Each square large square on ECG paper incorporates how many small squares?

25 small squares 

Each small square on ECG paper measures how many seconds? 

Each large square measure how many seconds? 

small = 0.04 seconds 

Large: 0.20 seconds 

What is one way to calculate the heart rate on a rhythm strip? 

You count the R-R intervals in 6 seconds and multiply by 10. 

What is telemetry monitoring?

Telemetry monitoring is the observation of the patient's heart rate and rhythm to rapidly diagnose  dysrhythmia, ischenia, or infarction

What is a normal sinus rhythm? 

A rhythm that originates in the SA node and follows the normal conduction pattern in the cardiac cycle 

 What is the SA node?

SA node is the "pacemaker" of the heart and it is located in the Rt atrium 

What is the conduction pattern of the cardiac cycle? 

It starts in the SA node--->AV node---> Bundle of HIS--->(R/L)Bundle Braches  and ends with the  Purkinje fibers

What does the P wave represent? 

How long is the normal duration? 

It represents the depolarization of the atria 

Duration= 0.06-0.12 seconds 

What is the PR interval? 

What is the normal duration of the PR interval? 

The PR interval is the time it takes for an impulse to spread through the atria, AV node,Bundle of HIS and purkinje fibers

0.12-0.20 seconds 

What does thre QRS complex represent?

How long is its duration? 

QRS represents the depolarizaion of the ventricles(ventricular contraction) 

The normal duration = 0.04-0.12 seconds 

What is the ST segment and how long is its duration?

The ST segment is the time it takes bewteen ventricular depolarization to repolarization. 

Its normal duration = 0.12 seconds 

What is the T wave?

How long is its duration? 

The T wave represents the repolarization of the ventricles

Its normal duration is: 0.16 sec 

What is the QT interval?

How long is its duration? 

The QT interval is the total time for depolaration and repolarization of the ventricles

The normal duration = 0.34-0.43 seconds 

What is the rate of the SA node? 

SA node = 60-100/min 

What is the rate of the AV node? 

AV node = 40-60/minute 

What is the rate of the Bundle of HIS and Purkinje fibers?

Rate = 20-40/minute 

What is the rate of sinus bradycardia?

What is the medication treatment for the pt who is symptomatic?

Heart Rate = < 60/bpm

Medication Treatment = Atropine

What is  the mneumonic for remembering Atropine side effects?

No pee.....No see

No sweat...No shit

What is the rate for sinus tachycardia?

What are some associated causes to this condition?

Heart rate > 100bpm

Associated causes:Exercise, fever,pain, hypotension, hypovolemia, anemia, hypoxia, hypoglycemia, anxiety, fear, medication side effects

What are some S/S the patient may complain about with sinus tachycardia?

Dizziness, dyspnea, and hypotension

What is a PAC?

What are some of the causes?

PAC (premature atrial contraction)- is a contraction originating from an ectopic focus in the atrium in a location other than the SA node

In a normal heart: Emotional stress, physical fatigue, caffeine, tobacco, alcohol

Other causes: Hypoxia, electrolyte imbalances, hyper thyroidism, COPD, CAD, and valvular disease

What is the medication treatment for PAC?

Beta blockers

What is PSVT?

What is the heart rate?

PSVT(paraxysmal supraventricular tachycardia)- is a dysrhythmia originating in an ectopic focus anywhere above the bifurcation of the Bundle of HIS

Heart rate = 100-300bpm

What are some causes of PSVT?

In a normal heart:

overexertion,emotional stress, deep inspiration, caffeine and tobacco

Other causes:

Rheumatic heart disease, digitalis toxicity, CAD, and cor pulmonale

What are the treatments for PSVT?

Vagal stimulation(Valsalva manuever/coughing)

Drug therapy: IV adenosine(drug of choice), IV beta blockers, calcium channel blockers, digoxin,amiodarone

What is atrial flutter?

What is its distinguishing characteristic on ECG?

Atrial Flutter is an atrial tachydysrhythmia that originates from a single ecotpoic focus in the right atrium.

It is identified by recurring,regular sawtooth-shaped flutter waves

What is the atrial rate of atrial flutter?

Atrial rate = 250-350bpm

What are the causes of atrial flutter?

CAD, Hypertension(HTN),mitral valve disorders, pulmonary embolus, chronic lung disease, cor pulmonale, cardiomyopathy, hyperthyroidism

Drugs: Digoxin, quinine and epinepherine

What is the treatment for atrial flutter?

*The goal is to slow ventricular response by increasing AV block

Drugs: Beta blockers/Calcium Channel blockers

Electrical cardioversion( used in emergency situations)

What is atrial fibrillation?

What is the atrial/ventricular rates?

atrial fibrillation is a loss of effective atrial contraction by a total disorginanization of  atrial electrical activity

Atrial = 350-600 bpm

Ventricular = 50-180 bpm

What are the underlying causes to atrial fibrillation?

CAD,Rheumatic heart disease, Cardiomyopathy, hypertensive heart disease, heart failure, pericarditis

What condition may develop as a result of A-fib?

Thrombi formation

What is the treatment(s) for A-fib?

Drugs used for ventricular rate control = Calcium channel blockers, beta blockers, and digoxin

Other drugs/tx: Coumadin(prevention of thrombus formation)

Cardioversion(after 3-4 wks of anticoagulation therapy)

What is a junctional rhythm?

What are the types?

What are the rates?

A junctional rhythm is a dysrhythmia that originates in the AV node b/c the SA node failed to fire or the signal was blocked. 

Escape

Accelerated

Junctional tachycardia

Rates (escape rhythm)= 40-60 bpm

(accelerated)= 61-100bpm

(  junctional tachycardia)= 101-150bpm

What is the ECG characteristics of a junctional rhythm?

The P wave is abnormal in shape and inverted. It may be hidden in the QRS complex

What is the treatment for junctional rhythms?

Atropine is used for escape rhythms

Digoxin is withheld if accelerated/tachycardia rhythms are caused by dig toxicity

Beta blockers, calcium channel blockers and amiodorone are used for rate control.

What is the treatment for First degree AV block?

There is no treatment

What is third degree AV block?

What are some of the causes?

It is a form of AV disassociation in which no impulses from the atria are conducted to the ventricles. (atria contract independently from the ventricles)

Causes include: Severe heart disease-

                 (CAD,MI, myocarditis,cardiomyopathy)

             Other systemic diseases:

            (Amyloidosis/sceleroderma)

                    Drugs:

                  (Digoxin, beta-blockers, calcium channel blockers)

What are the ECG characteristics of Third degree AV block?

Atrial rate = 60-100bpm

**Ventricular rate depends on site of block-

AV node = 40-60

Bundle of HIS/Purkinje = 20-40bpm

* There is NO relationship between the P wave and QRS complex

What is the treatment(s) for third degree block?

Transcutaneous pacemaker is used until transvenous pacemaker can be inserted.

**Pts will need permanent pacemaker

Drugs to increase heart rate:

Atropine, epinepherine, dopamine

What is a PVC?

PVC(premature ventricular contraction)- is a contraction originating in the ventricles. It is a premature occurance of QRS complex.

What are the types of PVCs?

Multifocal- PVCs that are in a differenbt shape from each other

Unifocal- PVCs that have the same shape

Ventricular bigeminy- when every other beat is a PVC

Ventricular trigemity- when every third beat is a PVC

Couplet- two consecutive PVCs

**Triplet- when there are three consecutive consecutive PVCs

** V-tach occurs when there are three or more consecutive PVCs

What are the causes of PVCs?

Causes:

caffeine, alcohol, nicotine,

Drugs: aminophylline, epinepherine, isoproternol and digoxin

Other: electrolyte imbalances, hypoxia, fever, exercise, emotional stress, MI, MVP, heart failure, CAD

What is the treatment for PVCs?

Treatment is based on cause.

O2 for hypoxia

Electrolyte replacement(potassium)

Drug therapy: Beta blockers, procainamide, amiodarone, Lidocaine

What is ventriciular tachycardia?

V-tach is a run of three or more PVCs. It occurs when an ecotpoiuc focus fire repetitvely and the ventricle takes control as the pacemaker.

What are the causes for V-tach?

Causes:

MI,CAD, significant electrolyte imbalances, cardiomyopathy, MVP, long QT syndrome, digitalis toxicity and CNS disorders

Decreased cardiac output in V-tach results in what symptoms?

Hypotension, Pulmonary edema, decreased cerebral blood flow, cardiopulmonary arrest

What is the treatment for ventricular tachycardia?

Pt w/ a pulse:

Drugs: IV procainamide, amiodarone,or Lidocaine

If the pt is pulseless:

IV amiodarone or lidocaine is used followed by cardioversion

What is ventricular fibrillation?

It is a severe derangement of the heart rhythm. The ventricile is "quivering" and no effective contraction or cardiac output occurs.

It results in unresponsive, pulseless, apneic state. Pt will die if not treated immediately

What is the treatment for V-fib?

Immediate initiation of CPR and ACLS measures(i.e.-defibrillation)

What is Asystole?

It is the total absence of ventricular electrical activity. Noventricular contraction occurs.

Pt is unresponsive,pulseless and apneic.

This is a lethal rhythm!

What is the treatment for asytole?

Consists of:

CPR

Initiation of ACLS

IV w/ epinepherine and atropine

What is P.E.A.?

What are the causes?

PEA(pulseless electrical activity) -electrical activity is seen by ECG but the pt has no pulse.

Most frequent causes:

Hypovolemia, hypoxia, metabolic acidosis, hyper/hypokalemia, hypothermia, drug overdose, cardiac tamponade, MI tension pneumothorax, pulmonary embolus 

What are the treatments for PEA?

**Treatment is directed toward correctrion oiof underlining cause 

CPR

Intubation

IV Epinepherine

What is a prodysrythmia?

Occasionally occurs when antidysrhythmic drugs are given for the dysrhythmia it was trying to treat.

Example med: Digoxin