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EKG
EKG - Chapter 9
| Question | Answer |
|---|---|
| Escape Beat | The SA node does not initiate an impulse; another part of the conduction system initiates and impulse |
| Escape Rhythm | Another area of the conduction system (NOT the SA node) acts as the primary pacemaker |
| Ectopic focus / Ectopic pacemaker | An area of the conduction system generates an impulse even when the SA node is working properly |
| Dysrhythmia / arhythmia | difficult / abnormal rhythm; inconsistent pattern |
| Sinus rhythm | Any rhythm that begins in the SA node (P Wave) |
| "Heart Blocks" | Also known as "AV Blocks"; caused by problems in the conduction of electrical impulses between the atria and the ventricles |
| Sinus | begins in the SA node |
| Atrial | begins in the atria |
| Junctional | begins in the AV junction |
| Ventricular | begins in the ventricles |
| Supraventricular | begins somewhere above the vetricles |
| Bradycardia | heartbeat below 60 bpm |
| Tachycardia | heartbeat above 100 bpm |
| Premature | too early |
| Escape | comes later than expected |
| Multifocal | originates from multiple locations in the heart |
| Paroxysmal | comes and goes in bursts |
| Uniform | stays the same |
| Monomorphic | has a key feature; stays the same every time |
| Polymorphic | has a key feature that changes from beat to beat |
| Sinus arrest | "sinus pause"; the SA node does not initiate an impulse |
| Symptomatic | having symptoms / experiencing cardiac symptoms |
| Asymptomatic | having no symptoms |
| Sinus arrhythmia | May happen naturally in some children and adults; patients usually asymptomatic; does not require treatment unless heart rate slows enough to disrupt cardiac output |
| Atrial rhythms | P waves are abnormally shaped, hidden, notched, biphasic |
| Wandering atrial pacemaker / Multiformed atrial rhythm | occurs when impulses begin in multiple areas; P waves vary; PR interval varies; QRS is normal; irregular rhythm |
| Atrial Tachycardia | P wave is hidden in the previous T wave; cannot measure P wave; QRS normal; HR is 100-250 bpm |
| Multifocal Atrial Tachycardia (MAT) | Similar to Wandering Atrial Pacemaker; HR is greater than 100 bpm |
| Supraventricular Tachycardia | Originates above the Ventricles; P wave may or may not be present; cannot measure PR interval; QRS complex normal; HR 150-250 bpm |
| Atrial Fibrillation / "A Fib" | Common, multiple impulse sites; No clear P waves; irregular; normal QRS; wavy baseline; if HR is >100 bpm, it is "uncontrolled". If HR is <100, it is "controlled". |
| Rapid Ventricular Response (RVR) | Uncontrolled A - Fib |
| Atrial Flutter | Impulse firing at a rapid rate in the atria; multiple P waves giving a "sawtooth" appearance called "F waves"; more than one P wave for each QRS; if HR is >100 bpm, it is "uncontrolled". If HR is <100, it is "controlled". |
| Atrial Rate vs Ventricular Rate | If there are more P waves than QRS complexes, these rates will be different; the atrial rate will be higher; the ventricular rate is the HR |
| Vagal maneuvers | Out of the scope of practice for EKG techs; may only perform under direction of a provider; meant to stimulate the vagal nerve and slow heart rate |
| Transient rhythm | A rhythm that comes and goes |
| Sustained rhythm | A rhythm that is always happening |
| Retrograde | Impulses travel backward through the atria; inverted P wave; may also be hidden in the QRS or appear after |
| Premature junctional complexes (PJC) | Early beats; inverted P wave; appears in normal sinus rhythm and in sinus bradycardia |
| Junctional escape beats | Late beats; inverted P wave; appears in normal sinus rhythm and in sinus bradycardia |
| Junctional Rhythm | A series of junctional escape beats; can be caused by fatigue, stimulants, heart disease, electrolyte imbalances, hypoxia, or COPD. Pts may not be symptomatic and may only be seen on the EKG |
| Accelerated Junctional Rhythm | Similar to junctional rhythm, but HR is accelerated to "make up" for lost cardiac output |
| Junctional Tachycardia | Junctional rhythm with HR 100 bpm or higher |
| QRS complex | Tall and narrow; easily seen on tracing; correlates to ventricles |
| Premature Ventricular Complexes (PVCs) | QRS is wide and unusual or "bizarre"; may occur in couplets, or may occur in a pattern; may occur in "runs" |
| Bigeminy | every other heart beat |
| Trigeminy | every third heart beat |
| Unifocal | PVCs appearing the same |
| Multifocal | PVCs appear different |
| Ventricular escape beats | Wide and bizarre QRS complex; appears late; often underlying sinus bradycardia rhythm |
| Idioventricular Rhythm | Three or more ventricular escape beats in a row |
| Agonal Rhythm | A sustained idioventricular rhythm; associated with dying; very slow; HR 20-40 bpm; wide and bizarre QRS complexes |
| Accelerated Idioventricular Rhythm (AIVR) | Three or more ventricular escape beats happen in a row with a higher rate; between 40-100 bpm; wide and bizarre QRS |
| Ventricular tachycardia (V-Tach) | Dangerous, deadly rhythm; QRS complexes may be uniform (monomorphic) or varied (polymorphic); no discernable P waves; HR 120-300 bpm |
| Bundle Branch Block (BBB) | Wide QRS complex; V1 and V6 are abnormal |
| Ventricular Fibrillation (V-Fib) | Chaotic rhythm; no P wave; disorganized |
| Asystole | "Flatline" |
| The EKG Tech must always check the patient to see if their condition matches the tracing... | ...loose or disconnected lead wires or low gain on the EKG can look like V-Fib or asystole, or other dangerous rhythms. |
| Causes of V-Tach | Ischemic heart disease; cardiomyopathy; electrolyte imbalance; medications; drug abuse |
| Defibrillation | Using a machine to deliver a shock to the patient's heart to restore a rhythm; usually an AED (automated external defibrillator) |
| Conducted beat | Electrical impulse continues through the AV node and AV bundles to the ventricles |
| Blocked beat | Electrical impulse stops completely |
| First-degree heart block | PR interval is longer than 0.20 sec; R-R intervals are regular |
| Second-degree heart block: Mobitz type 1 (Wenckenbach) | PR interval gets longer and longer until the beat is blocked |
| Second-degree heart block: Mobitz type 2 | Multiple P waves for QRS complexes; regularly irregular rhythm; PR interval is consistent; |
| Third-degree heart block | Can be a deadly rhythm; No relationship between P waves and QRS complexes; P waves and QRS complexes are consistent and regular in their spacing; unable to measure PR interval |
| Fixed-rate pacemaker | Shows a pacemaker "spike" before every complex; a pacemaker that has a pre-set heart rate. Atrial pacemakers will show a spike before the P wave; Ventricular pacemakers will show a spike before the QRS complex |
| Failure to Sense / Failure to Pace / Failure to Fire | all terms relating to no pacemaker spike on an EKG for a patient who is known to have a pacemaker |
| Failure to Capture | Pacemaker malfunction; the spike will appear on the tracing, but there will be no other electrical activity noted on the tracing |
| ST segment depression | the ST segment is at least 1mm (1 block) below baseline; caused by ischemia (tissue damage) |
| ST elevation / STEMI (ST Elevation Myocardial Infarction) | The ST segment is elevated at least 1mm (1 block) above baseline; indicates a MI has happened or was happening during the EKG |
Created by:
PJohnson85