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24 Principles of Anesthesia II > Basic & Advanced EKG (Exam I) (Assessment Review) > Flashcards

Basic & Advanced EKG (Exam I) (Assessment Review) Flashcards

1
Q

In what leads should a p-wave be positive?

A
  • I, II, aVF, V4-V6
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2
Q

What should the duration of a p-wave be?

A
  • < 0.12 seconds
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3
Q

What should the duration of a PR interval be?

A
  • 0.1 - 0.2 seconds
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4
Q

What should the duration of a QRS complex be?

A
  • < 0.12 seconds
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5
Q

Elevation/depression of an ST segment by __ mm is clinically relevant

A

1

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6
Q

T-waves should be positive in which leads?

A
  • I, II, V3-V6
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7
Q

What does Paroxysmal mean?

A

Intermittent

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8
Q

Venticular ectopy is usually indicative of what?

A
  • K⁺ imbalances
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9
Q

What effects do halothane/enflurane have in regards to arrhythmias?

A
  • Halothane & enflurane sensitize the myocardium
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10
Q

What arrhythmia in infants can result from sevoflurane?

A
  • Bradycardia (via oculo-cardiac reflex?)
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11
Q

What can desflurane cause during induction?

A

Prolonged QT

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12
Q

What two adverse events can occur from local anesthetic injection into the vasculature?

A
  • Severe bradycardia
  • Asystole
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13
Q

How would excessive intravascular lidocaine be treated?

A
  • Lipid rescue
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14
Q

What is the exhaustive list of conditions that can result in perioperative dysrhythmias?

(this card sucks)

A
  • General anesthetics
  • Local anesthetics
  • Abnormal ABG or electrolytes
  • Endotracheal intubation
  • Autonomic reflexes
  • CVP cannulation
  • Surgical stimulation of heart/lungs
  • Location of surgery
  • Hypoxemia
  • Cardiac Ischemia
  • Catecholamine excess
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15
Q

What anatomic structure (discussed in class) causes dysrhythmias when stimulated during cardiac surgeries?

A
  • Pulmonary arteries
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16
Q

What example was given of a surgical location where stimulation results in dysrhythmias?

A
  • Eyes (due to oculo-cardiac reflexes)
  • Heart/lungs
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17
Q

Where does lead V1 go? V2?

A
  • V1 - 4th ICS, right of sternum
  • V2 - 4th ICS, left of sternum
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18
Q

Where does lead V3 go?
V4?

A
  • V3 - between V2 and V4
  • V4 - 5th ICS, left of sternum
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19
Q

Where does lead V5 go?
V6?

A
  • V5 - 5th ICS, left of sternum
  • V6 - 5th ICS, left of sternum
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20
Q

What wave is the first negative deflection after the p-wave on any lead?

A
  • Q-wave
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21
Q

What wave is the first positive deflection after a p-wave?

A
  • R-wave
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22
Q

Describe an s-wave.

A
  • Negative deflection below baseline after an R or Q wave.
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23
Q

What QRS is denoted by 1 in the figure below?

A

R

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24
Q

What QRS is denoted by 2 in the figure below?

A

QS

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25
Q

What QRS is denoted by 3 in the figure below?

A

qRs

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26
Q

What QRS is denoted by 4 in the figure below?

A

rS

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27
Q

What QRS is denoted by 5 in the figure below?

A

qR

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28
Q

What QRS is denoted by 6 in the figure below?

A

rSR’

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29
Q

1 small box on an EKG strip equals _____.

A

1mm or 0.04s

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30
Q

1 large box on an EKG strip equals ______.

A

5mm or 0.2s

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31
Q

If healthy, both the QRS complex and T-wave should be ______ in leads I, II, & III.

A

positive.

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32
Q

What is the mean electrical axis of the heart?

A

59°

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33
Q

A clockwise shift of the mean electrical axis shift of the heart is indicative of what?

A
  • Right-axis deviation
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34
Q

A counter-clockwise shift of the mean electrical axis shift of the heart is indicative of what?

A
  • Left-axis deviation
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35
Q

Regarding Lead I, where is the negative terminal connected? How about the positive terminal?

A

Negative terminal = Right arm
Positive terminal = Left arm

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36
Q

Regarding Lead II, where is the negative terminal connected? How about the positive terminal?

A

Negative terminal = Right arm
Positive terminal = Left leg

37
Q

Regarding Lead III, where is the negative terminal connected? How about the positive terminal?

A

Negative terminal = Left arm
Positive terminal = Left leg

38
Q

Which lead can be used as the determinant of posterior vs anterior injury?

A

V2

39
Q

In which precordial lead does the QRS complex have the most magnitude?

A

V4

40
Q

What mV is denoted by a small box on an EKG strip?

A

0.1mV

41
Q

What mV is denoted by a large box on an EKG strip?

A

0.5mV

42
Q

What angle is viewed utilizing aVF?

A

90°

43
Q

What angle is viewed utilizing aVL?

A

-30°

44
Q

What angle is viewed utilizing aVR?
How does this compare to lead II?

A

-150°
- aVR is essentially opposite lead II. (not exactly though, Lead II’s negative terminal is -120°)

45
Q

What are the positive & negative terminals for lead aVR?

A

Negative = left arm + left leg (+30°)
Positive = right arm (-150°)

46
Q

What are the positive & negative terminals for lead aVF?

A

Negative = left arm + right arm
Positive = left leg

47
Q

What are the positive & negative terminals for lead aVL?

A

Negative = left leg + right arm
Positive = left arm

48
Q

What cardiac EKG lead is the least useful in practice but most unique in its position? (this one has a lot of test questions about it)

A

aVR

49
Q

What is the axis of Lead I?

A

0°

50
Q

What is the axis of Lead III?

A

120°

51
Q

What degree change would characterize an extreme axis deviation?

A

-90° to 180°

52
Q

What would the mV of this QRS complex be?

A

+1.5mV

53
Q

What would the mV of this QRS complex be?

A
  • 1.0mV ( approximation)
54
Q

Determine the mV of leads I & III and subsequently the degree & axis of deviation noted by these strips.

A
  • Lead I ≈ -2.5mV
  • Lead III ≈ +1.75mV
  • Deviation ≈ inbetween +180° & +120° ≈ 170° due to greater Lead I magnitude. Significant right axis deviation
55
Q

The EKG strips below are indicative of what pathology?

A

Right Bundle Branch Block (RBBB)

56
Q

A notched, wide R wave on Lead V6 would likely be indicative of what condition?

A
  • Left Bundle Branch Block (LBBB)
57
Q

A positive current of injury noted on V2 would be indicative of what?

A

Posterior MI

58
Q

A negative current of injury noted on V2 would be indicative of what?

A

Anterior MI

59
Q

What axis would be expected with a negative QS deflection in leads I and II and a positive R deflection in Lead III?

A

Right Axis Deviation

60
Q

What axis would be expected with a negative QS deflection in leads II and III and a positive R deflection in Lead I?

A

Left Axis Deviation

61
Q

A positive V1 QRS with negative QRS in leads I, II, and III would the resulting axis be?

A
  • Extreme Axis Deviation
62
Q

What block would you expect to present with a right axis deviation?

A
  • Posterior Hemiblock
63
Q

What block would you expect to present with a left axis deviation?

A
  • Anterior Hemiblock
64
Q

What is an MCL1 lead?
How is it placed?

A
  • Modified V1 lead
  • Negative on left arm, positive in 4th ICS right of sternum.
65
Q

What would leads I, III, and III look like with normal axis?

A
  • All + QRS
66
Q

Differentiate physiologic left axis and pathologic left axis deviation.

A
  • Physiologic = (+ Lead I & III) & (+ or isoelectric Lead II)
  • Pathologic = (+ Lead I) & (- Lead II & III)
67
Q

What is the most common cause of right ventricular hypertrophy?

A
  • Lung disease, pulmonary embolus, and pulmonary valve disease.
68
Q

In what situations would you find physiologic left axis deviation?

A
  • Obesity & athleticism
69
Q

Bundle Branch Block diagnosis is dependent on ______.
Hemiblock diagnosis is based on _______________.

A
  • time
  • axis deviation
70
Q

What pertinent anatomical features of the heart are fed via the RCA?

A
  • Inferior & posterior wall
  • Right ventricle
  • SA & AV node
  • Posterior fascicle of LBB
71
Q

What pertinent anatomical features of the heart are fed via the LAD?

A
  • Anterior wall of LV
  • Septal wall
  • Bundle of His & BB
72
Q

What severe outcome should you worry about with septal infarct?

A

Septal rupture

73
Q

What pertinent anatomical features of the heart are fed via the circumflex artery?

A
  • Lateral wall of LV
  • *SA & AV nodes (?)
  • Posterior wall of LV

should be RCA, no?

74
Q

Why is morphine now avoided in MI’s?

A
  • Morphine causes histamine release.
75
Q

What percentage occlusion would be assumed with chest pain on exertion?

A

70 - 85% occlusion

76
Q

What percentage occlusion would be assumed with chest pain at rest?

A

90% occlusion

77
Q

What percentage occlusion would be assumed with chest pain unrelieved by nitroglycerin?

A

100% occlusion

78
Q

What should be administered before nitroglycerin with an acute right-sided MI?

A

fluid bolus

79
Q

Are EKGs better in regards to sensitivity or specificity?

A
  • Specificity (If MI is shown on EKG then its likely an MI) but sensitivity is 50% for EKGs so a negative EKG result doesn’t rule out MI.
80
Q

What sign would indicate ischemia?

A
  • Symmetrical inverted T-waves in two or more related leads.
81
Q

What sign would indicate an injury pattern?

A
  • ST segment elevation of more than 1mm in two or more related leads.

most important thing to look for

82
Q

What sign would indicate infarction?

A
  • Pathologic Q waves ( >40ms wide or ⅓ the depth of r-wave height) coupled with ST elevation.
83
Q

Which leads indicate a true lateral MI?
Which would indicate a high lateral?

A
  • True lateral = V5 & V6
  • High lateral = I, aVL
84
Q

What is the most commonly seen MI?
What is commonly seen with this type of MI?
Do you use nitrates?

A
  • Inferior
  • Bradycardia, hypotension, 1st degree or Mobitz 1 blocks, and nausea.
  • Caution with nitrates due to RV’s being preload dependent w/ inferior MI’s
85
Q

What is the most lethal MI?
What dysrhythmias are commonly seen with this type of MI?
Do you use nitrates?

A
  • Anterior Wall (LAD)
  • CHB and VF/Vtach
  • Yes to nitrates.
86
Q

What would cause one to prepare defibrillation pads for a patient undergoing an anterior MI? (other than vfib/vtach)

A
  • Presence of BBB or hemiblock whilst undergoing an anterior MI
87
Q

What condition presents with ST elevation on all leads?
How is it diagnosed?

A
  • Pericarditis
  • Patient feels better when they lean forward and there won’t be reciprocal ST depression.
  • Diagnosed via fever, WBCs, hx of IVDU, etc.
88
Q

What condition looks like myocardial infarction on an EKG but can be fatal if thrombolytics are administered?

A
  • Dissecting thoracic aorta aneurysm.
89
Q

What four conditions mimic myocardial infarction in their EKG presentation?

A
  • LBBB
  • LV hypertrophy
  • Pericarditis
  • Thoracic aortic dissection

24 Principles of Anesthesia II (23 decks)

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