Chapter 8 ECG

Understand the blood flow through the heart

1. Unoxygenated blood enters the right atrium from the superior vena cava. 2. The blood flows through the tricuspid valve into the right ventricle. 3. From the right ventricle, the blood flows through the pulmonic valve into the pulmonary artery. 4. The right and left pulmonary arteries carry unoxygenated blood to the right and left lungs for gas exchange. 5. The blood releases carbon dioxide as waste and picks up a fresh supply of oxygen. 6. The oxygenated blood flows through four pulmonary veins from the lungs into the left atrium. 7. From the left atrium, the blood flows through the bicuspid valve into the left ventricle. 8. Left ventricular contraction forces blood through the aortic valve into the aorta for distribution to the systemic circulation.

Junctional tachycardia occurs when the junctional rate is how many beats per minute?

100-180

The tx for controlling atrial arrhythmias is to first control the heart rate, then use of what to return the atira to a sinus rhythm?

Anticoagulation therapy

A noticeable apical or peripheral pulse rate is usually the only outward sign that a patient has which of the following?

Atrial tachycardia

loss of capture

Loss of capture occurs when pacemaker spikes appear on the patient's EKG tracing but are not followed by the appropriate waveforms.

Failure of the heart to pump oxygenated blood efficiently causing cardiopulmonary arrest, is an example of what type of cardiac compromise?

Mechanical malfunction​

The primary difference between the sinus tachycardia and atrial tachycardia is found in the appearance of which of the following ekg tracing?

P wave

temporary pacemaker

Power source outside the body --Transvenous --Epicardial --Transcutaneous

Junctional Tachycardia

Rate: 100 to 180bpm Regularity: regular P-wave: inverted, absent, or occur after the QRS-complex PR-interval: short or absent

Atrial Tachycardia

Rate: 150-250 beats per minute Regularity: regular P-waves: may be upright or inverted will appear different from underlying rhythm QRS-complex: Normal PR interval- may be normal, shortened, or prolonged

Idioventricular Rhythm

Rate: 20-40bpm Regularity: regular P-wave: absent QRS-complex: wide and bizarre PR-interval: absent

Premature Ventricular Complex

Rhythm Irregular Rate The underlying rate P Wave Absent PR Interval Not measurable QRS Wide (> 0.10 sec), bizarre appearance

Ventricular Asystole

TEA: trans-cutaneous pacemaker, epinephrine, atropine

Which of the following is the absence of any ventricular activity, no depolarization, no pulse, no blood is flowing through the heart, no cardiac output?

Ventricular asystole

Which of the following presents on the ECG as chaotic indistinguishable waves caused by multiple ectopic and reentry paths originating from many different areas in the ventricle walls, yet has no recognizable rhythm or pattern?​

Ventricular fibrillation

Which of the following does not allow the heart to rest between contractions (depolarization)?

Ventricular tachycardia

ventricular tachycardia

a very rapid heartbeat that begins within the ventricles

supraventricular arrhythmia

arrhythmia that originates above the AV node in the atria

What type of pacemaker rhythm is shown in the ECG tracing below?​

atrial pacing rhythm

Left untreated, some atrial arrhythmias can cause what to form in the heart?

blood clots

permanent pacemaker

changes in pulse rate in rythem may indicate pacer failure dizziness may be due to decreased heart rate leading to decreased cardiac output; should carry a card in wallet with type and serial number of pacemaker; report redness and tenderness - s/s infection

What type of pacemaker ECG reading does the tracing below represent?​

dual chamber pacing rhythm

acute myocardial infarction

heart attack

normal sinus rhythm

heart rhythm originating in the sinoatrial node with a rate in patients at rest of 60 to 100 beats per minute

In a pacemaker ekg, if a spike appears by itself with no p wave and no qrs complex, it is called what?

loss of capture

junctional tachycardia rhythm

may have an inverted or absent P wave or a P wave that follows the QRS complex. Heart rate is between 100 and 150 bpm

In atrial arrhythmias, the atrioventricular (AV) node overrides the SA node impulses and the AV node becomes the heart's____________.​

pacemaker

The ECG tracings in this picture are very short vertical straight lines which can be as small as 2 ms. What do these tracings represent?​

pacemaker spikes

Accelerated Junctional Rhythm

regular rhythm, rate 60-100, p waves inverted or occur before during or after QRS, PRI measured if p before QRS <0.12

what are the types of pacemakers?

temporary permanent asynchronous synchronous

junctional rhythm

the SA node is nonfunctional, P waves are absent, and heart is paced by the AV node at 40-60 beats/min

ventricular fibrillation

the rapid, irregular, and useless contractions of the ventricles

In what type of rhythm will ventricular pacemaker spikes be seen before each QRS complex and normally, no atrial spikes are visible, and P waves may not be visible, except possibly in precordial lead V1?​

ventricular pacing rhythm

Which of the following is the use of high electrical energy to destroy abnormal electrical pathways?

​Ablation

Blockage of one or more coronary arteries that supply blood to the left ventricle is usually the cause of which of the following?

​Acute myocardial infarction

Which of the following weakens an arterial wall and can cause the vessel to rupture?

​Aneurysm

What cardiac medication would be given if the indication is bradycardia?

​Atropine

When medication no longer controls tachycardia, which of the following may be implanted into the patient to control these life threatening arrhythmias

​Implantable cardioverter defibrillator

What is defined as a decrease in oxygenated blood flow to the heart muscle?

​Ischemia

Untreated ischemia causes injury to what part of the heart?

​Myocardium

What cardiac medication would be given if the indication is an acute coronary syndrome?

​Nitroglycerin

Over sensing or under sensing pacemakers can be detected on an ekg when the pacemaker fails to sense intrinsic what?

​P or R waves

What condition is where the heart muscle cannot contract even though electrical activity appears on the ekg?

​Pulseless electrical activity

An ekg tracing from a patient with a pacemaker may have wide or bizarre what if the pacemaker captures the chamber it is pacing?

​QRS complexes

What is the largest cause of natural deaths in the US?

​Sudden cardiac arrest

What type of heart rates occur more commonly in infants, children, and young adults who are anxious or extremely fatigued?

​Supraventricular tachycardia

A patient in a asystole is not defibrillated as this is what type of condition?

​Terminal

Which of the following is considered a very unstable rhythm that is usually a precursor to ventricular fibrillation or sudden cardiac death?​

​Ventricular tachycardia

Embolic strokes often form in the heart due to what?

​bradycardia

When the heartbeat originates outside of the the SA node, it is called what?

​ectopic beat

When the malfunction is ________________, the ECG will show no pacemaker spikes on the ECG tracing.​

​failure to pace

How do you recognize if a patient has a pacemaker or defibrillator?

​stimulus

Except for ______________, in the other ventricular arrhythmias, the P wave is non-existent, so there is no atrial depolarization, no atrial contraction, and no atrial kick.​

​ventricular tachycardia

An abnormal ST segment may appear on an EKG with which of the following wall injuries?

Acute ischemia or injury in Leads II, III, and aVF with an inferior wall injury