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549 Module 9
EKG
89
Nursing
Graduate
11/09/2011

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Cards

Term
When an impulse is moving toward an electrode, it is seen as a(n) ___?___ line.
Definition
upward
Term
Lead 1 goes from ___?___ to ___?___.
Definition
right arm to left arm
Term
Lead 2 goes from ___?___ to ___?___.
Definition
right arm to left let
Term
Lead 3 goes from ___?___ to ___?___.
Definition
left arm to left leg
Term
What is the Einthoven Triangle?
Definition
imaginary inverted equilateral triangle centered on the chest with points on the arm and leg leads
Term
What degrees are assigned to Lead I?
Definition
180 to 0
Term
What degrees are assigned to Lead II?
Definition
-120 to +60
Term
What degrees are assigned to Lead III?
Definition
-60 to +120
Term
Which leads are used to estimate axis deviation?
Definition
Lead I, AVF (left leg)
Term
What deflections are seen in a right axis deviation?
Definition
I: -
AVF: +
Term
What deflections are seen in a normal deviation?
Definition
I: +
AVF: +
Term
What deflections are seen in a left axis deviation?
Definition
I: +
AVF: -
Term
What deflections are seen in an extreme right deviation?
Definition
I: -
AVF: -
Term
What are the components of the electrical conduction system?
Definition
-sinoatrial (SA) node
-intraatrial pathway
-internodal pathways
-atrioventricular (AV) junction
-Bundle of His
-right bundle branch
-left bundle branch
-Purkinje fibers
Term
Each small box on EKG paper represents ___?___ seconds
Definition
0.04 sec
Term
What is the normal range for the PR interval?
Definition
0.12-0.20 sec
Term
What is the normal range for the QRS interval?
Definition
< 0.12 sec
Term
The P wave corresponds to the event of ___?___ when the impulse is in the ___?___
Definition
atrial depolarization

internodal pathways
Term
The QRS complex corresponds to the event of ___?___
Definition
ventricular depolarization
Term
The T wave corresponds to the event of ___?___
Definition
ventricular repolarization
Term
The P wave is upright in Lead ___?___
Definition
Lead II
Term
The PR interval isoelectric line following the P wave corresponds to the event of ___?___
Definition
impulse delay at the AV junction
Term
A wave repolarizes in the same direction that it depolarized. T/F
Definition
true
Term
What is the inherent rate of the SA node?
Definition
60-100 bpm
Term
What is the inherent rate of the AV junction?
Definition
40-60 bpm
Term
What is the inherent rate of the ventricle?
Definition
20-40 bpm
Term
1st way to determine ECG rate: Count number of QRS complexes in 6 seconds (___?___ large boxes) and multiply by ___?___
Definition
30 large blocks

x10
Term
2nd way to determine ECG rate: Choose R wave at the beginning of large box and count large boxes until next R wave using the scale ___?___
Definition
300 > 150 > 100 > 75 > 60 > 50 > 43 bpm
Term
3rd way to determine ECG rate: Count number of small squares between 2 R waves and divide into ___?___ or large squares into ___?___
Definition
1500

300
Term
In normal sinus rhythm, R-R is variable. T/F
Definition
false- constant
Term
What is the difference between sinus rhythm and sinus arrhythmia?
Definition
in sinus arrhythmia, P-P is variable which also causes R-R variability
Term
What are causes of sinus arrhythmia?
Definition
-normal
-children
-r/t respirations
Term
What is the difference between sinus rhythm and sinus bradycardia?
Definition
in sinus bradycardia, rate is < 60 bpm
Term
What are causes of sinus bradycardia?
Definition
-excellent physical conditioning
-high vagal tone (nausea, inferior MI, occasional fright)
-sinoatrial dz
-beta-receptor blocking drugs
-other medications
Term
What are features of sinus tachycardia?
Definition
-rate > 100 bpm
-gradual onset and termination
Term
What are causes of sinus tachycardia?
Definition
-external stress
-meds
-hyperthyroid
-PE
-anemia
-CHF
-AV fistula
-myocarditis
-pheochromocytoma
Term
Where do PACs (premature atrial contractions/complexes) originate?
Definition
irritable focus in atrium
Term
How does the PR interval in PACs differ from sinus complexes?
Definition
prolonged or different in PACs
Term
What are causes of PACs?
Definition
-common incidental finding
-anxiety
-exhaustion
-hypoxia
-caffeine
-smoking
-PE
-hyperthyroidisim
-heart dz
Term
What are features of atrial fibrillation?
Definition
-variable R-R (irregularly irregular)
-no PR intervatl
-multiple irritable foci within atria
Term
Why is a rapid ventricular response of > 100 bpm desirable in afib?
Definition
trying to grab onto impulses received
Term
What are causes of afib?
Definition
-CAD
-valvular dz
-atrial fibrosis from aging inflammation of atria
-increased sympathetic and parasympathetic activity
-toxins
-hyperthyroid
-cardiac trauma
-pericarditis
-increased atrial pressure
-idiopathic
Term
What are features of atrial flutter?
Definition
-single irritable focus in atrium
-atrial rate 250-300 bpm
Term
What is the cause of the sawtooth appearance of atrial flutter?
Definition
looping of energy in atria
Term
What is 2:1 conduction in atrial flutter?
Definition
-1 ventricular contraction for every 2 atrial contractions
-1 hump between QRS complexes
Term
What are causes of atrial flutter?
Definition
-CAD
-valvular dz
-atrial fibrosis from aging inflammation of atria
-increased sympathetic and parasympathetic activity
-toxins
-hyperthyroid
-cardiac trauma
-pericarditis
-increased atrial pressure
-idiopathic
Term
What are features of supraventricular tachycardia?
Definition
-indistinguishable P waves
-rate 150-250 bpm
Term
What are causes of SVT?
Definition
-AV nodal re-entry or bypass
Term
What is the difference between sinus rhythm and 1st degree AV block?
Definition
PR interval > 0.2 sec
Term
What are causes of 1st degree AV block?
Definition
-increased vagal tone
-medications
Term
What are features of 2nd degree Type I AV block (Wenckebach)?
Definition
-at level of AV node
-progressive lengthening of PR interval followed by dropped QRS complex, so more P waves than QRS complexes
-R-R irregular (grouped beats, regularly irregular)
-generally slow rate
Term
What are causes of 2nd degree Type I AV block (Wenckebach)?
Definition
-increased vagal tone
-highly trained athletes
-responses to rapid atrial pacing during EPS
-acute inferior MI
Term
What is the difference between Type I (Wenckebach) and Type II (Classic) 2nd degree AV block?
Definition
II (Classic) at level of Bundle of His or lower
Term
What are causes of 2nd degree Type II AV block (Classic)?
Definition
-anterior MI (reflect trifasicular block)
-significant dz to conduction system
Term
What is the difference between 2nd degree Type I (Wenckebach) and 3rd degree (Complete) AV block?
Definition
-R-R is constant
Term
What are causes of 3rd degree AV block (Complete)?
Definition
-ischemic heart dz
-inferior MI
-myocarditis
-trauma
-extreme hyperkalemia
-infections (e.g. Lyme)
-infiltrative processes (e.g. sarcoidosis, amyloidosis, neoplasm)
-idiopathic fibrosis
-medications (e.g. Dig, beta blockers, CCB, antiarrhythmics)
-ablation
Term
Higher degree of AV block corresponds to ___?___ location in heart and ___?___ severity.
Definition
lower location in heart

increased severity
Term
What are features of junctional rhythm?
Definition
-initiated at AV junction
-P wave inverted, close to QRS, or buried in QRS
-rate 40-60 bpm
Term
What are causes of junctional rhythm?
Definition
-excessive vagal tone
-highly trained athletes
-sick sinus syndrome
-drugs that slow sinus rate
-ischemia
Term
What is the difference between junctional rhythm and accelerated junctional?
Definition
accelerated: 60-100 bpm
Term
What are causes of accelerated junctional?
Definition
-increased automaticity
-enhanced phase 4 depolarization (e.g. ischemia, MI, dig toxicity, hypokalemia and other electrolyte disturbances, hypoxemia)
Term
What is the difference between junctional rhythm and junctional tachycardia?
Definition
junctional tach: rate > 100 bpm
Term
What are causes of junctional tachycardia?
Definition
-increased automaticity
-enhanced phase 4 depolarization (e.g. ischemia, MI, dig toxicity, hypokalemia and other electrolyte disturbances, hypoxemia)
-high degree AV block
Term
What are features of PJCs?
Definition
-irritable focus within the AV junction
-P wave inverted or after QRS, PRI < 0.12
Term
What are causes of PJCs?
Definition
-incidental finding in normal heart
-anxiety
-exhaustion
-hypoxia
-caffeine
-smoking
-PE
-hyperthyroidism
-heart dz
Term
What occurs in LBBB?
Definition
right ventricle receives impulse before left
Term
What are causes of LBBB?
Definition
underlying cardiac pathology
Term
A wide QRS in leads ___?___ indicates LBBB.
Definition
V5 and V6
Term
A wide QRS in leads ___?___ indicates RBBB.
Definition
V1 and V2
Term
What occurs in RBBB?
Definition
left ventricle receives impulse before right
Term
What are causes of RBBB?
Definition
-healthy
-CAD
-lung dz
-PE
-cardiomyopathy
-atrial and ventricular septal defects
Term
What are features of idioventricular rhythm?
Definition
-impulse initiated in ventricle
-P waves disassociated
-QRS wide, bizarre, > .12
-rate 20-40 bpm
Term
What are causes of idioventricular rhythm?
Definition
escaped rhythm d/t failure of other pacemaker sites
Term
What is the difference between idioventricular and accelerated idioventricular rhythm?
Definition
accelerated: 40-100 bpm
Term
What are causes of accelerated idioventricular rhythm?
Definition
-increased automaticity
-enhanced phase 4 depolarization (e.g. ischemia, MI, dig toxicity, hypokalemia, other electrolyte imbalances, hypoxiemia)
Term
What are features of PVCs?
Definition
-single irritable focus within ventricles
-wide QRS complex
Term
What are causes of PVCs?
Definition
-heart dz
-drug toxicity
-hypoxia
-electrolyte imbalance
-stimulants (coffee, tea, tobacco, anxiety)
Term
What are features of vtach?
Definition
-irritable focus within ventricles firing irregularly (reentry)
-QRS wide, bizarre
-no P wave for every QRS, maybe disassociated P waves
-rate 150-250 (< 150 slow VT, > 250 v-flutter)
Term
What are causes of vtach?
Definition
-organic heart dz
-drugs
-ischemia
-dilated cardiomyopathy
Term
What are features of Torsades de Pointes?
Definition
-polymorphic vtach (QRS morphology changes)
-no baseline
Term
What are causes of Torsades de Pointes?
Definition
-congenital or acquired prolongation of QT interval
-medications (quinidine, sotolol, amiodarone, ibutilide, tikosyn, etc.)
Term
What are features of vfib?
Definition
-multiple irritable foci in ventricles
-completely chaotic
Term
What are causes of vfib?
Definition
-organic heart dz
-drugs
-ischemia
Term
What are features of asystole?
Definition
-no cardiac activity
Term
What are causes of asystole?
Definition
-sinus arrest
-vagally mediated
Term
What are features of paced rhythm?
Definition
-pacemaker spikes immediately followed by P wave or QRS complex
-wide QRS complex
Term
What are features of wandering atrial pacemaker?
Definition
-pacemaker wanders bw SA node, atria, and AV junction
-P waves differ in morphology
-PR interval and R-R vary
-rate < 100 bpm
Term
What are features of multifocal atrial tachycardia?
Definition
-multiple foci firing in atria
-P waves differ in morphology
-PR interval and R-R vary
-rate > 100 bpm
Term
What are features of atrial tachycardia?
Definition
-irritable focus within atrium
-rate 150-250 bpm
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