V₁-V₆ are what related to an EKG:

A. bipolar leads located on the extremities

B. unipolar limb leads

C. chest electrodes

C. chest electrodes

 -these measure the electrical forces in the horizontal plane

Match the chest electrode with its proper placement: EKG

V₁, V₂, V₃, V₄, V₅, V₆

A. 5th intercostal space at the left midclavicular line

B. 5th intercostal space at the left midaxillary line

C. 4th intercostal space at the left sternal border

D. 4th intercostal space at the right sternal border

E. 5th intercostal space at the left anterior axillary line

F. halfway between V₂ & V₄

V₁ - D 4th intercostal space at the right sternal border

V₂ - C 4th intercostal space at the left sternal border

V₃ - F halfway between V₂ & V₄

V₄ - A 5th intercostal space at the left midclavicular line

V₅ - E 5th intercostal space at the left anterior axillary line

V₆ - B 5th intercostal space at the left midaxillary line

-Lead placement for limb leads aVR, aVL, aVF

-These unipolar leads use the center of the heart as their negative electrode

The ability to initiate an impulse spontaneously and continuously

A. excitability

B. contractility

C. conductivity

D. automaticity

D. automaticity

a property of cardiac cells

The ability to be electrically stimulated

A. automaticity

B. excitability

C. conductivity

D. contractility

B. excitability

a property of cardiac cells

The ability to transmit an impulse along a membrane in an orderly manner

A. conductivity

B. contractility

C. excitability

D. automaticity

A. conductivity

a property of cardiac cells

The ability to respond mechanically to an impulse

A. automaticity

B. excitability

C. conductivity

D. contractility

D. contractility

a property of cardiac cells

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What does the P Wave represent?

the passage of the electrical impulse through the atrium causing atrial depolarization (contraction)

-should be upright

-comes from the SA Node

-roundness indicates the Intraatrial Fibers/Tracts are intact & working

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The PR segment and ST segment are Isoelectric.  What does this mean?

[image]

What does the PR segment represent?

[image]

What does the PR interval represent?

[image]

What does the QRS complex represent?

represents time taken for DEPOLARIZATION (contraction) of both ventricles (systole)

-wider QRS complex indicates ventricular problem (more severe)

[image]

What does the ST segment represent?

represents the time between ventricular depolarization and repolarization (diastole); should be isoelectric and level with baseline

-any change from baseline of at least 1mm warrants MD call

[image]

What  does T wave represent?

represents time for ventricular repolarization

-should be the same direction as the QRS

[image]

What does the QT interval represent?

What is the normal bpm of the SA node?

A. 80-110

B. 40-60

C. 60-100

D. 80-100

C. 60-100

-adult rate

40-60 bpm is the normal rate of the _______; 20-40 is the normal rate of the ________.

A. AV node, Bundle of His

B. Bundle branches, Purkinje Fibers

C. SA node, AV node

D. AV node, Purkinje Fibers

Match durations with correct part of ECG.

P Wave, QRS Complex, T Wave, PR interval, QT segment

A) 0.34-0.43 sec

B) 0.16 sec

C) 0.06-0.12 sec

D) 0.12-0.20 sec

E) 0.04-0.12 sec

P Wave - C) 0.06-0.12 sec

QRS Complex - E) 0.04-0.12 sec

T Wave - B) 0.16 sec

PR interval - D) 0.12-0.20 sec

QT segment - A) 0.34-0.43 sec

[image]

A. Ventricular Fibrillation

B. Polymorphic V-Tach

C. Atrial Fibrillation

D. Atrial Flutter

D. Atrial Flutter

-atrial rhythm regular; rate 250-400 bpm

-ventricular rate variable

-SAWTOOTH P-WAVE PATTERN

[image]

A. Atrial Fibrillation

B. Premature Atrial Contraction

C. Atrial Flutter

D. Siuns Bradycardia

A. Atrial Fibrillation

-atrial rhythm grossly irregular; rate >400 bpm

-ventricular rhythm irregular

-QRS complexes of uniform configuration and duration

-PR interval indiscernible

-no discernible P-waves: appear as erratic/fibrillary wave

[image]

A. Sinus bradycardia

B. Atrial Fibrillation

C. Normal sinus rhythm

D. Premature atrial contraction

D. Premature atrial contraction

-1 competitor pacemaker

-most common etopic beat

-impulse generated by an irritable atrial cell

-abnormal shaped P-wave: smaller, squated

-QRS unaffected, longer pause after atrial competitor fires

-caused by a stimulant: caffeine, etc.

[image]

A. sinus bradycardia

B. premature atrial contraction

C. atrial fibrillation

D. atrial bradycardia

A. sinus bradycardia

-atrial and ventricular rhythm regular

-rate <60 bpm

-normal P-wave preceding each QRS

[image]

A. normal sinus rhythm

B. premature atrial contraction

C. sinus tachycardia

D. atrial flutter

C. sinus tachycardia

-atrial and vantricular rhythm regular

-rate 100-160 bpm

-normal P-wave preceding each QRS

-QRS may appear slightly compressed

(each has one P-wave then a QRS then one T-wave, then it starts all over)

[image]

A. sinus tachycardia

B. atrial fibrillation

C. atrial flutter

D. supraventricular tachycardia

D. supraventricular tachycardia (SVT)

-atrial and ventricular rhythm are regular

-rate >160 bpm

-difficult to determine P-wave from preceding T-wave

Causes of Sinus Bradycardia

Select all that apply

A. well conditioned athlete

B. anticholinesterase, beta blockers, digoxin, narcotics

C. pulmonary embolism

D. increased intracranial pressure

E. vagal stimulation

A,B,D,E

A. well conditioned athlete

B. anticholinesterase, beta blockers, digoxin, narcotics

D. increased intracranial pressure

E. vagal stimulation

A normal Telemetry strip is how long?

A. 3 secs

B. 1 sec

C. 5 secs

D. 6 secs

The tiniest individual box comprising the telemetry strip represents ____ (vertically) and ______ (horizontally).

A. 1 mV, 4 secs

B. 0.04 mV, 0.1 sec

C. 0.04 sec, 0.1 mV

D. 0.1 mV, 0.04 sec

D. 0.1 mV, 0.04 sec

-these are grouped in bordered boxes 5X5 units making these 0.5 mV (vertically) and 0.2 sec (horizontally)

Causes of Sinus Tachycardia

Select all that apply

A. fever, exercise

B. pain

C. dehydration

D. hypovolemic shock

E. atropine, epinephrine

F. caffeine

Causes of Supraventricular Tachycardia (SVT)

Select all that apply

A. well conditioned athlete

B. beta blockers

C. cardioversion

D. abnormal atrioventricular conduction system

E. hypokalemia

D,E

-also stress, hypoxia, heart disease, Digoxin toxicity, caffeine, marijuana, or CNS stimulants

Causes of Atrial Flutter

Select all that apply

A. Digoxin toxicity

B. increased ICP

C. dehydration

D. tricuspid or mitral valve disease

E. heart failure

A,D,E

-also pulmonary embolism and inferior wall MI

Causes of Atrial Fibrillation

Select all that apply

A. COPD

B. sepsis

C. hypothyroidism

D. hyperkalemia

E. thyrotoxicosis

F. ischemic heart disease

A,B,E,F

-also heart failure, pulmonary embolism, atrial irritation, Nifedipine and digoxin use

-thyrotoxidosis AKA "thyroid storm"

Your patient presents in unstable condition and is in Atrial Fibrillation.  What would you expect the MD orders to be?

A. administer beta blockers and antiarrythmics STAT

B. schedule radiofrequency alblation following stabilization

C. surgery to implant a temporary pacemaker

D. cardioversion

D. immediate cardioversion

-synchronized cardioversion is the use of a synchronized circuit in the defibrillator to deliver a countershock that is programmed to occur on the R-wave of the QRS complex of the ECG.  (OK think about how fast that occurs and this machine is programmed to hit that with a shock, that's nuts)  Interesting stuff on page 833-834 in the textbook explains the differences in defibrillation and cardioversion.

Your patient presents in stable condition in Atrial Fibrillation. What do you anticipate the MD orders to be?

A. defibrillation

B. immediate cardioversion

C. administer a beta blocker

D. schedule valve replacement surgery

C. administer a beta blocker

-treatment of the pt in stable condition with A Fib is drug therapy (beta blocker, calcium channel blocker, and antiarrythmics) or chemical cardioversion

-also may call for radiofrequency ablation of the Bundle of His

Your patient presents in unstable condition with Atrial Flutter.  What would you expect the MD orders to be?

A. immediate cardioversion

B. start IV and begin D5 with 20 Kcal

C. blood chemistry to assess electrolyes

D. intubate and prep for surgery

Your patient presents in stable condition with Atrial Flutter.  What do you expect the MD orders to be?

A. immediate cardioversion

B. administer a calcium channel blocker

C. induced hypothermia

D. vagal stimulation

B. administer a calcium channel blocker

-as part of drug therapy that may also include a beta-adrenergic blocker, or antiarrhythmic

-anticoagulation therapy is used to prevent PE or stroke

Treatments of Sinus Bradycardia include:  Select all that apply:

A. correct underlying cause

B. administer atropine

C. placement of a pacemaker

D. dopamine, epinephrine, and/or norepinephrine

ALL

-dopamine, epinephrine, and norepinephrine are used in instances of low cardiac output such as shock

Treatments of Sinus Tachycardia include all of the following except:

A. Coumadin

B. Diltiazem

C. Metoprolol

D. induced hypothermia

A. Coumadin

-anticoagulation therapy is not necessary for Sinus Tachycardia

-Diltiazem is the prototype calcium channel blocker (I recognized Norvasc it is also a calcium channel blocker)

-Metoprolol is a beta blocker

[image]

A. 1st degree AV block

B. normal sinus

C. sinus bradycardia

D. premature atrial contraction

A. 1st degree AV block

-atrial and ventricular rhythms normal

-QRS normal

****PR interval >0.2 seconds****

True

-1st degree AV block can also be caused by inferior wall ischemia or MI, hypothyroidism, and can be seen in healthy people

Treatments for 1st degree AV block include:

Select all that apply

A. temporary pacemaker

B. elective cardioversion

C. correction of underlying cause

D. anticoagulants

E. treat symptomatic bradycardia

[image]

A. Premature atrial contraction

B. ventricular fibrilation

C. 2nd degree type 1 AV block

D. 2nd degree type 2 AV block

C. 2nd degree type 1 AV block (Wenckebach)

-atrial rate regular, ventricular rate irregular

-atrial rate exceeds ventricular rate

****PR interval progressively gets longer with each cycle until a QRS complex drops, the PR interval following the dropped QRS is shorter****

Inferior wall MI, cardiac surgery, and COPD are all possible causes of 2nd degree type 1 AV block. 

True or False?

False

-Inferior wall MI and cardiac surgery are causes but COPD is not a cause, COPD is a cause of atrial fibrilation

-other causes of 2nd degree type 1 AV block are: vagal stimulation, Digoxin toxicity, beta blockers or procainaminde

Treatments for 2nd degree type 1 AV block are:

Select all that apply

A. temporary pacemaker

B. permanent pacemaker

C. elective cardioversion

D. radio frequency ablation

A,B

-also may have to treat sympomatic bradycardia as it develops

[image]

A. Wenckebach rhythm

B. 2nd degree type 2 AV block

C. Premature atrial contraction

D. Atrial flutter

B. 2nd degree type 2 AV block

-atrial rhythm regular

-ventricular rhythm regular or irregular

****PR interval is CONSTANT, QRS is periodically dropped****

Possible causes of 2nd degree type 2 AV block are:

Select all that apply

A. severe coronary artery disease

B. inferior wall MI

C. anterior wall MI

D. myocarditis

E. Digoxin toxicity

The common standard treatment for both types of 2nd degree AV block and 3rd degree AV block is?

A. life long beta blocker therapy

B. radio frequency ablation

C. electric cardioversion

D. temporary/permanent pacemaker

[image]

A. Ventricular tachycardia

B. 3rd degree heart block

C. Premature ventricular complex

D. 2nd degree type 2 AV block

B. 3rd degree heart block

-atrial rhythm regular

-ventricular rate regular and slower than atrial rhythm

****QRS wide, no apparent association between SA and ventricular activity****

Possible causes of 3rd degree heart block are:

Select all that apply

A. inferior wall MI

B. anterior wall MI

C. hypoxia

D. Digoxin toxicity

ALL

-as well as other chronic heart diseases

[image]

A. Bundle branch block

B. 3rd degree AV block

C. ventricular tachycardia

D. atrial flutter

A. Bundle branch block

Looking at the ECG you'll see that:

• Rhythm - Regular
• Rate - Normal
• QRS Duration - Prolonged
• P Wave - Ratio 1:1
• P Wave rate - Normal and same as QRS rate
• P-R Interval - Normal

[image]

A. 2nd degree type 1 AV block

B. 2nd degree type 2 AV block

C. 3rd degree AV block

D. premature ventricular contraction

D. premature ventricular contraction

-atrial rhythm regular, ventricular rhythm irregular

****2 criteria:1) T-wave going in opposite direction of QRS 2) QRS wider than 0.12 followed by compensatory pause****

Possible causes of Premature Ventricular Contraction are:

Select all that apply

A. heart failure

B. hypercalcemia

C. old or acute MI

D. hypermagnesmia

E. stress, anxiety, pain

A,C,E

-PVC can be caused by hypocalcemia and hypomagnesmia

-also caused by ischemia, and drug toxicity

[image]

A. ventricular tachycardia

B. ventricular fibrilation

C. 3rd degree heart block

D. bundle branch block

A. ventricular tachycardia

****ventricular rate greater than 100 bpm, rhythm regular or irregular, wide/bizarre QRS complexes independant of P-waves****

-no discernible P-waves

-may start and stop suddenly

->30 secs equals sustained

-myocardial ischemia

-MI

-aneurism

-CAD

-mitral valve prolapse

-hypercalcemia

-hypomagnesmia

-drug toxicity

-severe anxiety

Your pt on the cardiac unit falls into V-Tach and has no pulse.  What actions would be appropriate?

Select all that apply

A. initiate CPR

B. cardioversion

C. intubation

D. admin vasopressors

A,C,D

-defibrilation, not cardioversion, is appropriate

Your patient on the cardiac unit shows V-Tach with a pulse.  What actions are appropriate?

A. defibrilation

B. cardioversion

C. admin lidocaine

D. CPR

C. admin lidocaine

-also may administer procainamide or amiodarone

-if V-Tach is recurrent an implanted cardioverter/defibrilator may be placed

[image]

A. Torsades de Pointes

B. ventricular fibrilation

C. asystole

D. atrial fibrilation

A. Torsades de Pointes (polymorphic V-Tach)

-ventricular rate 140-220 bpm, rhythm regular or irregular

****QRS complexes wide, bizarre, and independant of P-waves****

-P-waves none discernible

-may start and stop suddenly

Polymorphic V-Tach is usually caused by:

A. hyperkalemia

B. hypocalcemia

C. hypernatremia

D. hypomagnesmia

Treatments for Torsades de Pointes include all of the following except:

A. radio-frequency ablation

B. defibrilation

C. Magnesium sulfate

D. electrical cardioversion

A.radio-frequencey ablation

-Magnesium sulfate due to hypomagnesmia

[image]

A. polymorphic V-Tach

B. ventricular fibrillation

C. bundle branch block

D. atrial tachycardia

B. ventricular fibrilation

-ventricular rhythm chaotic, rate is rapid

****QRS complexes wide, irregular, no visible P-waves****

Possible causes of V-Fib include all of the following except:

A. myocardial ischemia

B. MI

C. V-Tach

D. hypokalemia

E. hypocalcemia

F. alkalosis

E. hypocalcemia

-other causes include: hypoxemia, electrical shock, hypothermia, and Digoxin or epinephrine shock

In the case of pulseless V-Fib the RN would initiate CPR, defibrilate, intubate, and administer epinephrine and antiarrythmics.

True or False?

[image]

A. sinus rhythm

B. V-Fib

C. A-Fib

D. asystole

D. asystole

****FLATLINE****

Treatment in the case of asystole includes:

Select all that apply

A. defibrillation

B. CPR

C. adenosine

D. epinephrine

B,D

-defibrillation won't work without a shockable rhythm

-adenosine causes brief asystole

Place the following in order of the progression of CAD.

A. complicated lesion

B. fibrious plaque

C. collateral circulation

D. fatty streak

The pt has to be NPO for how long prior to checking lipids?

A. none

B. 2 hrs

C. 6 hrs

D. 12 hrs

C. 6 hrs

-Eating will affect triglyceride levels

Which of these is the "good" cholesterol?

A. LDL

B. HDL

B. HDL

-LDL is the "bad" cholesterol

Match the desired value with the correct cholesterol:

total cholesterol, LDL, HDL, triglycerides

A. >60

B. <150

C. <100

D. <200

total cholesterol = <200

LDL = <100

HDL = >60

triglycerides = <150

Statins are cholesterol lowering medications.  Which of the following is not an example of a statin?

A. Zocor

B. Lipitor

C. Crestor

D. Metoprolol

D. metoprolol

- adverse effects of statins include: liver dysfunction, rhabdomyopathy (breakdown of skeletal muscles) evidenced by joint pain

-must monitor liver enzymes

myocardial ischemia

-CAD leading to narrowing of the arteries

-75% blockage required for ischemia to occur

-progresses to anerobic metabolism, lactic acid prompts nerve roots of cardiac nerves