ECG Rhythms

NUR360 at NAU Module 4

What are the two normal cardiac rhythms?

normal sinus rhythm

sinus arrhythmia

normal sinus rhythm rate

60-100 bpm

what causes sinus arrhythmia?

the SA node fires irregularly

This arrhythmia is often caused by changes in intrathoracic pressure during breathing

sinus arrhythmia

sinus arrhythmia rate

60-100bpm

sinus bradycardia rate

<60bpm

How many p waves should precede each QRS complex?

One P wave should precede each QRS complex.

sinus tachycardia rate

>100bpm

premature atrial contaction (PAC)

a contraction starting from a location that isn’t the SA node. it occurs sooner than the next expected sinus beat

PAC results in an abnormal _ wave

p

what dysrhythmia is this (look at where the arrows point)?

PAC (1)

T/F: The P wave may not be visible at all in PAC.

true, it may be hidden in the preceding T wave

normal length of P wave

<0.12 seconds (3 small squares)

normal length of QRS complex

0.06-0.12 seconds (1.5 to 3 small squares)

In a person with a healthy heart, isolated PACs are/are not significant?

they are not significant

supraventricular tachycardia is also called what?

atrial tachycardia or paroxysmal supraventricular tachycardia (PSVT)

PSVT occurs because of a _____ phenomenon (reexcitaiton of the atria when there is a 1-way block)

reentrant

Causes of PSVT in a healthy heart

overexertion, emotional stress, deep inspiration, and stimulants (such as caffeine/tobacco)

other causes of PSVT (not in a healthy heart)

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

PSVT rate

151-220bpm

PSVT rhythm (regular or irregular)

regular or slightly irregular

what is the shape of the P wave in PSVT?

may be abnormal or be hidden in the preceding T wave

normal length of PR interval

0.12-0.20 seconds (3-5 small squares)

atrial flutter origin

a single ectopic focus in the R (or less often the L) atrium

What rhythm is this (top strip)?

atrial flutter

T/F: Atrial flutter commonly occurs in a healthy heart

false, it rarely occurs in a healthy heart

____ _____ is characterized by total disorganization of atrial electrical activity because of multiple ectopic foci.

atrial fibrillation

What is the most common dysrhythmia?

atrial fibrillation

T/F: Atrial fibrillation usually occurs in a patient with underlying heart disease, such as CAD, valvular heart disease, cardiomyopathy, hypertensive heart disease, HF, and pericarditis.

true

During atrial fibrillation, what is the PR interval?

not measurable

also no discrete P waves!

What is the rhythm in atrial fibrillation?

irregularly irregular

What to do for unstable atrial fibrillation?

immediate synchronized cardioversion

What is this rhythm?

atrial fibrillation

What is this rhythm?

PAC

What is this rhythm?

atrial flutter

What is the atrial rate for atrial flutter?

250-350bpm

Synchronized cardioversion is used for unstable ______ with a pulse when the rhythm is amenable to cardioversion.

tachyarrhythmias

What is the shock synced to in synchronized cardioversion?

the r wave

T/F: Synchronized cardioversion is painless

false

______ ______ uses catheter-delivered energy to interrupt an arrhythmogenic focus or pathway.

catheter ablation

T/F: Catheter ablation is used for typical atrial flutter.

true

If you want to tell sinus bradycardia apart from junctional rhythm, what is the key part to look at?

the p wave

junctional rhythm, where does the impulse arise from?

the AV node

junctional rhythm rate

40-60bpm

What are the p waves like on a junctional rhythm?

absent, inverted, or occur after the QRS complex

What is this rhythm?

junctional rhythm

What is this rhythm?

junctional rhythm

What is this rhythm?

sinus bradycardia

What is this rhythm?

sinus tachycardia

The QRS complex in PVC is wide/narrow?

wide (>0.12 seconds)

What rhythm is this?

premature ventricular contraction

T/F: Premature ventricular contractions may be benign or reflect ventricular instability

true, significance rises with symptoms, structural disease, ischemia, or high burden

T/F: In PVCs, there is no preceding sinus P linked to the PVC.

true

PVC- an early, wide, abnormal QRS complex without a preceding P wave, followed by a _____ ____.

compensatory pause

In this procedure, doctors open blocked arteries using a tiny metal balloon and place a small metal mesh tube to keep the vessel open

angioplasty and stenting

____ prevents new clots from forming in coronary arteries

heparin

T/F: A person can have both atrial flutter and AFib

true

a fast, abnormal heart rhythm starting in the heart’s lower chambers that prevents the heart from filling with enough blood to pump to the body

V. tach

Which one is taller, v tach or v fib?

v tach

what rhythm is this?

v fib

what rhythm is this?

v tach

What is treatment for PEA?

CPR and epinephrine

What is treatment for asystole?

CPR and epinephrine

How does cardiac ablasion work?

a doctor creates tiny scars on cells that send faulty electrical signals, allowing a normal to return

T/F: Synchronized cardioversion uses a timed, high-energy electrical shock

false, it uses a low-energy shock

T/F: Defibrillation is used when a patient has a pulse.

false, it is used when a patient has NO PULSE

T/F: Defibrillation is unsynchronized

true

T/F: EVAR is a minimally invasive surgery for AAA that tends to have a quick-recovery.

true