Bradycardia
Rate: below 60 bpm, P wave: upright, rounded, PR Interval: normal QRS: normal
Normal Sinus Rhythm
Rate: 60-100 bpm, P wave: upright, rounded, PR Interval: normal QRS: normal
Tachycardia
Rate: above 100 bpm, P wave: upright, rounded, PR Interval: normal QRS: normal
Multifocal Atrial Tachycardia (MAT)
At least 3 different P waves, rate over 100
Premature Atrial Contractions (PAC)
Rate: underlying rhythm, with abnormal, ectopic beat
Wandering Atrial Pacemaker (WAP)
At least 3 different P waves, rate 60-100 bpm
Atrial Fibrillation (A Fib)
no P-P rate, irreg R-R rate, no P wave, chaotic line between QRS complexes
Atrial Flutter
F wave rate: 250-350, normal R-R rate, classic "sawtooth" pattern between regular QRS complexes
P wave
Atrial depolarization (contraction)
QRS complex
Ventricular depolarization (contraction)
T wave
Ventricular repolarization
Premature Junctional Complex (PJC)
Rate: underlying rhythm with early ectopic, junctional complexes, inverted or absent P waves
Junctional Escape
Rate: 40-60 bpm, P wave: inverted, absent, or after the QRS, QRS: normal
Accelerated Junctional
Rate: 60-100 bpm, P wave: inverted, absent, or after the QRS, QRS: normal
Junctional Tachycardia
Rate: over 100 bpm, P wave: inverted, absent, or after the QRS, QRS: normal
Supraventricular Tachycardia
Rate: 150-250 bpm, regular rhythm
First-Degree Heart Block
Rate: 60-100 bpm, PR Interval: 0.20 seconds or greater, P wave: normal, QRS: normal
Second-Degree Heart Block, Type I (Mobitz I or Wenckebach)
Regular pattern of prolonging PR Interval (small, medium, long), followed by a dropped QRS complex
Second-Degree Heart Block, Type II (Mobitz II)
All PR Intervals are the same (usually short) and random dropped QRS complexes.
Third-Degree Heart Block
Random PR Intervals and random dropped QRS complexes
Premature Ventricular Complex (PVC)
Rate: underlying rhythm with early, ectopic QRS complex, P wave: normal on normal complexes, absent on ectopic beats, QRS: normal on normal complexes, wide and bizarre on ectopic complexes
Agonal
Rate: less than 20 bpm, P wave: absent, QRS: wide and bizarre
Idioventricular
Rate: 20-40 bpm, P wave: absent, QRS: wide
Accelerated Idioventricular
Rate: 40-100 bpm P wave: absent, QRS: wide
Ventricular Tachycardia
Rate: above 100 bpm, P wave: absent, could be classic "sawtooth", wavy, polymorphic pattern.
Torsade de Pointes
Specific type of polymorphic Ventricular Tachycardia, looks like a party streamer or a sound wave.
Ventricular Fibrillation (V Fib)
No rate, no P wave, no QRS. Just chaotic scribble line.
Asystole
Flat line, no rate.
Sinus Arrest
A pause in the ECG of at least 2 seconds.
Paced Atrial
A spike appears immediately before the P wave, indicating the pacemaker is in the atrium.
Paced Ventricular
A spike appears immediately before the QRS complex, indicating the pacemaker is in the ventricle.
Paced Atrial-Ventricular
Spikes appear before both the P waves and the QRS complexes, indicating the pacemaker is in both the atrium and the ventricle.
Standard Leads
Lead I, Lead II, and Lead III
Precordial Leads
V1, V2, V3, V4, V5, V6
Augmented Leads
aVR, aVL, aVF
1500 Method
Most accurate method to determine heart rate. Count the number of small boxes between any two points. Divide 1500 by that number.
300 Method
Less accurate method to determine heart rate. Count the number of large boxes between any two points. Divide 300 by that number.
Sequence Method
Less accurate method to determine heart rate. Count the number of large boxes in between any two points and count down in a sequence of 300, 150, 100, 75, 60, 50.
6-Second Method
Only method to use for irregular rhythms, and a method to quickly estimate a heart rate. Count the number of whole complexes in six seconds and multiply by 10.
B. "I must not get my monitor wet at any time.
Which of the following statements illustrates the patient understands Holter monitor procedures?
A. "I can take take my monitor off before showering."
B. "I must not get my monitor wet at any time."
C. "I can move the electrodes on my chest if they bother
60-100 BPM
Average adult resting heart rate
12 - 20 minute
Average adult respiration rate
100 - 160 BPM
Average infant resting heart rate
A. "I can wear jeans and boots for my stress test.
Which of the following statements illustrates the need for further patient education?
A. "I can wear jeans and boots for my stress test."
B. "I must not eat for several hours prior to the stress test."
C. "I must notify the doctor of any chest pain during
C. A 54 year-old male with unrelieved chest pain and ST segment elevation
Which of the following patients should not receive a stress test?
A. A 67 year-old female with transient chest pain and a normal EKG
B. A 74 year-old male who has a history of myocardial infarction
C. A 54 year-old male with unrelieved chest pain and ST s
B. Stop the test immediately, let the patient sit, and notify the physician
During a stress test, your patient states that he feels dizzy and nauseous. His heart rate is 98. What should you do?
A. Decrease the treadmill until the dizziness resolves
B. Stop the test immediately, let the patient sit, and notify the physician
C. All
C. Informed consent
After the physician explained the procedure, the patient signed paperwork allowing providers to perform the stress test. This is an example of
A. Tort
B. Negligence
C. Informed consent
D. HIPAA
B. Limb leads are placed on the patient's torso instead of the limbs
What modification to lead placement is made to stress testing?
A. V6 is placed at the 5th intercostal space at the midaxillary line
B. Limb leads are placed on the patient's torso instead of the limbs
C. A limb lead is applied to the right leg to act as a
Manubrium
What is this called?
Sternum
What is this called?
Depressed ST segment
What is this?
Elevated ST segment
What is this?
ST segment Elevation Myocardial Infarction; also known as a classic heart attack
What does STEMI mean?
0.12 - 0.16 seconds
normal PR Interval
0.04 - 0.10 seconds
normal QRS
1. Premature Atrial Complex (PAC)
2. Wandering Atrial Pacemaker (WAP)
3. Multifocal Atrial Tachycardia (MAT)
4. Atrial Fibrillation (A Fib)
5. Atrial Flutter
6. Supraventricular Tachycardia (SVT)
6 dysrhythmias that originate in the ATRIA
60 - 100 bpm
normal rate of the SA node
40 - 60 bpm
normal rate of the AV node
The P wave is inverted, absent, buried, or after the QRS
How do we identify junctional dysrhythmias?
The SA node is not working, so the AV node takes over. It causes the electrical impulse to flow backward and it shows in the absent or inverted P wave.
Why are P waves different in junctional dysrhythmias?
1. Premature Junctional Complex (PJC)
2. Junctional Escape (sometimes just called "Escape Rhythm")
3. Accelerated Junctional
4. Junctional Tachycardia
4 dysrhythmias that originate in the AV junction
True.
They are early complexes that appear in otherwise normal rhythms. It is a premature beat or series of beats before the heart resumes its regular rhythm.
True or False? PAC, PJC, and PVC are technically not rhythms.
If the patient is under 8 years old or if the patient has dextrocardia (organs reversed).
When should you do a right-sided EKG?
Holter monitor
What is this?
Pacemaker
What is this?
During a hospital stay
When is telemetry used?
Place EKG leads on the patient's back
What do you do if the patient has an inferior wall infarction?
Place lead close to the amputation point on the affected limb and place the corresponding lead on the other limb in the same place as the first lead
What do you do if the patient has an amputation?
Pallor (pale)
Diaphoresis (sweating)
Hypotension
Labored, shallow, or slow respiration
Anxiety or confusion
Cyanosis
Lethargy (excessively tired)
Angina (chest pain)
Dizziness
Weakness
Syncope (fainting)
Signs of low cardiac output
D. Surgical
A patient tells the EKG technician he underwent coronary bypass grafting two years ago. This is an example of which of the following type of history?
A. Medical
B. Social
C. Medication
D. Surgical
A. Call for help and begin CPR
While performing a standard 12-lead EKG, a technician notices the patient stops breathing and has no pulse. What should the technician do first?
A. Call for help and begin CPR
B. Assess the patient's respirations
C. Interpret the EKG tracing
D. Defibrilla
First-degree has PR interval of 0.2 or greater
Second-degree, Type I has elongating PR intervals (small, medium, large) followed by a missing QRS, then repeats
Second-degree, Type II has all PR intervals are the same (usually short) followed by random dro
How do you tell the difference between heart blocks?
Irregularity in the EKG caused by factors OTHER than electrical activity in the heart.
What is artifact?
Cell phone interference
What is this type of artifact?
25 mm/second
Only change the speed when ordered by a physician and then remember to set it back immediately after.
What is the typical speed setting for an EKG?
10 mm/mV
Only change the gain when ordered by a physician and then remember to set it back immediately after.
What is the typical gain setting for an EKG?
Add three more leads on the back V7, V8, V9
Keep limb leads where they are.
Leave V1, V2, V3 where they are.
V4 becomes V7
V5 becomes V8
V6 becomes V9
Document new leads on EKG.
Posterior Wall MI lead placement
Wandering baseline artifact
May be caused by a loose electrode; body creams, oils or lotions
Somatic Tremor artifact
Caused by tense muscles or a muscle contraction
Bruce Protocol
Treadmill running at 1.7 mph with 10% incline then every 3 minutes the speed is increased by 0.8 mph and 2% incline increase until exhaustion
Most commonly used stress test protocol
Modified Bruce Protocol
walking at 1.7 mph and 0% for the first 3 minutes than increases in grade
Used in older people and those with cardiac disease
Naughton Protocol
for sicker patients gradual increase in intensity
speed at 2 mph uses 2 min stages
RA Lead (white) to right arm with tab facing upper arm
LA Lead (black) to left arm with tab facing upper arm
RL Lead (green) to right leg with tab facing upper leg
LL Lead (red) to left leg with tab facing upper leg
V1 Lead (red) fourth intercostal space
EKG electrode placement
Usually indicates ischemia, or blockage
What does ST segment depression mean?
When evidence of a significant heart dysrhythmia or STEMI is found.
What is a "positive" stress test or Holter monitor test?
Defibrillation
What is the treatment for Ventricular fibrillation?
CPR, O2, Advanced Life Support, epinephrine, and crash cart ready (do not defibrillate)
What is the treatment for asystole?
Bundle branch block (BBB)
Occurs when the electrical impulse is blocked from traveling down the bundle of His or bundle branches. Results in the ventricles beating at a different rate than the atria.
Shows on the EKG as a slightly wider QRS complex, though not as wide as ventricul