NR509: ECG & Cardiology Station
Handouts - 2024/2025 Edition - Ace
Your Exams!
Afib - correct answers--The 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 - correct answers--Impulse 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 - correct answers--Accelerated 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) - correct answers--Impulse 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 - correct answers--Follows 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 - correct answers--• 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 - correct answers--One 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
Handouts - 2024/2025 Edition - Ace
Your Exams!
Afib - correct answers--The 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 - correct answers--Impulse 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 - correct answers--Accelerated 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) - correct answers--Impulse 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 - correct answers--Follows 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 - correct answers--• 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 - correct answers--One 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
