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Cardio

BC3- Cardio - EKG

QuestionAnswer
SA Node location base of the right atrium
SA Node normal pacemaker of the heart
SA Node rate 60-100
How is the SA node connected to the AV node by internodal pathways
AV Node location apex of the right atrium
AV node rate slows the impulse down to 40-60
What is the back-up with the SA node doesn't work? AV
Conduction system of the heart SA Node - AV Node - Bundle of HIS - Bundle Branches - Perkinje Fibers
Ventricle Rate 20-40
Juctional Rate 40-60
Parasympathetic slows down
Sympathetic fight or flight
1 small box on EKG strip = .04 seconds
1 large box on EKG strip = .20 seconds
15 large boxes on EKG strip = 3 seconds
P wave measures produced as impusle from SA and AV junction - cause atrial contraction
PRI is what? beginning of the P to the beginning of the Q wave = time between arial depolarization (contraction) and the start of ventricular conduction (depolarization)
Normal PRI .12-.20 seconds
QRS Complex Conduction of impulse through Bundle of HIS to Perkinje Fibers causing contraction of ventricles
Normal QRS .04-.10 seconds
If QRS "widens" to > .10 seconds indicates a bundle branch block
What does QTI measure measures depolarization and repolarization
Formula for QT Interval QT interval / sq root of R
Normal QTI less than or equal to 0.40 seconds
How do you measure QTI from the beginning of the Q to the end of the T
Electrolytes that may increase QTI hypocalcemia, hypomagnesium, hypokalemia
CNS disorders that may increase QTI stroke, subarrachnoid hemorrhage, trauma
Drugs that may increase QTI tricyclics, phenothiazines, erythromycin, albuterol, lopressor, decongestants, diuretics, Amiodorone
Rule of Thumb for QTI If patient is not tachycardic, the QT interval should not be more than half the R-R interval
T wave indicates ventricular repolarization
Sinus Rhythm originates from SA Node
Sinus Rhythm HR 60-100
Sinus Rhythm P wave for every QRS = 1:1
Sinus Rhythm PRI .12-.20 seconds (normal)
Sinus Rhythm QRS .04-.10 seconds (normal)
Sinus Bradycardia orginiates from SA Node
Sinus Bradycardia HR <60
Sinus Bradycardia P wave for every QRS = 1:1
Sinus Bradycardia PRI .12-.20 seconds (normal)
Sinus Bradycardia QRS .04-.10 seconds (normal)
Causes of Sinus Bradycardia Hyperkalemia, Vagal activity increased, Digoxin (common), Late hypoxia - corrected with 02
Effects of Sinus Bradycardia increase preload, decreased mean arterial pressure
Treatment of Sinus Bradycardia treat cause; pacer, atropine
Sinus Tachycardia originates from SA Node
Sinus Tachycardia HR 100-150
Sinus Tachycardia PRI .12-.20 seconds (normal)
Sinus Tachycardia QRS .04-.10 seconds (normal)
Sinus Tachycardia P wave for every QRS = 1:1
Causes of Sinus Tachycardia Increase catecholamine release, hypercalcemia, fever, early symptom of hypoxia, hypovolemia, pump failure
Effects of Sinus Tachycardia decreased filling times, decreased MAP, increased myocardial demand, increase O2 demand,
Treatment of Sinus Tachycardia treat underlying cause, calcium channel blockers, beta blockers, bed rest, oxygen
Premature Atrial Contraction (PAC) is not _________ a rhythm
PAC originates in an ectopic focus in either atrium appearing earlier than a P wave generated by the SA node
PAC's may be due to use of stimulants
PAC's are often seen in what conditions CHF, COPD, infections, medications
PAC HR 60-100
PAC P wave has different configuration than those originating in the SA node
PAC PRI .12-.20 seconds (normal)
PAC QRS - P ratio each QRS has a P
Causes of PAC Hypokalemia, digitalis toxicity, hypoxia
Treatment of PAC treat the underlying cause
Sinus Dysrhythmia Rate Rates vary
Sinus Dysrhythmia PRI .12-.20 seconds (normal)
Sinus Dysrhythmia P wave for every QRS = P wave for each QRS
Sinus Dysrhythmia P-P regularly irregular short with inspiration, long with expiration
Causes of Sinus Dysrhythmia common in young children and young adults
Effects of Sinus Dysrhythmia alters filling time, variable oxygen demand
Treatment of Sinus Dysrhythmia none
Sinus Arrest Rate Rate normal to slow
Sinus Arrest Rhythm Irregular
Sinus Arrest P waves normal morphology
Sinus Arrest PRI .12-.20 seconds (normal)
Sinus Arrest QRS .04-.10 seconds (normal)
Causes of Sinus Arrest Ischemia of SA node, Digitalis toxicity, Excessive vagal tone
Effect of Sinus Arrest Frequent or prolonged episodes of dec C.O.; cardiac standstill, cessation of SA node activity
Treatment of Sinus Arrest observe if asymptomatic; bradycardic with symptoms treat w/ atropine 0.5mg bolus; pacer
Atrial Tachycardia HR 150-250
Atrial (blank)
Who is most often affected by atrial tachycardia kids
Atrial Tachycardia is also known as SupraVentricular Tachycardia (SVT)
Effects of Atrial Tachycardia decreased filling times, decreased MAP, increased myocardial O2 demand and work
Treatment of Atrial Tachycardia control ventricular rate, digoxin, calcium blockers, vagal stimulation, override pacer, cardioversion
Saw Tooth Patter = Atrial flutter
Atrial Flutter atrial rates 200-400 bpm
Atrial Flutter ventricular rates 140-160 bpm
Atrial Flutter typical rhythm regular
Most common atrial flutter rate is 300 bpm
Most common atrial flutter conduction rate is 2:1
Most common atrial flutter ventricular response 150 bpm
Atrial flutter with variable conduction is caused by constant fluctuations in the conduction ratios through the AV node - (AV node holds on)
Atrial Flutter causes increased atrial automaticity, atrial re-entry; digoxin (common), hypokalemia, aging
Effects of Atrial Flutter decreased filling time, loss of atrial kick, decreased MAP,
Treatment of Atrial Flutter control ventricular rate, digoxin, calcium channel blockers, vagal stimulation, over-ride pacer, cardioversion
Atrial Fibrillation is mostly common in adults
Atrial Fibrillation PRI No PRI
Atrial Fibrillation Pulse rate >300 and usually not observable
Atrial Fibrillation P wave P wave "f" waves or fibrillatory waves
Atrial Fibrillation QRS rate variable
Atrial Fibrillation rhythm irregularly irregular
Atrial Fibrillation P waves absence of observable P waves
Filbillatory or "f" waves occur at the rate of 400-700 bpm
Causes of Atrial Fibrillation increased atrial automaticity, atrial re-entry, digoxin (common), hypokalemia, aging
Differential Diagnosis of Atrial Fibrillation Atrial enlargement (esp left), age >60, MAD RAT PPP, Idiopathic
Effects of Atrial Fibrillation decreased filling time, loss of atrial kick, decreased MAP
Treatment of Atrial Fibrillation control ventricular rate, Digoxin, calcium blockers, vagal stimulation, over-ride pacer, cardioversion
What does MAD RAT PPP stand for Myocardial infarction; Atherosclerosis; Drugs: digoxin; Rheumatic heart disease; Alcoholic holiday heart; Thyrotoxicosis (endocrine); Pulmonary emboli; Pericarditis; Pneumonia: right middle lobe
Junctional Rhythm is associated with which node AV
Junction Rhythm P wave absent, inverted, biphasic or after the QRS
Junction Rhythm QRS .04-.10 seconds (normal)
Junctional Rhythm Rate 40-60 bpm and regular
Causes of Junctional Rhythm atrial and sinus bradycardia, standstill or block
Effect of Junctional Rhythm Decreased C.O., loss of atrial kick, decreased MAP,
Treatment of Junctional Rhythm treat cause if hypotensive, pacer, atropine
Junctional Bradycardia P wave absent, inverted, biphasic or after the QRS
Junctional Bradycardia QRS .04-.10 seconds (normal)
Junctional Bradycardia Rate <40
Causes of Junctional Bradycardia Atrial & sinus bradycardia, standstill, or block (SA node isn't working), vagal hyperactivity
Effects of Junctional Bradycardia Decreased C.O, loss of atrial kick, decreased MAP
Treatment of Junctional Bradycardia treat cause if hypotensive; pacer, atropine
Premature Junctional Contractions (PJC) Early beat without P waves
Premature Junctional Contractions (PJC) QRS morphology .04-.10 (normal)
Causes of Premature Junctional Contractions Hyperkalemia (6-5/4mEq/L), hypercalcemia, hypoxia, elevated preload
Effects of Prejature Junctional Contractions Decreased C.O., loss of atrial contribution to ventricular preload for that beat
Treatment of Premature Junctional Contractions treat the underlying cause
Accelerated Junctional Rhythm P wave absent, inverted, biphasic or after QRS
Accelerated Junctional Rhythm QRS morphology .04-.10 seconds (normal)
Accelerated Junctional Rhythm HR 60-100 bpm, regular
Causes of Accelerated Junctional Rhythm Hyperkalemia, Hypercalcemia, Hypoxia, Elevated preload
Effects of Accelerated Junctional Rhythm Decreased C.O., Loss of atrial contribution to ventricular preload
Treatment of Accelerated Junctional Rhythm treat the underlying cause
Junctional Tachycardia HR 100-130 bpm, regular
Junctional Tachycardia P wave morphology absent, inverted, biphasic or after the QRS
Junctional Tachycardia QRS .04-.10 seconds (normal
Causes of Junctional Tachycardia Hyperkalemia, Hypercalcemia, Hypoxia, Elevated preload
Effects of Junctional Tachycardia Decreased C.O., loss of atrial contribution to ventricular preload, increased myocardial oxygen demand and workload
Treatment of Junctional Tachycardia treat the underlying cause
Definition of Accelerated Junctional Rhythm Junctional rhythm with rates of between 60-100 bpm
Definition of Junctional Tachycardia Junctional Rhythm with rates between 100-130 bpm
Junctional Rhythm that exceeds 140 bpm AV nodal reentry tachycardia (AVNRT); Rates between 130-140 can be called either junctional tach or AVNRT
QRS complex widens the lower you go
Premature Ventricular Contraction (PVC) Early beat with P wave - QRS usual opposite in deflection
Causes of PVC's aginag and induction of anesthesia, myocardial ischemia, hypoxia, acid-base disturbances, eletrolyte disturbances, increased sympathetic tone
Effect of PVC's Decreased C.O., loss of atrial contribution to ventricular preload for that beat
Treatment of PVC's If frequent and symptomatic give amiodorone
Unifocal PVC mach each other
Differential Diagnosis of PVC's idiopathic and benign, anxiety, fatigue, drugs: nicotine, alcohol, caffeine; heart disease, electrolyte disorder
Ventricular Tachycardia Rate 100-250, regular
Ventricular Tachycardia P waves if P waves are present, they are not associated with QRS complexes
Ventricular Tachycardia PRI none
Ventricular Tachycardia QRS greater than .12 seconds
Causes of Ventricular Tachycardia aging & induction of anesthesia; myocardial ischemia; hypoxia; acid-base disturbances; electrolyte disturbances; increased sympathetic tone
If patient is in Ventricular Tachycardia and has no pulse defibrilate at 200 joules
If patient is in Ventricular Tachycardia and has a pulse - treat with amiodorone
Is Ventricular Tachycardia life threatening? Yes
Effects of Ventricular Tachycardia Decreased C.O., loss of atrial contribution to ventricular preload for that beat
Ventricular Fibrillation rhythm chaotic
Ventricular Fibrillation P wave None
Ventricular Fibrillation QRS None
Causes of Ventricular Fibrillation Aging & induction of anesthesia, myocardial ischemia, hypoxia, acid-base disturbances, electrolyte disturbances, increased sympathetic tone, rapid infusion of potassium
What is the number one cause of sudden cardiac death ventricular fibrillation
Effect of Ventricular Fibrillation Lethal, no C.O.
Treatment of Ventricular Fibrillation defibrillation and consider possible causes, Amiodorone
If in V-Fib De-Fib
Treatment of Torsades De Pointes try to defib (usually cannot be converted) then **administer Magneusium Sulfate
Torsade de Pointes HR 200-250 bpn, irregular
Torsade de Pointes P wave None
Torsade de Pointes QRS None
Torsade de Pointes PRI none
First Degree Block Rate depends on underlying rhythm
First Degree Block Rhythm regular
First Degree Block P waves normal PRI >.20 seconds
First Degree Block QRS normally less than .12 seconds
Causes of First Degree Block Hyperkalemia, Hypokalemia, Endocarditis, Age, Ischemia at the AV junction
Effects of First Degree Block None
Treatment of First Degree Block None
Asystole QRS absent
Asystole P wave absent
Treatment of Asystole CPR, pacer, 1mg epinephrine, 1mg Atropine
Created by: okrecota on 2008-01-14



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