NURS 213 FINAL
REVIEW STUDY
GUIDE 2024/2025
GUARANTEED PASS
,Dysrhythmias & ACS
● EKG Basics
○ CO (SVxHR)
○ <Sweet Apples Have Big Price=
■ SA Node (60-100 bpm)
■ AV node (40-60 bpm)
■ HIS Bundle
■ Bundle Branches
■ Purkinje fibers (pacemaker cells contract 20-40 bpm)
○ PQRST
■ P = atria squeeze/contract… depolarize. Sends out a charge.
■ QRS = Ventricles squeeze… depolarize/contract. Send out a charge.
■ T = Ventricles relax/repolarizing/refilling with blood
○ How to count the BPM on a strip?
■ Count the peaks and multiply by 10
○ Boxes
■ PR interval 0.12-0.20 seconds
■ QRS < 0.12 seconds
● Normal Sinus Rhythm (NSR)
○ 60-100 BPM
● Normal Sinus Tachycardia (ST)
○ >100 BPM
○ Causes anxiety, pain, drugs, etc.
○ Vagal maneuver (bear down or carotid massage)
○ B-Blockers (LOL drugs)
○ Calcium Channel Blockers (Diltiazem)
● Normal Sinus Bradycardia (SB)
○ < 60 BPM
○ If showing s/sx of low O2 then treat causes
○ Stop drugs that decrease HR (BBlockers, Digoxin)
○ Atropine (increases HR)
● Atrial Fibrillation (AF)
○ Usually >100 BMP and irregular rhythm with no P wave
○ Uncoordinated electrical activity in the atria
○ Rapid firing of the atria leads to pooling of blood
○ RISK FOR CLOTS (MI, PE, CVA, DVT)
○ The main pacemaker (SA Node) loses control, AV node as back-up
○ Causes: heart surgery, pulmonary HTN, stimulants/alcohol, hyperthyroidism
○ S/Sx: all stem from low O2, low CO… chest pain, low O2 sat, lethargy/fatigue,
anxiety, palpitations, SOB/dyspnea, elevated HR, dizziness/syncope
○ Interventions: anticoagulants (Warfarin. Watch INR 2.5-3.5. Watch green leafy
veggies with this drug.), B-Blockers, Cardiac Ablation (burns erratic cells),
Digoxin (Do not administer if <60BPM, listen to apical for one min. Helps get a
, deeper contraction and slows the HR. Monitor visual changes for toxicity. Low K+
increases the risk for toxicity.), Electrocardioversion (50-200 joules. Mini shock
that is in sequence with rhythm)
● Atrial Flutter
○ Looks like birds fluttering on the EKG strip
○ fast, saw-toothed flutter, regular rhythm
○ The rate is usually 75-150 BPM
○ Causes: lung problems (COPD), cardiac problems (pulmonary HTN/HF, valvular
disease, hyperthyroid crisis), CABG (bypass surgery)
○ S/Sx: signs of low O2 (chest pain, low O2 sat, low BP, tachycardia, lethargy,
anxiety, palpitations, SOB, dizziness, EVEN HR & Rhythm)
○ Interventions: exactly like A-Fib! Anticoagulants, beta-blockers, calcium channel
blockers, digoxin, cardioversion
● Supraventricular Tachycardia (SVT)/(PSVT)
○ 150-200 BPM
○ Episodes of rapid HR that starts in a part of the heart that is above the ventricles
○ The Main pacemaker fires but the problem is somewhere in the AV node area…
instead of going into the ventricles it goes right back into the atria and essentially
doubles the HR
○ Regular rhythm - just really fast
○ Causes: Stimulants, sepsis, stress, CAD (narrowing of arteries), CHF,
Myocarditis, COPD
○ S/Sx: all stem from low O2 (chest pain, low SpO2, low BP, tachycardia, lethargy,
anxiety, palpitations, SOB, elevated HR, dizziness/syncope
○ Interventions: Use NON-Drug interventions FIRST!! Vagal maneuvers. If that
does not work, Adenosine!!! If drugs don't work, cardiac ablation or
electro-cardioversion
● Premature Ventricular Contraction (PVC)
○ Bigeminy, trigeminy… unifocal or multifocal.
○ Contractions occur early before normal impulses.
○ Irregular rhythm, wide and bizarre-looking.
○ Causes: Stimulants (caffeine, nicotine/cigarettes, alcohol), sepsis, stress,
electrolyte imbalances
○ S/Sx are usually absent. If there are multiple in a row, the pt might say it feels like
their heart is skipping a beat.
○ Interventions: TREAT THE CAUSE, digoxin, correction of electrolytes,
LIDOCAINE or AMIODARONE
● Ventricular Tachycardia (VT)
○ Deadly rhythm
○ Shock ONLY if in pulseless VT
○ SA and AV nodes lose control as main pacemakers
○ There is zero cardiac output
○ 100-250 BPM
○ Regular rhythm that looks like tombstones
REVIEW STUDY
GUIDE 2024/2025
GUARANTEED PASS
,Dysrhythmias & ACS
● EKG Basics
○ CO (SVxHR)
○ <Sweet Apples Have Big Price=
■ SA Node (60-100 bpm)
■ AV node (40-60 bpm)
■ HIS Bundle
■ Bundle Branches
■ Purkinje fibers (pacemaker cells contract 20-40 bpm)
○ PQRST
■ P = atria squeeze/contract… depolarize. Sends out a charge.
■ QRS = Ventricles squeeze… depolarize/contract. Send out a charge.
■ T = Ventricles relax/repolarizing/refilling with blood
○ How to count the BPM on a strip?
■ Count the peaks and multiply by 10
○ Boxes
■ PR interval 0.12-0.20 seconds
■ QRS < 0.12 seconds
● Normal Sinus Rhythm (NSR)
○ 60-100 BPM
● Normal Sinus Tachycardia (ST)
○ >100 BPM
○ Causes anxiety, pain, drugs, etc.
○ Vagal maneuver (bear down or carotid massage)
○ B-Blockers (LOL drugs)
○ Calcium Channel Blockers (Diltiazem)
● Normal Sinus Bradycardia (SB)
○ < 60 BPM
○ If showing s/sx of low O2 then treat causes
○ Stop drugs that decrease HR (BBlockers, Digoxin)
○ Atropine (increases HR)
● Atrial Fibrillation (AF)
○ Usually >100 BMP and irregular rhythm with no P wave
○ Uncoordinated electrical activity in the atria
○ Rapid firing of the atria leads to pooling of blood
○ RISK FOR CLOTS (MI, PE, CVA, DVT)
○ The main pacemaker (SA Node) loses control, AV node as back-up
○ Causes: heart surgery, pulmonary HTN, stimulants/alcohol, hyperthyroidism
○ S/Sx: all stem from low O2, low CO… chest pain, low O2 sat, lethargy/fatigue,
anxiety, palpitations, SOB/dyspnea, elevated HR, dizziness/syncope
○ Interventions: anticoagulants (Warfarin. Watch INR 2.5-3.5. Watch green leafy
veggies with this drug.), B-Blockers, Cardiac Ablation (burns erratic cells),
Digoxin (Do not administer if <60BPM, listen to apical for one min. Helps get a
, deeper contraction and slows the HR. Monitor visual changes for toxicity. Low K+
increases the risk for toxicity.), Electrocardioversion (50-200 joules. Mini shock
that is in sequence with rhythm)
● Atrial Flutter
○ Looks like birds fluttering on the EKG strip
○ fast, saw-toothed flutter, regular rhythm
○ The rate is usually 75-150 BPM
○ Causes: lung problems (COPD), cardiac problems (pulmonary HTN/HF, valvular
disease, hyperthyroid crisis), CABG (bypass surgery)
○ S/Sx: signs of low O2 (chest pain, low O2 sat, low BP, tachycardia, lethargy,
anxiety, palpitations, SOB, dizziness, EVEN HR & Rhythm)
○ Interventions: exactly like A-Fib! Anticoagulants, beta-blockers, calcium channel
blockers, digoxin, cardioversion
● Supraventricular Tachycardia (SVT)/(PSVT)
○ 150-200 BPM
○ Episodes of rapid HR that starts in a part of the heart that is above the ventricles
○ The Main pacemaker fires but the problem is somewhere in the AV node area…
instead of going into the ventricles it goes right back into the atria and essentially
doubles the HR
○ Regular rhythm - just really fast
○ Causes: Stimulants, sepsis, stress, CAD (narrowing of arteries), CHF,
Myocarditis, COPD
○ S/Sx: all stem from low O2 (chest pain, low SpO2, low BP, tachycardia, lethargy,
anxiety, palpitations, SOB, elevated HR, dizziness/syncope
○ Interventions: Use NON-Drug interventions FIRST!! Vagal maneuvers. If that
does not work, Adenosine!!! If drugs don't work, cardiac ablation or
electro-cardioversion
● Premature Ventricular Contraction (PVC)
○ Bigeminy, trigeminy… unifocal or multifocal.
○ Contractions occur early before normal impulses.
○ Irregular rhythm, wide and bizarre-looking.
○ Causes: Stimulants (caffeine, nicotine/cigarettes, alcohol), sepsis, stress,
electrolyte imbalances
○ S/Sx are usually absent. If there are multiple in a row, the pt might say it feels like
their heart is skipping a beat.
○ Interventions: TREAT THE CAUSE, digoxin, correction of electrolytes,
LIDOCAINE or AMIODARONE
● Ventricular Tachycardia (VT)
○ Deadly rhythm
○ Shock ONLY if in pulseless VT
○ SA and AV nodes lose control as main pacemakers
○ There is zero cardiac output
○ 100-250 BPM
○ Regular rhythm that looks like tombstones
