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Flashcards in EKG Interpretation Deck (19)
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1

Heart Rate useing R wave measurement by counting mnemonics

Regular rhythms
– Find a QRS that occurs on or near a dark line
– Count off on dark lines between that QRS
and the next QRS
– The count is 300, 150, 100, 75, 60, 50

2

Does the rhythm originate in the sinus node?

must be round, upright P waves that all look the same

3

Is atrial conduction normal

-all P waves look alike
-normal PR interval

4

is ventricular conduction normal

Is there a QRS for every P wave?
– Does every QRS look the same?
– Is the QRS nice and neat or big and
sloppy?

5

questisn to ask yourself when examining an ekg

What is normal for this person?
• Is this strip a change from baseline?
• Is this person symptomatic?
– Short of Breath
– Dizzy
– Diaphoretic
– Chest Pain
– Hypotension
Does this person have cardiopulmonary or
vascular disease?
• Where is this person and what is he or she
doing

6

normal sinus rhythm

HR 60-100 bpm
• Regular
• P for every QRS
• PR interval normal
• QRS duration normal
• Impulse originates in
the sinus node, follows
normal conduction
pathway

7

sinus bradycardia

HR < 60 bpm
• Only difference
between sinus
bradycardia and
normal sinus rhythm
• Normal in trained
athletes
• Can occur with
increased vagal
stimulation, as with
suctioning or vomiting
• Usually asymptomatic
unless pathology
present

8

sinus tachycardia

HR > 100 bpm
• Only difference
between sinus
tachycardia and
normal sinus rhythm
• Always has underlying
cause
• Increased sympathetic
stimulation - pain, fear,
anxiety, exercise,
• Increased oxygen
demands - fever, CHF,
infection, anemia

9

premature atrial complexes

Underlying rhythm is
sinus
• Beat is early
• P wave of PAC looks
different from other P
waves
• Caused by emotional
stress, nicotine,
caffeine, alcohol,
hypoxemia, infection,
myocardial ischemia,
rheumatic disease,
atrial damage
• Causes irregular pulse
when palpated

10

`A-Fib

No coordinated electrial
activity in atria
• Irregularly irregular
• Chaotic baseline
• NO P WAVES
• Ventricular response (HR)
may be normal, slow, or
too fast
• Seen with advanced age,
CHF, ischemia or
infarction, cardiomyopathy,
digoxin toxicity,
stress or pain, rheumatic
heart disease
• Loss of atrial kick
• Potential for rapid heart
rate
• Mural thrombi (30%)

11

atrial flutter

More than one P
before every QRS
• P waves are called
flutter waves
• All look identical
• Produces “sawtooth”
pattern
• Can be regular or
irregular
• Causes include
rheumatic heart
disease, mitral valve
disease, coronary
artery disease, stress,
hypoxemia,
pericarditis
• May lead to atrial
fibrillation

12

premature ventricular complexes

Wide and bizarre QRS
without a P wave
• Occurs earlier than
next normal sinus beat
• Caused by caffeine or nicotine,
stress, electrolyte imbalance,
myocardial ischemia, acute
infarction
• Symptoms can include
palpitations, shortness of breath,
dizziness associated with
decreased cardiac output
Unifocal PVCs all
look the same
• Multifocal PVCs
appear different, more
serious
• Two in a row is a pair
or couplet
• Can occur in patterns
– Bigeminy - every other
beat a PVC
– Trigeminy - every third
beat a PVC
• Can progress to
ventricular tachycardia or
ventricular fibrillation

13

V-tach

Three or more PVCs
in a row
• No P waves
• QRS complexes are
wide and bizarre
• Heart rate between
100 and 250 bpm
• Caused by ischemia or
acute infarction, reaction
to medications, electrolyte
imbalance
• Cardiac output severely
compromised
• May have palpable pulse
• Usually a medical
emergency

14

V-fib

• No coordinated
electrical activity in
ventricles
• Grossly irregular zig
zag pattern of baseline
• NO CARDIAC
OUTPUT
• Causes are similar to
ventricular tachycardia
• Treatment is
defibrillation as soon
as rhythm is identified

15

junctional rhythm

AV node takes over as
pacemaker
• no P waves before the
QRS
• normal looking QRS
• Heart rate between 40
and 60 BPM
• Regular
• Failure of sinus node
as in digoxin toxicity,
infarction, ischemia of,
or trauma to the
conduction system
• May be symptomatic
with slow heart rates

16

1st degree AV block

Long PR interval
• Regular rhythm
• Normal rate
• QRS complexes
appear normal
• Causes include coronary
artery disease, rheumatic
heart disease, infarction,
abnormal response to
medication (digoxin, beta
blockers)
• Usually benign, only rarely
progresses to more severe
block

17

2nd degree AV block type 1

Progressive
prolongation of PR
interval until a QRS
complex is dropped
• Normal P waves with
constant P-P interval
• QRS complexes
appear normal
• Right coronary artery
disease or infarction,
digoxin toxicity or
beta blockade
• Usually asymptomatic
• Rarely progresses to
higher form of AV
block

18

2nd degree AV block type 2

Impulse not conducted to
ventricles
• QRS complex is dropped
• 2 to 4 P waves for every
QRS
• No change in PR interval
• Heart rate often less than
60 bpm
• Myocardial infarction,
ischemia or infarction
involving the AV node or
Bundle of His, digoxin
toxicity
• Symptoms may occur with
low heart rates
• Frequently progresses to
complete heart block

19

3rd degree or complete heart block

No impulses initiated
above the ventricles
are conducted to the
ventricles
• P waves regular, all
look alike
• QRS all look alike
• Rate usually 30 to 50
bpm
• Caused by acute MI,
digoxin toxicity
• Usually symptomatic due
to decreased cardiac
output
• Life-threatening
• Treatment is pacemaker