BC3- Cardio - EKG
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| SA Node location | base of the right atrium
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| SA Node | normal pacemaker of the heart
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| SA Node rate | 60-100
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| How is the SA node connected to the AV node | by internodal pathways
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| AV Node location | apex of the right atrium
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| AV node rate | slows the impulse down to 40-60
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| What is the back-up with the SA node doesn't work? | AV
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| Conduction system of the heart | SA Node - AV Node - Bundle of HIS - Bundle Branches - Perkinje Fibers
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| Ventricle Rate | 20-40
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| Juctional Rate | 40-60
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| Parasympathetic | slows down
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| Sympathetic | fight or flight
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| 1 small box on EKG strip = | .04 seconds
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| 1 large box on EKG strip = | .20 seconds
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| 15 large boxes on EKG strip = | 3 seconds
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| P wave measures | produced as impusle from SA and AV junction - cause atrial contraction
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| 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)
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| Normal PRI | .12-.20 seconds
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| QRS Complex | Conduction of impulse through Bundle of HIS to Perkinje Fibers causing contraction of ventricles
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| Normal QRS | .04-.10 seconds
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| If QRS "widens" to > .10 seconds | indicates a bundle branch block
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| What does QTI measure | measures depolarization and repolarization
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| Formula for QT Interval | QT interval / sq root of R
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| Normal QTI | less than or equal to 0.40 seconds
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| How do you measure QTI | from the beginning of the Q to the end of the T
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| Electrolytes that may increase QTI | hypocalcemia, hypomagnesium, hypokalemia
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| CNS disorders that may increase QTI | stroke, subarrachnoid hemorrhage, trauma
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| Drugs that may increase QTI | tricyclics, phenothiazines, erythromycin, albuterol, lopressor, decongestants, diuretics, Amiodorone
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| Rule of Thumb for QTI | If patient is not tachycardic, the QT interval should not be more than half the R-R interval
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| T wave indicates | ventricular repolarization
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| Sinus Rhythm originates from | SA Node
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| Sinus Rhythm HR | 60-100
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| Sinus Rhythm P wave for every QRS = | 1:1
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| Sinus Rhythm PRI | .12-.20 seconds (normal)
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| Sinus Rhythm QRS | .04-.10 seconds (normal)
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| Sinus Bradycardia orginiates from | SA Node
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| Sinus Bradycardia HR | <60
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| Sinus Bradycardia P wave for every QRS = | 1:1
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| Sinus Bradycardia PRI | .12-.20 seconds (normal)
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| Sinus Bradycardia QRS | .04-.10 seconds (normal)
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| Causes of Sinus Bradycardia | Hyperkalemia, Vagal activity increased, Digoxin (common), Late hypoxia - corrected with 02
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| Effects of Sinus Bradycardia | increase preload, decreased mean arterial pressure
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| Treatment of Sinus Bradycardia | treat cause; pacer, atropine
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| Sinus Tachycardia originates from | SA Node
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| Sinus Tachycardia HR | 100-150
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| Sinus Tachycardia PRI | .12-.20 seconds (normal)
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| Sinus Tachycardia QRS | .04-.10 seconds (normal)
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| Sinus Tachycardia P wave for every QRS = | 1:1
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| Causes of Sinus Tachycardia | Increase catecholamine release, hypercalcemia, fever, early symptom of hypoxia, hypovolemia, pump failure
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| Effects of Sinus Tachycardia | decreased filling times, decreased MAP, increased myocardial demand, increase O2 demand,
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| Treatment of Sinus Tachycardia | treat underlying cause, calcium channel blockers, beta blockers, bed rest, oxygen
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| Premature Atrial Contraction (PAC) is not _________ | a rhythm
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| PAC originates in | an ectopic focus in either atrium appearing earlier than a P wave generated by the SA node
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| PAC's may be due to use of | stimulants
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| PAC's are often seen in what conditions | CHF, COPD, infections, medications
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| PAC HR | 60-100
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| PAC P wave | has different configuration than those originating in the SA node
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| PAC PRI | .12-.20 seconds (normal)
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| PAC QRS - P ratio | each QRS has a P
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| Causes of PAC | Hypokalemia, digitalis toxicity, hypoxia
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| Treatment of PAC | treat the underlying cause
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| Sinus Dysrhythmia Rate | Rates vary
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| Sinus Dysrhythmia PRI | .12-.20 seconds (normal)
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| Sinus Dysrhythmia P wave for every QRS = | P wave for each QRS
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| Sinus Dysrhythmia P-P | regularly irregular short with inspiration, long with expiration
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| Causes of Sinus Dysrhythmia | common in young children and young adults
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| Effects of Sinus Dysrhythmia | alters filling time, variable oxygen demand
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| Treatment of Sinus Dysrhythmia | none
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| Sinus Arrest Rate | Rate normal to slow
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| Sinus Arrest Rhythm | Irregular
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| Sinus Arrest P waves | normal morphology
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| Sinus Arrest PRI | .12-.20 seconds (normal)
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| Sinus Arrest QRS | .04-.10 seconds (normal)
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| Causes of Sinus Arrest | Ischemia of SA node, Digitalis toxicity, Excessive vagal tone
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| Effect of Sinus Arrest | Frequent or prolonged episodes of dec C.O.; cardiac standstill, cessation of SA node activity
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| Treatment of Sinus Arrest | observe if asymptomatic; bradycardic with symptoms treat w/ atropine 0.5mg bolus; pacer
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| Atrial Tachycardia HR | 150-250
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| Atrial | (blank)
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| Who is most often affected by atrial tachycardia | kids
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| Atrial Tachycardia is also known as | SupraVentricular Tachycardia (SVT)
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| Effects of Atrial Tachycardia | decreased filling times, decreased MAP, increased myocardial O2 demand and work
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| Treatment of Atrial Tachycardia | control ventricular rate, digoxin, calcium blockers, vagal stimulation, override pacer, cardioversion
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| Saw Tooth Patter = | Atrial flutter
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| Atrial Flutter atrial rates | 200-400 bpm
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| Atrial Flutter ventricular rates | 140-160 bpm
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| Atrial Flutter typical rhythm | regular
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| Most common atrial flutter rate is | 300 bpm
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| Most common atrial flutter conduction rate is | 2:1
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| Most common atrial flutter ventricular response | 150 bpm
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| Atrial flutter with variable conduction is caused by | constant fluctuations in the conduction ratios through the AV node - (AV node holds on)
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| Atrial Flutter causes | increased atrial automaticity, atrial re-entry; digoxin (common), hypokalemia, aging
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| Effects of Atrial Flutter | decreased filling time, loss of atrial kick, decreased MAP,
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| Treatment of Atrial Flutter | control ventricular rate, digoxin, calcium channel blockers, vagal stimulation, over-ride pacer, cardioversion
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| Atrial Fibrillation is mostly common in | adults
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| Atrial Fibrillation PRI | No PRI
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| Atrial Fibrillation Pulse rate | >300 and usually not observable
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| Atrial Fibrillation P wave | P wave "f" waves or fibrillatory waves
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| Atrial Fibrillation QRS rate | variable
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| Atrial Fibrillation rhythm | irregularly irregular
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| Atrial Fibrillation P waves | absence of observable P waves
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| Filbillatory or "f" waves occur at the rate of | 400-700 bpm
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| Causes of Atrial Fibrillation | increased atrial automaticity, atrial re-entry, digoxin (common), hypokalemia, aging
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| Differential Diagnosis of Atrial Fibrillation | Atrial enlargement (esp left), age >60, MAD RAT PPP, Idiopathic
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| Effects of Atrial Fibrillation | decreased filling time, loss of atrial kick, decreased MAP
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| Treatment of Atrial Fibrillation | control ventricular rate, Digoxin, calcium blockers, vagal stimulation, over-ride pacer, cardioversion
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| 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
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| Junctional Rhythm is associated with which node | AV
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| Junction Rhythm P wave | absent, inverted, biphasic or after the QRS
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| Junction Rhythm QRS | .04-.10 seconds (normal)
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| Junctional Rhythm Rate | 40-60 bpm and regular
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| Causes of Junctional Rhythm | atrial and sinus bradycardia, standstill or block
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| Effect of Junctional Rhythm | Decreased C.O., loss of atrial kick, decreased MAP,
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| Treatment of Junctional Rhythm | treat cause if hypotensive, pacer, atropine
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| Junctional Bradycardia P wave | absent, inverted, biphasic or after the QRS
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| Junctional Bradycardia QRS | .04-.10 seconds (normal)
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| Junctional Bradycardia Rate | <40
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| Causes of Junctional Bradycardia | Atrial & sinus bradycardia, standstill, or block (SA node isn't working), vagal hyperactivity
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| Effects of Junctional Bradycardia | Decreased C.O, loss of atrial kick, decreased MAP
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| Treatment of Junctional Bradycardia | treat cause if hypotensive; pacer, atropine
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| Premature Junctional Contractions (PJC) | Early beat without P waves
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| Premature Junctional Contractions (PJC) QRS morphology | .04-.10 (normal)
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| Causes of Premature Junctional Contractions | Hyperkalemia (6-5/4mEq/L), hypercalcemia, hypoxia, elevated preload
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| Effects of Prejature Junctional Contractions | Decreased C.O., loss of atrial contribution to ventricular preload for that beat
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| Treatment of Premature Junctional Contractions | treat the underlying cause
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| Accelerated Junctional Rhythm P wave | absent, inverted, biphasic or after QRS
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| Accelerated Junctional Rhythm QRS morphology | .04-.10 seconds (normal)
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| Accelerated Junctional Rhythm HR | 60-100 bpm, regular
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| Causes of Accelerated Junctional Rhythm | Hyperkalemia, Hypercalcemia, Hypoxia, Elevated preload
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| Effects of Accelerated Junctional Rhythm | Decreased C.O., Loss of atrial contribution to ventricular preload
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| Treatment of Accelerated Junctional Rhythm | treat the underlying cause
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| Junctional Tachycardia HR | 100-130 bpm, regular
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| Junctional Tachycardia P wave morphology | absent, inverted, biphasic or after the QRS
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| Junctional Tachycardia QRS | .04-.10 seconds (normal
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| Causes of Junctional Tachycardia | Hyperkalemia, Hypercalcemia, Hypoxia, Elevated preload
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| Effects of Junctional Tachycardia | Decreased C.O., loss of atrial contribution to ventricular preload, increased myocardial oxygen demand and workload
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| Treatment of Junctional Tachycardia | treat the underlying cause
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| Definition of Accelerated Junctional Rhythm | Junctional rhythm with rates of between 60-100 bpm
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| Definition of Junctional Tachycardia | Junctional Rhythm with rates between 100-130 bpm
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| Junctional Rhythm that exceeds 140 bpm | AV nodal reentry tachycardia (AVNRT); Rates between 130-140 can be called either junctional tach or AVNRT
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| QRS complex widens | the lower you go
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| Premature Ventricular Contraction (PVC) | Early beat with P wave - QRS usual opposite in deflection
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| Causes of PVC's | aginag and induction of anesthesia, myocardial ischemia, hypoxia, acid-base disturbances, eletrolyte disturbances, increased sympathetic tone
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| Effect of PVC's | Decreased C.O., loss of atrial contribution to ventricular preload for that beat
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| Treatment of PVC's | If frequent and symptomatic give amiodorone
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| Unifocal PVC | mach each other
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| Differential Diagnosis of PVC's | idiopathic and benign, anxiety, fatigue, drugs: nicotine, alcohol, caffeine; heart disease, electrolyte disorder
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| Ventricular Tachycardia Rate | 100-250, regular
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| Ventricular Tachycardia P waves | if P waves are present, they are not associated with QRS complexes
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| Ventricular Tachycardia PRI | none
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| Ventricular Tachycardia QRS | greater than .12 seconds
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| Causes of Ventricular Tachycardia | aging & induction of anesthesia; myocardial ischemia; hypoxia; acid-base disturbances; electrolyte disturbances; increased sympathetic tone
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| If patient is in Ventricular Tachycardia and has no pulse | defibrilate at 200 joules
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| If patient is in Ventricular Tachycardia and has a pulse - | treat with amiodorone
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| Is Ventricular Tachycardia life threatening? | Yes
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| Effects of Ventricular Tachycardia | Decreased C.O., loss of atrial contribution to ventricular preload for that beat
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| Ventricular Fibrillation rhythm | chaotic
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| Ventricular Fibrillation P wave | None
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| Ventricular Fibrillation QRS | None
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| Causes of Ventricular Fibrillation | Aging & induction of anesthesia, myocardial ischemia, hypoxia, acid-base disturbances, electrolyte disturbances, increased sympathetic tone, rapid infusion of potassium
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| What is the number one cause of sudden cardiac death | ventricular fibrillation
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| Effect of Ventricular Fibrillation | Lethal, no C.O.
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| Treatment of Ventricular Fibrillation | defibrillation and consider possible causes, Amiodorone
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| If in V-Fib | De-Fib
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| Treatment of Torsades De Pointes | try to defib (usually cannot be converted) then **administer Magneusium Sulfate
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| Torsade de Pointes HR | 200-250 bpn, irregular
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| Torsade de Pointes P wave | None
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| Torsade de Pointes QRS | None
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| Torsade de Pointes PRI | none
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| First Degree Block Rate | depends on underlying rhythm
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| First Degree Block Rhythm | regular
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| First Degree Block P waves | normal PRI >.20 seconds
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| First Degree Block QRS | normally less than .12 seconds
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| Causes of First Degree Block | Hyperkalemia, Hypokalemia, Endocarditis, Age, Ischemia at the AV junction
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| Effects of First Degree Block | None
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| Treatment of First Degree Block | None
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| Asystole QRS | absent
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| Asystole P wave | absent
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| Treatment of Asystole | CPR, pacer, 1mg epinephrine, 1mg Atropine
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