Exam (elaborations)
Advent Health EKG 2024/2025 graded A+ by experts
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Advent Health EKG 2024/2025 graded A+ by experts
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Advent Health EKGAfib - ANSThe impulse originates in the Atria
• The Atrial rate is > 300 and unable to measure [N/A]
• No discernable P waves - PRI & Atrial rhythm cannot be measured [N/A]
• The Ventricular rhythm is irregular
• QRS within normal limits
• If the Ventricular rate is <100 the rhythm is controlled A-fib;
if the Ventricular rate is > 100 the rhythm is uncontrolled A-fib
• This is a chronic rhythm for some patients
Treatment: controlled patients: anticoagulants and antiarrythmics; uncontrolled but stable
patients: Beta blockers, calcium channel blockers, or digoxin; Unstable patients: cardioversion
Junctional Rhythm - ANSImpulse starts in the AV junction
• P waves are absent, short, inverted or retrograde
• Ventricular Rhythm: Regular
• Ventricular Rate: 40-60 bpm
• QRS is usually within normal limits
Accelerated Junctional Rhythm - ANSAccelerated Junctional
Same criteria as Junctional Rhythm, except the Ventricular rate is 60-100
For stable patients: IV access, vagal maneuvers, adenosine, O2, Beta blockers, calcium
channel blockers
Idioventricular Rhythm (IVR) - ANSImpulse originates in the ventricles
▪ Rhythm: Ventricular is usually regular
▪ Rate: Ventricular between 20-40
▪ QRS: ≥ 0.12
▪ Atrial rate, rhythm, and PRI: N/A
- Treatment: assess pt, check for DNR in chart, transcutaneous pacing, atropine. NEVER GIVE
ANTI-ARRYTHMICS MEDICATIONS
Accelerated Idioventricular Rhythm - ANSFollows the same criteria as IVR, except Ventricular
rate is 40-100.
• If no intervention happens, the patient will deteriorate.
- Treatment: assess pt, atropine, transcutaneous pacing. NEVER GIVE ANTI-ARRHYTHMIC
MEDICATIONS
Ventricular Pacing - ANS• The pacemaker lead is placed in to right ventricle.
• The pacemaker generator fires an impulse Initiating ventricular activity.
• The right ventricle will contract first followed by the left ventricle. This results in a wide QRS
• Atrial activity is typically absent. Therefore, Atrial rhythm, rate, and PRI are non- measurable
, • Rhythm: Ventricular regular
• Rate: Ventricular within set pacer limits. Measured from pacer spike to pacer spike
• QRS: Wide; Pacer spike seen before each QRS. Measured from pacer spike to end
of QRS
Atrial-ventricular Pacing - ANSOne pacemaker lead is placed into the right atria and another is
placed into the right
ventricle.
• The pacemaker generator fires an impulse to the atria and then to the ventricle sequentially
causing atrial then ventricular contraction.
• Rhythm: Atrial and Ventricular regular
• Rate: Atrial and Ventricular same & within set limits
• P waves: Pacer spike seen at beginning of atrial activity P waves may or may not be seen
(lead type dependent)
• PRI: WNL - Measured from atrial spike to ventricular spike
• QRS: Wide - Measured from ventricular spike to end of QRS
Failure to capture - ANSA pacer spike note followed by the appropriate atrial or ventricular
response
• Can be a potentially lethal situation!
Failure to pace - ANSAbsence of pacer activity (spikes) when the pacemaker generator should
have fired an impulse.
• Typically seen when the patient's intrinsic heart rate falls less than the pacemaker's low HR
limit and
the pacer fails to fire.
normal sinus rhythm (NSR) - ANSImpulse starts in the SA Node
• Rate: Atrial & Ventricular 60-100 [WNL]
• Rhythm: Atrial and Ventricular are regular
• P waves: Normal; each followed by QRS
• PRI: 0.12 - 0.20 [WNL]
• QRS: 0.04 - 0.10 [WNL]
Sinus Tachycardia - ANSThese rhythms follow all the criteria for NSR except for the rate.
• Rate: Atrial and Ventricular 100-150
Sinus Bradycardia - ANSThese rhythms follow all the criteria for NSR except for the rate.
• Rate: Atrial and Ventricular < 60
Sinus Arrythmia - ANS• Impulse starts in the SA Node but activity varies with respirations
• Rate: Atrial and Ventricular are 60-100, but varies (slower or faster)
• Rhythm: Atrial and Ventricular is irregular (P-P and R-R intervals are irregular)
• P waves: Normal and each is followed by a QRS
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