Identifying EKGs

starts 7 min into the presentation

What is Premature Ventricular Contraction (PVC)?

early beat which originates from ventricles not SA node; ectopic beat

What does this EKG represent?

represents PVC

What does this EKG represent?

represents PVC bigeminy

What does this EKG represent?

represents PVC trigeminy

What does this EKG represent?

represents PVC quadrigeminy

What are the causes for PVC?

exercise, stress, too much caffeine, electrolyte imbalances, digoxin toxicity, hypoxia, MI, or most heart disease processes

What is the medical treatment for PVC?

treat underlying cause, such as eliminating caffeine, manage stress, correct electrolyte imbalance

What is “special” about Symptomatic PVCs?

they can be treated with beta blockers

How are Paced Rhythms represented?

via distinct pacing spikes

What does this EKG represent?

Paced Rhythm

What is the common demand for Paced Rhythm?

Demand Pacemakers; they send out electrical impulse when the heart rate falls below a preset rate

What does this EKG represent?

Ventricular Tachycardia

How can we identify Ventricular Tachycardia?

via wide QRS complexes, and we can’t really see and P waves / T waves due to the heart beating so quickly

What is Ventricular Tachycardia (VT)?

ventricles aren’t adequately pumping blood; LIFE THREATENING

What are the causes for Ventricular Tachycardia?

ischemic heart disease, cardiomyopathy, congenital coronary artery abnormalities, cocaine and other drugs, digoxin toxicity, potassium imbalance

What are S/S of Ventricular Tachycardia?

patient might have dizziness, shortness of breath, chest pain, palpitations, or faint

What are some nursing interventions for Stable VT?

antiarrhythmic drugs such as sotalol or amiodarone. Carefully
monitor EKG, BP, and pulse

What are some nursing interventions for Unstable VT?

symptomatic patients are cardioverted, pulseless are defibrillated

What does this EKG represent?

Sinus Tachycardia

What is Sinus Tachycardia?

rapid, regular rhythm originating in the SA node. It’s characterized by a heart rate about 100 BPM; Alarming above 150 BPM

What are the causes for Sinus Tachycardia?

exercise, anxiety, fever, shock, heart failure, excessive caffeine, drugs, and tobacco use

What is the medical treatment for Sinus Tachycardia?

vagal maneuvers, treating the underlying cause

What does this EKG represent?

Sinus Bradycardia

What is Sinus Bradycardia?

slow rhythm that originates in the SA node. It is characterized by a heart rate less than 60 BPM

What are the causes for Sinus Bradycardia?

advancing age, inflammatory heart condition, hypothyroidism, myocardial infarction, normal resting rate for athletes, increased intracranial pressure, sinus node dysfunction, and medications (overdose of digoxin, beta blockers, and calcium channel blockers)

What is the medical treatment for Sinus Bradycardia?

treat underlying condition, atropine, or pacemaker

What does this EKG represent?

Sinus Rhythm

What is a Sinus Rhythm?

a regular rhythm with a rate of 60 - 100 BPM. There is a P wave before every QRS complex and a T wave after every QRS

What does this EKG represent?

Atrial Fibrillation

What is Atrial Fibrillation characterized by?

wavy baseline, P waves irregular / absent - atria quivering with irregular QRS complexes

What are the causes of Atrial Fibillation?

advancing age, hypertension, alcohol consumption, diabetes, asthma, cardiomyopathy, MI, and cardiac surgery

What is the medical treatment for Atrial Fibrillation?

beta blockers, calcium channel blockers, digoxin, cardioversion, or ablation

What do patients with Atrial Fibrillation have higher chance for?

clots, making them at risk for pulmonary embolus / stroke— likely need an anticoagulant

What does this EKG represent?

3rd Degree Heart Block (Complete Heart Block)

What is 3rd Degree Heart Block?

complete failure of the heart conduction system; the electrical signal from the atria isn’t making it to the ventricles— less QRS complexes
than P waves. No pattern or relationship noted between P waves to QRS.

“If your ps and qs don’t agree, then you have a 3rd degree”

What might the patient experience with 3rd Degree Heart Block?

hypotension, angina, and bradycardia; the HR is often 30 - 40 BPM

What is the medical treatment for 3rd Degree Heart Block?

atropine or pacemaker for irreversible heart blocks

What does this EKG represent?

Supraventricular Tachycardia (SVT)

What is SVT characterized by?

rate of 150 - 250 BPM. The P waver may be tween, but is mostly hidden in the T wave.

What is the medical treatment for SVT?

vagal maneuvers (bearing down like having a BM / breathing thru a straw), adenosine, calcium channel blockers, or cardioversion

How does the cardioversion work regarding SVT?

involves delivering a synchronized electric shock to the heart using defibrillator pads or paddles. This is often done in a hospital setting under sedation

Why is the shock delivered on the R wave of the QRS complex for SVT?

if it lands on a T wave it could throw the patient into ventricular arrhythmia

What does this EKG represent?

Asystole

What is Asystole?

the heart has no electrical activity and no pumping of the blood; looks like a flat line. This is LIFE THREATENING, and the heart needs to be restarted

What is the medical treatment for Asystole?

CPR and cardiac medications are given in hopes to restart the heart’s electrical activity and pump. DO NOT SHOCK THIS RHYTHM!

What does this EKG represent?

Ventricular Fibrillation

What is Ventricular Fibrillation?

quivering of the ventricles instead of coordinated forceful contraction. LIFE THREATENING— ALWAYS PULSELESS

What is Ventricular Fibrillation caused by?

CAD resulting in Myocardial Infarction (MI), untreated VT, previous MI, cardiomyopathy, illegal drugs

What is the medical treatment for Ventricular Fibrillation?

immediate defibrillation. Ideally within 15-20 seconds of onset and CPR

What does this EKG represent?

Atrial Flutter

What is Atrial Flutter?

multiple P waves for every QRS complex causes “flutter waves”. It’s treated similarly to Atrial Fibrillation.

often described as “sawtooth” pattern

What is the medical treatment for Atrial Flutter?

beta blockers, calcium channel blockers, digoxin, cardioversion, or ablation. Patient should be on anticoagulants to prevent thrombus