EKG Exam 1

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Pandora320
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257718
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EKG Exam 1
Updated:
2015-01-03 20:20:32
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EKG
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Description:
Rates and Rhythms for Exam 1
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  1. Myocytes are _______ with influx of positive sodium ions and ____________ moves through heart causing a __________.
    • depolarized
    • depolarization
    • contraction
  2. Einthoven’s Triangle
    • Limb leads I, II, and III
    • Bipolar leads
  3. Augmented leads
    • aVR, aVL, aVF
    • Unipolar leads
  4. Conduction system of the heart
    • Sinoatrial node (SA node)
    • Atrial-ventricular node (AV node)
    • Bundle of HIS
    • Left and Right Bundle Branches
    • Purkinje fibers
  5. Chest Leads
    • V1, V2, V3, V4, V5, V6
    • Unipolar chest (precordial) leads
    • Placement:
    • V1 - 4th Intercostal space to the right of the sternum
    • V2 - 4th Intercostal space to the left of the sternum
    • V3 - Midway between V2 and V4
    • V4 - 5th Intercostal space at the midclavicular line
    • V5 - Anterior axillary line at the same level as V4
    • V6 - Midaxillary line at the same level as V4 and V5
  6. Big Box (sec)
    0.2 seconds (for 25 mm/s paper speed)
  7. Small Box (sec)
    0.04 seconds (for 25 mm/s paper speed)
  8. 5 big boxes (sec)
    1 second (for 25 mm/s paper speed)
  9. 6 second strip
    • 30 big boxes ((5 big boxes = 1 sec) x 6 = 30 big boxes)
    • Multiply # of complexes by 10 for rate.
    • (for 25 mm/s paper speed)
  10. 1500 small boxes
    • 1 minute (1500/x) for regular rhythm
    • (1500 * 0.04 = 60 seconds)
    • (for 25 mm/s paper speed)
    • x = # of small boxes separating wave forms (generally R wave)
  11. P-wave
    • atrial depolarization
    • size is proportional to atrial size
  12. QRS
    • ventricular depolarization
    • Normal is <= 0.1 sec
    • First down wave is Q, unless preceded by up wave (R), then it's S.
    • First up is R, can have R' (2nd up wave)
    • S is ventricular depolarization
  13. PRI
    • PR Interval
    • Conduction from SA to AV node
    • Beginning of P wave to beginning of Q wave
    • Normal range 0.12-0.20 sec (3-5 small boxes)
  14. T wave
    • after the QRS complex and a brief flat/isoelectric segment
    • ventricular repolarization
  15. QT interval
    beginning of QRS to end of T wave
  16. J point
    end of S segment
  17. U wave
    • after T wave
    • electrolyte abnormalities
  18. Bradycardia
    Less than 60 bpm
  19. Tachycardia
    Greater than 100 bpm
  20. Format for Identification:
    • Rate (fast or slow)
    • Rhythm (regular, irregular - regularly irregular or irregularly irregular)
    • P wave (present or not)
    • PR Interval (normal or not)
    • QRS duration (P for each QRS?, narrow or wide?)
  21. RSR
    • Regular Sinus Rhythm
    • Normal Sinus Rhythm (NSR)
    • Rate 60-100
    • Rhythm is regular
    • P:QRS 1:1
    • PRI normal
    • QRS normal
  22. Sinus Bradycardia
    • Rate less than 60
    • Rhythm is regular
    • P:QRS 1:1
    • PRI normal
    • QRS normal
  23. Sinus Tachycardia
    • Rate greater than 100
    • Rhythm is regular
    • P:QRS 1:1
    • PRI normal
    • QRS normal
  24. Sinus Arrhythmia
    • Rate increases with inspiration, decreases with expiration
    • Rhythm is irregular
    • P:QRS 1:1
    • PRI normal
    • QRS normal
  25. Sinus Pause/Arrest
    • Rate varies
    • Rhythm is irregular
    • P:QRS 1:1
    • PRI normal
    • QRS normal
    • Dropped beats - doesn't march out
    • Pause < 1.7 sec
    • Arrest 1.7 - 3.0 sec
  26. Sinus Block
    • Rate varies
    • Rhythm is irregular
    • P:QRS 1:1
    • PRI normal
    • QRS normal
    • Dropped beats - marches out
  27. Sinus Pause v. Sinus Arrest
    • Pause is 1.7 to 3 seconds
    • Arrest is greater than 3 seconds
  28. Premature Atrial Contraction
    • (event)
    • Rate 60-100
    • Rhythm slightly irregular
    • P-waves slightly different
    • PRI normal
    • QRS normal
    • Also called PAC, APC, APB
  29. Wandering Atrial Pacemaker
    • Rate varies (but <100)
    • Rhythm is Irregularly irregular
    • P waves have differing morphology (at least 3 - WAP)
    • P:QRS 1:1
    • PRI is variable, depends on focus
    • QRS is normal
    • WAP
  30. Multifocal Atrial Tachycardia
    • Rate > 100 (tachy WAP)
    • Rhythm is Irregularly irregular
    • P-waves have differing morphology
    • P:QRS 1:1
    • PRI is variable
    • QRS is normal
    • MAT
  31. Atrial Fibrillation
    • Atrial rate > 350
    • Ventricular Rate varies
    • Rhythm is Irregularly irregular
    • No P-waves are discernible, so PRI not measurable
    • QRS is normal
    • A-fib
  32. Premature Junctional Contraction
    • (event)
    • Rate is 60-100, depends on underlying rhythm
    • Rhythm is slighly irregular
    • P-waves are absent, inverted, or retrograde
    • PRI < 0.12 if P precedes QRS
    • QRS is normal
    • PJC
  33. Junctional Escape Beat
    • (event)
    • Rate is based on underlying rhythm
    • Rhythm is irregular because of event
    • P-wave is variable (none, 1:1 if antegrade, or retrograde)
    • PRI is absent, short or retrograde
    • QRS is normal
  34. Junctional Rhythm
    • Rate is 40-60
    • Rhythm is regular
    • P-wave is absent, inverted, retrograde
    • PRI < 0.12 if P precedes QRS
    • QRS < 0.12
  35. Premature Ventricular Contraction
    • (event)
    • Rate is 60-100 depends on underlying rhythm
    • Rhythm is slightly irregular
    • P-wave is absent so PRI is absent
    • QRS is > 0.18
    • PVC, VPC, VPB
  36. PVC can be caused by:
    • Caffeine
    • asthma meds - epinephrine, isoprotenenol, aminophylline
    • Acute MI
    • Mitral valve prolapse
    • Also - electrolyte disturbances (hypokalemia, hypomagnesemia, hypoxemia)
  37. Ventricular Tachycardia
    • Rate is 140-220 or faster
    • 4+ PVC's in a row
    • Rhythm is regular
    • No P-waves, no PRI
    • (P waves could be hiding in the QRS complexes)
    • QRS is > 0.18
  38. PVC Compensatory pause
    starts back on cycle
  39. PVC Non-conpensatory pause
    doesn't start back on cycle
  40. PVC Interpolated
    When PVC falls between the normal QRS and the next P and the QRS comes when expected

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