therapeutics exam 3! (ECG STRIPS module 8)

Supraventricular tachycardia

- HR is very fast (up to 250 bpm), occurs suddenly and may respind to vagal maneuvers - p wave is often undetectable because it is hidden in preceding QRS - unable to assess PR interval - QRS duration is normal (0.10 sec), less than 2.5 small squares

ventricular fibrillation

- PT WILL NOT HAVE A PULSE (needs defibrillation and CPR) - no p waves or QRS complexes are identifiable. complete chaos, ventricles quivering (one big squiggly line) - fibrillation can be course or fine, may be mistaken for asystole if really fine

first degree heart block

- Rate usually slower, conduction is slowed as it moves through the AV junction - P waves are upright and uniform (all look similar) - Each P wave is followed by a QRS and each QRS is preceded by a P wave - PR interval is prolonged (longer than 3-5 small squares) (> 0.20 sec) - PR interval is consistently long (approx. same length for all beats) - QRS duration is normal (< 0.10 sec), less than 2.5 small squares

PVCs

- not an arrythmia itself, but abnormal beats originating from somewhere in the ventricles - p waves are absent preceding a PVC (since the impulse does not originate in the atria - the PVA QRS duration is prolonged (wide, bizarre appearance), other than QRS complexes may be normal - unifocal (uniform) PVC's look different (impulses originate from the same focus/location in the ventricles) - multifocal PVC's look different (impulses originate from multiple foci/locations in ventricles) - if a PVC occures every other beat, it is termed bigeminy - if a PVC occurs every third beat, it is termed trigeminy - if 3 or more PVC's occur in a row, it is termed a "run on V-tach"

bradycardia

- rate is low (< 60 bpm), rhythm can be regular or irregular -p waves are upright and uniform (all look similar) - each p wave is followed by a QRS and each QRS is preceeded by a p wave - PR interval is normal (3-5 small squares) 0.12-0.20 sec - QRS duration is normal (<0.10 sec), less than 2.5 small squares

third degree (complete heart block)

- rate is usually very slow (60 or less) -p waves are present and normal - no relationship between P waves and QRS complexes

second degree heart block type 2 (mobitz II)

- rate varies, rhythm irregular - p waves are present and occur at a regular rhythm (p waves regular, NOT QRS complexes) - some p waves are not followed by a QRS - each QRS is preceded by a p wave - QRS duration is normal (<0.10 sec), less than 2.5 small squares. QRS not present with dropped beats

second degree heart block 1 (mobitz I, wenckebach)

- rate varies, rhytm irregular -progressive delay in conduction leading to a dropped beat (nonconducting p wave), p waves are present - some p waves are not followed by a QRS - each QRS is preceded by a p wave - PR interval becomes progressively longer until a dropped beat (longer than 3-5 sm sq) (0.20 sec) - QRS duration is normal (<0.10), less than 2.5 small squares. QRS not present with dropped beats

atrial fibrillation

- rhythm is usually irregular, rate depends on rate of AV conduction - multply ectopic foci in the atria firing off cresting ineffective impulses, atria quiver rather than contract - no p waves between QRS complexes, just fibrillation (squiggly line) -QRS duration is normal (0.10 sec), less than 2.5 small squares

ventricular tachycardia

- sustained PVC's in a row, rate > 100 bpm - if the pt does not have a pulse, it is termed pulseless v-tach (patient needs defibrillation and CPR) - p waves are absent (since the impulses do not originate in the atria -QRS duration is prolonged (wide, bizarre appearance)

atrial flutter

- ventricular rate usually normal, atrial rate 200-350, rhythm may be regular or irregular - p waves appear in a sawtooth or sharktooth pattern - multiple nonconducting flutter p waves before each QRS -QRS duration is normal (0.10 sec), less than 2.5 small squares

tachycardia

-rate is high (>100 bpm), rythm can be regular or irregular - p waves are upright and uniform (all look similar) - each p wave is followed by a QRS and each QRS is preceeded by a p wave - PR interval is normal (3-5 small squares) 0.12-0.20 sec QRS duration is normal (<0.10 sec), less than 2.5 small squres (ECG interpretation guide ppt slide 3)

asystole

FLAT LINE - no electrical activity, PT DOES NOT HAVE A PULSE (pt needs CPR) not a shockable rhythm - no p waves or QRS complexes are identifiable. complete chaos, ventricles quivering (one big squiggly line) - always confirm asystole in another lead to make sure it's not fine v-fib

normal sinus rhythm (NSR)

normal rate of 60-100 bpm, rhythm is regular - p waves are upright and uniform (all look similar) - each p wave is followed by a QRS and each. QRS is proceeded by a P wave - PR interval is normal (3-5 small squares) 0.12-0.20 sec QRS duration is normal (<0.10 sec), less than 2.5 small squares (ECG interpretation guide ppt slide 3)