medsurge ECG

what does the P wave on an ECG represent?

upper heart, atria, beating

what does the qrs complex on an ECG represent? whats a normal duration?

lower heart, ventricles, beating - 0.06-0.12 (1.5-3 squares)

what is the PR interval and what’s normal?

start of P to start of QRS / how long it takes electrical signals to get from atria to ventricles - 0.12-0.20 seconds (3-5 squares)

What is an st elevation/depression?

S is higher or lower than Q w/ a J point above or below it’s normal midline

What are the five steps to ECG analysis?

Rate: fast, normal, slow

Rhythm: regular or irregular

P wave for each QRS?

PR and QRS duration

Ectopy? (characteristics - PVCs, PACs, 1 degree AV block, etc)

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sinus bradycardia

What are causes of bradycardia?

lower metabolic needs, vagal stimulation, meds (b-blockers, digoxin, CCBs, amio, lithium), increased intracranial pressure, CAD

What are symptoms of bradycardia?

decreased cardiac output, syncope, fatigue, lightheadedness

What are treatments for bradycardia?

treat cause if possible, medications: atropine, dopamine, epinephrine

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sinus tachycardia

what are causes of sinus tachycardia?

exercise, stress, fever, sepsis, hypovolemia, low BP, PE (pulmonary embolism), MI, COPD, hypoxia, illicit drugs, etc.

what are complications of sinus tachycardia?

decreased cardiac output, coronary blood flow, and McO2 (myocardia 02 consumption)

What are treatments for sinus tachycardia?

treat the cause if possible, vagal maneuvers

Meds: B-blockers, calcium channel blockers

Electrical: syncronized cardioversion if 150+ and unstable

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premature atrial complex (PAC)

What are causes of PAC’s?

caffeine, alcohol, nicotine, hypervolemia, anxiety, hypokalemia, pregnancy, atrial ischemia, MI

What are symtoms of PACs

common, Palpitations (feeling like the heart is racing, pounding, or skipping a beat) Chest tightness or discomfort Shortness of breath Dizziness or lightheadedness Fatigue AnxietyW

What are treatments of PACs?

none unless frequent which may lead to AFIB, treat underlying cause

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atrial fibrilation

What are causes of Afib?

CAD, MI, CABG, HF, valve disease, pericarditis, substance abuse

What are symptoms of Afib

strokes, SOB, low bp, chest pain

What are treatments for Afib?

rate/rythm control: ablation, MAZE

Meds: amiodarone, adenosine, verapamil, B-blockers, CC-blockers, digoxin

Electrical: synchronized cardioversion if rate 150+ and unstable

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A flutter

What causes aflutter

CHF, CAD, HTN, MI, cardiomyopathy, substance abuse etc.

What are symptoms of aflutter?

low cardiac output, stroke, SOB, low bp, chest pain

What are treatments for aflutter?

vagal maneuvers

Meds: anticoagulants, CC-blockers, B-blockers, adenosine

Electrical: syncronized cardioversion, ablation

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supraventricular tachycardia (SVT)

what are causes of SVT

CAD, cardiomyopathy, caffeine, nicotine, hypoxemia, stress

What are symptoms of SVT’s

SOB, low cardiac output, palpitations, syncope

What are treatments for SVTs?

Stable: vagal maneuvers, adenosine

Unstable: synchronized cardioversion

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junctional rhythm

what are treatment notes for Junctional rhythms?

treat similar to sinus bradycardia, if signs of low cardiac output

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premature ventricular complex (PVCs)

What are causes and symptoms of PVCs?

common, age caffeine, nicotine, alcohol, LV hypertrophy - feels like a skipped beat, palpitations, LV dysfunction

What are treatments for PVCs

unually none, treat underlying cause

Meds: b-blockers, amiodarone

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ventricular tachycardia

What are cause of v tach?

CAD, cardiomyopathy, mitral valve disease, aortic stenosis, myocarditis, MI

What are complications and treatments for v tach (3 categories)?

Sudden cardiac death

No pulse: CPR, defibrilate, Epi, Amiodarone or Lidocaine

Unstable with pulse: cardioversion

Stable with pulse: valgal maneuvers, adenosine, antiarrhythmic infusion, B-blockers, eletrolyte correction, etc. - Treat cause

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Ventricular fibrillation

What are causes and complications of v fib?

CAD and MI (most common), trauma, cardiomyopathy, congenital heart disease, drugs: cocaine/meth - sudden cardiac death

What are treatments for v fib

defibrilation, acls’s (advanced cardiac life support) - CPR, epi, amiodarone/lidocaine

ICD’s (implantable cardio device), PCI with stents, CABG

What are causes of asystole?

lack of electrical impulse, hypoxia, hypovolemia, hydrogen ion (acid base imbalance) hypo/hyperglycemia, hypo/hyperkalemia, trauma, toxins, tamponade, tension pneumothorax, thrombus

What are complications and treatments of asystole?

sudden cardiac death

CPR, EPI, fix reversible causes

What is PEA?

pulseless electrical activity - treatments and causes same as aystole

What is cardioversion?

a synchronized shock to the QRS complex that resets electrical conduction of the heart

What are indications for cardioversion?

unstable tachycardia, >150 (emergent), stable irregular fast heart rate that is not responding to medications (planned - 3 week anticoagulation for clients with afib or unknown duration)

What are the three types of pace makers?

Pads, epicardial (external with direct heart attacement), and endocardial (transvenous, patient can’t shower)D

describe pacemaker modes and the related letter system w/ example

fixed, demand, tachydysrhythmia (shocks arrhythmia)

First letter - chamber paced: A, V, D (atrial, ventricular or dual)

Second letter - chamber sensed: AVorD

Third letter - pacemaker response plan: T, I, D, 0 (triggered, inhibited, dual, no sensing)

Example: DDD - atria and ventricles are paced and sensed and will inhibit or trigger pacing as needed

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1st degree av block (long PR interval) - an ectopy: must have a rhythm associated with it

What are causes of 1st degree AV blocks?

increased vagal tone (vagus nerve activity), CCBs (calcium channel blockers), B-blockers, digoxin, hyperkalemia

What are complications of 1st degree av blocks?

rarely causes complications, decreased cardiac output

What are treatments for 1st degree AV blocks?

treat reversible causes, discontinue rate lowering meds

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2nd degree AV block type 1 - irregular PR interval w/ dropped QRS

What are causes for 2nd degree av block type 1

high vagal tone (athletes), acute MI, AV nodal disease, myocarditis

What are complications and treatments for 2nd degree av block type 1

heart failure, decreased cardiac output

atropine, pace, reverse cause (MI, meds)

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2nd degree av block type 2 - regular PR interval w/ dropped QRS

What are causes and complications of 2nd degree av block type 2?

MI, AV node blocking meds (digoxin, CCBs, BBs)

Progression to heart block, decreased cardiac output

What are treatments for 2nd degree AV block type 2?

correct reversible causes, (MI, increased vagal tone, meds), avoid meds that impair AV node conduction, pacemaker

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3rd degree AV block (complete heart block, no p waves)

What are causes and complications of 3rd degree AV blocks?

acute MI

VT, VF, worsening symptoms of HF

What are treatments of 3rd degree av block

pacing, correct reversible causes (MI, increased vagal tone, meds that depress conduction), avoid meds that impair AV conduction

bundle branches

qrs is longer than .12

pace makers

, A is before the p wave V paced is after P wave

what is this rythm and what med will you give during the code?

torades - a type of v tach: give magnesium