EKG Study Guide

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Check the sensor and cable attachments

A nurse has just attached a cardiac monitor to a patient and she notes "chaotic electrical activity" on the monitor. It looks like Ventricular Fibrillation. After she makes certain that the patient is responsive, what is the next task she should perform?

Ventricular Tachycardia (V-Tach)

A sequence of three PVCs in a row is ventricular tachycardia. The rate will be 120-200 bpm. This rhythm has two variations, monomorphic and polymorphic. These variations are discussed separately.

Every second complex

Bigeminy PVC's are occur how often in a cardiac tracing?

the device delivers an electrical impulse of sufficient strength to result in depolarization

Capture refers to which of the following?

Thirty

How many large boxes are in six seconds?

Left BBB

Identify the branch bundle block.

Right BBB

Identify the branch bundle block.

Bundle of His

In Third Degree Heart Block, the tracing demonstrates a narrow, normal appearing QRS complex at a rate of 52. Which region of the heart is the likely locus of stimulation?

At least a portion of the P wave is positively deflected

In addition to Premature Atrial Complexes being an early cardiac complex in a rhythm strip; which morphologic feature most closely identifies this complex as being atrial rather than another locus of stimulation?

P waves are inverted or buried.

In addition to premature junctional complexes being an early cardiac complex in a rhythm strip; which morphologic feature most closely identifies this complex as being junctional rather than another locus of stimulation?

Always treat the patient, not the monitor

In cardiac monitoring it is best to always

Left leg (foot)

In lead aVF the sensor is placed on the

Atrial Fibrillation (A-Fib)

Irritable sites in the atria fire very rapidly, between 400-600 bpm. This very rapid pacemaking caused the atria to quiver. The ventricles beat at a slower rate due to the AV node's blocking of some of the atrial impulses.

Wandering Atrial Pacemaker

Is an irregular rhythm. In is similar to multifocal atrial tachycardia but the heart rate is under 100 bpm. P waves are present but will vary in shape.

Junctional Escape Rhythm

Junctional escape beats originate in the AV junction and are late in timing. They often occur during sinus arrest or after premature atrial complexes. The QRS complex will be measured at 0.10 sec or less. Rhythm will be regular with a rate of 40-60 bpm.

Left arm and right arm

Lead I is formed by which two locations?

Right arm and left leg

Lead II is formed by which two locations?

Left arm and left leg

Lead III is formed by which two locations?

the generator is unable to deliver a sufficient amount of energy to cause depolarization.

Loss of Capture refers to which of the following?

the device interprets non-cardiac sources of energy as being cardiac. This results in the device not turning on when it should.

Oversensing refers to which of the following?

Sinus Tachycardia

Rhythm is a normal sinus rhythm but with a heart rate over 100 bpm. It is a normal response to exercise, excitement and some illnesses.

Sinus Arrhythmia

Rhythm looks normal except for slight irregularities. A frequency cause of this rhythm can be rhythm variations caused by respiration.

143

Select the heart rate most closely associated with this tracing.

200

Select the heart rate most closely associated with this tracing.

Select the heart rate most closely associated with this tracing?

0.10 seconds (2 ½ small boxes)

Select the number that most closely represents the QRS complex duration.

316

Select the number that most closely represents the atrial rate.

103

Select the number that most closely represents the heart rate.

110

Select the number that most closely represents the heart rate.

40 (four complete complexes)

Select the number that most closely represents the heart rate.

200

Select the number that most closely represents the ventricular rate.

Run of Ventricular Tachycardia

Select the term that most closely describes the abnormality in this tracing.

There are two sensors on the skin surface completing the circuit for that view

Some leads are referred to as bipolar because?

Only one sensor on the skin surface

Some leads are referred to as unipolar because

Ventricular depolarization

The QRS complex measurement represent the period of time for which of the following?

Left arm

The ground for Lead II is located on the

Right arm

The ground for Lead III is located on the

Left shoulder (arm)

The lead aVL the positive pole is located on the

Right shoulder (arm)

The lead aVR the positive pole is located on the

Try to talk to patient while immediately checking leads

The nurse walks into patient room and notices the patient monitor displaying a flatline. Does the nurse:

Atrial Flutter

There are two types of atrial flutter. Type I (also called classical or typical) has a rate of 250-350 bpm. Type II (also called non-typical) are faster, ranging from 350-450 bpm. EKG tracings will show tightly spaced waves or saw-tooth waveforms (F-waves).

Junctional Tachycardia

This abnormal rhythm originates in the bundle of His. It is observed as three or more premature junctional complexes (PJCs) appearing in a row. Heart rate will be over 100 bpm.

Normal Sinus Rhythm

This is the normal rhythm of the heart. The electrical impulse originates within the SA node and travels through the atria to the AV node. After a brief delay, the impulse travels down the bundle branches, thought the Purkinje fibers to the ventricles.

Premature Atrial Complex

This occurs when an ectopic sites within the atria fires an impulse before the next impulse from the SA node. If the ectopic site is near the SA node, the P wave will likely have a shape similar to a sinus rhythm. But this P wave will occur earlier than expected.

Wolff-Parkinson-White Syndrome (WPW)

This occurs when the impulse travels between the atria and ventricles via an abnormal path, called the bundle of Kent. The impulse, not being delayed by the AV node, can cause the ventricles to contract prematurely. EKG characteristics include a shorter PR Interval, longer QRS complex and a delta wave.

Ventricular Tachycardia Polymorphic

This rhythm has QRS complexes that very in shape and size. If the rhythm has a long QT Interval, it could be Torsade de Pointes.

Sinus Pause

This rhythm includes sinus arrest and sinus exit block. Sinus arrest is caused by failure of the SA node to create an impulse. An interruption in R-R regularity can be observed. With sinus exit block the SA node generates an impulse but it is blocked before being transmitted through the atria. R-R regularity continues with the beats that follow the missed beat. Depressed ST segments can also be observed.

Second Degree Heart Block: Mobitz Type 1 (Wenckebach Block)

This rhythm is a Type I, some impulses are blocked but not all. More P waves can be observed vs QRS Complexes on a tracing. Each successive impulse undergoes a longer delay. After 3 or 4 beats the next impulse is blocked. On an EKG tracing, PR Intervals will lengthen progressively with each beat until a QRS Complex is missing. After this blocked beat, the cycle of lengthening PR Intervals resumes. This heart block is also called a Wenckebach block.

Sinus Bradycardia

This rhythm is a sinus rhythm with a rate of 40-60 bpm.

Idioventricular Rhythm (IVR)

This rhythm is a slow rhythm of under 50 bpm. It indicates that then ventricles are producing escape beats.

Torsades de Pointes

This rhythm is a special form of ventricular tachycardia. The QRS complexes vary in shape and amplitude and appear to wind around the baseline.

First Degree Heart Block

This rhythm is actually a delay rather than a block. It is cause by a conduction delay at the AV node or bundle of His. This means than the PR Interval will be longer than normal (over 0.20 sec.).

Asystole

This rhythm is the state of no cardiac electrical activity and no cardiac output. Immediate action is required.

Failure to Capture

This rhythm means that the ventricles fail to response to the pacemaker impulse. On an EKG tracing, the pacemaker spike will appear but it will not be followed by a QRS complex.

Failure to Sense

This rhythm means that the ventricles fail to response to the pacemaker impulse. On an EKG tracing, the pacemaker spike will appear but it will not be followed by a QRS complex.

Premature Ventricular Complexes (PVCs)

This rhythm occur when a ventricular site generates an impulse. This happens before the next regular sinus beat. Look for a wide QRS complex, equal or greater than 0.12 sec. The QRS complex shape can be bizarre. The P wave will be absent.

Premature Junctional Complex (PJC)

This rhythm occurs when an irritable site within the AV node fires an impulse before the SA node. This impulse interrupts the sinus rhythm. The QRS complex will be narrow, usually measured at 0.10 sec or less.

Accelerated Junctional Rhythm

This rhythm occurs when the AV junction fires impulses at above 60 bpm. Rhythm will be very regular. The QRS complex is narrow (0.10 sec or less).

Ventricular Tachycardia Monomorphic

This rhythm occurs when the electrical impulse originates in one of the ventricles. The QRS complex is wide. Rate is above 100 bpm.

Failure to Pace/Fire

This rhythm occurs when the pacemaker does not generate an electrical impulse. On an EKG tracing, pacemaker spikes will be missing.

Accelerated Idioventricular Rhythm (AIVR)

This rhythm occurs when three or more ventricular escape beats appear in a sequence. Heart rate will be 50-100 bpm. The QRS complex will be wide (0.12 sec. or more).

Ventricular Fibrillation (V-Fib)

This rhythm originates in the ventricles and it chaotic. No normal EKG waves are present. No heart rate can be observed. The rhythm is an emergency condition requiring immediate action.

Supraventricular Tachycardia (SVT)

This term covers three types of tachycardia that originate in the atria, AV junction or SA node.

a device that doesn't know when to turn off.

Undersensing refers to which of the following?

Triplet or Salvo PVC's

What is another name for Run of Ventricular Tachycardia?

0.18 seconds

What is the PR interval measurement in this tracing?

No PR interval to measure

What is the PR interval measurement in this tracing?

0.08 seconds

What is the PR interval measurement?

Absent, due to lack of P waves

What is the PR interval measurement?

0.06 seconds

What is the QRS complex duration measurement?

Heart rate greater than 100 bpm

What is the difference between Accelerated Idioventricular Rhythm and Ventricular Tachycardia?

3.52 seconds

What is the duration of the pause in this tracing?

10 mm/mV

What is the gain set to in standard calibration?

What is the heart rate in this tracing?

What is the heart rate of the tracing below?

Biphasic

What is the most correct description of the P wave in the fifth complex?

Couplet PVC's

What is the most correct interpretation of the abnormality in this tracing?

Ventricular Pacemaker with Loss of Capture

What is the most correct interpretation of this tracing.

Atrial Fibrillation with Rapid Ventricular Response