ADV DX ECG's Word Scramble
A B L R I A T D E L T A P T T H O S N I A C - C E
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| Question | Answer |
| receptor site mnemonic ABCD | alpha constrict-beta dilate |
| Hypoxia and ischemia of myocardium causes | <PaO2, <HB, <perfusion |
| most common AV Heart block causes | meds like digitalis, damage from MI |
| causes of 2nd degree heart block type 2 | damaged bundle branch fallowing an MI or degenerative disease |
| when are PVC's dangerous | multiple PVC's in less than 1 minute (indicates irritable vent area), couplets (2in a row), salvos (3 in a row), or R on T phenomenon |
| *atrial flutter pattern on ECG strip is caused by | rapid firing of ectopic foci, sawtooth Pwave with normal QRS |
| how is ventrical response determined | QRS complexes and pulse strength (to fast/slow, irritability, lethal, absent) |
| where are V1 and V2 located | 4th intercostal space V1 on the left and V2 on the right |
| COPD dysrhythmias | Tachycardia, Multifocal atrial tachycardia, ventricle ectopic beats are most common (from hypoxemia & meds) & worsen at night due to hypoxemia. |
| *more than one Pwave may indicative of | atrial flutter (Pwaves look alike), atrial fib (Pwaves don't look alike), 2nd or 3rd degree heart block |
| electrical conduction of the ventricles | from bundle of his in AV junction to bundle branches (30-40 bpm) to purkinje network (30-40 bpm) |
| ST Segment | begins at end of QRS and ends at beginning of Twave, normally flat |
| causes of dysrrhythmias | hypoxia, ischemia, sympathetic stimulation, drugs, electrolyte imbalance |
| *what causes Vtach | hypoxic heart, as with severe myocardial ischemia |
| myocardial cells | contract in response to elec stimuli and pump blood |
| 1 small box on strip | .04 seconds |
| V Fib | Uncoordinated vent depolarization’s |
| wide QRS indicates | originates in ventricular if supraventricular it has deviated from normal course |
| AV block | Conduction block w/in AV node (sometimes bundle of his) |
| interpreting dysrrhythmias can be accomplished in 3 levels | 1ventrical response (abnormal conduction), 2 categorize based on origin, 3 electro-physiology (pathway of conduction disturbance) |
| Atrial flutter rate according to Karol’s handout | 250-350 |
| R-prime | a QRS complex that has a second positive deflection, the first is the R, the second is R-prime |
| *Pwave | (.11 seconds) depolarization of the atria, impulse spreads across atria and triggers atrial contractions |
| normal QRS | <.12 |
| ectopic impulse | impulse originating outside the SA Node |
| T-Wave | ventricals returning to resting state |
| long QT interval | >1/2 of R-R (if HR is <80bpm), hypokalemia, hypocacemia, side effect of meds like quinidine |
| *Right atrium enlargement is seen in pts | chronic pulm hypertension (as with COPD) |
| norepinephrine | neurotransmitter of the sympathetic NS, aka adrenergic, >HR, >contractility |
| Chief complaint suggestive of ECG | chest pain, exert ional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, pedal edema, fainting, palpations, nausea and indigestion in high risk pts |
| Past medical hx suggestive of ECG | hx of heart disease, hx of cardiac surgery |
| long term bradycardia can be caused by | damage to SA node by MI |
| significant increase in Q wave (.04) is indicative of what | infarction |
| what is the back up pacemaker | AV junction |
| 1st degree AV heart block | (mildest) prolonged PRI >.20 second delay at AV node |
| VPB (Ventricular premature beats) | Wide QRS, caused by eptopic foci in ventricle. |
| electrophysiology of dysrrhythmias | ectopic beat/rhythm, escape beats/rhythms, AV block, bundle branch block |
| disease states that cause bradycardia | hypothyroidism, hypothermia, hyperkalemia, meds |
| electrical conduction system of the atria | SA node to the 3 internodal atrial conduction tracts leading to AV node and 1 intranodal conduction tract to left atrium (Bachman’s bundle) |
| SVT most often caused by | reentry currents in atria or from vent to atria. Rate 140-250 |
| *QRS complex | (<.12) impulse spreads to ventricals, triggers ventrical contraction, (depolarization) |
| what does QRS represent | ventrical depolarization |
| what electrolyte imbalance cause dysrrhythmias | potassium, magnesium and calcium are most common |
| *SA Node | normally is pacemaker, has greatest automaticity, causes depolarization (60-100bpm) |
| normal ECG has how many leads | 12, 6 limb (vertical plane) and 6 chest (horizontal plane) |
| Right axis deviation | right vent is enlarged |
| how can sympathetic stimulus cause ischemia | >workload w/o concurrent blood flow (blocked coronary arteries) |
| what is the normal intrinsic rate of secondary pacemaker | 60-80 |
| what is paroxysmal atrial tachycardia | 160-240 bpm, ectopic foci in the atrium takes over as pacemaker, sudden onset and ending, may cause hypotension, CHF, or ischemic episode, or recent/pre existing MI |
| physical exam suggestive of ECG | unexplained tachycardia at rest, hypotension, <capillary refill, abnormal heart sounds, pedal edema, cool cyanotic extremities, abnormal heave or lift of pericardium, diaphoresis, JVD, abnormal sensorium, hepatojugular reflex, bilateral insp crackles |
| QRS is equally spaced with 4 large boxes between, whats the rate | 75 (300/4 is 75) |
| frontal plane | vertical plane of the limb leads, measures up-down, right-left etc. |
| evaluating 3rd degree heart block | rate <60, rhythm is regular, Pwave is normal but not always followed by QRS, PRI varies many with no relationship to QRS, QRS is usually wide but can also be normal |
| acetycholine | neurotransmitter of the parasympathetic NS, aka cholinergic, <HR |
| U-wave | follows Twave, may be seen or unseen, final phase of ventrical re-polarization |
| *evaluate Pwave | positive, round, <.10, <2.5 mm tall, all should look alike |
| *sinus tachycardia | 100-150 BPM with SA node as pacemaker, most often caused by fever, pain, hypoxemia, hypovelemia, hypotension, sepsis, heart failure and suctioning |
| V Flutter | vent depolarizes >200/min |
| pacemaker cells | cells w/high degree of automaticity that provide electrical power to heart |
| during re-polarization what happens in the myocardial cells | K- moves back inside and NA+ and CA+ move to the outside |
| 1st degree block | PRI >.20, caused by increased vagal tone, digitalis, beta- blockers, calcium channel blockers or ischemia damage. |
| what does T wave represent | ventrical re-polarization |
| causes of junctional rhythm | AV node damage, electrolyte disturbance, digitalis toxicity, heart failure, valve disease, rheumatic fever |
| The 3 types of heart cells are | pacemaker (automaticity), conducting (conduct electricity), and myocardial cells ( contract in response to electricity) |
| common causes of PVC's | anxiety, caffeine, alcohol, tobacco and meds. Also seen in pts with HX of MI, heart disease, acidosis, electrolyte imbalance, CHF, and hypoxia |
| Salvos | 3 PVC's in a row, also known as a run of Vtach |
| S-prime | second S wave in QRS |
| categories of origin are | atrial, junctional, ventricular |
| Junctional rhythm | area of AV junction assumes pacemaker |
| *absolute bradycardia | <60 bpm w/no problems to pt (athlete) |
| IVCD | intraventricular conduction delay. |
| short PRI indicates | progression of elec impulse is outside normal path |
| caused of atrial flutter | valvular heart disease, MI, hypertension, cardiomyopathy, myocarditis and pericarditis |
| *relative bradycardia | <60 bpm not tolerated well by pt, pts with compromised cardiac function may cause hypotension, syncope, <CO, CHF or shock |
| narrow QRS | normal, supraventricular |
| calculating bpm | add the large boxes between R waves and devide into 300 so 300/3 is 100 bpm |
| *Right atrium enlargement is diagnosed by | rt deviation of Pwave, tall Pwave or prominent or negative Pwave |
| 2nd degree AV Block type 2 aka Mobitz type 2 | rare and serious, many Pwaves with out QRS, PRI can be normal or prolonged, but is always constant |
| danger of PAT (paroxysmal atrial tachycardia) | >myocardial O2 demand but pump is ineffective because of rate, especially dangerous in pt with bad heart |
| V Tach | Caused by aberrant vent automatically or intra-ventricular reentry, can be sustained or paroxysmal (short run) wide QRS 100-200 bpm. |
| *evaluating ST segment | norm is isoelectric(flat), elevated is myocardial injury, depressed is ischemia |
| evaluating junctional rhythm | rate 40-60, accelerated 60-100, junctional tachycardia >100, rhythm is reg, Pwave is absent, inverted or short, can be befor or after QRS, PRI if present is short, QRS <.12 |
| *evaluating the Qwave | norm is <.04 and less than 1/3 amplitude of R, greater than 1/3 R is pathologic, indicative of new or old MI |
| deviation of the ST segment up or down suggests what | abnormal myocardial perfussion and oxygenation (due to hyperkalemia), cardiac ischemia but no perminant damage |
| PEA | pulseless electrical activity, rare and usually follows an event like tension pneumo, cardiac trauma, severe electrolyte imbalance or acid-base disturbance |
| QT interval | from beginning of Q to end of T, should be ½ of R-R |
| normal mean axis | between 0 and 90 degrees |
| acute infarction looks like what on ECG | elevated ST segment |
| elevated ST | infarction, greater the height-greater the damage |
| evaluating atrial flutter | rate 180-400, rhythm is regular, Pwave is sawtooth can be 2:1, 3:1 etc, PRI not measurable (to many Pwave), QRS is normal <.12 sec |
| Asystole | cardiac standstill-flatline-no pulse, dead |
| causes of left axis deviation | rt vent infarction, left vent hypertrophy, abdominal obesity, ascites, or ab tumor, pregnancy |
| 2nd degree AV block | slow conduction at AV node so some don’t get through. Ventricle rhythm is < atrial rhythm. |
| cases of right axis deviation | left vent infarction, rt vent hypertrophy, COPD, pulm emboli, normal in infants, |
| blocked coronary artery causes what | ischemia and infarction leads to dysrrhythmias and <QT |
| R on T phenomenon | PVC's occur during Twave of preceding beat, can cause PVC's to turn into Vtach (when it happens Vtach QRS wave looks more rounded) |
| *bradycardia rate | <60 |
| PEA rhythm | any rhythm that does not produce a pulse except Vtach, Vfib and asystole |
| Sick sinus syndrome | disturbance of SA node causing marked variable in rhythm – cycles of brady and tachy. |
| 3rd degree block | most extreme and dangerous heart block. Conduction problem is in bundle of his (narrow QRS) or in bundled branches (wide QRS), complete block, no conduction atria and ventricals |
| what can slow the SA node rate (or stop it) | vagal stimulation (parasympathetic), also drugs disease etc |
| accelerated idoventricular rhythm | variation of idoventricular but rate is 60-100 |
| evaluating for A-Fib | rate can be as high as 400bpm, rhythm is irregular irregular, Pwave is chaotic and irregular, PRI is unmeasurable, QRS <.12 |
| action potential | electrical charge passing through cell and propagating to other cells (all in one fashion) |
| COPD causes what kind of axis deviation | hyperinflation rotates heart & causes R axis deviation. |
| prolonged PR interval | AV block |
| QRS >.12 | Complete RBBB or LBBB (3rd degree block), IVCD, or PVC’S (v-tach & pacemakers) |
| What do ECG's not measure | pumping ability, abnormalities of cardiac structure, probability of MI |
| caused of A Fib | same as a-flutter plus hyperthyroidism, pulm diseases and congenital heart diseases |
| Cor pulmonale (R vent enlargement) causes what kind of deviation | R axis deviation |
| Systole | ventrical contraction |
| *respiratory meds that cause sinus tachycardia | methylxanthines (phosphodiesterase inhibitors) and B agonist |
| Pwave following QRS is what | junctional rhythm, shows retrograde conduction (up), and will be inverted (looks like ST segment is dipped) |
| bipolar leads | leads I, II, and III, voltage is measured as a difference in between two electrodes |
| where is the greatest degree of of automaticity | SA node-thus the pacemaker |
| atrial kick | contraction of the atria (at latter end of systole) just before ventrical contraction-aids in ventrical filling and accounts for 10-20% of CO in healthy person |
| Ventricular Fibrillation | chaotic unorganized ventrical activity, wavy irregular pattern, no QRS, no rate, rhythm, Pwave or PRI |
| normal PR interval | .20 |
| QRS is equally spaced with 3 large boxes between, whats the rate | 100 (300/3 is 100) |
| Second degree AV Block Type 1, aka Mobitz 1 aka Wenkebach | (intermediate block) PRI gets long each beat until QRS is dropped, same causes as type 1 |
| AV Node delay | .05 seconds, delay before passing into bundle of his, allows for complete filling of ventricals before contraction (also protects vents from fast rates) |
| *AV Node | normally acts as back up pacemaker (40-60 bpm) |
| lung receptor | B2 |
| S&S of dysrrhythmias | chest pain, dyspnea, fine crackles, palpations, pale cool skin, dizziness/syncope, sense of impending doom, low BP-<90systolic, <LOC |
| SA Node is stimulated by the sympathetic nervous system, what kinds of things can increase SA Node rate | (fight or flight) stress, anxiety, exercise, medication. CHF, hyperthyroidism |
| *elevated or depressed ST segment | depressed ischemia, elevated MI |
| evaluating for 1st degree heart block | rate normal, rhythm regular, Pwave normal, PRI prolonged (>.20), QRS norm at <.12 |
| elevated T | ischemia (usually seen with depressed ST |
| evaluating sinus dysrrhythmias | usually benign, everything is normal except rhythm, rhythm will be off (space between the R-R) |
| Infarctions | blockage of one or more coronary vessels leading to regionalized tissue ischemia and tissue death |
| Left axis deviation | left vent is enlarged |
| Atrial tachy | Series of 3 or more PAC’s (includes PAT-paroxysmal atrial tach) |
| Calculating EKG HR | Between R-R, add lg boxes at .20 each and sm boxes at .04 then divide into 60. 2lg + 3sm is 60/.2+.2+.04+.04+.04 equals 60/.52 is a HR of 115 |
| what does the QRS reflect on ECG | electrical activity of the ventricals |
| isoelectric | flat (no positive of negative charge) |
| Ventricular Tachycardia | run of 5 or more PVC's, looks like a series of wide QRS's w/no Pwave, tombstones or fireman hats |
| If Pwave appears befor QRS in junctional rythm | Pwave is not responsible for QRS if PRI is less than .12 |
| Atrial Fibrillation | quivering of the atrials caused by multiple ectopic beats, causes complete loss of atrial pumping ability and increased risk of mural thrombi and emboli |
| PVC | ectopic beat originating in ventrical, can occur in normal or diseased heart |
| alpha and beta adrenergic receptor sites | alpha are in blood vessels through out body and B receptor are in heart and lung only |
| depressed ST | ischemia |
| evaluating Vtach | rate 140-300 bpm, rhythm is regular, no Pwave with PVC, no PTI with PVC, wide QRS |
| MI and ischemia cause what | dysrrhythmias and <CO |
| Junctional escape Rhythms | Inverted or no p-wave, AV node rhythm of 40-60 |
| poor cardiac output and HR | to slow causes <output, HR to fast vents, not enough time to full so less blood pumping <CO |
| where is V6 located | 5th intercostal in the midaxillary line (mid axillary would be if you cut body in half from top down, so mid axillary is under armpit) V3, V4 and V5 are located in between V2 and V6 |
| 1 large box on strip | .20 seconds |
| causes of PAT | stress, mitral valve disease, rheumatic heart disease, digitalis toxicity, alcohol, caffeine or nicotine |
| automaticity | cells that have the ability to generate electrical activity spontaneously |
| *evaluating QRS | norm <.12, wide w/bundle branch block, ectopic beat in vent (PVC's), ventrical dysrrhythmias (vtach, idioventricular rhythm or premature ventricular complex), 3rd degree heart block |
| *cor pulmonale (rt atrium enlargement) shifts axis how | to the right |
| atrial flutter usually resolves how | deteriorates to atrial Fib or spontaneously returns to normal |
| what is the normal intrinsic rate of primary pacemaker | 60-100 |
| what clinical findings suggest the need for ECG's | orthopnea and syncope |
| polarized | resting state |
| coronary arteries | supply 02 and nutrients to heart, arise from descending aorta and branches to coronary vessels |
| 1st degree AV heart block causes | meds (digitalis), >vagal tone, hyperkalemia, myocarditis, and degenerative disease |
| *long PRI indicates | delay in conduction or AV block |
| atrial flutter reduces CO how | reducing atrial kick |
| evaluating 2nd degree mobitz 2 | rate varies but ventrical is always less than atrial, rhythm is regular regular or regular irregular, Pwave looks normal but no QRS follows some.PRI is norm or long but all look alike, QRS <.12 |
| re-polarization | return to resting state (negative charge returns) |
| depolarization | muscle contraction(loss of negative charge) |
| evaluating PAT | rate 160-240 bpm, rhythm normal, Pwave abnormalities-hidden in QRS or if before QRS it appears pointed, can combine with Twave, PRI is usually not measurable |
| All PVC's are followed by what | compensatory pause (because they are premature) |
| *odd shaped Pwaves are indicative of | atrial enlargement |
| *4 major characteristics of cardiac cells | automaticity, excitability/irritability, conductivity, contractility/rhythmical |
| during depolarization what happens in the myocardial cells | K- moves out and NA+ and CA+ moves in |
| what are the chest leads | V1-V6 |
| A Fib | Uncoordinated atrial depolarization’s |
| What is an ECG | an indirect measurement of the electrical activity within the heart |
| Prolonged QRS .12-.10 causes | R or L bundle branch block, IVCD or L anterior or posterior fascicular block. |
| heart receptor | alpha and B1 |
| difference between fibrillate and flutter | flutter you can count and fibrillation is a quiver-chaotic, Ventrical fib and flutter originate low in the heart, so no QRS as with atrial fib and flutter (they have a QRS) |
| Pt complaint with PAT | light headed, palpations, possible fainting |
| evaluating idioventricular rhythm | rate 30-40, rhythm is regular, Pwave is absent, PRI none, QRS >.12 |
| what does P wave represent | atrial depolarization |
| transient bradycardia may be caused by | >vagal tone from carotid massage, manipulation of tubes, suctioning, valsalva maneuver |
| Diastole | ventrical relax |
| irregular rhythms | may be random or in patterns, ectopic beat, escape beat, second degree AV block, atrial Fib, sinus dysrrhythmias |
| evaluating for PVC's | rate is underlying, rhythm is regular, Pwave is not associated with PVC (others are normal), PRI not measurable (others are norm), QRS norm except with PVC>.12 abnormal look and premature, Twave is opposite direction of PVC (PVC up Twave down) |
| Atrioventricular Junction | AV Node and bundle of His (.05 second delay) |
| blood vessel receptor | alpha and B2 |
| *PRI | PR interval, .12-.20, measures time from onset of atrial contraction to onset of vent contraction, aka time for elec impulse to spread through and AV node (3-5 small squares) |
| 2nd degree Type 1 (wenkebach) | AV node block. PRI it elongates then drops QRS – most often seen in sleeping pt with high vagal tone (rarely is pacing indicated) |
| *F-waves | flutter waves, caused by rapid contractions of atria upon stimulation by re-entry or accelerated automaticity |
| *tachycardia rate | >100 |
| *evaluating PR interval | norm .12-.20 seconds, >.20 is possible heart block (delayed AV node) |
| augmented leads | leads aVR, aVL, aVF are augmented by the machine because they are unipolar |
| what are the 6 limb leads | I, II, III, aVR, aVL, aVF |
| causes of 3rd degree heart blocks | inferior MI, increased vagal tone, myocarditis, digitalis toxicity, may be permanent condition following MI or degenerative disease |
| mural thrombi | thrombi that form along the atrial walls (stagnated blood) during atrial flutter, migration may cause emboli |
| ECG's are useful for assessing what | impact of lung disease on heart, severity of infarction, heart rhythm, never pick pumping ability or QT |
| normal QRS | <.12 |
| 3rd degree | complete block, but escape rhythms cause QRS but they originate in AV node, bundle of his or vent region. No synchrony between Pwaves & QRS atrial rhythm can be normal, but vent will be 30-40 |
| must know ID these strips and how to treat including meds | brady, sinus tach, PVC, fine and course VFib, asystol, depressed ST and elevated ST |
| idoventricular rhythm | normal pacemaker is not setting pace, trials norm but ventrical wave is irritable ectopic beat, looks like slow wide bizarre QRS, with brady, leads to rapid heart failure, (looks like row of slow moving PVC's) |
Created by:
williamwallace
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