EKG Interpretation Quiz

Questions and Answers

What treatment should be administered if a patient exhibits pulseless Ventricular Tachycardia?

Cardioversion

Immediate defibrillation and CPR (correct)

Beta-adrenergic blockers

Amiodarone

What is a common cause of Ventricular Tachycardia (V-tach)?

Coronary artery disease (CAD) (correct)

Atrial fibrillation

Severe hypothermia

Hypotension

Which of the following symptoms is typically associated with Ventricular Fibrillation (V-fib)?

Weak or absent pulse (correct)

P wave visible in the ECG

Rapid heartbeat over 150 bpm

Persistent high blood pressure

What defines targeting treatment for stable Ventricular Tachycardia with monomorphic QRS complexes?

ACLS followed by amiodarone Signup and view all the answers

What is the heart rate observation for diagnosing Ventricular Tachycardia?

<blockquote> 100 bpm </blockquote> Signup and view all the answers

Which drug can potentially cause Ventricular Tachycardia?

Digoxin Signup and view all the answers

What does the QRS complex look like in Ventricular Tachycardia?

Wide and bizarre Signup and view all the answers

When should magnesium IV be administered in the context of Ventricular Tachycardia?

For patients with a prolonged QT interval Signup and view all the answers

Which of the following is true about the symptoms of Ventricular Fibrillation?

No muscular contraction occurs Signup and view all the answers

What describes the ventricular rhythm when a patient is experiencing Ventricular Tachycardia?

Regular and rapid Signup and view all the answers

What is a primary characteristic of Type II second-degree AV block?

QRS complex may be wide. Signup and view all the answers

Which of the following symptoms may NOT be experienced by a patient with Type II second-degree AV block?

Regular pulse Signup and view all the answers

What is the potential progression for Type II second-degree AV block?

Progression to complete heart block. Signup and view all the answers

In treating hypotension related to Type II second-degree AV block, which medication would be administered to improve cardiac output?

Dopamine Signup and view all the answers

Which best describes the atrial and ventricular rhythms in Type II second-degree AV block?

Atrial rhythm is regular; ventricular rhythm is irregular. Signup and view all the answers

What is the usual treatment for patients with Type II second-degree AV block experiencing infrequent dropped beats but no symptoms?

Close monitoring. Signup and view all the answers

Which of the following conditions may lead to Type II second-degree AV block?

Anterior wall myocardial infarction. Signup and view all the answers

What happens to cardiac output in Third-degree AV block?

Cardiac output becomes life-threateningly low. Signup and view all the answers

What is a common cause of complete heart block at the AV node?

Coronary artery disease Signup and view all the answers

What distinguishes 3rd-degree heart block?

Regular and independent P waves and QRS complexes Signup and view all the answers

Which of the following treatments can be administered for symptomatic bradycardia?

Atropine Signup and view all the answers

Which arrhythmia is characterized by the absence of P waves?

Atrial Fibrillation Signup and view all the answers

What is a potential intervention for a patient experiencing Type II 2nd-degree heart block?

Temporary pacing Signup and view all the answers

What clinical sign may indicate worsening heart failure?

Hypotension and pallor Signup and view all the answers

In which arrhythmia would you expect to see flutter waves?

Atrial Flutter Signup and view all the answers

What rhythm is indicated when the QRS complex appears wide and bizarre?

Ventricular Tachycardia Signup and view all the answers

Which of the following is NOT a characteristic of 1st-degree AV block?

Varied PR intervals Signup and view all the answers

Which of the following interventions is appropriate for a patient with pulmonary edema?

Administer oxygen therapy Signup and view all the answers

What is the primary role of the sinoatrial (SA) node in the heart?

To generate electrical impulses at a rate of 60-100 bpm Signup and view all the answers

What does the term 'automaticity' refer to in the context of cardiac function?

The capacity to generate impulses without external stimulation Signup and view all the answers

What is the purpose of the atrioventricular (AV) node in heart conduction?

To delay impulses so the atrium can fully empty into the ventricles Signup and view all the answers

In a standard 12-lead EKG, what is the usual heart rate range set by the primary pacemaker?

60-100 bpm Signup and view all the answers

How do you measure the PR interval on an EKG strip?

From the beginning of the P wave to the beginning of the QRS complex Signup and view all the answers

What does a prominent U wave on an EKG indicate?

Hypokalemia or digoxin toxicity Signup and view all the answers

What is the normal duration range of the QRS complex on an EKG?

0.06 - 0.12 seconds Signup and view all the answers

Which electrode placement is considered the 'ground' lead in a 5-lead EKG setup?

C (Brown) Signup and view all the answers

Which of the following indicates a need for cleaning the skin before an EKG?

To ensure proper adhesion of the electrodes Signup and view all the answers

When determining heart rate using the six-second method on an EKG, how do you calculate it?

Identify R waves and multiply the total by 10 Signup and view all the answers

What does 're-entry' refer to in electrical conduction within the heart?

The looping of electrical impulses within a circular conduction path Signup and view all the answers

How can an arrhythmia occur in relation to automaticity?

By having the SA node function too slowly or too fast Signup and view all the answers

What is indicated by an absent P wave on an EKG?

Atrial block or ventricular standstill Signup and view all the answers

Which of the following EKG intervals is measured from the start of the QRS complex to the end of the T wave?

QT interval Signup and view all the answers

What is a typical heart rate for a patient in normal sinus rhythm?

60 - 100 bpm Signup and view all the answers

What characterizes atrial fibrillation?

Irregular baseline waves with no P waves Signup and view all the answers

In junctional arrhythmias, when is the P wave typically observed?

Before the QRS complex Signup and view all the answers

What should be monitored in a patient with atrial fibrillation?

Signs and symptoms of cardiac output Signup and view all the answers

What is a common treatment for refractory atrial fibrillation when cardioversion is unsuccessful?

Radiofrequency ablation therapy Signup and view all the answers

What is the role of the atrial kick in heart function?

It contributes to final filling of the ventricles Signup and view all the answers

Which medication would be used to slow ventricular rate in atrial fibrillation?

Diltiazem Signup and view all the answers

What type of arrhythmia is indicated by a shortened PR interval if measurable?

Junctional arrhythmia Signup and view all the answers

What is a typical range for ventricular rate in atrial fibrillation?

100 - 150 bpm Signup and view all the answers

Which symptom is commonly associated with cardiac output (CO) impairment?

Hypotension Signup and view all the answers

What distinguishes junctional arrhythmias from other arrhythmias?

Inverted or absent P waves Signup and view all the answers

Which of the following can lead to the development of atrial fibrillation?

Diabetes and obesity Signup and view all the answers

What is expected with the R wave in the presence of irregular heart rhythms?

R waves of varying shapes and sizes Signup and view all the answers

How should a medical professional evaluate T waves in an EKG?

Assess for normal shape and presence Signup and view all the answers

Study Notes

EKG Interpretation Overview

Electrocardiogram (EKG/ECG) shows electrical activity during heartbeats.
Depolarization: Change in electric charge distribution; more positive ions mark heart contraction.
Repolarization: Return to resting state following contraction.
Automaticity: Heart's ability to generate impulses without external stimulation, can lead to arrhythmias if altered.
Atrial kick: Blood pumped due to atrial contraction contributes about 30% of cardiac output.

Cardiac Conduction System

Impulse originates at the Sinoatrial Node (SA node), functioning as the heart's primary pacemaker (60-100 bpm).
Atrioventricular Node (AV node) acts as the gatekeeper (40-60 bpm), introducing a necessary delay for complete atrial emptying.
Electrical signals pass through the Bundle of His, branching into right and left branches, reaching Purkinje fibers (20-40 bpm).

12-Lead Electrode Placement

Total of 10 leads: 4 limb leads, 6 chest leads.
RA (right arm), LA (left arm), RL (right leg), LL (left leg) position for limb leads.
V1-V6 chest leads measure electrical activity from different heart locations:
- V1: 4th intercostal space, right of sternum
- V2: 4th intercostal space, left of sternum
- V3: Midway between V2 and V4
- V4: 5th intercostal space, mid-clavicular line
- V5: Level with V4 at left anterior mid-axillary line
- V6: Level with V5 at mid-axillary line

Interpreting EKG Rhythms

Key intervals:
- PR Interval: From start of P wave to start of QRS complex; normal duration is ≤0.20 seconds.
- QRS Complex: From end of PR interval to end of S wave; normal duration is 0.06-0.12 seconds.
- QT Interval: Determines ventricular repolarization duration, from start of QRS to end of T wave.
P Wave: Reflects atrial depolarization; absent in some arrhythmias.

Heart Rate Calculation

Count P waves within 30 large squares for atrial rate, multiply by 10 for bpm.
Similar method can be used for R waves for ventricular rate measurement.

Atrial Fibrillation (A-fib)

Characterized by chaotic atrial electrical activity; leads to loss of atrial kick and irregular ventricular response (100-150 bpm).
Causes include cardiac surgery, hypertension, diabetes, sleep apnea, and pulmonary embolism.
Treatments focus on rhythm control and rate control, including beta-blockers and possible radiofrequency ablation.

Junctional Arrhythmias

Impulses originate from the AV junction, leading to potential inversion or absence of the P wave.
PR interval may be short if measurable.
Can mimic atrial conduction issues; often seen in myocardial ischemia.

Ventricular Arrhythmias

Ventricular Tachycardia (V-tach): ≥3 PVCs in succession with ventricular rate >100 bpm; can progress to V-fib.
- Symptoms include weak pulse and hypotension.
- Treatment varies based on presence of a pulse; options include defibrillation or medication (amiodarone, lidocaine).
Ventricular Fibrillation (V-fib): Chaotic electrical activity with no cardiac output; common cause of sudden cardiac arrest.
- Immediate CPR and defibrillation are essential for survival.

General Considerations

Older adults: Increased PR, QRS, and QT intervals compared to children.
Monitor for signs of cardiac output (CO) and clinical symptoms like hypotension or syncopal episodes.
Encourage patients to report any changes in pulse, chest pain, or dyspnea.### Type II Second-Degree AV Block (Mobitz Type II)
Characterized by dropped QRS complexes with regular atrial rhythm and often irregular ventricular rhythm
P wave and PR interval remain consistent; QRS complex may be wide
Asymptomatic initially, but may develop palpitations, fatigue, dyspnea, chest pain, or light-headedness as dropped beats increase
Possible hypotension with a slow or irregular pulse
Occurs due to impaired conduction at the bundle of His or bundle branches, often linked to anterior wall MI or severe coronary artery disease (CAD)
Treatment may include monitoring if asymptomatic or symptomatic treatment to improve cardiac output (CO) using atropine, dopamine, or epinephrine, while discontinuing digoxin if implicated
Transcutaneous pacing may be necessary; often requires permanent pacemaker placement

Third-Degree AV Block (Complete Heart Block)

Atria and ventricles beat independently due to complete obstruction of impulses at the AV node
Characterized by normal P waves that do not correlate with QRS complexes, leading to loss of atrial kick and life-threatening decreases in CO
Symptoms include severe fatigue, dyspnea, chest pain, light-headedness, changes in mental status, hypotension, and bradycardia
Causes can include congenital defects, CAD (particularly anterior or inferior wall MI), digoxin toxicity, calcium channel blockers, or beta-adrenergic blockers
Treatment involves atropine or temporary pacing to enhance CO, administration of dopamine or epinephrine, and ensuring a patent IV catheter for medications
Bed rest and oxygen therapy may be ordered until the block resolves or a permanent pacemaker is implanted

Arrhythmias Overview

Sinus Bradycardia: Normal sinus rhythm (NSR) with slowed heart rate; spaces between beats are elongated
Sinus Tachycardia: NSR but with closely spaced beats; heart rate is elevated
Atrial Flutter: Characterized by flutter waves; regular atrial contraction disrupted
Atrial Fibrillation (Afib): Absence of P waves, showing fibrillatory waves instead, leading to irregular ventricular response
Junctional Rhythm: Inverted P waves with shorter PR intervals; indicates junctional pacemaker action
Premature Ventricular Contractions (PVC): Early QRS complex followed by a pause; indicates ectopic beats
Ventricular Tachycardia (V-tach): Abnormal wide and bizarre QRS complexes; serious arrhythmia
Ventricular Fibrillation (V-fib): Coarse or fine waves; life-threatening arrhythmia requiring immediate intervention
Asystole: Nearly flatline ECG indicating cardiac arrest; requires advanced life support
1st-Degree AV Block: Prolonged PR interval; indicates delayed conduction but usually asymptomatic
Type I Second-Degree AV Block: Gradually lengthening PR interval leading to dropped beats, with T wave inversion noted
Type II Second-Degree AV Block: Characterized by dropped QRS complexes
3rd-Degree AV Block: Complete dissociation between P waves and QRS complexes, with respective independent rates and rhythms

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Description

Test your knowledge on EKG interpretation and the electrical pathway through the heart. This quiz covers the fundamentals of how electrical currents move during a heartbeat, focusing on key concepts such as the role of the sinoatrial node. Enhance your understanding of electrocardiograms with this engaging quiz.