA and AV junction - cause atrial contraction |
| PRI is what? | beginning of the P to the beginning of the Q wave = time between arial depolarization (contraction) and the start of ventricular conduction (depolarization) |
| Normal PRI | .12-.20 seconds |
| QRS Complex | Conduction of impulse through Bundle of HIS to Perkinje Fibers causing contraction of ventricles |
| Normal QRS | .04-.10 seconds |
| If QRS "widens" to > .10 seconds | indicates a bundle branch block |
| What does QTI measure | measures depolarization and repolarization |
| Formula for QT Interval | QT interval / sq root of R |
| Normal QTI | less than or equal to 0.40 seconds |
| How do you measure QTI | from the beginning of the Q to the end of the T |
| Electrolytes that may increase QTI | hypocalcemia, hypomagnesium, hypokalemia |
| CNS disorders that may increase QTI | stroke, subarrachnoid hemorrhage, trauma |
| Drugs that may increase QTI | tricyclics, phenothiazines, erythromycin, albuterol, lopressor, decongestants, diuretics, Amiodorone |
| Rule of Thumb for QTI | If patient is not tachycardic, the QT interval should not be more than half the R-R interval |
| T wave indicates | ventricular repolarization |
| Sinus Rhythm originates from | SA Node |
| Sinus Rhythm HR | 60-100 |
| Sinus Rhythm P wave for every QRS = | 1:1 |
| Sinus Rhythm PRI | .12-.20 seconds (normal) |
| Sinus Rhythm QRS | .04-.10 seconds (normal) |
| Sinus Bradycardia orginiates from | SA Node |
| Sinus Bradycardia HR | <60 |
| Sinus Bradycardia P wave for every QRS = | 1:1 |
| Sinus Bradycardia PRI | .12-.20 seconds (normal) |
| Sinus Bradycardia QRS | .04-.10 seconds (normal) |
| Causes of Sinus Bradycardia | Hyperkalemia, Vagal activity increased, Digoxin (common), Late hypoxia - corrected with 02 |
| Effects of Sinus Bradycardia | increase preload, decreased mean arterial pressure |
| Treatment of Sinus Bradycardia | treat cause; pacer, atropine |
| Sinus Tachycardia originates from | SA Node |
| Sinus Tachycardia HR | 100-150 |
| Sinus Tachycardia PRI | .12-.20 seconds (normal) |
| Sinus Tachycardia QRS | .04-.10 seconds (normal) |
| Sinus Tachycardia P wave for every QRS = | 1:1 |
| Causes of Sinus Tachycardia | Increase catecholamine release, hypercalcemia, fever, early symptom of hypoxia, hypovolemia, pump failure |
| Effects of Sinus Tachycardia | decreased filling times, decreased MAP, increased myocardial demand, increase O2 demand, |
| Treatment of Sinus Tachycardia | treat underlying cause, calcium channel blockers, beta blockers, bed rest, oxygen |
| Premature Atrial Contraction (PAC) is not _________ | a rhythm |
| PAC originates in | an ectopic focus in either atrium appearing earlier than a P wave generated by the SA node |
| PAC's may be due to use of | stimulants |
| PAC's are often seen in what conditions | CHF, COPD, infections, medications |
| PAC HR | 60-100 |
| PAC P wave | has different configuration than those originating in the SA node |
| PAC PRI | .12-.20 seconds (normal) |
| PAC QRS - P ratio | each QRS has a P |
| Causes of PAC | Hypokalemia, digitalis toxicity, hypoxia |
| Treatment of PAC | treat the underlying cause |
| Sinus Dysrhythmia Rate | Rates vary |
| Sinus Dysrhythmia PRI | .12-.20 seconds (normal) |
| Sinus Dysrhythmia P wave for every QRS = | P wave for each QRS |
| Sinus Dysrhythmia P-P | regularly irregular short with inspiration, long with expiration |
| Causes of Sinus Dysrhythmia | common in young children and young adults |
| Effects of Sinus Dysrhythmia | alters filling time, variable oxygen demand |
| Treatment of Sinus Dysrhythmia | none |
| Sinus Arrest Rate | Rate normal to slow |
| Sinus Arrest Rhythm | Irregular |
| Sinus Arrest P waves | normal morphology |
| Sinus Arrest PRI | .12-.20 seconds (normal) |
| Sinus Arrest QRS | .04-.10 seconds (normal) |
| Causes of Sinus Arrest | Ischemia of SA node, Digitalis toxicity, Excessive vagal tone |
| Effect of Sinus Arrest | Frequent or prolonged episodes of dec C.O.; cardiac standstill, cessation of SA node activity |
| Treatment of Sinus Arrest | observe if asymptomatic; bradycardic with symptoms treat w/ atropine 0.5mg bolus; pacer |
| Atrial Tachycardia HR | 150-250 |
| Atrial | (blank) |
| Who is most often affected by atrial tachycardia | kids |
| Atrial Tachycardia is also known as | SupraVentricular Tachycardia (SVT) |
| Effects of Atrial Tachycardia | decreased filling times, decreased MAP, increased myocardial O2 demand and work |
| Treatment of Atrial Tachycardia | control ventricular rate, digoxin, calcium blockers, vagal stimulation, override pacer, cardioversion |
| Saw Tooth Patter = | Atrial flutter |
| Atrial Flutter atrial rates | 200-400 bpm |
| Atrial Flutter ventricular rates | 140-160 bpm |
| Atrial Flutter typical rhythm | regular |
| Most common atrial flutter rate is | 300 bpm |
| Most common atrial flutter conduction rate is | 2:1 |
| Most common atrial flutter ventricular response | 150 bpm |
| Atrial flutter with variable conduction is caused by | constant fluctuations in the conduction ratios through the AV node - (AV node holds on) |
| Atrial Flutter causes | increased atrial automaticity, atrial re-entry; digoxin (common), hypokalemia, aging |
| Effects of Atrial Flutter | decreased filling time, loss of atrial kick, decreased MAP, |
| Treatment of Atrial Flutter | control ventricular rate, digoxin, calcium channel blockers, vagal stimulation, over-ride pacer, cardioversion |
| Atrial Fibrillation is mostly common in | adults |
| Atrial Fibrillation PRI | No PRI |
| Atrial Fibrillation Pulse rate | >300 and usually not observable |
| Atrial Fibrillation P wave | P wave "f" waves or fibrillatory waves |
| Atrial Fibrillation QRS rate | variable |
| Atrial Fibrillation rhythm | irregularly irregular |
| Atrial Fibrillation P waves | absence of observable P waves |
| Filbillatory or "f" waves occur at the rate of | 400-700 bpm |
| Causes of Atrial Fibrillation | increased atrial automaticity, atrial re-entry, digoxin (common), hypokalemia, aging |
| Differential Diagnosis of Atrial Fibrillation | Atrial enlargement (esp left), age >60, MAD RAT PPP, Idiopathic |
| Effects of Atrial Fibrillation | decreased filling time, loss of atrial kick, decreased MAP |
| Treatment of Atrial Fibrillation | control ventricular rate, Digoxin, calcium blockers, vagal stimulation, over-ride pacer, cardioversion |
| What does MAD RAT PPP stand for | Myocardial infarction; Atherosclerosis; Drugs: digoxin; Rheumatic heart disease; Alcoholic holiday heart; Thyrotoxicosis (endocrine); Pulmonary emboli; Pericarditis; Pneumonia: right middle lobe |
| Junctional Rhythm is associated with which node | AV |
| Junction Rhythm P wave | absent, inverted, biphasic or after the QRS |
| Junction Rhythm QRS | .04-.10 seconds (normal) |
| Junctional Rhythm Rate | 40-60 bpm and regular |
| Causes of Junctional Rhythm | atrial and sinus bradycardia, standstill or block |
| Effect of Junctional Rhythm | Decreased C.O., loss of atrial kick, decreased MAP, |
| Treatment of Junctional Rhythm | treat cause if hypotensive, pacer, atropine |
| Junctional Bradycardia P wave | absent, inverted, biphasic or after the QRS |
| Junctional Bradycardia QRS | .04-.10 seconds (normal) |
| Junctional Bradycardia Rate | <40 |
| Causes of Junctional Bradycardia | Atrial & sinus bradycardia, standstill, or block (SA node isn't working), vagal hyperactivity |
| Effects of Junctional Bradycardia | Decreased C.O, loss of atrial kick, decreased MAP |
| Treatment of Junctional Bradycardia | treat cause if hypotensive; pacer, atropine |
| Premature Junctional Contractions (PJC) | Early beat without P waves |
| Premature Junctional Contractions (PJC) QRS morphology | .04-.10 (normal) |
| Causes of Premature Junctional Contractions | Hyperkalemia (6-5/4mEq/L), hypercalcemia, hypoxia, elevated preload |
| Effects of Prejature Junctional Contractions | Decreased C.O., loss of atrial contribution to ventricular preload for that beat |
| Treatment of Premature Junctional Contractions | treat the underlying cause |
| Accelerated Junctional Rhythm P wave | absent, inverted, biphasic or after QRS |
| Accelerated Junctional Rhythm QRS morphology | .04-.10 seconds (normal) |
| Accelerated Junctional Rhythm HR | 60-100 bpm, regular |
| Causes of Accelerated Junctional Rhythm | Hyperkalemia, Hypercalcemia, Hypoxia, Elevated preload |
| Effects of Accelerated Junctional Rhythm | Decreased C.O., Loss of atrial contribution to ventricular preload |
| Treatment of Accelerated Junctional Rhythm | treat the underlying cause |
| Junctional Tachycardia HR | 100-130 bpm, regular |
| Junctional Tachycardia P wave morphology | absent, inverted, biphasic or after the QRS |
| Junctional Tachycardia QRS | .04-.10 seconds (normal |
| Causes of Junctional Tachycardia | Hyperkalemia, Hypercalcemia, Hypoxia, Elevated preload |
| Effects of Junctional Tachycardia | Decreased C.O., loss of atrial contribution to ventricular preload, increased myocardial oxygen demand and workload |
| Treatment of Junctional Tachycardia | treat the underlying cause |
| Definition of Accelerated Junctional Rhythm | Junctional rhythm with rates of between 60-100 bpm |
| Definition of Junctional Tachycardia | Junctional Rhythm with rates between 100-130 bpm |
| Junctional Rhythm that exceeds 140 bpm | AV nodal reentry tachycardia (AVNRT); Rates between 130-140 can be called either junctional tach or AVNRT |
| QRS complex widens | the lower you go |
| Premature Ventricular Contraction (PVC) | Early beat with P wave - QRS usual opposite in deflection |
| Causes of PVC's | aginag and induction of anesthesia, myocardial ischemia, hypoxia, acid-base disturbances, eletrolyte disturbances, increased sympathetic tone |
| Effect of PVC's | Decreased C.O., loss of atrial contribution to ventricular preload for that beat |
| Treatment of PVC's | If frequent and symptomatic give amiodorone |
| Unifocal PVC | mach each other |
| Differential Diagnosis of PVC's | idiopathic and benign, anxiety, fatigue, drugs: nicotine, alcohol, caffeine; heart disease, electrolyte disorder |
| Ventricular Tachycardia Rate | 100-250, regular |
| Ventricular Tachycardia P waves | if P waves are present, they are not associated with QRS complexes |
| Ventricular Tachycardia PRI | none |
| Ventricular Tachycardia QRS | greater than .12 seconds |
| Causes of Ventricular Tachycardia | aging & induction of anesthesia; myocardial ischemia; hypoxia; acid-base disturbances; electrolyte disturbances; increased sympathetic tone |
| If patient is in Ventricular Tachycardia and has no pulse | defibrilate at 200 joules |
| If patient is in Ventricular Tachycardia and has a pulse - | treat with amiodorone |
| Is Ventricular Tachycardia life threatening? | Yes |
| Effects of Ventricular Tachycardia | Decreased C.O., loss of atrial contribution to ventricular preload for that beat |
| Ventricular Fibrillation rhythm | chaotic |
| Ventricular Fibrillation P wave | None |
| Ventricular Fibrillation QRS | None |
| Causes of Ventricular Fibrillation | Aging & induction of anesthesia, myocardial ischemia, hypoxia, acid-base disturbances, electrolyte disturbances, increased sympathetic tone, rapid infusion of potassium |
| What is the number one cause of sudden cardiac death | ventricular fibrillation |
| Effect of Ventricular Fibrillation | Lethal, no C.O. |
| Treatment of Ventricular Fibrillation | defibrillation and consider possible causes, Amiodorone |
| If in V-Fib | De-Fib |
| Treatment of Torsades De Pointes | try to defib (usually cannot be converted) then **administer Magneusium Sulfate |
| Torsade de Pointes HR | 200-250 bpn, irregular |
| Torsade de Pointes P wave | None |
| Torsade de Pointes QRS | None |
| Torsade de Pointes PRI | none |
| First Degree Block Rate | depends on underlying rhythm |
| First Degree Block Rhythm | regular |
| First Degree Block P waves | normal PRI >.20 seconds |
| First Degree Block QRS | normally less than .12 seconds |
| Causes of First Degree Block | Hyperkalemia, Hypokalemia, Endocarditis, Age, Ischemia at the AV junction |
| Effects of First Degree Block | None |
| Treatment of First Degree Block | None |
| Asystole QRS | absent |
| Asystole P wave | absent |
| Treatment of Asystole | CPR, pacer, 1mg epinephrine, 1mg Atropine |
Created by:
okrecota
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