EKG information and interpretation
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| Automaticity | The cell's ability to spontaneously initiate an impulse
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| Excitability | indicates how well a cell responds to an electrical stimulus
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| Conductivity | how well the cell contracts after receiving a stimulus
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| Electrical activity | precedes mechanical activity
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| Mechanical activity | cannot occur without electrical activity
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| Electrical activity can occur | without being followed by mechanical activity
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| EKG | a graphic recording of the electrical activity generated by the functioning heart.
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| EKGs help to identify | Primary conduction abnormalities, dysrhythmias, cardiac hypertrophy, pericarditis, electrolyte imbalances, MI - site & extent
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| SA Node | The hearts main pacemaker 60-100 BPM
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| SA Node location | right atrium near the superior vena cava
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| AV Node location | lower part of right atria near the tricuspid valve
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| AV Node delays cardiac impulses for | protection of ventricles against excessively high atrial rates; allows atria to contract and empty blood into ventricle at end of diastole (atrial kick)
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| Tissue surrounding AV Node | contains pacemaker cells that fire at 40-60 BPM
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| Bundle of HIS | located in septum between the 2 ventricles
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| Purkinje Fibers | Terminal portion of the conduction system, third pacemaker 20-40 BPM
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| Atria | Low pressure chambers, reservoirs for respective ventricles
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| Right ventricle | low pressure chamber, sends deoxygenated blood to lungs
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| Left ventricle | high pressure chamber, send oxygenated blood to body
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| Tricuspid valve | AV valve between right atrium & right ventricle
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| Mitral valve | AV Valve between left atrium & left ventricle
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| Atrioventricular (AV) Valves | Tricuspid & Mitral, unidirectional, closure produces S1 (Lub) sound
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| Semilunar Valves | Pulmonic & Aortic, unidirectional, closure produces S2 (dub) sound
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| Pulmonic valve | Between right ventricle and pulmonary artery
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| Aortic valve | Between left ventricle and aorta
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| Depolarization | discharge of energy that accompanies the transfer of electricle charges across the cell membrane
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| Repolarization | return of electrical charges to their original state of readiness
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| Baseline | a starting or resting line of the EKG
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| Wave | a deflection from the baseline
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| Biphasic | a deflection wtih both positive and negative components
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| P Wave | first deflection; represents atrial depolarization
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| PR interval | from the beginning of the P wave to the onset of the Q wave; represents conduction of the impulse through the atria to the AV node (0.12 - 0.2 seconds)
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| QRS Complex | represents ventriclular depolarization; 0.06 - 0.12 seconds
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| ST Segment | End of S wave to beginning of the T wave
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| PR interval too long | > 0.2 seconds; indicates AV block
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| PR interval too short | <0.12 seconds; junctional rhythm
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| T wave | Repolarization of the ventricles
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| QRS Complex too long | >0.12 seconds; something slowing conduction; could be caused by bundle branch block, hypertrophied ventricle
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| ST Segment depression (below baseline) | hypoxia, ischemia, electrolyte issues, healing MI
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| ST segment elevation (above baseline) | Infarction (MI)
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| QT Interval | beginning of Q wave to end of T wave; 0.36 - 0.44 seconds
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| T wave tall & tented | Hyperkalemia
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| T wave shape | should be upright and slightly rounded
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| QT Interval >0.44 seconds | BAD; puts pt at risk of developing V-tach or toursades
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| Normal heart rate | 60-100 BPM
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| Tachycardia | >100 BPM
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| Bradycardia | <60 BPM
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| Cardiac Output | Stroke volume X Heart Rate
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| Sinus Tachycardia Interventions | Treat the cause; rest, oxygen, analgesics, fluids, diuretics, beta-blockers, digoxin
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| Causes of Sinus Tachycardia | CHF, hypovolemia, hypotension, anemia, exercise, fever, hypoxia, pain, anxiety, hyperthyroidism, pulmonary embolism, AWMI, response to drugs that stimulate heart, alcohol, caffeine, nicotine
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| Causes of Sinus Bradycardia | Athletes with well conditioned hearts, digitalis, beta blockers, calcium channel blockers, sleep, elevated ICP, inferior wall MI, vagal stimulation caused by vomitting or severe pain, hypothyroidism, hypothermia
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| Sinus Bradycardia Interventions | Identify underlying cause; If symptomatic - Atropine, pacemaker, dopamine
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| Causes of PACs | Coronary and valvular heart disease, dig toxicity, hyperthyroidism, elevated catecholamine levels, acute respiratory failure, COPD, fatigue, anxiety, electrolyte imbalances, ischemia, MI, early CHF, alcohol, nicotine, caffeine
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| PAC interventions | If symptomatic, focus on eliminating the cause or may treat with antiarrhythmics
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| Causes of Atrial Fibrillation | Valvular disorders, hypertension, CAD, MI, cardiomyopathy, COPD, CHF, rheumatic heart disease, hyperthyroid, dig intoxication
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| Interventions for Atrial Fibrillation | Control (slow) rate and improve cardiac output. If symptomatic - syncronized cardioversion. Diltiazem, Verampamil, Digoxin, beta blockers to slow conduction through AV node. Other anti-arrhythmic drugs once ventricular response controlled.
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| Danger of Atrial Fibrillation | Stroke - clot forms and breaks loose, anticoagulant therapy unless contraindicated (heparin/coumadin)
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| Interventions for Ventricular Tachycardia in consious stable patient | order 12 lead EKG to determine type of tachycardia
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| Interventions for Ventricular Tachycardia in unstable patient | Call for help, Start CRP, Immediate synchronized cardioversion followed by drug therapy
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| Interventions for Ventricular Tachycardia in pulseless patient | ACLS - shock, CPR for 2 minutes, shock & vasopressors, shock and antiarrhythmic (amiodarone, lidocane, magnesium)
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| Ventricular Tachycardia | Lethal dysrhythmia - Assess pt, call for help, start CPR
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| Ventricular Fibrillation (V Fib) Interventions | Assess Pt, call for help, start CPR, Code Cart/ACLS
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| Causes of V Fib | MI, Myocardial ischemia, hypokalemia, hyperkalemia, hypercalcemia, cocain toxicity, hypoxia, hypothermia, acid-base imbalance, electric shock
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| Asystole Interventions | Assess, call code, CPR, intubate, O2, Vasopressin, epinephrine, atropine, pacemaker (confirm in more than 1 lead)
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| Causes of asystole | Severe metabolic deficit, acute respiratory failure, MI, severe electrolyte disturbances, massive pulmonary embolism, electric shock, cocaine OD
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| Asystole | Flatline - ventricular standstill - no electrical activity, no contraction, no cardiac output
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| Ventricular Fibrillation | Lethal Rhythm - rapid disorganized depolarizations of the ventricles characterized by a lack of organized electrical impulse, conduction and ventricular contraction.
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