CARDIAC HEALTHSTREAM TELEMETRY EXAM Q & A 2023/2024

CARDIAC HEALTHSTREAM TELEMETRY EXAM Q & A 2023/2024 Normal Conduction System - CORRECT ANSWER--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 14-40 Tele Strip Paper - CORRECT ANSWER--Small box = 0.04 sec -Large boxes = 5 x 5 small boxes, 0.20 sec SA Node Rate - CORRECT ANSWER-60-100 bpm AV Node Rate - CORRECT ANSWER-40-60 bpm Ventricles / Purkinje Fibers Rate - CORRECT ANSWER-20-40 bpm Tele Tracing Waves - CORRECT ANSWER-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 - CORRECT ANSWER-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 - CORRECT ANSWER-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 - CORRECT ANSWER-Q-Wave = 1st Negative Deflection R-Wave = 1st Postive Deflection S-Wave= Negative Deflection following R-Wave Normal QRS Complex - CORRECT ANSWER-0.08-0.12 sec (2-3 small squares) Duration of this will lengthen when electrical activity takes a long time to travel through the heart. Normal conduction, AV node -> His-Purkinje system -> fast duration of this complex Consider BBB or Ventricular origin if higher Q-T interval - CORRECT ANSWER-0.35 - 0.43 sec Heart rate - CORRECT ANSWER-bradycardia <60 Normal 60-100 tachycardia <100 Tele tracing measurements - CORRECT ANSWER-HR PR Interval QRS Complex Regularity Telemetry Interpretation - CORRECT ANSWER-1. What is the Rate? (atrial, ventricular) 2. Is it Regular? (R to R) 3. Are there P waves? (PRl <0.20? Does every QRS complex have a P wave? 4. Width of QRS complex? (< 0.12) 6-Second Strip Interpretation method - CORRECT ANSWER-1. count 30 small squares 2. Can do for atrial or ventricular rate (R to R usually suffices) 3. Multiply # of R waves (in the 30 sq.) by 10 to get the HR HR = # of R waves x 10 Sinus Rhythms (SA Node) - CORRECT ANSWER--Normal Sinus Rhythm (NSR) -Sinus Bradycardia -Sinus Tachycardia (ST) -Sinus Arrythmia Normal Sinus Rhythm - CORRECT ANSWER-Rate: 60-100 P-waves: 0.12-0.20 Regularity: Regular R-R Sinus Bradycardia - CORRECT ANSWER-Rate: <60 P-waves: 0.12-0.20 Regulartiy: Regular R-R Sinus Tachycardia (ST) - CORRECT ANSWER-Rate: >100 P-waves: 0.12-0.20 Regularity: Regular R-R Sinus Arrhythmia - CORRECT ANSWER-Rate: Varies P-Waves: 0.12-0.20 Regularity: Irregular R-R Junctional Rhythms (AV Node/Junction) - CORRECT ANSWER--Junctional Escape -Premature Junctional Contraction (PJCs) -Accelerated Junctional Rhythm Junctional Rhythm Pathophysiology - CORRECT ANSWER-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 - CORRECT ANSWER--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 - CORRECT ANSWER--Rate: 40-60 bpm b/c AV as backup pacemaker, beats late in timining -P-waves: Inverted, following QRS, or lost -QRS 0.10 sec or less -Rhythm: Regular -Narrow PRI <0.12 Accelerated Junctional Escape Rhythm - CORRECT ANSWER--Rate: >60 bpm bc AV fires above this -Same as Junctional Escape Premature Junctional Contractions (PJCs) - CORRECT ANSWER--Random, early Junctional beats -QRS 0.10 sec or less -Typically followed by a long, compensatory pause PJC vs Junctional Escape beat - CORRECT ANSWERVentricular Rhythms - CORRECT ANSWER--Idioventricular Rhythm / agonal (~20-40) -Accelerated Idioventricular rhythm (60-100) -Premature Ventricular Complex -Ventricular Tachycardia >100 -Ventricular Fibrillation -Torsades de Pointes