ECG Study Notes Chapter 4-8

Signs and symptoms of decreased carbon output are...

1.Dizziness
2.Syncope
3.Clammy and cool
4.Confusion
5.Cold feeling

Arrhythmic is any rhythm other than...

sinus rhythm

______________ is completed when an error is made.

Incident report

The normal speed of paper exiting the EKG machine is ____.

25mm/sec

_______waves many times maybe caused by low _____( k+) on high_____(ca+).

U waves
Potassium
Calcium

Sinus arrhythmia, the pacemaker cells of the _______ fire irregularly.

SA node

Refers to the lack of blood supply?

Iscochemia

Rates less than 60 bpm is also known as _______

bradycardia

Atrial and ventricle rates are within normal limits at____

60-100 bpm

________means that "P" is within normal limits.

Sinus

__________ __________ is characterized by a sinus rate below 60 bpm and a regular rhythm.

Sinus bradycardia

No symptoms means ________.

no treatment necessary

In sinus bradycardia the atrial and ventricular rhythms are regular, as are their rates, expect that both under ______bpm.

60

Beats under 60 bpm is sinus__________________

bradycardia

In sinus bradycardia you will see a ____ wave preceding each _____complex and a _______PR interval, QRS complex, Twave and QT interval.

P-wave
QRS complex
normal

In sinus tachycardia the rhythm is regular with rate above_____bpm.

100

Tachycardia can lower cardiac output by reducing_______ filling time and the amount of ________pumped by the ventricles during each _________.

ventricle
blood
contraction

If tachycardia leads to cardiac __________, treatment may include medications to slow the heart rate.

ischemia

The most commonly used drugs include beta-adrengric blockers, such as metoprolo, atenolol, and calcium channel blocker, but not _________.

atropin

______________when one or two beats aren't formed.

Sinus pause

_______________ when three or more beats aren't formed

Sinus arrest

Sinus arrest occurs when the ____ nodes fail to generate and impulse.

SA nodes

Pauses of ___ to ___ seconds normally occur in healthy adults during sleep and occasionally in patients with increased vagal tone.

2 to 3

In sinoatrial (SA) block, the SA node discharges impulses at _______________ impulses.

regular

Based on the length of the delay, SA blocks are divided into _____ categories.

3

The blocks 3 categories are :

first, second, and third-degree

AV is short for ?

Atrial ventricular

If sinus arrest is frequent and prolonged, the patient will most likely have________.

symptoms

A patient with sinus arrest is at risk for ________.

syncope

A ___________ patients needs lifelong treatment.

symptomatic

For a patient with symptomatic sinus bradycardia, appropriate nursing intervention includes establishing I.V. access to administer.

atropine

A monitor shows an irregular rhythm and a rate that increases and decreases in consistent cycles. This rhythm most likely represents:

sinus arrhythmia

Dyspnea is defined as___

trouble breathing.

Atrial arrhythmia are thought to result from three mechanisms which are :

Enhanced aromaticity
Reentry
Triggered activity

An "atrial kick" is if the blood pumps into the ventricle, this is a result of atrial contraction this contributes to approx. _____% of the total cardiac output.

30

_____ are rarely dangerous in a patient who doesn't have heart disease.

PAC

PAC is short for

Premature Atrial Contractions (PAC)

Triggered activity of and injured cell is known as

afterdepolarization

Bigeminy means

Every other beat is a PAC

Trigeminy means

Every third beat is a PAC

Couplets are defined as

Two PAC's in a row

______ ______ has an atrial rate of 150 to 250 bpm.

Atrial tachycardia

_______ types of atrial tachycardia exist.

3

The 3 types of atrial tachycardia are:

atrial tachycardia with block
multifocal atrial tachycardia
paroxysmal atrial tachycardia (PAT)

Atrial tachycardia can occur in patients with _______hearts.

normal

A rhythm is irregular when a ______ occurs

PAC

Valsava's maneuver or carotid sinus massage may be used to treat atrial ________

tachycardia

_______therapy may be used when other treatments fail.

Drug

Drug therapy include

digoxin
beta-adrenergic blockers
calcium channel blockers

___________is defined as chaotic, asynchronous, electrical activity in atrial tissue.

Atrial fibrillation

Atrial flutter is a _______ _______, is characteristics are an atrial rate of 250/350 bpm

superventricular tachycardia

Atrial flutter

Characterized by a "saw-toothed" wave formation with a slower ventricular rate. The atrial rate generally ranges form 220 to 350 beats/min. Cardioversion may be used.

Atrial fibrillation, sometimes called

A-fib

__________ is the most common arrhythmia, affecting an estimated 2 million people in the U.S.

Atrial fibrillation

As with atrial flutters, atrial fib results in a loss of _____ ____.

atrial kick

Absence of P-wave indicates that the impulse is not made in the ______.

atrium

As with other atrial arrhythmia's, a-fib eliminates atrial kick. That loss, combined with the decreased filling times associated with______rates

rapid

A person with a A-fib, you may see there _____pulse is slower than the ______pulse

radial
apical

Electrical cardioversion is most successful if used within the first _____hours of treatment and less successful if the rhythm has existed for a long time.

48

A wandering pacemaker is an _______ rhythm that results when the hearts pacemaker changes its focus from SA nodes to another area above the ventricles.

irregular

A wandering pacemaker may be caused by

increased vagal tone
dioxin toxicity
organic heart diseases (rheumatic carditis)

Arrhythmia may be normal in ________patients and is common in________ who may have a slow heart rate.

young
athletes

If the fib. rate is controlled cardiac _______ should b normal. Faster your heart rate output it will _______

output
decrease

AV junction = AV nodes and ______ ___ _____

Bundle of His

Possible causes of junctional tachycardia include:

digoxin toxicity (most common cause)

K+ is

Potassium

K+ low or high levels can be a major concern in _______care.

cardiac

PVC's are usually caused by electrical irritability in the _______ ________ or muscle tissue.

conduction system

This irritability may be provoked by anything that disrupts normal electrolyte shifts during cell _____ and _______.

depolarization
repolarization

What conditions can disrupt electrolyte shifts?

Electrolyte imbalances, such as hypokalemia, hyerkalemia, hypomagnesemia, and hypocalcemia

In a PVC an ____ wave is absent.

P wave

Premature QRS complex appears as ____ and ______

wide
bizarre

One the ECG strip, ______ looks wide and bizarre and appears as an early beat causing atrial and ventricular irregularity.

PVC

PVC stands for

Premature Ventricular contraction

A horizontal baseline called a _____ _____ may follow the T wave of the PVC

compensatory pause

Two PVC in a row are call a pair or a ________

couplet

PVC that looks different from one another arises from different sites or from the same site with abnormal conditions is called _____ ______

Multiform PVC

PVC that occurs every other beat is known as ____

bigeminy

PVC that occurs every third beat is known as _______

trigeminy

In R- on - T phenomenon, the ______ occurs so early that it falls on the T wave of the preceding beat. This is because cells haven't fully repolarized, resulting in ____ ___ or ventricular fibrillation.

PVC
ventricular tachycardia

_______ PVC may be dangerous and life-threatening.

Multifocal

Known as the rhythms of last resort...

idioventricular rhythm

Idioventricular rhythms acts as a safety mechanisms to prevent _________ standstill when no impulses are conducted to the ventricles from above the bundle of His.

ventricular

The cells of the _________system take over and act as the heart's pacemaker to generate electrical impulses.

His-Purkinje system

V-tach is short for

ventricular tachycardia

V-tach is 3 or more _____ in a row and v rate exceeds 100 bpm.

PVC

The treatment of V-Tach is an unresponsive patient is pround shock would mean ______ _______

Cardio version (Paddles) Clear

Treatment would depend on whether patients pulse is ______ or undetectable.

detectable

______ patients generally have a heart rate greater than 150bpm.

Unstable

V-tach would be used to treat with _________ if patient is awake and alert, with no signs of cardiac

lidocione

Maxium output level for a defibilator is ____ ____

360 Joules

Be aware that other factors cam mimic ventricular ________ on an ECG strip. Such as electric razors, muscle movement (shivering) and ______.

fibrillation
coughing

__________ is the most effective treatment for ventricular fibrillation.

Defibrillation

Fine V-fib --->
cause---> v-fib
medicine to convert is ________

epinephrine

The presence of small fibrillatory _______ indicates fine ventricular fib.

waves

Treatment for ventricular arrhythmia is _________.

lidocaine

Arrhythmia's can be life-threatening. If asystole occurs, start _____ immediately.

CPR

P-waves are absent in ______

V-tach

PVC are most dangerous if they

are multiformed and increase in frequency