1
Q
SA node inherent rate
A
60-100
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2
Q
AV node inherent rate
A
40-60
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3
Q
AV node location
A
in the wall between the right atrium and right ventricles
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4
Q
AV node relays impulses from ___ to ____
A
SA node to ventricles
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5
Q
Four main cardiac cycle electrical events
A
cardiac action potential
depolarization
repolarization
refractory period
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6
Q
contraction of the heart
A
depolarization; systole
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7
Q
during depolarization, __ flows into cell __ flows out
A
Na; K
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8
Q
resting state of the heart
A
repolarization; diastole
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9
Q
EKG: Positive Deflection
A
impulse moving towards lead
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10
Q
EKG: Negative Deflection
A
impulse moving away from lead
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11
Q
P wave=
A
atrial depolarization
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12
Q
QRS complex=
A
ventricular depolarization
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13
Q
T wave=
A
ventricular repolarization (most sensitive time)
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14
Q
U Wave=
A
final phase of repolarization
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15
Q
PR Interval #
A
0.12-0.20; measure at the beginning of Q
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16
Q
PR Interval measures from ___ to ___
A
beginning of P to beginning of QRS
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17
Q
QRS Interval #
A
0.06-0.12
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18
Q
QRS interval measured from ___ to ___
A
beginning of the Q to the end of the S wave
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19
Q
QT measure from __ to ___
A
beginning of QRS to end of T wave
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20
Q
QT interval #
A
0.32-0.40
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21
Q
Total time from ventricular depolarization to repolarization
A
QT interval
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22
Q
Rule of 10
A
irregular rhythm; count number of R waves in a 6 second strip
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23
Q
Rule of 1500 or 300
A
regular rhythm; count small boxes between R waves
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24
Q
Atrial Dysrhythmias
A
PAC- premature atrial contraction
PAT/SVT- Paroxysmal Atrial Tachycardia/ Supraventricular Tachycardia
A Flutter-
A Fib
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25
Q
Key points of atrial dysrhythmias
A
-originate from foci within atria, not SA node
-different or variable P waves
-NORMAL QRS complexes
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26
Q
Rhythm: a single beat that occurs when an electrical impulse starts in the atrium before next normal SA node impulse
Waves: P wave is early, differs in size and shape, PR interval will be shortened
A
Premature Atrial Contractions (PAC)
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27
Q
Controlled A FIb
A
<100 with ventricular bpm
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28
Q
uncontrolled A fib
A
rate >100 ventricular bpm
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29
Q
Atrial rate is 300-600 per minute and ventricular can be up to 120-200 bpm
no p waves, no measurable PR interval; normal QRS, ventricular rate is irregular and varied
A
A fib
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30
Q
Treatment for A-fib
A
rate and rhythm control
antithrombotic- aspirin
rate control- beta blockers
rhythm control- amiodarone
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31
Q
causes: cardiac or pulmonary diseases, digoxin toxicity, PE
rate: rapid atrial rate (250-400)
rhythm: sawtooth pattern
waves: normal QRS, no p wave, no pr interval
A
A-flutter
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32
Q
pacemaker of the heart
A
SA node
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33
Q
Bundle of His
Junctional Fibers
Purkinjie Fibers
inherent rate #
A
14-20 ventricular contractions; no atrial contractions; not life supporting
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34
Q
do you see atrial repolarization on the rhythm strip?
A
no, only ventricular
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35
Q
Relative refractory period
A
most of T wave,
can be depolarized with a strong stimulus
can cause R on T phenomenon
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36
Q
Absolute refractory period
A
most of QRS complex
cardiac cells can not be stimulated to depolarize
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37
Q
1 little box on EKG strip =
A
0.04 seconds
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38
Q
1 big box on EKG strip=
A
0.20 seconds
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39
Q
To analyze rhythm strip, you always need a ___ second strip
A
6
40
Q
P-P interval measures
A
atrial rate and rhythm; measure from the beginning of the p wave
41
Q
To interpret rhythm, measure
A
Regular or Irr [p-p r-r
PR (0.12-0.20)
QRS (0.06-0.12)
QT (0.32-0.40)
42
Q
ST segment info
A
-early ventricular repolarization
-end of QRS complex to start of T wave
-should be isoelectric
43
Q
sinus arrhythmia: everything is regular except ___
A
rhythm
44
Q
Sinus: if interruption lasts <3 seconds =
A
sinus pause
45
Q
P wave that came too soon
A
PAC
46
Q
SInus: if interruption lasts >3 seconds =
A
sinus arrest
47
Q
Premature Atrial Contraction (PAC) causes
A
caffeine, alcohol, hypokalemia, pregnancy, atrial MI, and w/tachycardia
48
Q
A Fib causes
A
-heart valve disorders, cardiomyopathy, MI, COPD/lung diseases, CHF, pericarditis
49
Q
Causes loss of atrial kick (decreased CO by 30%)
A
A fib
50
Q
Paroxysmal Afib
A
its transient, comes and goes
51
Q
possible treatment for A flutter
A
adenosine
52
Q
Junctional Rhythms originate within the ___ ___
A
AV node
53
Q
Junctional Rhythm HR
A
40-60 bpm
54
Q
Accelerated Junctional Rhythm HR
A
> 60-100 bpm
55
Q
Junctional Tachycardia HR
A
> 100 bpm
56
Q
-occurs when irritable site within AV node fires impulse before SA node fire
-impulse interrupts sinus rhythm
-narrow QRS, absent or unidentifiable P wave
-just monitor
A
Premature Junctional Complexes (PJC)
57
Q
Junctional rhythm causes
A
-digoxin toxicity
-Av node ischemia
-isoproterenol infusion
58
Q
Rhythm: AV node is pacemaker
Waves: P wave may occur just before QRS, during QRS, or not at all
Narrow QRS with normal QRS intervals
A
Junctional Rhythm
59
Q
If person with Junctional Rhythm is symptomatic, treat like
A
bradycardia
60
Q
with junctional rhythm, patient loses ___
A
atrial kick
61
Q
SA-AV-SA-AV
A
AVNRT-SVT-Paroxysmal Atrial Tachycardia
62
Q
AVNRT-SVT-Paroxysmal Atrial Tachycardia causes
A
caffeine, nicotine, hypoxemia, stress, CAD, cardiomyopathy
63
Q
rate: 151-250
rhythm: an impulse that is re-routed repeatedly back to the same area
waves: P waves are difficult to see hidden T waves from previous beat
Normal QRS
A
AVNRT-SVT-Paroxysmal Atrial Tachycardia
64
Q
Symptoms of unstable patient with AVNRT-SVT-Paroxysmal Atrial Tachycardia
A
decreased CO, decreased BP, decreased urine output
cold/clammy skin, dizziness, decreased LOC
65
Q
treatment for stable AVNRT-SVT-Paroxysmal Atrial Tachycardia
A
vagal maneuvers, adenosine, CCB, BB
66
Q
treatment for unstable AVNRT-SVT-Paroxysmal Atrial Tachycardia
A
Vagal maneuvers, synchronized cardioversion
67
Q
ventricular dysrhythmias
A
-Premature Ventricular contraction
-Idioventricular rhythm
-Polymorphic VT/ Torsades de Pointe
-VFib
-Agonal
-Asystole/Ventricular standstill
68
Q
Premature Ventricular Contraction (PVC) causes
A
electrolytes (hypokalemia), MI, acidosis, dig toxicity
69
Q
Rate: variable
Rhythm: irregular
waves: no p waves, QRS complex is wide and bizarre,
types: multifocal, bigeminy (every other beat), trigeminy (every third beat), couplets, salvo, runs of VT (>4 or more), concerned with 6/min…uni (one type of deflection) vs multifocal (different deflections)
A
PVC
70
Q
increased PVC is warning sign for
A
Ventricular tachycardia (V tach)
71
Q
Rate: >100 bpm
Rhythm: regular rhythm, monomorphic
Waves: no P-waves, wide QRS complex, T wave opposite QRS
A
V Tach
72
Q
V Tach causes
A
myocardial irritability, R on T phenomenon, ACS/MI, ischemia, prolonged QT(i), heart failure, CMO, electrolyte imbalance,
73
Q
V Tach treatment
A
Pulse: RRT, amiodarone, procainamide, lidocaine, cardioversion,
No pulse: CPR, defib
74
Q
Polymorphic VT/ Torsades de Pointes causes
A
hypomagnesemia,
meds: Cipro, methadone, haloperidol, erythromycin,
75
Q
Waves: No p-waves, associated with prolonged QT(i), Mg+ levels, and meds
Rhythm: twisting of the points
rate: >100 bpm
A
Polymorphic VT (Torsades de Pointes)
76
Q
___ = D fib
A
V fib
77
Q
Rate: >100 bpm
Rhythm: fine or coarse, rapid chaotic irregular rhythm, no organized
Waves: no measurable P waves, PR intervals, no measurable QRS complexes, ST or T waves
no CO= clinical death
A
Ventricular Fibrillation (V Fib)
78
Q
Rate: 20-40 (from ventricles)
Rhythm: usually regular, SA/AV node not initiating, beat coming from Bundle of HIS or Perkinje fibers
Waves: no p waves, wide abnormal QRS
A
Idioventricular- Ventricular Escape Rhythm
79
Q
Causes: End of Life, multi-system organ failure,
rate: <20 bpm
rhythm: irregular
waves: no p waves, QRS extremely wide and slurred, often not treated
A
Agonal Rhythm
80
Q
Rate: <20 bpm
Rhythm: no electrical activity, requires 2 lead confirmation
waves: standstill, only p waves noted
A
Ventricular standstill/ Asystole
81
Q
PEA is treated like___
A
asystole
82
Q
PEA & Asystole are shockable rhythms: true or false
A
false
83
Q
Conduction abnormalities
A
heart blocks:
-1st degree
-2nd degree type 1 (wenchebach)
2nd degree type 2
3rd degree (complete Hb)
84
Q
Conduction abnormalities facts
A
hemodynamics worse as degree worsens
causes: lyme disease , dig toxicity, CCB, MI and ischemia
85
Q
R coronary artery feeds blood to the
A
SA node
86
Q
Rate: regular, atrial impulse is slower than normal
Rhythm: regular
waves: P wave normal size, shape, QRS- normal, PR(i) CONSISTENTLY PROLONGED >0.20 seconds and the same for all
A
First Degree AV Heart Block
87
Q
2nd degree HB type 1 [wenchebach] treatment for asymptomatic
A
no treatment
88
Q
2nd Degree HB type 1 [wenchebach] symptomatic treatment
A
atropine
89
Q
Rate: Regular
Rhythm: atrial regular, ventricular irregular, patterned 1 beat loss,
Waves: p waves present but all conducted, PR (i) lengthens until one is not conducted, QRS normal, but periodically dropped, sa/av node not carrying consistently
A
2nd degree HB type 1 [wenchebach]
90
Q
Rate: atrial rate regular, ventricular rate slower than atrial,
rhythm: atrial regular, ventricular rhythm irregular, patterned 1 beat loss,
Waves: p waves normal, but not all conducted, PR(i) is normal or prolonged all PR(i) are the same, THERE is NO LENGTHENING of PR(i)
waves: QRS normal, but occasionally dropped
A
2nd degree HB type 2 (mobitz II)
91
Q
2nd Degree HB Type II (Mobitz II) treatment
A
temp pacemaker
AVOID ATROPINE
92
Q
Lethal Rhythms
A
V FIb
V tach
3rd degree AV Block (complete HB)
idioventricular
asystole
PEA
93
Q
Rate: A and V rate regular but not the same (no association)
Rhythm: A rate faster than V rate and are regular. 2 independent rhythms @ same time
waves: P waves present but have no relationship w/ QRS complex, P waves march on, PR(i) not measurable, QRS wide or narrow
A
3rd Degree HB (complete HB)
94
Q
There are 2 independent rhythms happening at the same time
A
3rd degree HB
95
Q
3rd degree HB treatment
A
AVOID atropine, pacemaker at bedside
