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Cardiac Telemetry study guide
Normal Conduction System -SA Node = Primary Pacemaker of the Heart, rate of 60-100 bpm -Internodal Pathways = Pathways connecting SA Node and AV Node -AV Node = Backup pacemaker, rate of 40-60 bpm -Bundle of His = splits nerve fibers down Left & Right Sides, His- Purkinje is conduction system of heart -L & R Bundle Brancehs = lead to left & right of the myocardium -Purkinje Fibers / Network = ends of the muscle, last escape pacemaker sites rate of 14- Tele Strip Paper -Small box = 0.04 sec -Large boxes = 5 x 5 small boxes, 0.20 sec SA Node Rate 60-100 bpm AV Node Rate 40-60 bpm Ventricles / Purkinje Fibers Rate 20-40 bpm
Tele Tracing Waves P-wave -PR-Interval (PRI) = 0.12 - 0.20 sec -QRS complex = 0.08-0.12 sec T-wave Q-wave U-wave Normal PRI 0.12-0.20 sec (3-5 small squares) -Indicates AV conduction time -Measure from P wave start to QRS wave -Consider heart blocks if abnormal Normal Etiology SA Node Firing of SA Node causing depolarization of Atria. The impulse travels from SA node, through internodal pathways to AV node, where it is delayed for short amount of time. (PRI) Tele Tracing QRS Complex Q-Wave = 1st Negative Deflection R-Wave = 1st Postive Deflection S-Wave= Negative Deflection following R-Wave Normal QRS Complex 0.08-0.12 sec (2-3 small squares)
HR = # of R waves x 10 Sinus Rhythms (SA Node) -Normal Sinus Rhythm (NSR) -Sinus Bradycardia -Sinus Tachycardia (ST) -Sinus Arrythmia Normal Sinus Rhythm Rate: 60- P-waves: 0.12-0. Regularity: Regular R-R Sinus Bradycardia Rate: < P-waves: 0.12-0. Regulartiy: Regular R-R Sinus Tachycardia (ST) Rate: > P-waves: 0.12-0. Regularity: Regular R-R
Sinus Arrhythmia Rate: Varies P-Waves: 0.12-0. Regularity: Irregular R-R Junctional Rhythms (AV Node/Junction) -Junctional Escape -Premature Junctional Contraction (PJCs) -Accelerated Junctional Rhythm Junctional Rhythm Pathophysiology SA node does not control the heart's rhythm, may be a block in pathway. AV node takes over as pacemaker. Atria still contract before ventricles d/t backwards conduction of AV to atria. Junctional Rhythm ECG Presentation -Usually with lost P wave or inverted P wave, closer to QRS -May have Retrograde P wave (depolarization from the AV node back to the SA node) -Narrow PRI Junctional Escape Rhythm -Rate: 40-60 bpm b/c AV as backup pacemaker, beats late in timining
Ventricular Rhythms -Idioventricular Rhythm / agonal (~20-40) -Accelerated Idioventricular rhythm (60-100) -Premature Ventricular Complex -Ventricular Tachycardia > -Ventricular Fibrillation -Torsades de Pointes Idioventricular Rhythm -Rate: <50 bpm, slow -Impulses originating from the ventricles, escape p, no SA/AV impulse -Indicates ventricles producing escape beats -No P-waves -Wide QRS >0. Accelerated Idioventricular Rhythm -Rate: 50-100 bpm When 3 or more ventricular beats appear in sequence. Same rules as idioventricular except faster rate. -QRS wide >0. Premature Ventricular Complex (PVC) Occur when a ventricular site generates an impulse before next regular sinus beat. Frequent PVC's may cause heart to skip a beat.
-Wide QRS -QRS shape can be WIDE & bizarre -No P wave -Bigeminy, Trigenminy, Quadrigeminy types -Couplet (2 PVCs consecutive) -Triplet (3 PVCs consecutive) PVC Bigeminy every other beat is PVC PVC Trigeminy every 3rd beat is PVC PVC Couplet and Triplet Quadrigeminy
-No HR -Emergency condition Torsades de Pointes -Type of VT -"corkscrew" appearance -QTc prolong pt (like those on antipsychotics, are at risk) -Mg is the antidote -QRS complexes vary in shape and amplitude & appear to wind around baseline Atrial Rhythms -Atrial Fibrillation (Afib) -Atrial Flutter / AF RVR -Wandering Atrial Pacemaker -Multifocal Atrial Tachycardia Atrial Fibrillation (Afib) -No P waves Atria quiver, fibrillatory waves. Fast firing. -Irregular Ventricular Beats (R to R) -Rate >100 is Afib with Rapid Ventricular Response
Atrial Flutter (AFlutter) -Classic "Saw tooth pattern" -Often regular (d/t typical 4:1 atrial pulses ratio), but can be irregular Multifocal Atrial Tachycardia (MAT) When many non-SA sites firing impulses. -Rate: >100 bpm -P-waves vary in shape, see at least 3 dif. types -PRI varies -Ventricular rhythm is regular (R to R) Wandering Atrial Pacemaker (WAP) -Similar to MAT but Rate <100 bpm -P waves present & vary in shape (at least 3 dif.) -Irregular atrial rhythm, regular ventricular rhythm
Second Degree AV Block, Type 1 -PRI longer & longer, until QRS dropped Second Degree AV Block, Type 2 -Dropped QRS, no prolongation Third Degree AV Block aka CHB -CHB = Complete Heart Block -complete dissociation of P-waves & QRS complese "husband and wife that don't talk anymore" ventricles don't get atrial impulses, so see p waves doing their own thing without correlation Bundle Branch Block -Delay in either Left or Right bundle branches. -Need 12 lead EKG to Specify
-Defined by WIDE QRS complex, sometimes with bunny ears, but otherwise normal rhythm Tachy Rhythms
- ST - Sinus Tachycardia
- AFib RVR
- SVT - SupraVentricular Tachycardia
- VT - Ventricular Tachycardia
- Torsades de Pointe Brady Rhythms
- Sinus Bradycardia
- Junctional (Junctional Escape)
- Ventricular (Ventricular Escape)
