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_MS2 Cardio > 8/4- Basics of ECG: Bridging Theory and Practice > Flashcards

8/4- Basics of ECG: Bridging Theory and Practice Flashcards

1
Q

Which ECG limb lead has a negative QRS complex in normal subjects?

A. Lead I

B. Lead II

C. Lead aVF

D. Lead aVR

E. Lead aVL

A

Which ECG limb lead has a negative QRS complex in normal subjects?

A. Lead I

B. Lead II

C. Lead aVF

D. Lead aVR

E. Lead aVL

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2
Q

Which chest leads are most aligned with overall position of heart in chest cavity?

A. V1/V2

B. V3/V4

C. V5/V6

A

Which chest leads are most aligned with overall position of heart in chest cavity?

A. V1/V2

B. V3/V4

C. V5/V6

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3
Q

Which chest leads have consistently positive QRS complexes?

A. V1/V2 “septal leads”

B. V3/V4 “anterior leads”

C. V5/V6 “lateral heads”

A

Which chest leads have consistently positive QRS complexes?

A. V1/V2 “septal leads”*

B. V3/V4 “anterior leads”

C. V5/V6 “lateral heads”

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4
Q

Where is the sinus node located?

A. Right atrium near SVC

B. Right atrium near IVC

C. Left atrium near pulmonary veins

A

Where is the sinus node located?

A. Right atrium near SVC

B. Right atrium near IVC

C. Left atrium near pulmonary veins

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5
Q

What is a normal QRS axis?

A. -30 to +90 degrees in the frontal plane

B. 0 to + 90 degrees in the frontal plane

C. -30 to -90 degrees in the frontal plane

A

What is a normal QRS axis?

A. -30 to +90 degrees in the frontal plane

B. 0 to + 90 degrees in the frontal plane

C. -30 to -90 degrees in the frontal plane

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6
Q

Describe (broadly) the normal QRS axis?

A

Downward and to the left (-30 to +90)

  • QRS is positive in Leads I and aVF
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7
Q

What planes are used in placing ECG leads? Number/type of leads?

A

Frontal plane:

  • 3 standard limb leads: bipolar leads I, II, III
  • 3 augmented limb leads: aVF, aVR, aVL

Horizontal plane:

  • 6 precordial chest leads
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8
Q

What is Einthoven’s triangle?

A

3 electrodes: RA, LA, LL

  • generate 3 bipolar limb leads I, II, and III

Lead 1: bipolar vector from R arm to L arm

Lead 2: R arm to L leg

Lead 3: L arm to L leg

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9
Q

What is the setup for the augmented limb leads?

A

Augmented limb leads: aVR, aVL, and aVF use combination of electrodes as ground (vector looks like it’s coming from the other two)

aVR: ground L arm, L leg

aVL: ground R arm, L leg

aVF: ground R arm, L arm

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10
Q

How far apart are the vectors for the 3 bipolar leads?

A

60 degrees (0, 60, and 120)

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11
Q

How far apart are the vectors for the 3 augmented leads?

A

120 degrees (-150, -30, and 90)

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12
Q

Which vectors point downward?

Another name for them?

What do they reflect?

A

“Inferior leads”; inflect pathology in the inferior wall of the left ventricle

Leads: II, III, aVF

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13
Q

How do we group limb leads (broad groups)?

A

Inferior leads: II, III, aVF

Lateral leads: I and aVL

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14
Q

What do inferior leads reflect? Where do they point?

A
  • Point inferiorly
  • Reflect inferior LV wall pathology (e.g. ischemia or infarction)
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15
Q

What do superior leads reflect? Where do they point?

A
  • Point laterally
  • Reflect lateral LV wall pathology
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16
Q

Which lead(s) do(es) not have a positive QRS complex? Why?

A

aVR

  • All standard ECG leads have a positive QRS except aVR
  • The aVR vector points upward and to the right, while the heart is on the left side, pointing downward
17
Q

Where are the precordial chest leads placed?

A

???

V1-

V2-

V3-

V4-

V5-

V6-

18
Q

How do we group chest/precordial leads?

A

Chest leads V1-V6 derived from + chest electrodes placed over chest wall

V1, V2: septal (or anteroseptal) leads

V3, V4: anterior leads

V5, V6: lateral leads

19
Q

QRS is negative in leads ___ and positive in ___

A

QRS is negative in leads V1/V2 and positive in V5/V6

As you move from V1 to V6, the leads are becoming more positive/upright (V1 pointing out to the right, while others fan across until V6 is pointing left and most aligned with the heart in the chest cavity)

20
Q

T/F: V5 and V6 are better aligned with the chest orientation in the chest and are thus “positive”?

A

True

21
Q

Draw/label normal EKG (P, QRS, T) wave?

A
22
Q

Sequence of depolarization in the heart?

A
  • Sinus node
  • AV node
  • His bundle
  • Bundle branches
  • Purkinje fibers
  • Myocardium
23
Q

Cardiac structures and the corresponding ECG waves:

  • Sinus node:
  • AV node:
  • His bundle:
  • Bundle branches:
  • Purkinje fibers:
  • Myocardium
A

Cardiac structures and the corresponding ECG waves:

  • Sinus node: P wave
  • AV node: PR interval
  • His bundle: PR interval
  • Bundle branches: QRS interval
  • Purkinje fibers: QRS interval
  • Myocardium: QRS interval
24
Q

Localization of ECG abnormalities:

  • Abnormal P wave
  • Long PR interval
  • Short PR interval
  • Wide QRS interval
A

Localization of ECG abnormalities:

  • Abnormal P wave: ectopic atrial rhythm
  • Long PR interval: AV block
  • Short PR interval: accessory tract
  • Wide QRS interval: bundle branch block or dilated ventricles
25
Q

What is the QRS axis? Direction?

A

The QRS axis is the overall direction of ventricular depolarization

  • Ventricular depolarization proceeds from the right and left bundle branches and outward from ENDOcardium to EPIcardium
  • It proceeds downward and to the left in the frontal plane
26
Q

How can a normal heart vector be up to 0 to -30 if the heart points down and to the left?

A

Left ventricle may undergo concentric hypertrophy in response to high blood pressure, causing the heart axis to shift leftward

27
Q

What is commonly seen in the EKG of individuals over the age of 50 or 60?

A

This leftward deviation/shift of the heart axis

28
Q

The indeterminate axis/area is where?

A
  • 90 to +/- 180
29
Q

Deviation:

  • Normal:
  • Left:
  • Right:
  • Indeterminate:
A

Deviation:

  • Normal: -30 to +90
  • Left: -30 to -90
  • Right: +90 to 180
  • Indeterminate: -90 to 180
30
Q

Axis shift is typically important as a marker of what?

A

Ventricular hypertrophy

(Left hypertrophy -> left deviation and vice versa)

_MS2 Cardio (35 decks)

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