Cardiology & EKG

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1

Arrhythmia

irregular heartbeat, any term used to refer to any of your hearts rate or rhythm.

2

Artifacts

any type of interference during EKG (environment)

3

Atrial depolarization

-contraction of the Systole -the first part of the cardiac cycle -P wave.

4

Ventricle repolarization

-T wave on the graph. - relaxing of the heart --> diastole

5

QRS

ventricle depolarization (contraction systole)

6

Electrocardiogram (EKG)

Tool used to record the electrical activity of the heart.

7

Electrocardiograph

a device that amplifies low-voltage electric impulses detected on the skin and produces a printed record of that electrical activity

8

Standard bipolar limb Lead 1

records the electrical activity of the Left arm and right arm

9

(LA & RA)

...

10

Standard bipolar limb Lead 2

records the electrical activity of the Left Leg and Right Arm

11

(LL & RA)

...

12

Standard bipolar limb Lead 3

records the electrical activity of Left leg & Left arm

13

(LL & LA)

...

14

Augmented limb leads: aVR

records the electrical activity from RA & (LA - LL)

15

Augmented limb leads: aVL

records the electrical activity from LA & (RA - LL)

16

Augmented limb leads: aVF

records the electrical activity from LL & (RA - LA)

17

Reasons for performing an EKG

It can detect damage from previous heart attacks, enlargement of the heart muscle, disturbances in the rhythm & other abnormal conditions.

18

How often is an EKG preformed?

an EKG is preformed along with the routine annual physical examination every 5-10 years.

19

the EKG is interpreted by the?

Provider

20

the tracing paper is normally running at a speed of?

25 mm/second

21

P-R interval (normal)

0.12 - 0.2 seconds

22

QRS complex (normal)

0.06 - 0.12 seconds

23

T-wave (normal)

s

24

small box

measures 1 mm by 1 mm 0.04 seconds

25

Big box

measures 5 mm by 5 mm -0.2 seconds

26

Sinus Rhythm

when there is a P wave before every QRS it is called?

27

Intervals

measuring more than 1 movement

28

Amplifier

device on electrocardiograph that enlarges EKG impulses

29

Galvanometer

instrument that measures current by electromagnetic action.

30

Stylus

pen like instrument, produces printed representation on the EKG paper.

31

Segment

section of the EKG

32

Remind patient to eat?

a low-fat, low cholesterol diet and keep their salt and sodium intake at minimum

33

Advise patient to get...

proper rest, perform approved exercise, and keep weight at an acceptable level.

34

Instruct patients to take their prescribed medication..

regularly and immediately to report to the provider any problems they might experience and remind them not to take OTC meds w/ out permission.

35

Remind them to keep their scheduled....

appointments an make a list of questions for the doctor to review w/them at that time.

36

Advise patients not to use and avoid?

the use of tobacco and alcohol

37

Advise patient to practice?

Stress reducing behaviors

38

V1

fourth intercostal space at right margin of the sternum

39

V2

fourth intercostal space at left margin of sternum

40

V4

fifth intercostal space on left midclavicular line

41

V3

midway between V2 and V4 (V3 is placed after V4)

42

V5

Horizontal to V4 at left anterior axillary line

43

V6

Horizontal to V4 at midaxillary line

44

Standardization

process of bringing into conformity w/ a standard; pertaining to an EKG. a mark made at the beginning of each lead to establish a standard.

45

the usual standardization mark is?

2 mm wide by 10 mm high & the sensitivity setting should be set at 1.

46

the standardization mark should be indicated where?

in front of each lead to provide reliable reading.

47

if the tracing is too large

the sensitivity dials should be turned down to?, 1/2 to produce a standardization mark 5 mm high and 2 mm wide.

48

if the tracing is too small

the sensitivity dial can be turned up to 2, making the impulse 20 mm high and 2 mm wide.

49

if the EKG cycles are too close together the speed can be changed to?

50 mm per second this adjustment should be noted in pen on the tracing

50

Somatic tremor

-muscle voltage artifacts-caused by shivering from nervousness or cold, Parkinsons

51

Wandering basline

caused by improperly applied electrodes/ improperly cleaned skin

52

Somatic tremor or involuntary muscle movement

Caused by shivering or twitching

53

Interrupted baseline

card image

caused by an electrode becoming separated from the wire or by a broken lead wire.

54

Sinus bradycardia

card image

A heart rate less than 60 BPM

55

Sinus tachycardia

card image

heart rate above 100 BPM

56

Normal Sinus rhythm

the P-wave, QRS complex, and T-wave continually repeat their patterns.

57

a patients Normal heart rate?

ranges between 60 and 100 beats per min

58

Premature Atrial contractions (PACs)

card image

Atrium contracts early. P-wave is shaped diff. than on a normal EKG. when atrium contracts a P-wave appears.

59

Paroxysmal Atrial Tachycardia (PAT)

card image

an episode during which the heart ranges from 160 to 250 BPM and lasts momentarily. Flutter in heart.

60

Atrial fibrillation (A-fib)

it caused rapid multiple electrical signals that fire from areas in the atria other than the SA node the heart can range from 400 to 500 BPM, some causes are myocardial infarction, hypertension, heart failure, thyroid disorders. P-waves can't be identified because of irregular complexes.

61

Premature Ventricular contractions (PVCs)

card image

Ventricle is contracting early & followed by a pause before the next cycle occurs. also seen in patients with hypertension, coronary artery disease, and lung disease.

62

Ventricular tachycardia

card image

Ventricle is beating super-fast. Seen in patients with cardiac disease/myocardial infarction. Life threatening condition. There are no P-waves and the QRS complexes are imprecise. PVCs occurring at 150-250 BPM

63

Ventricular fibrillation (V-Fib)

seen in patients with cardiac disease, or ppl experiencing myocardial infarction. Ventricles appear to tremor, there is no cardiac output. Referred to jagged rhythm as sawtooth rhythm. life threatening/ unconscious

64

1500 method

count number of small squares between two consecutive R-raves and divide that number by 1500, it is the most accurate method of obtaining a heart rate, used on regular rhythms.

65

1st degree

PR interval is greater than 0.2

66

*Type1 second degree AV Block

P-R interval progressively gets wider until QRS drops

67

Heart *Type 2 second degree AV Block (wenckebach

Mobitz 2), 2:1 conduction ratio P-R is constant for 2 or more consecutive PR's every 3rd beat QRS Drops.

68

3rd degree

atrium & ventricle are beating consistently, but no together at the same time.

69

How are EKGs read?

electrical waves, intervals, and segments

70

EKG on patients leg the wire is going?

toward the patient’s heart.

71

RA/RL

white/green

72

LA/LL

Black/red

73

middle

Brown

74

an EKG is preformed along with the routine annual physical examination every

5-10 years.

75

Endocardium

-The innermost layer of the heart. -The function is to prevent blood cell destruction and clotting. It is also the layer in which the heart's condition system is embedded.

76

Myocardium

The middle and contractile layer of the heart.

77

Pericardium

Outermost layer of the heart. It is attached with ligaments to the spinal column & diaphragm fixing the heart position.

78

Heart chambers

A structure in the middle of the heart called the sputum, divides the heart into 2 sides. The right side pumps Deoxygenated blood with low pressure from the veins into the lungs (pulmonary circulation) and left side, that pumps oxygenated blood with high pressure toward the tissues through arteries (systemic circulation).

79

Right atrium

Receives deoxygenated blood returning to the heart from the body via the superior vena cava which carries blood from the upper body and the inferior vena cava which carries blood from the lower body. Right atrium (RA) receives blood from coronary sinus, the largest vein that drains the heart muscles deoxygenated blood.

80

Right ventricle

Receives deoxygenated blood from the right atrium which it pumps to the lungs for oxygenation through the pulmonary trunk and then to the pulmonary arteries.

81

Pulmonary arteries

Are the only arteries in the body that carry deoxygenated blood ( bcuz there going away from the heart)

82

Left atrium

Receives oxygenated blood returning from the lungs via the right and left pulmonary veins.

83

Pulmonary veins

Are the only veins that carry oxygenated blood? ( because they are going towards the heart )

84

Left ventricle

receives the oxygenated blood from the left atrium and pumps it through the aorta, the largest artery of the body.

85

Heart valves

The purpose of the heart valves is to prevent backflow of blood.....assuring uni-directional flow thru the heart.

86

Systole

Period of contractions of both atrial/ventricles

87

Diastole

Period of relaxation and filling all cardiac chambers.

88

Heart sounds

Caused by the closure of the heart valves

89

S1 first heart sound (Lubb)

Occurs during ventricle contraction & the closure of the AV valves

90

S2 second heart sound (Dupp)

Occurs during ventricular relaxation. Pulmonary aortic valves close. Murmurs are caused by diseases of the valves or other structural abnormalities.

91

Heart rate

# of contractions per min. Normal heart rate is 60/100 BPM

92

EKG

Graphical presentation of heart electricity over time.

93

electrocardiogram galvanometer

Measures the hearts electricity traveling through the system. Important tool for the patients diagnosis & evaluation. Monitoring patients HR. evaluates injuries to the heart muscle, and pacemakers and conductive system muscle. Evaluates the response toward medication & provides a baseline record for medical procedures.

94

Standard bipolar Limb leads record?

Electrical activity in the frontal plane.

95

Pericardial chest unipolar leads; V1-V6

These electrodes are positive and record the heart electricity in the horizontal plane. ******

96

Augmented leads

Records electrical activity in the frontal plane.

97

Vertical axis |

1 small square: 1mm , 1 large square: 5 mm

98

Horizontal axis -------

1 small square: 0.04, 1 large square: 0.2

99

Asses’ rhythm and regularity Heart rate is

considered regular if all RR & PP on EKG leads are equal. If there are changes in their durations the rhythm is irregular.

100

12 Lead EKG Chest

V1, V2, V3, V4, V5, V6
pericardial/SINGLE

101

12 Lead EKG 3 AV

AVR, AVL, AVF

102

12 Lead EKG LIMB LEADS

I, II, III
STANDARD LIMB LEADS/BI-POLAR (2 POLES)

103

Depolarization

Contracting

104

Re-polarization

RECOVERY/P-WAVE (ARTIRIA)

105

WHAT VESSEL CARRIES DEOXINGINAATED BLOOD

SUPPERIOR/INFERIOR VENA CAVA

106

WHATS DIFFERENT W/THE PULMONARY ARTERY?

THE BLOOD IS DEOXYGENIATED BLOOD

107

ARTERIES DO WHAT?

CARRY BLOOD AWAY FROM THE HEART

108

VEINS DO WHAT

CARRY BLOOD INTO THE HEART

109

systolic

Contraction of the heart- Depolarization

110

Diastolic

relaxation - recovery

111

Heart Risk Factors

Hypertension
Smoking
diabeties
race
obesity

112

Cyanosis

No oxygen in your bloos, you turn blue, hypoxia

113

The cardiac cycle is

1 heart beat

114

Blood supply does what?

Supplies oxygen through the heart

115

Rheumatic Fever is?

caused by tonsillitis and streptococcus, can cause Rheumatic heart disease

116

Heart Disease MI

Myocardial Infarction

117

Corenary artery desease?

reduction of blood supply to the heart.

118

tackycardia

fast heart rate over 100

119

angina

chest pain

120

what do you take for an angina?

Nitroglycerin

121

CAD -

coronary heart disease

122

Coronary Heart Disease (CAD)

damage to the artery

123

EKG- Ground

right leg

124

Conduction part of the heart

1. Sinoarterial node (SA)/Pacemaker
2. AV Node (Arterial ventricular node
3. Bundle of his
4. penjerky fibers

125

Another word for standard leads?

Bi-Polar leads; I, II, III

126

Another word for body?

Somatic

127

Somatic artifact is

body movement, Parkensens Disease, chewing gum, talking not plugged in

128

WHAT COMES AFTER THE SA NODE?

AV Node

129

what are the sticky pads called that are stuck to you in an EKG?

Electrodes

130

What are AVL, AVF, AVR known for?

Augmented, Left ventricle, leg & pQRS. Augmented and are UNI_POLAR

131

Nitrogenglycerin

underneath through (sublingual) does what, dilates blood vessels.

132

Miltral Valve is also known as?

Bicuspid valve

133

Arterial Sclerosis is

hardening of the arteries

134

Athro sclerosis

yellow plaque buildup in the arterial walss.

135

You loose collogen because?

because of elastysity , because of age and blood is heald back and elastyty of the arterial walls.

136

EKG Numbering

300
150
100
75
50