Advanced EKG (1) Flashcards by Angela Bever

EKG changes with hyperkalemia:

P waves widened and low amplitude d/t slow conduction

QRS widening, loss of ST, tall tented T waves

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EKG changes with hypokalemia:

ST depression and flattening of T wave

Native T wave

U wave (positive inflection after T wave)

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EKG changes with hypercalcemia:

Mild: broad based tall peaking T wave

Severe: Very wide QRS, low R wave, no p wave, tall peaking T wave

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What can cause hypercalcemia?

Messing with thyroid/ PTH

Neck surgeries

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EKG changes with hypocalcemia:

Narrowing QRS complex
Reduced PR
T wave flattening and inverted
Prolonged QT interval
U wave
ST depression and prolonged

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When is it common to see a J wave (Osborn wave)?

Hypothermia
Hypercalcemia

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When is the J point positive vs negative deflections?

Positive deflection in precordial and limb leads

Negative deflections in aVR and V1

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What is the delta wave and what does it mean?

Slurred upstroke in QRS (delta wave): related to pre-excitation in the ventricles (EX: WPW)

short PR
Broad QRS

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What med do you want to avoid if EKG has a delta wave?

Cardizem

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Whats this?

Delta wave

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What patient is at risk for complete heart block?

Ventricular disease
Electrolyte abnormalities

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Why is the 5 lead better at giving info than the 3 lead?

5 lead allows monitoring of 2 or more concurrent leads

3 lead only allows for monitoring in one lead at a time

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Which lead is a good one to look at for atrial arrythmias?

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Which lead is common choice for cardioversion?

Lead 2: large upright deflection and ease for “synchronizing” with the R wave

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What is a good lead to look at the left ventricle?

Lead 3

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L1, L2 and L3 should all be __________ deflections

Positive

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How many electrodes used in 12 lead?

10 electrodes: 4 limb/ 6 precordial (v leads/MCL leads)

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Where to place limb leads:

Shoulder do NOT count as limbs

place on wrists or ankles–avoid bony prominences

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Placement for precordial leads:

V1: 4th intercostal space right sternal border

V2: 4th intercostal space left sternal border

V3: sandwich between V2 and V4

V4: 5th intercostal space left of sternum mid clavicular

V5: 5th ICS left sternal anterior axillary line

V6: 5th ICS left sternal mid axillary line

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Steps to determine where heart issue is occuring:

I: inferior (L2, L3, aVF)
See: septal (V1,V2)
All: Anterior (V3, V4)
Leads: Lateral (V5, V6, L1, aVL)

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R wave:

1st positive deflection after P wave

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Q wave:

First negative deflection after p wave

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S wave:

Negative deflection below baseline after R or Q wave

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What 2 reasons is the J-point important for?

Determining bundle branch blocks

Measuring ST segment elevation

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What does RSR complex indicate?

classic pattern for right bundle branch block in MCL1 (V1)

What complex is this?

QS complex: entire complex is below isoelectric line

Deflection in a normal axis (0-90):

Positive in L1, L2, L#

Physiologic let axis (0 to -40) deflections:

L1: + L2: + or split L3: -

Pathologic left axis (-40 to -90) deflections:

L1: + L2: - L3: - Anterior hemiblock

Right axis (90-180) deflections:

L1: - L2: +/- or half up half down L3: + posterior hemiblock

Extreme right axis (no mans land) deflections:

L1: - L2: - L3: - ventricular origin

What is the most common cause of axis deviations?

HTN, Hypertrophy--takes longer for muscle to contract

What length does the qrs have to be in order for bundle branch dx?

Qrs >0.12 or wider than 3 little squares

What lead do we look at left turn/right turn signal trick to dx BBB?

V1--circle J point then draw line back to the complex arrow pointing up= R BBB arrow pointing down= L BBB

If someone is having an MI with BBB--how does the BBB affect mortality rate?

4x higher mortality rate when bundle branch block present

Bifascicular block RBBB + Anterior hemiblock (L axis deviation) increases risk for:

high risk for v fib

RBBB + posterior hemiblock increases risk for:

Not good--probably has LAD occlusion complete heart block, bradycardia, vfib

Bundle branch diagnosis is dependent on ________ whereas hemiblocks are based on _____________.

Time Axis deviation

Where does most blood supply for the SA/AV come from?

RCA issues could cause elevated CVP/ JVD

Where does the RCA supply blood to?

Inferior Wall (LV) Posterior Wall (LV) Right Ventricle SA and AV Node Posterior fascicle of LBB

Where does the LAD supply blood to?

“Widow Maker” Anterior Wall of LV Septal Wall Bundle of His and BB

Where does the circumflex artery supply blood to?

Lateral Wall of LV SA and AV nodes Posterior Wall of LV

If there is posterior involvement which arteries might be occluded?

RCA and circumflex

What can we give to interrupt atherosclerotic plaque formation?

ASA or heparin

If a patient is having back pain with an MI, where might the origin be?

Posterior wall

Chest pain on exertion represent what % occulsion?

70-85%

Chest pain at rest represent what % occlusion?

90%

Chest pain unrelieved by nitro represents what % occlusion?

100% -- need bypass

What is the limitation of 12 lead ekg?

Sensitivity: machines ability to "see" the MI most are 50% sensitive to picking up MIs Cant rule anything out with just EKG

What are the "i's" of infarction?

Ischemia: transient reduction in blood flow to myocardium Inverted T waves in 2 or more leads

Which leads is it normal to have inverted T wave?

L2 and V1

What can ST depression indicate?

Ischemia or subendocardial injury Could be hypokalemia or digitalis

What does a pathological Q wave look like and what does it indicate?

Full thickness infarction Q wave greater than 40ms wide or measures 1/3 height of R wave Path q wave w/ST elevation= Acute MI Without acute ST changes= old

What artery corresponds with inferior leads?

RCA

What artery corresponds with septal and anterior leads?

LAD

What artery corresponds with lateral leads?

Circumflex

Where is the infarct likely coming from when ST depression is seen in V1-V4?

Posterior

What is the most common MI location? What are S/S?

Inferior MI--RCA occlusion hypotension, JVD, clear lungs

What is the most lethal MI location?

Anterior MI--LAD

What is a common infarction imitator?

LBBB: late depolarization makes ST elevation difficult to distinguish LBBB considered a non-diagnostic ECG Left vent hypertrophy: won’t have reciprocal changes Dissecting Thoracic aortic aneurysm:

What is going on when there is ST elevation in all leads?

Pericarditis (ST elevation in at least 6 leads) lean pt forward to help with pain pt may have flu like symptoms

What is a distinguishing factor for dissecting thoracic aortic aneurysm compared to acute MI?

Dissecting aortic aneurysm can have ST segment elevation but doesnt have reciprocal changes CXR/CT chest: Widened mediastinum

Advanced EKG (1) Flashcards

(62 cards)