MS2 T1 - EKG & interpretations

cardiac output

HR x SV

pulmonary vein

only vein in body that carried oxygenated blood

pulmonary circulation

blood travels through capillaries in the alveoli for gas exchange

lung only

systemic circulation

blood travels to the rest of the body to provide oxygenated blood

coronary circulation

apart of systemic

arteries supply blood to myocardium

conduction system order

SA node

AV node

bundle of HIS

bundle branches (R&L)

purkinje fibers

cardiac conduction system

will affect CO if there is problem

creation & transportation of electrical impulse

specialized SA node cells responsible for creating electrical impulse leadings to ventricular contraction

sinoatrial node (SA node)

@ right atria

each electrical impulse travels through interatrial pathways to depolarize atria

primary pacemaker / natural pacemaker

creates P wave on EKG

lack of P wave or neg deflection means malfunction of node

atrioventricular node (AV node)

@ floor of R atrium

secondary pacemaker / backup pacemaker → firing rate of 40-60 bpm

PQRST =

1 lub dub, 1 pulse, 1 CO, 1 SV

P wave

represents depolarization of the L & R atria

normal is <0.12 sec (120 milisec) or less than (or about) 3 small boxes

QRS complex

represents ventricular depolarization (contraction period)

normal is <3 boxes or <120 ms

T wave

represents repolarization of ventricles

refractory period (bounce back)

P wave duration

0.08 - 0.12 sec (80 - 120 ms)

2 - 3 small boxes

PR interval duration

0.12 - 0.2 sec (120 - 200 ms)

3 - 5 small boxes

QRS complex or interval duration

<0.12 sec

<3 small boxes

NSR qualifications

P wave → present, upright & identical, <0.12 sec

QRS complex → <3 small boxes, after P wave, <0.12 sec

PR interval (PRI) → 3 - 5 small boxes (1 big box)

Rate → 60 - 100 bpm

Rhythm → regular (= RR duration)

ST segment → no elevation

T wave → upright & identical

ST segment

time between ventricular depolarization & repolarization

resting phase

normally isoelectric (elevation means MI, depression may mean ischemia)

small box duration

0.045 sec

big box duration

0.2 sec

6 second strip is how many boxes

30 big boxes

abnormal EKG

atrial → atrial flutter & atrial fibrillation (A.fib)

junction → junctional rhythm (JR), accelerated JR, junctional tachy

AV block 1°

ventricle → v tach, v.fib

sinus → SVT, tachy, block

A.fib

70% to get stroke

hard to count P waves (or cannot count at all) but QRS clear

atrial flutter

countable P waves

SA node not firing electrical pulses → comes from 3 areas to make QRS

junction (secondary pacemaker)

HR < 60

none or downward p wave

junctional rhythm

HR 40 - 60

accelerated junctional rhythm (AJR)

HR 60 - 100

junctional tachy

HR > 100

AV block (1°)

PRI > 0.2 sec

for all types best tx is pacemaker

v tach

use carotid artery

must be consistent w/ every QRS

no T, P, QRI wave

VTCP

VTSP

VTCP

w/ pulse

if pt is asleep wake them up

tell pt to bear down as if constipated

NOT shockable

VTSP

w/o pulse call code → start CPR

SHOCKABLE

V.fib

if asleep → call code → start CPR

SHOCKABLE

SVT

HR > 150

sinus tachy

HR 101 - 150

adinosin tx

sinus block

RR <60

everything norm just slow → bradycardia

atropine & pacemaker tx

artificial (pacemaker)

atrial → spike b4 P wave

ventricular → spike b4 QRS

atrioventricular → spike both

biventricular → 3

nonelectric / asystole

asystole → clinical death

pulseless electrical activity (PEA)

• rhythm but no pulse

artificial pacemaker rhythms

nonshockable rhythms (CPR only)

asystole

PEA

VT w/ pulse

shockable rhythms

AV blocks

VT w/o pulse

V.Fib

bradycardia s&s

Chest pain

Hypotension

Altered mental status

Dizziness & fainting

med for bradycardia

atropine

sinus arrest

> 10 sec

sinus pause

< 2 sec

sinus arrest risk factors

ischemia, MI, damage of SA node

drug side effects (digitalis or salicylates)

A flutter causes

some may not find cause

cardiac disease (MI, HTN, SA node disease, etc)

disease in body that affects the heart (COPD, PE, hypoxia)

substances that change the way the heart transmits electrical impulses (digitalis toxicity, drug abuse, etc)

age

A flutter treatment

antiarrhythmic agents

• amiodarone, adenosine, digoxin, cardizem

anticoagulant

• coumadin, pradaxa, lovenox

• reduces risk of clots & stroke

AFib characteristics

no discernable P wave d/t atrial quivering

bpm 400 - 600

palpitations, tachy, weakness, dizziness, lightheadedness, reduced exercise capacity, mild dyspnea

AFib treatment

beta-blockers

• metoprolol

calcium channel blockers

• cardizem, procardia, norvasc

JR characteristics

40 - 60 bpm

normally do not have P wave or has inverted P wave (b/c conduction is backwards)

AJR BPM

> 60 - 100

JT BPM

> 100

VT treatment

asymptomatic & non sustained DO NOT require treatment

symptomatic &/or sustained req immediate action

VTCD

w/ a pulse

DONT called code blue or start CPR

VTCD treatment

regular & monomorphic

• adenosine

irregular or polymorphic

• amiodarone

VT w/o pulse treatment

call code immediately then start CPR

defibrillation ASAP

1st degree heart block symptoms

often no symptoms

detected during routine EKG

HR & rhythm are usually normal