Cardiac Dysrhythmias
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| Where is the SA node located | upper posterior wall of the right atrium
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| If the SA node fails what takes over for pacemaking of the heart? | the AV node
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| what rate does the SA node fire ? | 60- 100 bpm
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| What rate does the AV node normally fire at ? | 40 - 60 bpm
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| What is the rhythm called when the AV node initiates the impulses? | nodal or junctional rhythm
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| If the AV node fails what initiates the impulses for the cardiac cycle? | the ventricles
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| At what rate would the ventricles fire if they initiate the cardiac cycle? | 20 -40 bpm
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| what is the rhythm called when the ventricles are the initiators in the cardiac cycle? | ventricular escape rhythm
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| What is the cycle of firing starting at the SA node to....? | the AV node, down the bundle of His, which divides into right and left bundle branches , through the purkinje fibers (in the ventricles)
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| To be considered normal what must a cardiac cycle consist of on an ECG? | a P, QRS and T wave
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| What is the most commonly used lead for ECG monitoring? | Lead II
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| What do the horizontal lines on ECG paper refer to? | time
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| What do the verticle lines on the ECG refer to? | volts
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| How much time is a small sqaure on the ECG worth? | .04 seconds
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| How many small squares are there to one big square on the ECG? | 5
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| How much time is a large square representative of? | .20 seconds
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| What is the straight line or flat line of the ECG representative of? | no electrical activity
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| What does the P wave represent? | atrial depolarization
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| What happens to the atria when they deplarize? | they contract
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| What is the PR interval representative of? | the time it takes for the impulse to travel from the SA node to the AV node
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| What does the QRS complex represent? | ventricular depolarization
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| What happens to the ventricles during depolarization? | they contract
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| What occurs to the atria during the QRS complex | they repolarize
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| What is repolarization representative of? | relaxation
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| Why can you NOT see the atria repolarization somewhere in the QRS complex? | because the ventricular activity is stronger
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| What is the normal time frame for the QRS interval? | .06-.10 seconds
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| What does the T wave represent? | ventricular repolarization
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| When the ventricles repolarize what are they doing? | relaxing
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| What happens to the T wave that is indicative of damage to the heart? | it may be inverted
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| What is the U wave representative of? | hypokalemia
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| If your T wave is distorted what should you look for? | K levels (U wave is possibly there)
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| What does the ST segment represent? | time from completion of a contraction to recovery or repolarization
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| What part of the cardiac complexes are examined if the patient is having chest pain? | the ST segment
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| If the ST segment is inverted what is this indicating? | ischemia
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| What comprises the 5 steps for cardiac rhythm identification? | Regularity, Heart Rate, the P wave, the PR interval, the QRS complex
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| How do you measure regularity on the ECG? | R - R interval
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| What method to deterimine HR would you use for an irregular rhythm? | the 6 second method
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| What method is used for regular rhythm calculation? | counting the small boxes and divinding 1500 into it
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| What are the rules for Sinus Rhythm? | Regular rhythm R-R, P, QRS and T wave, uniform waves, HR 60-100 bpm
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| What are the rules for sinus brady? | rhythm: regular, HR less than 60, P wave smooth rounded, PR interval .12 to .20 and QRS interval .06-.10
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| What are the rules for sinus tach? | rhythm: regular, HR 101-180, P wave rounded, PR interval .12-.20, QRS interval .06-.10
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| What signs may present with sinus tach? | dyspnea or angina
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| What is the treatment dependent on with sinus tach? | the cause
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| What is characteristic of an atrial dysrhythmia? | it is usually faster than 100 bpm and can exceed 200
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| What happes to P waves when the impulse occurs outside the SA node? | they look different - flattened, notched or peaked
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| What is a PAC | premature atrial contraction
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| what is an PAC in layman terms | early beat
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| What causes a PAC? | the atria fire before the SA node fires
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| How can you see a PAC? | there is a shortened R-R interval
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| What are the rules for a PAC? | rhythm: premature beat interrupts the rhythm, HR depends on the underlying rhythm, P wave: early beat is abnormally shaped, PR interval essentially normal, QRS interval is .06 - .10 seconds
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| What is atrial flutter? | when the atria contract rapidly
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| what is the normal rate for atrial flutter? | 250 - 350 bpm
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| What is the differentiation between atrial flutter and atrial fibrillation? | the rate in fibrillation is more rapid and more chaotic than flutter
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| What is the rate for atrial fibrillation? | 350-600 bpm
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| What causes atrial flutter? | rheumatic or ischemic heart disease, CHF, hypertension, pericarditis, PE and post op CABG
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| What are the rules for atrial flutter | rhythm: ventricular rhythm can be regular or irregular, HR varies, P wave : saw toothed, PR interval-none, QRS complex-.06-.10
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| What are the usual symptoms for atrial flutter? | none
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| What is the treatment for atrial flutter? | cardioversion
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| What meds control atrial flutter? | calcium channel blockers and beta blockers, digoxin, quinidine, propranolol, procainamide
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| What causes atrial fibrillation? | aging, rheumatic or ischemic heart disease, heart failure, HTN, pericarditis, PE and post op CABG
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| What are the rules for atrial fibrillation? | rhythm-grossly irregular, HR atrial not measureable, ventricular is 100, P wave-none, PR interval-none, QRS .06-.10
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| What is the term used for ventricular rate greater than 100 in atrial fibrillation? | rapid ventricular response
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| What is RVR? | rapid ventricular response
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| What is the treatment for atrial fibrillation if patient is unstable? | cardioversion
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| what treatment is used for stable atrial fibrillation? | medications
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| What medications can control atrial fibrillation? | digoxin, beta blockers, calcium channel blockers
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| What drugs are used to convert the rhythm in atrial fibrillation? | dofetilide, quinidine, flecainide, propafenone, and ibutilide IV
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| What is the Maze procedure used for? | to create a route for electrical impulses to travel through the AV node
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| What is a PVC? | premature ventricular contraction
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| Where does the impulse originate in a PVC? | in the ventricles
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| What is a unifocal PVC? | the PVCs all come from the same irritable ventricular area
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| What is a multifocal PVC? | they originate from several irritable areas in teh ventricle
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| PVC can look different shapes, why? | it depends on where the impulse originates in the ventricles
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| What are the PVC rules? | rhyhtm-depends on the underlying rhythm, HR depends on underlying rhythm, P wave -absent, PR interval-none, QRS complex-if the PVC is greater than .11 it can invert the QRS or T wave
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| what are the s/sx of PVCs? | pt may describe as skipped beat or palpitation
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| What is the treatment for PVCs? | few require none, more require antidysrhythmic medications
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| What is Ventricular Tachycardia? | continuous firing of a ectopic focus the ventricles are the pacemaker
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| What causes VT? | myocardial irritability, MI and cardiomyopathy
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| What are the VT rules? | rhythm-regular, HR 150 - 250 bpm, P wave absent, PR interval none, QRS greater than .11 sec
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| What are the signs and symptoms of VT? | dyspnea, palpitations, light headedness, angina
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| What are the VT rules? | Rhythm-regular,HR 150-250 bpm, P wave-absent,PR interval-none,QRS greater than .11 sec
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| What are the signs ans symptoms of VT? | sudden onset of rapid HR and dyspnea,palpitations,light headedness and angina
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| What is the treatment of VT? | if pulseless - CPR, defibrillation followed by medication : if stable, meds and ACLS protocol
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| What medications are used to treat stable VT? | amiodarone, procainamide, sotalol, lidocaine,phenytoin or beta blockers
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| When does VFib occur? | when many ectopic foci fire at same time
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| What is the ventricular activity like with VFib? | chaotic and the ventricle quivers with complete loss of cardiac output
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| Where does a single chamber pacemaker go in the heart? | right atrium or right ventricle
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| Where aer dual chamber pacemakers placed? | both in right atrium and ventricle
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| what is the usual set rate of a pacemaker? | 72 bpm
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| What is seen on an ECG lead with a paced rhythm? | a spike will be seen in the trace
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| What is an ICD? | implantable cardioverter defibrillator
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| Why are patients with ICDs anxious? | due to the anticipation of receiving a shock or having another cardiac arrest
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| What is ablation? | mechanical, chemical or radiofrequency to destroy pathways to stop dysrhythmias
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Created by:
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