EKG Final by THIDA

Chapter 8

HEART BLOCK DYSRYTHMIAS

Which of the following statements best describes 1st� heart block?

The electrical current is delayed or blocked a long normal conduction pathway is at or about the AV junction

What is the cause of a heart block dysrhythmia?

The electrical current has difficulty traveling down to normal conduction pathway

Which of the following statements best describes 1st� heart block

The electrical current is delayed or blocked along a normal conduction pathway at or above the AV junction

Which heart block rhythm has a CONSTANT PR interval that measures greater than 0.20 second?

First-degree AV block

Which heart block has regular P-P, R-R intervals that BOTH occur at the SAME rate?

First Degree heart block

The observation guidelines used to assess the blood supply to the viral organs of the body to maintain normal function are called:

Cardiac output parameters

What symptom would you observe in a patient with first degree AV block?

The patient should have NORMAL cardiac output and NO symptom

An impulse that occurs too soon after the preceding impulse, causing a period when no other impulses can occur on the VENTRICLES, is known as:

Blocked or non-conductive impulse

Which heart blocks are the only blocks with an irregular VENTRICULAR response?

Second heart blocks

Which of the following heart block dysrhythmia is identified by repetitious prolonging PR interval pattern after each blocked QRS complex?

Second degree heart block type 1

Which of the following is a characteristic of P-P intervals in all heart block dysrhythmia?

Regular

Second degree heart block type one is usually due to

Inflammation around the AV node

Frequent NONconducted QRS complexes I'll likely to cause sign of

Low cardiac output

With second degree AV block type 1

Not all of the P waves are followed by a QRS complex. P-P regular and R-R irregular

Which heart block dysrhythmia is known as "classical heart block"?

second degree AV block, type type 2

Which of the following heart block dysrhythmia is identified by missing QRS complexes and a consistent PR interval of measurement?

Second degree AV block, type 2

With second-degree AV block, type two

The PV's are all the same

Which of the following rhythm has a constant PR interval for all conducted beats?

Second - degree AV block type 2

Which type of heart block tends to progress quickly to third degree AV block or complete heart block?

Second - degree AV block type two

How do you distinguish between 2nd degree AV block type one and type two?

With type two, the PR intervals are constant

Which heart block dysrhythmia is highly unstable and considered a critical condition?

Second - degree AV block type two

FW report the second - degree AV block type two to a licensed practitioner you should prepare for

A code blue situation and application of a temporary pacemaker

When do you use the mnemotic "Lengthen, Lenthen, drop equals Wenckebsck"?

To determine the difference between a Second - degree type one or type two heart block.

Which heart block dysrhythmia is known as complete heart block (CHB)?

3rd degree AV block

Which of the following heart block dysrhythmias is identified by regular P-P and R-R intervals that are firing at two this distinctly different rate?

3rd� AV block

In which heart block dysrhythmia would be patient probably be unconscious and require immediate medical intervention

3rd� AV block

QRS complexes I measure 0.12 second or greater with a rate between 20 to 40 BPM indicate that there impulses causing ventricular depolarization are coming from the?

Purkinje fibers

That condition in which the atria and ventricles are electrically separated from one another is often referred to as

AV dissociation

1st� heart block, 2nd� heart block type one and two, and 3rd� AV block rates

1st�, second-degree type one and two are 60 to 100 BPM, except 3rd�, which is 20 to 40 BPM

Your responsibilities to care for a patient with complete heart block include

Observing the patient for symptom of low cardiac output, reporting any signs and symptoms to the licensed practitioner, initiating emergency procedures if needed.

In which heart block dysrhythmia are all electrical and impulses originating above the ventricles blocked and prevented from reaching the ventricles?

3rd degree AV block

With first degree heart block

The PR intervals are greater than 0.20 seconds in duration

In which of the heart block dysrhythmia are there more P waves than QRS complexes?

All type of heart blocks, except 1st� heart block

In 30� AV block if the impulse causing ventricular depot relation is coming from baby Junction the rate will be

60 to 100 bpm

What indicates whether the heart block is low, in the bundle of His, or higher, in the area of the AV tissue?

The ventricular rate and QRS configurations

Which heart block dysrhythmia has a PR interval that gets progressively longer until the QRS is dropped, and after the blocked beat, the cycle starts again?

2nd� AV block type one

What is the heart rate range for 1st� heart block

60 to 100 bpm

Who first discovered the two different types of second degree heart block?

Dr. Woldemar Mobitz

CHAPTER 9

RHYTHMS ORIGINATING FROM THE VENTRICLES

The ventricle pacemaker cells are found at;

The purkinje fibers

The inherence rate of the purkinje network is

20 to 40 beats per minute

In all ventricular dysrhythmias, P-P intervals are

Missing

QRS complexes that measures 0.12 second or greater with a rate between 20 to 40 bpm indicate that the impulses causing ventricular depolarization are coming from the

Purkinje fibers

Ventricular rhythms occurring within the range of purkinje fibers are referred to as

Ventricular escape rhythms

Ventricular rhythms occur because

Higher pacemaker sites within the heart have failed, the rate of automaticity from this portion of the heart is faster, this portion of the heart takes over the primary pacemaker within the heart

Which of the following is correct statement about premature ventricular complexes or PVCs?

PVCs maybe unifocal or multifocal in origin

Which of the following is caused by etopic impulse that occurs early in the cycle and originates from the ventricles?

PVC

PVCs can occur due to hypoxic states. What must be done to determine what is causing a patient's PVCs?

Draw blood sample to evaluate a hypoxic state

Isystole, ventricular fibrillation, and ventricular tachycardia are found in patient requiring immediate emergency intervention EXCEPT

Prematurely Ventricular contraction PVC

What are PVCs that occur in varied shapes and forms called?

Multifocal

PVCs that have an early complex and have a similar shape, suggesting that only one irritable focus is present, is called

Unifocal PVCs

PVCs that occurred doing the normal R-R interval without interrupting the normal cycle are known as

Interpolated

A PVC that occurs on the T wave for doing the vilnerable read off the ventricle refreactory period is called

R on T PVC

To PVCs back to back or called

coupling

More than 6 to 7 PVCs Per minute are called

Frequent PVCs

What is the cause of agonal rhythms?

Failure off all pacemakers of the heart

Which ventricular dysrhythmias has a heart rate less than 20 bpm?

Agonal

Which ventricular dysrhythmia has a heart rate between 20 and 40 bpm

Idioventricular rhythm

What is the primary difference between idioventricular rhythm and accelerated idioventricular rhythm ?

The heart rate

What is the heart rate for accelerated idioventricular rhythm?

40 to 100 bpm

Agonal rhythm rate

Less than 20 bpm

Idioventricular rhythm rate

22 to 40 bpm

Celebrated idioventricular rhythm

42 to 100 bpm

Ventricular fibrillation rate

Atrial and ventricular rates cannot be determined or identified

Which ventricular dysrhythmias occurs when three or more PVCs occur in a row and the ventricular rate is greater than 100 bpm?

Ventricular tachycardia

Should you do if you recognize ventricular tachycardia on the ECG monitor?

Notify a licensed practitioner immediately, initiate emergency protocol if the patient is unresponsive, save the rhythm strips to document the changes in rhythm

What percentage of patients with ventricular tachycardia become unconscious immediately?

50%

Ventricular fibrillation is typically described as

chaotic

Every patient experiencing ventricular fibrillation will be

Unconscious, apneic, and pulseless

Your patient is talking, he or she is not in ventricular fibrillation. What could be causing what appears to be ventricular fibrillation on a monitor?

Poorly attach or dried out electrodes, broken lead wires, excessive patient movement.

What is the difference between ventricular tachycardia and ventricular fibrillation?

Ventricular tachycardia has three or more PVCs and rate is greater than 100 bpm; ventricular fibrillation has no P wave and an early QRS complex that is wife and bizarre in appearance

Which ventricular dysrhythmias is often called "The straight of flatline" of rhythm?

Asystole

How are agonal rhythm and asystole rhythm the SAME?

Both have an absence P waves,
In both rhythms the patient will be unconscious,
Both rhythms a life-threatening and require basic and advanced life support

What symptom would a patient in asystole exhibit?

Unconsciousness and apnea

Apnea is the absence of

Breathing

What factors are important regarding crash carts?

The crash cart must be nearby and ready to go, the crash cart must be well-stocked with emergency supplies, their emergency equipment on the crash cart must be functioning properly

In which ventricular dysrhythmia are the ventricle walls quivering preventing any movement of blood out of the ventricles, resulting in no cardiac out put?

Ventricular fibrillation

The fastest electrical activity in the heart controls heart rate

True

Ventricular complexes and rhythms share a conspicuous morphologic similarity, normal P waves, and normal or wide QRS complexes.

False

PVCs called "escape beats," often occur when the heart rate is less than 60 bpm. This is the heart's effort to pick up the rate

True

Asystole must always be confirmed in at least one lead to rule out any other dysrhythmias

False

P-P intervals are a constant in all ventricular dysrhythmia

False

Some patients may complaint of " thumping or skipping" sensation with each PVC.

True

In Ventricular fibrillation, the ventricles are essentially in a continuous contraction-relaxation patterns, and no period of delay exists between depolarization.

True

With ventricular fibrillation, the entire myocardium is quivering similar to a bowl of Jell-O when shaken

True

Ventricular fibrillation is always a CODE BLUE situation

True

Doing an emergency, family, friends and other patients with me apprehensive curious regarding the situation. You should calmly explain that there is emergency and escort individuals out of the immediate area

True

Agonal rhythm is considered the last semblance of ordered electrical activity in a heart

True

Analysis of the P wave is particularly important with an agonal rhythm

False

Idioventricular rhythm occurs when those sinoatrial and junctional pacemakers failed to initiate an impulse

True

In idioventricular rhythms, the R-R interval is irregular

False

Atrial rate cannot be determined in Idioventricular rhythm's because of the absence of atrial the deporalization

True

Accelerated idioventricular rhythm is simply a faster Idioventricular rhythm

True

Due to the speed of accelerated idioventricular rhythm, the QRS complexes in this rhythm do not have the classic ventricular "wide and bizarre" appearance.

False

CHAPTER 10

Pacemaker Rhythms and Bundle Branch Block

When is a ventricular pacemaker used?

When conduction in the ventricles is not working properly, to stimulate the ventricles to contract

What is atrial pacemaker used alone?

When the conduction system from the AV node through the VENTRICLES is intact and functioning

What is the advantage of Atrioventricular ventricular pacing?

It mimics the normal cardiac conduction system and allows the atria to contract completely the prior to VENTRICLES To allow for an ATRIAL kick

What portion of the heart do electronic peacemakers mimic?

SA node

If the electronic pacemaker a set to 72 bpm and AV node is firing at 58 bpm, what is the patient's heart rate?

72 bpm

What type of pacemaker is used for patients with heart failure?

Atriobiventricular pacemaker

What terms refers to the ability of the heart muscles to respond to electrical stimulation and depolarize the myocardial tissue

Capture

Which term indicates the mark of an ECG tracing that represents the stimulation of electrical current from the pacemaker generator?

Pacing spike

Which pacemaker rhythm has a pacing spike before P waves?

Atrial pacemaker rhythm

Which pacemaker rhythm has a pacing spike before QRS complexes?

Ventricular pacemaker rhythm

Which of the following is not one of the components to be evaluated on the pacemaker tracing?

The QT interval

If the patient is experiencing hypertension, lightheadedness, black out, and bradycardia, what pacemaker complication may be occurring?

Malfunctioning

Which pacemaker complication shows a pacing Spike, but no waveform immediately following it?

Loss of capture

The pacemaker a complication in which the pacemaker perceives electrical current from sources other than the heart is:

Oversensing

What pacemaker complications occurs when the pacemaker does not sense the patient's own inherent rate?

Malsensing

What patient symptoms can occur with Malsensing "failure to sense?

With atrial pacing, ATRIAL fibrillation can occur, with ventricular pacing, ventricular tachycardia or ventricular fibrillation can occur

The steps in evaluating a pacemaker ECG tracing include:

What are the regularity and rate of the pace rhythm?
Is the ATRIAL capture present?
Is appropriate ventricular sensing occurring?
EXCEPT : what is the ratio of a paced beats to own beats in one minute?

What happens when one or both of the Ventricular pathways are not functioning properly due to damage or delay from cardiac disease, drugs, or other condition?

A bundle branch block occurs

What additional patient information is needed on the ECG tracing when a bundle branch block is discovered?

Patient's underlying rhythm

A bundle branch block must be considered when the QRS complex measured:

0.12 second or greater

If the dysrhythmia is one that originates from above the ventricles and you notice of wide QRS complex, which rhythm could this be?

Bundle branch block

How is a right bundle branch block RBBB distinguished from a left bundle branch block LBBB?

Lead V1 is referenced in the QRS is positively deflected, it is a RBBB; The QRS is negative, it is a LBBB

Bundle branch block rhythm often has similarities to a sinus complex, with the distinguishing criteria of:

QRS duration greater than 0.12 second

You observe a wide QRS complexes in lead 2. Which lead should you check to evaluate the location of the bundle branch block?

Lead V1

Atrioventricular pacing is similar to what characteristics of the heart?

Normal conduction pathway

What provides the extra blood supply needed for 10% to 30% of the normal cardiac output?

ATRIAL kick

What factor on a pacemaker tracing is similar to the measurement of the PR interval on a normal rhythm Tracing ?

Atrioventricular delay

The patient's own heart rhythm is known as:

Inherent rhythm

Appearance of the QRS complex after the pacing spike indicates what has occurred?

Ventricular capture

Complications of the pacemaker may include:

Slow firing than set, less effective sensing capabilities, lowell electrical current than determined

Which term indicates when the electrical current is sent from the pacemaker generator to the myocardium to cause depolarization of the myocardial tissue?

Chicken
Triggered

Electronic pacemakers function and are affective based upon the principle of that

The fastest pacemaker of the heart will control the heart rate.

When the pacemaker delivers ventricular pacing, the pacing spike will be followed by a wide QRS complex, which looks similar to:

Left bundle branch block

Pacemaker generators use what type of batteries to create the electrical Im impulses?

Lithium

What measurement on the ECG tracing represents how long it takes for the current to travel through the ventricular myocardial tissue?

QRS duration

Bundle branch block

Is a disorder in which one or both of The bundle branches fail to conduct impulses

With bundle branch block, patient will exhibit the normal effects of the basic underlying with them they are experiencing

Truep

Bundle branch blocks can be life-threatening

False

Every ATRIAL spike should have a P wave after it to indicate that do you electrical current is causing the cells to depolarize

True

The pacemakers electrical current can be dangerous to you or other people who encountered the patient. Use caution around the pacemaker site.

False

Pacemakers are sometimes temporary but are usually implanted under the skin to correct this w this year with Mears

True

A characteristic of a normal pace maker with them is a pacing Spike, with a P wave or wide QRS complex or both appearing on the tracing

True

The regularity of the pacemaker spikes should not be the same

False

Responsibility in caring for patients with pacemakers requires recognizing normal pace maker rhythms and possible complications

True

When the patient has a left bundle branch block, the left conduction pathway is blocked. The current travels down the left bundle branch to cause the left ventricle, septum, then the right ventricle to contract

False

When the patient has a right bundle branch block, the impulse will travel down the conduction pathway normally until after the bundle of His. Since the right side is blocked, the current must travel down the left bundle branch to activate the VENTRICLES.

True

CHAPTER 11

Exercise electrocardiography

A procedure that doesn't require entrance into a body cavity, tissue, or blood vessel is called:

Noninvasive

By what other names or names is electrocardiography known?

Exercise tolerance test
Treadmill stress test
Cardiac stress test

Why might a physician order an exercise electrocardiography for patient?

The patient has symptoms of cardiac problems that do not show up on a resting ECG

How long has exercise electrocardiography has been used?

More than 50 years

During an exercise stress test, what will the patient be asked to do?

Increase the level of exertion as the test progresses

What is obtained at the end of each exercise stage?

Blood pressure reading and a 12 lead ECG

In addition to monitoring the ECG and blood pressure, what else is assessed doing exercise electrocardiography?

Heart rate, oxygen level, physical appearance

What symptoms is the patient asked to report doing exercise electrocardiography?

Chest pain, dizziness, shortness pf breath

Your most important responsibility doing an exercise electrocardiography test this

Why for safety and be prepared for Mergen see

Exercise electrocardiography is used to evaluate

How the heart and blood vessels respond to physical activity
How well the patient's blood pressure is maintained during exercise
The functioning of the heart after a myocardial infarction

Which of the following is not a reason exercise electrocardiography is used?

To evaluate how the heart responds to electrical stimulation

Narrowing of the arteries surrounding the heart that causes a reduction in the blood flow to the heart is

Coronary vascular disease

An oppressive pain or pressure in the chest when the heart muscle does not receive enough oxygen due to partial or complete blockage of a coronary artery is

Angina

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