EKG Waveforms
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| What is a normal PR interval? | 0.12-0.20 seconds
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| What is a normal QRS? | 0.06-0.10 seconds
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| What happens during P waves? | Atrial depolarization
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| What happens during QRS waves? | Ventricular depolarization
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| What happens during T waves? | Ventricular repolarization
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| Characteristics of normal sinus rhythm (NSR) | * Rate: 60-100bpm * Rhythm: regular * 1P:1QRS * PR interval 0.12-0.20sec * QRS 0.06-0.10sec
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| Characteristics of sinus tachycardia. | * same as NSR, with HR >100bpm.
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| Characteristics of sinus bradycardia | * same as NSR< with HR <60bpm * do not treat unless patient is symptomatic. Treat with atropine 0.5mg or pacemaker therapy.
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| Characteristics of premature atrial contractions (PACs) | * Rhythm is normal until interrupted by early beats from the atria, which makes the rhythm irregular * Usually requires no treatment; advise client to reduce ETOH and caffeine intake, reduce stress, and stop smoking (if applicable).
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| Atrial tachycardia (supraventricular tachycardia, or SVT) | * Rate: 100-280bpm (~150-200bpm) * PR: unmeasurable * generally T-on-P waves * vagal maneuvers, adenosine, verapamil
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| Atrial flutter | * Atrial rate 240-360bpm; ventricular usually <150bpm * P:QRS may be 2:1, 4:1, 6:1 or variable * PR unmeasurable * characteristic F (sawtooth) waves
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| Atrial fibrillation | * Atrial rate 300-600bpm; ventricular 100-180bpm * Rhythm: irregularly irregular * P:QRS is variable * PR unmeasurable * f (fibrillatory) waves
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| How is A-fib/A-flutter treated? | ABCDE - adenosine, beta blockers, CCBs, digoxin, electrocardioversion. If <48h duration, safe to cardiovert. If >48h, must anticoagulate first before cardioversion, unless hemodynamically unstable.
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| Junctional rhythm characteristics | An inverted P wave either 1. before or 2. after the QRS. Can also have hidden P waves.
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| Junctional rhythm (junctional escape rhythm) | * 40-60bpm * If P wave is present, PR is generally <0.10sec. * Treat if symptomatic.
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| Accelerated junctional rhythm | * 60-100bpm
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| Junctional tachycardia | * >100bpm
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| Premature ventricular contractions (PVCs) | * Rate: variable * Rhythm: irregular, with PVC interrupting underlying rhythm followed by a compensatory pause. * P:QRS: no P before PVC * PR: absent with PVC. * QRS is wide, bizarre, >0.12sec.
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| How are PVCs treated? | Treat is experiencing symptoms - IV lidocaine, procainamide, quinidine, propanolol. Avoid stimulant use. A RUN OF 3 OR MORE PVCS = RUN OF VTACH.
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| Ventricular tachycardia (VT or VTach) | * Rate: 100-250bpm * Rhythm: regular * P waves usually not identifiable * PR not measured * wide, bizarre QRS, >0.12sec
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| How is VT treated? | Treat if VT is sustained or client is experiencing symptoms - amiodorone or lidocaine. If pt is unconcious or unstable, immediate defib is required.
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| Ventricular fibrillation (VF or VFib) | * rate: too rapid to count * rhythm: grossly irregular * no P waves, no PR * pt has *NO* CO! Call a code blue, DEFIB THE VFIB!
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| 1st Degree AV Block | * Rate usually 60-100bpm * Rhythm: regular * PR interval >0.20sec * Generally no treatment required.
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| 2nd degree AV block type 1, Mobitz I or Wenckebach | * Rate 60-100bpm * Rhythm atrial regular, ventricular irregular * PR interval progressively lengthens; absence of QRS at times * monitor; atropine or isproterenol if pt is symptomatic.
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| 2nd degree AV block type 11, Mobitz II | * atrial 60-100bpm, ventricular <60bpm * atrial regular, ventricular irregular * P:QRS typically 2:1, may vary * Atropine or isoproterenol; pacemaker
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| 3rd degree AV block (complete heart block) | * atrial 60-100bpm, ventricular 15-60bpm * atrial & ventricular regular * NO RELATIONSHIP BETWEEN P & QRS! * PR not measured. * QRS 0.06-0.10 if junctional escape rhythm, >0.12 if ventricular escape rhythm * immediate pacemaker therapy.
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| Bundle Branch Block (BBB) | * delayed conduction through the bundle of His (ventricles) * Need 12-lead EKG to determine if R or LBBB * widened QRS, >0.12sec. Generally has a "rabbit ears" appearance.
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| Difference between junctional rhythm w/ BBB and afib w/ BBB | * Junctional: no P waves, but REGULAR * Afib: no P waves, but IRREGULAR
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| Bigeminal PVCs | PVCs that occur every other beat.
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| Unifocal PVCs | Look exactly the same - probably came from the same site in the ventricles.
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| Trigeminal PVCs | Every third beat
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| Quadrigeminal PVCs | Every fourth beat
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| Couplet PVCs | Paired
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| Multifocal PVCs | When PVCs look different.
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| R-on-T Phenomenon | When a PVC has occurred during the vulnerable period of ventricular repolarization (on/near peak of T wave). May precipitate into VT or VF!
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| monomorphic VT | when QRS complexes are identical
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| polymorphic VT | when QRS complexes look different
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| Treatment of stable monomorphic VT with a pulse | * amiodorone 150mg IV bolus/10min, followed by 1mg/min infusion over 6hrs then 0.5mg/min over 18hrs. * lidocaine 1-1.5mg/kg IV bolus, then 0.5-0.75mg/kg IV q5-10min. Maintenance: 1-4mg/min. * AL drugs - ^
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| torsades de pointes | * polymorphic VT * pt becomes hemodynamically unstable very quickly
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| treating torsades de pointes | * remove/correct the causative factors. * Mg loading dose 1-2g/10mL dextrose 5% in water over 5min followed by maintenance infusion of 0.5-1g/hour.
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| ventricular standstill | * P waves w/o QRS complexes or an isoelectric line. May occur d/t acidosis, hypoxia, hyperkalemia, hypothermia or drug OD.
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| atrial kick accounts for ___ of CO. | 30%
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| Closure of the AV valves constitutes which heart sound? | S1. AV = mitral and tricuspid
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| Closure of the pulmonic valves constitutes which heart sound? | S2. PV = semilunar valves. aortic and pulmonic
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| P wave | * atrial depolarization * smooth and rounded * 1P:1QRS * + in lead II * abnormally tall, peaked P = enlargement of R atrium
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| PR interval | * represents the time from the onset of atrial depolarization to the time of ventricular depolarzation * 0.12-0.20sec
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| QRS complex | * ventricular depolarization * 0.06-0.10sec
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| ST segment | * represents end of ventricular depolarization and the beginning of ventricular repolarization * Normally isoelectric * elevation = ominous, MI * depression = myocardial ischemia * scooped out appearance w/ digitalis
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| T wave | * ventricular repolarization
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| 1 small box on EKG paper = ____sec | 0.04
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| 5 small boxes on EKG paper = ____sec | 0.20
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| 2 black lines = _____sec. a typical strip is _____sec. | 3, 6.
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