Term
| What is the purpose of the ECG? |
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Definition
| Records the heart's electrical activity and represents the stages of cardiac stimulation. |
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Term
| What is a normal sinus rhythm? What is bradycardic? Tachycardic? |
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Definition
| Normal = 60-100bpm, Brady = <60bpm, Tachy = >100bpm |
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Term
| What are the inherent rates of the following: Atria, AV junction, Ventricle? |
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Definition
| Atria = 60-80bpm, AV junction = 40-60bpm, Ventricle = 20-40bpm. |
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Term
| A rate of greater than what number indicates serious trouble? |
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Definition
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Term
| What are the two sets of numbers you need to remember for reading the heart rate on an ECG strip? |
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Definition
| 300-150-100, 75-60-50. (bold lines) |
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Term
| Is it normal to see a Q wave? |
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Definition
| No. Q wave is an indication of an MI. |
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Term
| What does the P wave signify? |
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Definition
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Term
| What does the QRS complex signify? |
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Definition
| Ventricular depolarization |
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Term
| What does the T wave signify? |
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Definition
| Ventricular repolarization. |
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Term
| From the SA node, where does the electrical impulse travel? (5 more stops) |
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Definition
| 1. A-V node 2. Bundle of His 3. R bundle brances 4. L bundle branches 5. purkinge fibers |
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Term
| If you can't find a significant wave that lands on a dark line, how can you calculate the heart rate? |
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Definition
| With a 6 second strip. On ECGs there are ticker marks for every 3 seconds that passes. Look at the number of COMPLETE QRS complexes in 6 seconds, multiply by 10 and that is your rate in bpm. |
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Term
| What is sinus arrhythmia? |
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Definition
| The SA paces, and there is a normal PQRST complex. But the rate changes with respiration (speeds up and slows down). The wave forms all look the same, but the groups are spaced differently. |
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Term
| Is sinus arrythmia something to worry about? |
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Definition
| Nope. CO is not comprimised, rate is adequate, and as long as there is no sign of ischemia, and the QRS complex is tight and P waves all look the same, it shouldn't be a problem at all. It's not uncommon in athletes. |
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Term
| What is a wandering pacemaker? What does it look like? |
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Definition
| Each atrial depolarization is coming from a different area of the atrium. All of the P waves look different from each other, but there is a p wave. Signal comes from atria, but NOT the SA node. |
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Term
| Are wandering pacemakers worrysome for the PT treating a patient? |
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Definition
| Not really. The atria is depolarizing, the QRS signifies normal ventricular depolarization, the rate is adequate, and so is C.O. From a PT standpoint, this should not limit the patient. |
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Term
| What aspects of an ECG may change as a result of an ectopic focus? |
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Definition
| Wave form may change and/or rate may change depending on the focus. |
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Term
| What is the difference between an atrial ectopic, and a wandering pacemaker? |
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Definition
| The wandering pacemaker is a result of many areas of the atrium taking control at different times. An atrial ectopic focus is not coming from the SA node, but it is always coming from the same place. So the P waves will look the same as each other in an atrial ectopic, but the wandering pacemaker p waves will all look different. |
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Term
| What is the primary characteristic of an AV ectopic focus? |
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Definition
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Term
| What is the ideojunctional rate? |
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Definition
| The rate at which the AV junction will fire, intrinsically. 40-60bpm. |
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Term
| What is the biggest characteristic provided by a ventricular ectopic focus? Why does this phenomenon occur? |
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Definition
| wide QRS complex. Because it takes a long time for depolarization to occur when the signal originates in muscle vs. nerve tissue. |
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Term
| Is the PT worried about a ventricular ectopic focus? |
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Definition
YES! There is not enough C.O.! Rate is slow, depolarization is incomplete, and the ventricles don't get filled completely in diastole b/c there's no atrial contraction.
= Big Problem. |
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Term
| What is the most important thing to look at when determining the origin of electrical impulse in the heart? |
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Definition
| The SHAPE. Not the rate. Because you can have a ventricular ectopic that is tachycardic - but the shape of that ventricular contraction with always have an absent p wave and wide QRS. |
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Term
| What is an escape beat? What is it's most defining characteristic? |
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Definition
| It is a beat in response to a pause in the normal pacing rate. The pacemaker pauses, and some other area of the heart 'escapes' control of the SA node and takes over pacing responsibility temporarily. You will see the pause on the ECG strip w/ the change in takeover. |
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Term
| What is a premature beat? |
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Definition
| An ectopic focus spontaneously fires too early. there will be no pause, as is seen in the escape beat. |
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Term
| What will an atrial escape beat look like? |
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Definition
| There is a p wave, QRS will be normal. But there is a pause in the sinus rhythm, the escape beat has a different p-wave than the sinus beat, and rate MAY be slower (60-80bpm) but this may not even be noticeable. |
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Term
| What does a junctional escape beat look like? |
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Definition
| There is a p wave until the junction beat takes over. Then there is a pause, then there is a beat without a p wave. QRS is tight. |
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Term
| What does a ventricular escape beat look like? |
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Definition
| normal p waves and QRS complexes, then a pause, then a wide QRS without a p wave. |
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Term
| Describe what a premature atrial contraction looks like. |
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Definition
| Prior to the premature contraction, the heart rate will be normal, normal P and QRS's. When the beat occurs, the rate will increase between the premature beat and the one just prior. The p wave will look different than previous ones, but the QRS will remain tight and normal. They appear spontaneously. |
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Term
| As PTs, are we worried about premature atrial contractions? |
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Definition
| No sir-ee Bob! The beat is WFL, CO is adequate. This could be normal - occasional irregular beats are normal. It's only when this deteriorates into a static tachycardia that we get worried. |
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Term
| What does a premature junctional contraction look like? |
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Definition
| Same as premature atrial, with amissing p wave. |
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Term
| Are premature ventricular contractions normal? |
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Definition
| Yep. Old people have them all the time. BUT >6/min or >3 in a row is pathological, and becomes ventricular tachy - which is bad. |
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Term
| What are PVCs associated with? |
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Definition
| hypoxemia of cardiac muscle. |
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Term
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Definition
| Like a premature junctional beat, only with a wide QRS. They're followed by a compensatory pause, and they often happen on top of the T wave of the previous beat. |
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Term
| Define Bigeminy and Trigeminy |
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Definition
| Every other beat is a PVC, Every third beat is PVC (respectively). |
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Term
| Gail repeated one phrase over and over and over again in lecture, regarding PVCs. Remember it and know it. |
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Definition
| PVCs are associated with hypoxemia of cardiac tissue!!!! |
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Term
| Is it appropriate to exercise a patient with a bigeminy ECG? Why or why not? |
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Definition
| Not at all. Multiple PVCs are a sign of cardiac hypoxemia. There is often inadequate CO because of the slow depolarizations. Exercise in people like this will only make them more hypoxemic. |
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Term
| What is a MultiFocal PVC? What is its clinical importance as it relates to your PT Tx? |
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Definition
| PVCs that come from a number of different foci in the ventricle. This is very bad, because different parts of the ventricle are fighting for control. If you see this, even if the rest of the strip looks normal, you need to be concerned. Something is wrong. |
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Term
| What is paroxysmal tachycardia? |
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Definition
| Sudden, unsolicited tachycardias. There is no good physiologic reason to elicit this rapid beating. 150-250 is the pathological tachy range. |
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Term
| What does atrial paroxysmal tachy look like on an ECG strip? |
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Definition
| normal beats, then all of a sudden the rate of the normal beats increases. There will be a p wave and normal QRS, just more of them than is normal. |
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Term
| What is ventricular tachycardia? |
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Definition
| 3+ PVCs in a row at >100bpm |
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Term
| Does ventricular tachycardia (VTach) concern us as PTs? Why or why not? |
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Definition
| Yes, it does. In this situation we don't even care of the contractions are multifocal or not. What is most important is that there are many ventricular contractions in a row that result in inadequate CO. |
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