EKG Rhythms Overview

Questions and Answers

What is the normal heart rate for Normal Sinus Rhythm?

150-250 bpm

100-150 bpm

60-100 bpm (correct)

40-60 bpm

What signifies a Sinus Arrest?

Absence of P-wave for a complete cycle.

What is Sinus Arrhythmia associated with?

Irregular heartbeats that are normal in young patients. (correct)

Fixed heart rate.

Fast heart rate.

Absent P-wave.

What indicates Sinus Bradycardia?

Heart rate below 60 bpm. Signup and view all the answers

In wandering atrial pacemaker, impulse originates from varying points in the atria.

True Signup and view all the answers

What is characterized by irregular P-waves and is associated with severe pulmonary disease?

MAT (multifocal atrial tachy) Signup and view all the answers

What is the heart rate range for Atrial Fibrillation?

350-450 bpm Signup and view all the answers

How does Atrial Flutter appear on an EKG?

Saw-tooth P-waves. Signup and view all the answers

In junctional escape beats, the P-wave is usually upright.

False Signup and view all the answers

What is indicated by a PRI greater than 0.20 seconds?

First-degree AV block. Signup and view all the answers

What condition is known as 'complete block' with no relationship between P waves and QRS complexes?

Third-degree AV block Signup and view all the answers

What does Asystole indicate?

No electrical activity in the heart. Signup and view all the answers

What is recognized as a hallmark of Ventricular Fibrillation?

Chaotic rhythm with no identifiable waves Signup and view all the answers

What is indicated by significant Q waves in the context of myocardial infarction?

Necrosis. Signup and view all the answers

What is indicated by ST segment elevation?

Injury Signup and view all the answers

What is the term for an abnormal heart rhythm with wide QRS complexes?

Ventricular Tachycardia. Signup and view all the answers

Match the following conditions with their characteristics:

Hypokalemia = Flat T wave, prominent U wave Hyperkalemia = Tall, peaked T wave Ischemia = T wave inversion Myocardial Infarction = Inverted T wave, ST seg elevation, Q wave present Signup and view all the answers

Study Notes

EKG Rhythms Overview

Normal Sinus Rhythm: Heart rate of 60-100 bpm with normal, evenly spaced P, QRS, and T complexes.
Sinus Arrest: A non-firing SA node results in absent P wave for a missed cycle.
Sinus Arrhythmia: Rhythmically irregular heart rate correlating with breathing, particularly common in younger patients.
Sinus Bradycardia: Normal sinus rhythm with a heart rate below 60 bpm (noted as a rate of 100 in the text).
Wandering Atrial Pacemaker: Impulses originate from varying atrial points leading to varied P wave contours.

Atrial Rhythms

Multifocal Atrial Tachycardia (MAT): Atrial impulses from multiple locations presenting with varied P waves; often associated with severe pulmonary disease.
Atrial Fibrillation: Atrial quivering (350-450 bpm) with irregular rhythms and indistinguishable P waves; increases thromboembolic risk unless effective conversion within 48 hours.
Atrial Flutter: Characterized by "saw tooth" P waves (250-350 bpm); arises from continuous rapid firing from a singular atrial focus.

Junctional Rhythms

Junctional Escape Beats: Retrograde atrial depolarization results in inverted P' waves.
Junctional Rhythm: Regular heart rate of 40-60 bpm with potential for inverted or buried P waves.
Junctional Tachycardia: Rapid rate (>60 bpm, 150-250) with regular rhythms; P waves are often inverted or follow the QRS.
Premature Junctional Contractions (PJC): Prematurely occurring beats with slightly widened QRS, variable P waves.

Premature Contractions

Premature Atrial Contractions (PACs): Comes from irritable atrial foci with earlier, different P shapes and usually followed by a pause.

Supraventricular Tachycardia (SVT)

Fast heart rate (150-250 bpm) from an irritable atrial focus; has possible overlapping P waves.

AV Blocks

First-Degree AV Block: Prolonged PRI (>0.20 sec) with consistent P waves.
Second-Degree Block: Mobitz Type I (Wenckebach): Gradual PRI lengthening culminating in a dropped QRS; benign pattern.
Second-Degree Block: Mobitz Type II: Normal PRI with abrupt QRS drops; serious and requires treatment.
Third-Degree AV Block: No relationship between P waves and QRS complexes with a heart rate around 40 bpm; serious condition.

Cardiac Arrest and Patterns

Asystole: Absence of electrical activity, represents a state of death.
Premature Ventricular Contractions (PVCs): Wide QRS complex with possible compensatory pauses; can lead to ventricular tachycardia if 3+ are present.

Ventricular Rhythms

Idioventricular Rhythm: Rapid, bizarre QRS complexes, ventricle irritated.
Ventricular Flutter: Smooth sine-wave shaped complexes (250-350 bpm) that can progress to ventricular fibrillation.
Torsades de Pointes: A specific type of ventricular tachycardia characterized by a twisting pattern; caused by hypomagnesemia.
Ventricular Fibrillation: Chaotic pattern (350-450 bpm) with no identifiable waves; requires immediate response.

Hypertrophy and Block Patterns

Right Atrial Hypertrophy: Tall P waves (>2.5 boxes) in specific lead placements; linked to pulmonary hypertension.
Left Atrial Hypertrophy: Widened P waves in lead I and biphasic in V1.
Right Ventricular Hypertrophy (RVH): Tall R waves in V1 with the pattern of decreasing amplitude in successive leads.
Left Ventricular Hypertrophy (LVH): Presence of deep S waves in V1 coupled with tall R waves in V5/V6.

Bundle Branch Blocks

Bundle Branch Block (BBB): Wide QRS complexes with "bunny ears" appearance; can't determine ischemia due to distortion.
Right Bundle Branch Block: Characteristic rabbit ears in V1/V2.
Left Bundle Branch Block: Bunny ears in V5/V6.

Myocardial Infarction (MI) and Ischemia

Ischemia: Indicated by T wave inversion; reversible damage.
Injury: ST segment elevation indicates acute myocardial injury; potentially reversible.
Necrosis: Defined by significant Q waves indicating irreversible damage.
Various infarct locations identified using specific leads (anterior, inferior, lateral, posterior).

Cardiac Effects of Electrolytes

Digitalis Effect: Shortened QT intervals and characteristic ST segment depression.
Hypercalcemia: Presents with short or absent QT segments.
Hypocalcemia: Indicates long QT intervals.
Hyperkalemia: Peaked, narrow T waves progressing to severe complications like a "sine wave."
Hypokalemia: Characterized by flat T waves and U waves.

Miscellaneous

Lown-Ganong-Levine Syndrome: Bypassing the AV node results in short PRI.
Pacemakers: Recognizable pacemaker spikes with wide QRS complexes.
Pericarditis: ST segment elevation across all leads; T wave may be elevated.
Pulmonary Embolus: Specific lead changes (S1 Q3 T3) indicative of acute right bundle branch block.
Wolff-Parkinson-White: Presence of a delta wave following the P wave with wide QRS; associated with paroxysmal tachycardia.
Axis Determination: Direction of depolarization movement assessed in leads I and AVF; various patterns can indicate deviations.

These notes cover key concepts associated with EKG rhythms and their significance. Understanding these will aid in recognizing and interpreting various cardiac conditions.

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Description

Explore various EKG rhythms including Normal Sinus Rhythm, Sinus Arrest, and Atrial Fibrillation. This quiz covers the characteristics, rates, and implications of different heart rhythms, making it essential for understanding cardiac health. Test your knowledge of these critical concepts in cardiology.