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ECG Workout

Exercises in Arrhythmia Interpretation

QuestionAnswer
Electrocardiogram Graphic representation of electrical activity of the heart
Parts of the conduction system of the heart 1) SA Node, 2) Internodal Tracts, 3) AV Node, 4) Bundle of His, 5) Right / Left Bundle Branch, 5) Purkinje Fibers
Accelerates the heart rate through the AV node and increases the force of ventricular contraction Stimulation of the sympathetic nervous system
Decreases conduction through the AV node and causes a small decrease in the force of ventricular contraction Stimulation of the parasympathetic nervous system
Parasympathetic Slows down
Sympathetic Speeds up
Depolarization Inside of cell becomes more positive than negative (Potassium leaves the cell, Sodium rushes in)
Repolarized Inside of cell becomes more negative than positive and returns to resting state (Sodium leaves cell, Potassium rushes in)
Dysrhythmia Any rhythm that isn't normal
What does the T Wave represent Ventricular repolarization
What does the U Wave represent Late ventricular repolarization
What does the QRS Complex represent Ventricular depolarization or the spread of the impulse throughout the ventricles
Normal duration of the QRS Complex .10 seconds or less
Is the Q Wave negative or positive negative
Is the R Wave negative or positive positive
How is the QRS Complex measured From the beginning of the QRS Complex to the end of the QRS Complex
Resting Cardiac Cell More negative ions inside the cell than outside the cell
The left ventricle is the ____________ ____________ of the heart. Largest Chamber
The P wave represents Atrial Depolarization (or depolarization of the right & left atria)
The P wave originates in the ___________ ___________, travels thru the __________, resulting in normal ________________. sinus node, atria
What does the Q wave represent Repolarization
Polarized No electrical activity occurring and a straight line is recorded on the ECG
Two kinds of cardiac cells 1) Myocardial cells (Working cells) 2) Pacemaker cells
What do horizontal lines on ECG Graph paper measure the duration of the waveform in seconds of time
What do vertical lines on ECG Graph paper measure the voltage or amplitude of the waveform in millimeters (mm)
Five steps to systematic evaluation of an EKG 1) Determine regularity 2) Calculate the rate 3) Examine the P waves 4) Measure the PR Interval 5) Measure the QRS Complex
Normal duration of the PR Interval .12 to .20 seconds
How is the PR Interval measured From the beginning of the P wave to the beginning of the QRS Complex
What does the QT interval represent Total ventricular activity (the time from the onset of ventricular depolarization to the end of ventricular repolarization
What does the ST segment represent early ventricular repolarization
A cardiac cycle consists of one ______________ or one __________ sequence. heartbeat or one PQRST sequence
Why is the QRS complex normally larger than the P wave depolarization of the larger muscle mass of the ventricles generates more voltage than does depolarization of the smaller muscle mass of the atria
What is the first deflection of the cardiac cycle the P wave
Where does a normal sinus P wave originate in the sinus node and travels through normal atria, resulting in normal depolarization
What do normal P waves look like smooth and round, positive in lead II, .5 to 2.5mm in height, .10 seconds or less in width, one P wave to each QRS complex
What does more than one P wave before each QRS complex indicate a conduction disturbance, such as that which occurs in second and third-degree heart block
What are two types of abnormal P waves 1) Abnormal Sinus P wave 2) Ectopic P wave
What does the PR Interval represent the time from the onset of atrial depolarization to the onset of ventricular depolarization
What does the normal PR Interval look like includes a P wave and the short isoelectric line that follows it
Is the S wave negative or positive negative
What is the J point (Junction point) The point where the QRS complex meets the ST segment
Where does the QRS complex end at the point where the straight line of the ST segment begins, even though the straight line may be above or below baseline
What term is used if the entire complex is negative QS complex (not a negative R wave because R waves are always positive)
What is a notch a wave that changes direction but doesn't cross the baseline
Describe the normal ST segment a flat line between the QRS complex and the T wave
Describe the normal T wave rounded and slightly asymmetrical (with the first p art of the T wave gradually sloping to the peak and returning more abruptly to baseline, positive in lead II, with an amplitude less than 5mm
The T wave always follows the... QRS Complex ( repolarization always follows depolarization)
How is the QT interval measured from the beginning of the QRS complex to the end of the T wave
How is duration of the QT interval determined by multiplying the number of small squares in the QT interval by 0.04 seconds
Describe the normal U wave small, rounded, and symmetrical, positive in lead II and 2 mm or less in amplitude (always smaller than the preceding T wave)
When is the U wave seen best when the heart rate is slow
What determines if the rhythm is irregular Variation of 0.12 seconds or more between the shortest and longest R wave
Rhythm: Regular Rate: 60 to 100 beats/minute P waves: Normal in size, shape and direction; positive in lead II; one P wave precedes each QRS complex PR interval: Normal (0.12 to 0.20 seconds) QRS Complex: Normal (0.10 seconds or less) Normal sinus rhythm
What is the rate for normal sinus rhythm 60 to 100 beats/minute
What is the rate for sinus tachycardia 100 to 160 beats/minute
Rhythm: Regular Rate: 100 to 160 beats/minute P waves: Normal in size, shape and direction; positive in lead II; one P wave precedes each QRS complex PR interval: Normal (0.12 to 0.20 seconds) QRS Complex: Normal (0.10 seconds or less) Sinus Tachycardia
What is the rate for sinus bradycardia 40 to 60 beats/minute
Rhythm: Regular Rate: 40 to 60 beats/minute P waves: Normal in size, shape and direction; positive in lead II; one P wave precedes each QRS complex PR interval: Normal (0.12 to 0.20 seconds) QRS Complex: Normal (0.10 seconds or less) Sinus Bradycardia
Sinus arrhythmia Rhythm: irregular Rate: Normal or Slow P waves: Normal in size, shape and direction; positive in lead II; one P wave precedes each QRS complex PR interval: Normal (0.12 to 0.20 seconds) QRS Complex: Normal (0.10 seconds or less)
Sinus block Basic rhythm resumes on time after pause
Sinus arrest Basic rhythm does not resume on time after pause
If the basic rhythm is irregular (sinus arrhythmia) sinus arrest can't be differentiated from sinus block so how is the rhythm interpreted as sinus arrhythmia with sinus pause
How is the PR Interval measured from the beginning of the P wave as it leaves baseline to the beginning of the QRS complex
How is the PR interval calculated count the number of small squares contained in the interval and multiply by 0.04 seconds
How is the QRS complex measured from the beginning of the QRS complex as it leaves baseline until the end of the QRS complex when the ST segment begins.
How is the QRS complex calculated count the number of small squares in the QRS complex measurement and multiply by 0.04 seconds
What is sinus pause a broad term used to describe rhythms in which there is a sudden failure of the SA node to initiate or conduct an impulse
This sinus rhythm is common among trained athletes Sinus Bradycardia
What causes sinus arrest a failure of the SA node to initiate an impulse and is therefore a disorder of automaticity.
What causes sinus exit block an electrical impulse is initiated by the SA node but is blocked as it exits the sinus node preventing conduction of the impulse to the atria
What is sinus exit block a disorder of conductivity
What is sinus arrest an arrhythmia caused by a failure of the SA node to initiate an impulse. The ECG will show a sudden pause in the sinus rhythm in which one or more beats are missing. The underlying rhythm does not resume on time following the pause.
The Sinus node is the ___________ ___________ of the heart dominant pacemaker
R wave Positive wave in the QRS complex
Sinus Arrhythmia an arrhythmia originating in the SA node that occurs when the SA node discharges impulses irregularly.
Sinus Bradycardia an arrhythmia originating in the sinus node characterized by a regular rhythm; normal p waves, pr interval, and qrs duration, and a rate between 40 and 60/beats per minute
Sinus tachycardia an arrhythmia originating in the sinus node characterized by a regular rhythm; normal p waves, pr interval, and qrs duration; and rate between 100 and 160 beats/per minute
S wave the negative deflection of the QRS complex that follows the R wave
Sympathetic Nervous System a part of the autonomic nervous system. stimulation increases heart rate, speeds conduction thru the AV node, increases the force of ventricular contraction and causes increase in BP
t wave a wave that follows the ST segment. represents ventricular repolarization
u wave a wave that sometimes follows the t wave. represents the ventricular repolarization.
qt interval the portion of the ecg between the onset of the qrs complex and the end of the t wave representing ventricular depolarization and repolarization
q wave the negative deflection of the qrs complex that precedes the r wave
p wave the waveform representing depolarization of the right and left atria
purkinje fibers a network of fibers that carry electrical impulses directly to ventricular muscle cells
parasympathetic nervous system a part of the autonomic nervous system. stimulation decreases the heart rate, slows conduction thru the av node, decreases the force of ventricular contraction and causes a drop in bp
normal sinus rhythm the normal rhythm of the heart originating in the sa node characterized by a regular rhythm; normal p waves, pr interval, and qrs duration; rate between 60 and 100 beats/minute
mitral valve one of two atrioventricular vales located between the left atrium and left ventricle, only has two cusps
myocardium the middle and thickest layer of the heart, composed primarily of cardiac muscle cells and responsible for the heart's ability to contract
negative deflection a waveform that is below baseline
j point the point where the qrs complex and th st segment meet
intraventricular septum the wall separating the right and left ventricles
intermodal atrial conduction tracts part of the electrical conduction system. consists of three pathways of specialized conducting tissue located in the walls of the right atrium. conducts impulses from the sa node to the av node
heart rate the number of heartbeats or qrs complexes per minute
depolarization electrical activation of a cardiac cell due to movement of ions across a cell membrane causing the inside of the cell to become more positive depolarization is an electrical event expected to result in muscle contraction.
what produces the p wave depolarization of the atria
what produces the qrs complex depolarization of the ventricles
dysrhythmia any rhythm other than a sinus rhythm. used interchangeably with arrhythmia
diastole the period of atrial or ventricular relaxation
conductivity the ability of a cardiac cell to receive an electrical impulse and conduct that impulse to an adjacent cardiac cell
contractility the ability of cardiac cells to cause cardiac muscle contraction in response to an electrical stimulus
bundle branches a part of the electrical conduction system consisting of the right and left bundle branches that conducts the electrical impulses from the bundle of his to the purkinje network
bundle of his a part of the electrical conduction system that connects the av node to the bundle branches
autonomic nervous system regulates functions of the body that are involuntary (not under conscious control) includes the sympathetic and parasympathetic nervous systems each producing opposite effects when stimulated
base of the heart top of the heart located at approximately the level of the second intercostal space
bradycardia an arrhythmia with a rate of less than 60 beats/minute
atrioventricular block a delay or failure of conduction of electrical impulses through the av node
atria the two thin-walled upper chambers of the heart. the right and left atria are separated from the ventricles by the mitral and tricuspid valves
apex of the heart the bottom of the heart formed by the tip of the left ventricle; located to the left of the sternum at approximately the fifth intercostal space, midclavicular line
absolute refractory period the period of time during ventricular depolarization and most of repolarization when cardiac cells cannot be stimulated to conduct an electrical impulse. this period begins with the onset of the qrs complex and ends at the peak of the t wave.
Created by: dawncherie