1.3.3 Describe the usual pattern of electrical flow

through the conduction system.

1.3.4 Give the inherent rates for the SA node, the

AV junction, and the ventricles.

1.4 Explain the influence of the nervous system on rate

of cardiac impulse formation.

1.4.1 Differentiate between irritability and escape.

1.4.2 Name the nervous system that exerts an

influence over rate of cardiac impulse formation.

1.4.3 Identify the two opposing branches of the

above-named nervous system, and tell how

each would influence the heart if stimulated.

1.4.4 Describe the effect on the heart if one of the

branches is blocked.

Chapter 2 WAVES AND MEASUREMENTS

2 Convey cardiac electrical stimuli to a visible graphic

medium suitable for arrhythmia interpretation.

2.1 Demonstrate the monitoring equipment used to

detect cardiac electrical activity.

2.1.1 Prepare equipment/materials for monitoring.

2.1.2 Demonstrate electrode placement for basic

arrhythmia monitoring.

2.1.3 Optimize contact between electrode and skin.

2.1.4 Select a lead that gives good wave visibility

for arrhythmia interpretation.

2.2 Cite specifications of the graph paper used to

display cardiac electrical activity.

2.2.1 Given the standardized speed at which EKG

graph paper is run through the EKG machine,

identify the time intervals associated with

each of the following:

a. time notches in the margins

b. one small box

c. one large box

2.3 Relate the components of a single cardiac cycle to

the electrophysiological events that created them.

2.3.1 Differentiate between the following graphic

deflections:

a. wave

b. segment

c. interval

d. complex

2.3.2 Given a single cardiac cycle, locate each of

the following components and describe the

electrical events that created it:

a. P wave

b. PR segment

c. PR interval

d. Q wave

e. R wave

f. S wave

g. QRS complex

h. ST segment

i. T wave

2.3.3 Give the normal time duration for each of the

following:

a. PR interval

b. QRS complex

2.3.4 Identify the two phases of the refractory

period.

2.3.5 Identify the vulnerable phase of the cardiac

cycle.

2.3.6 Recognize deflections on an EKG tracing that

were created by something other than cardiac

electrical activity.

2.4 Differentiate between a single cardiac cycle and an

EKG rhythm strip.

ALGrawany

xiv Learning Objectives

Chapter 3 ANALYZING EKG RHYTHM

STRIPS

3 Utilize an organized analysis format to gather necessary

data from a rhythm strip to interpret the presenting

arrhythmia.

3.1 Relate the use of a systematic analysis format to the

eventual interpretation of an arrhythmia.

3.2 Outline the five components of an organized

approach to rhythm strip analysis.

3.2.1 Describe the pertinent aspects of a systematic

analysis of regularity, including R–R intervals,

P–P intervals, patterns, and ectopics.

3.2.2 Describe the pertinent aspects of a systematic

analysis of rate.

3.2.3 Describe the pertinent aspects of a systematic

analysis of P waves, including location,

morphology, and patterns.

3.2.4 Describe the pertinent aspects of a systematic

analysis of PR intervals, including duration,

changes, and patterns.

3.2.5 Describe the pertinent aspects of a systematic

analysis of ORS complexes, including duration,

morphology, and patterns.

Chapter 4 SINUS RHYTHMS

4 Recognize arrhythmias that originate in the sinus node.

4.1 Describe the characteristics of a sinus pacemaker.

4.1.1 Outline the physiologic mechanisms common

to the sinus node.

4.1.2 Describe the expected path of conduction

for an impulse originating from a sinus

pacemaker.

4.1.3 Identify EKG features common to all

arrhythmias in the sinus category.

4.2 Outline the identifying features specific to each of

the arrhythmias originating in the sinus node.

4.2.1 Describe Normal Sinus Rhythm, including

etiology, conduction, and resulting EKG

features (regularity, rate, P waves, PR intervals,

and QRS complexes).

4.2.2 Describe Sinus Bradycardia, including etiology,

conduction, and resulting EKG features

(regularity, rate, P waves, PR intervals, and

QRS complexes).

4.2.3 Describe Sinus Tachycardia, including etiology,

conduction, and resulting EKG features

(regularity, rate, P waves, PR intervals, and

QRS complexes).

4.2.4 Describe Sinus Arrhythmia, including etiology,

conduction, and resulting EKG features

(regularity, rate, P waves, PR intervals, and

QRS complexes).

Chapter 5 ATRIAL RHYTHMS

5 Recognize arrhythmias that originate within the atria.

5.1 Describe the characteristics of an atrial pacemaker.

5.1.1 Outline the physiologic mechanisms common

to atrial pacemakers.

5.1.2 Describe the expected path of conduction for

an impulse originating from within the atria.

5.1.3 Identify EKG features common to all

arrhythmias in the atrial category.

5.2 Outline the identifying features specific to each of

the arrhythmias originating within the atria.

5.2.1 Describe Wandering Pacemaker, including

etiology, conduction, and resulting EKG

features (regularity, rate, P waves,

PR intervals, and QRS complexes).

5.2.2 Describe Premature Atrial Complexes, including

etiology, conduction, and resulting EKG

features (regularity, rate, P waves, PR

intervals, and QRS complexes).

5.2.3 Describe Atrial Tachycardia, including etiology,

conduction, and resulting EKG features

(regularity, rate, P waves, PR intervals,

and QRS complexes).

5.2.4 Describe Atrial Flutter, including etiology,

conduction, and resulting EKG features

(regularity, rate, P waves, PR intervals, and

QRS complexes).

5.2.5 Describe Atrial Fibrillation, including etiology,

conduction, and resulting EKG features

(regularity, rate, P waves, PR intervals, and

QRS complexes).

Chapter 6 JUNCTIONAL RHYTHMS

6 Recognize arrhythmias that originate in the AV junction.

6.1 Describe the characteristics of a junctional

pacemaker.

6.1.1 Outline the physiologic mechanisms common

to junctional pacemakers.

6.1.2 Describe the expected path of conduction for

an impulse originating in the AV junction.

6.1.3 Identify EKG features common to all

arrhythmias in the junctional category.

6.2 Outline the identifying features specific to each of

the arrhythmias originating in the AV junction.

6.2.1 Describe Premature Junctional Complexes,

including etiology, conduction, and resulting

EKG features (regularity, rate, P waves,

PR intervals, and QRS complexes).

6.2.2 Describe Junctional Escape Rhythm, including

etiology, conduction, and resulting EKG

features (regularity, rate, P waves, PR intervals,

and QRS complexes).

Learning Objectives xv

6.2.3 Describe Junctional Tachycardia, including

etiology, conduction, and resulting EKG

features (regularity, rate, P waves,

PR intervals, and QRS complexes).

6.2.4 Describe Accelerated Junctional Rhythm,

including etiology, conduction, and resulting

EKG features (regularity, rate, P waves,

PR intervals, and QRS complexes).

6.2.5 Describe the term Supraventricular Tachycardia,

and define circumstances in which it can be

used appropriately.

Chapter 7 HEART BLOCKS

7 Recognize arrhythmias that are manifestations of

conduction defects at the AV node.

7.1 Describe the characteristics of the category of

arrhythmias known as AV heart blocks.

7.1.1 Outline the physiologic mechanisms involved

in AV heart block.

7.1.2 Describe the conduction defects encountered

in AV heart blocks.

7.1.3 Identify EKG features common to all

arrhythmias in the heart block category.

7.2 Outline the identifying features specific to each

of the arrhythmias included in the heart block

category.

7.2.1 Describe First-Degree Heart Block, including

etiology, conduction, and resulting EKG

features (regularity, rate, P waves,

PR intervals, and QRS complexes).

7.2.2 Describe Type I Second-Degree Heart Block

(Wenckebach), including etiology,

conduction, and resulting EKG features

(regularity, rate, P waves, PR intervals, and

QRS complexes).

7.2.3 Describe Type II Second-Degree Heart Block,

including etiology, conduction, and resulting

EKG features (regularity, rate, P waves,

PR intervals, and QRS complexes).

7.2.4 Describe Third-Degree Heart Block, including

etiology, conduction, and resulting EKG

features (regularity, rate, P waves,

PR intervals, and QRS complexes).

Chapter 8 VENTRICULAR RHYTHMS

8 Recognize arrhythmias that originate in the ventricles.

8.1 Describe the characteristics of a ventricular

pacemaker.