Hallmark signs of ekg

  1. upright, rounded P-Waves
    Sinus rhythm
  2. Sinus Rhythm
    upright and rounded P-Waves
  3. HR less than 60, all other parameters WNL
    Sinus Bradycardia
  4. Sinus Bradycardia
    HR less than 60, all other parameters WNL
  5. Sinus Tachycardia
    HR 100-150, all other parameters WNL
  6. HR 100-150, all other parameter WNL
    Sinus Tachycardia
  7. irregular pattern that varies with respiration, all other parameters WNL
    Sinus Arrhythmia
  8. Sinus Arrhythmia
    irregular pattern that varies with respirations, all other parameters are WNL
  9. Sick Sinus Syndrome, what is it?
    • HR speeds up and slows down because the SA Node malfunction related to ischemia or fibrosis
    • Rate will vary through out strip
    • will need permanent pacemaker
    • AKA tachy-brady syndrome
  10. the P-Waves are different and the PRI varies
    Wandering Atrial Pacemaker

    the pacemaker switches from beat to beat, from the SA node to the atria and back
  11. wandering atrial pacemaker
    the P-Waves are different and the PRI varies

    pacemaker switches from beat to beat, from SA node to atria and back
  12. what is a PAC
    • premature meets usually indicate irritability in the area of myocardium in which they arise
    • PACs are not generally considered to be very significant since they do very little to affect the cardiac output
    • An increasing number of PACs a min may indicate the imminent onset of A Fib or A Flutter
  13. PACs
    a premature beat with atypical P-Wave appearance, but have a normal PRI and QRS
  14. Atrial tachycardia
    rapid rate with atypical P-Waves, normal PRI and QRS
  15. Rapid rate with atypical P-waves, normal PRI and QRS
    Atrial Tachycardia
  16. Atrial Flutter
    • Sawtooth appearance of the flutter waves
    • irritability in the atria
    • No P-Waves (the saw tooth pattern indicates the generation of many impulses in the atria)
  17. sawtooth appearance
    atrial flutter
  18. Atrial Fibrillation
    • Loss of Atrial Kick may seriously affect the patients ability to maintain adequate cardiac output
    • No P-wave
    • grossly irregular rhythm, rate less than 100=controlled, greater than 100=uncontrolled (cardioversion if unstable)
    • May order Dig to control the rate
  19. Junctional Escape Rhythm premature  beat with inverted P-Wave
    premature  beat with inverted P-Wave occurring before, during or after QRS with a rate of 40-60 BPM
  20. Premature beat with inverted P-Wave occurring before, during  or after the QRS with a rate of 40-60 BPM
    • Junctional Escape Rhythms
    • Assess for S/S of low cardiac output
    • (Atropine .5-1mg IVP)
  21. Accelerated Junctional Rhythm
    premature beat with inverted P-Wave occurring before, During or after QRS with a rate of 60-100 BPM
  22. Junctional Tachycardia
    premature beat with inverted P-Wave occurring before, during or after the QRS with rate of 100-150BPM
  23. Supraventricular Tachycardia
    the appearance of no definite or recurring P-Wave with normal QRS, rate is greater than 150
  24. 1st Degree Heart Block
    • conduction of supraventricular impulses is delayed longer than normal in the AV node
    • PRI is greater than 0.20 and QRS is WNL (<0.12)
    • usually asymptomatic
    • indicates some degree of damage to the conduction system in the AV node
    • rate generally 60-100 (depends on underlying rhythm)
  25. 2nd degree heart block Wenckebach
    progressively lengthening PRI, until dropped beat occurs; irregular with grouped beating
  26. Classical 2nd Degree Heart Block
    the PRI is constant for conducted beats and there is 2 or more P-Waves for every QRS complex
  27. Third degree heart block
    • Medical Emergency
    • there is no constant PRI, P-Waves and QRS complexes are regular, but there is no relationship
    • Asynchronized pacing set to fire constantly regardless of the underlying
    • Atropine 0.5-1mg at bedside, admin O2, pacemaker
  28. what happens in ventricular rhythms
    • the ventricles become the heart pacemaker
    • QRS greater than 0.12
  29. PVCs
    • Wide QRS with a T-wave deflected in the opposite direction of the wave
    • Lidocaine bolus 1-1.5mg/kg followed by gtt at 2-4mg/min
    • Amiodarone 300mg IVP followed by gtt 150mg
    • Procanimide
    • Oxygen
    • decrease activity
  30. Idioventricular Rhythm
    • generated low in ventricle
    • Wide QRS, Bizarre QRS, T-Wave usually deflected in the opposite direction of the R-Wave Rate 20-40
    • Atropine 0.5-1mg IVP
    • Notify Physician
  31. Wide QRS, bizarre QRS, T-Wave usually deflected in the opposite direction of the R-Wave, Rate 20-40
    Idioventricular rhythm
  32. Accelerated Idioventricular Rhythm (AIVR)
    Wide QRS (greater than 0.12), bizarre QRS, T-Wave usually in the opposite direction of the R-Wave with a rate of 40-150 BPM
  33. Wide QRS, bizarre QRS, t-wave usually in the opposite direction of the R-wave, waith a rate of 40-150
    • AIVR
    • Accelerated Idioventricular rhythm
  34. Wide, bizarre QRS complexes, T-Wave in the same direction as the R-Wave, rate 150-250
    Ventricular Tachycardia
  35. Ventricular Tachycardia
    • Wide, bizarre QRS complexes, T-Wave in the direction of the R-wave, rate 150-250
    • Unstable (unconscious) treat ssame as V-Fib and D-Fib
    • if conscious Lidocaine 1-1.5mg/kg bolus followed by gtt (2-4mg)
    • Assess, raise HOB, Do Not Leave Unattended!
  36. twisting of the points, type of V-Tach, the polarity of QRS changes from +  to - and vice versa
    Torsades de Pointes
  37. Torsades de Pointes
    • twisting of the points
    • type of V-Tach where the Polarity of QRS flips + are - and - are +
    • Cardioversion or defibrillation are treatments
  38. Ventricular Fibrillation
    • totallychaotic baseline with no discernable waves or complexes
    • Defib 200, 300, 360
    • CPR
  39. Bundle Branch Block
    • QRS 0.12 or greater
    • impulse wil travel along unaffected branch and activate the ventricle normally but the impulse is delayed in reaching the other ventricle because it has to go down a different pathway, Makes the ventricles depolarize sequentially instead of together. You will see a wide QRS pattern with 2 peaks
  40. Asytole
    there is no electrical activity and has flat baseline
  41. ST Depression =
  42. ST Elevation =
  43. Hypokalemia =
  44. Cardioversion is
  45. Defibrillation is
    • nonsynchronized
    • 200,300,360 (check pulse between)
  46. Pacemaker terminology
    the pacemaker has discharged an adequate electrical impulse and depolarization has occurred
  47. Pacemaker terminology
    • when a pacemaker spike fails to produce the desired effect (atrial or ventricular depolarization)
    • May result from: Low mA setting, Lead placement is in scarred tissue, or drifting of the lead wires away from the muscle wall
  48. Pacemaker Terminology
    Demand PAcing
    • the pacer is set to fire when the patient's heart rate falls below a set rate
    • Synchronous demand pacing means that a generated impulse occurs as needed basis
    • Asynchronous demand pacing is when the pacemaker is programmed to fire continuously at a fixed rate regardless of the underlying rhythm
  49. Pacemaker terminology
    means the pacemaker is "set" to detect the patient's own heart rhythm
  50. pacemaker function depends on the programming sequence or settings, each one represented by a letter
    • 1st letter identifies the chamber being paced
    • 2nd letter identified the chamber in which the pacer can sense the patient's electrical activity
    • 3rd letter tells one what the pacer does in response to sensing patient's own electrical activity
    • 4th letter tells the sophistication of the pacer (may not have 4th letter)
    • A=Atrial, V=Ventricle, D=Dual, O=Nothing
  51. ICD is multifunctional, what does it provide?
    • Anti-tachycardic pacing
    • bradycardic backup
    • synchronized cardioversion
    • defibrillation
    • pacing
Card Set
Hallmark signs of ekg
hallmark signs of ekg