COMPS:Unit 1: EKG Extra Stuff You Need to Know!!! Flashcards
(117 cards)
1
Q
What is ECG of EKG???
A
- Represents the electric impulses of the heart
- hearts functioning SHORT TERM
- Halter/Telemetry
- LONG TERM
2
Q
ECG ===
A
- Graphic rep of hearts electrical activity
- provides info about hearts function
3
Q
Why do PTs need to learn EKG??
4 Reasons:
A
- Basic anatomy & phys of heart–> norm vs. patho
- PT implications of rhythms –> norm vs. patho
- Diff b/w benign vs. life-threatening arrhythmias
- Read physicians notes on 12 lead EKG AND understand implications
4
Q
Myocytes….
What are they?
A
cells of myocardium
5
Q
3 Properties of Myocytes
A
- Automaticity
- Rhythmicity
- Conductivity
6
Q
Properties of myocytes
1. Automaticity
explain…
A
*Discharge e-stim w/out nerve impulse (automatic)
-
SA Node (natural pacemaker of heart)
- 60-100bpm
-
AV Node (backup pacemaker)
- 40-60bpm
- kicks in to keep adequate HR
-
Perkinje (next backup Pacemaker)
- 30-40bpm
7
Q
Properties of myocytes
2. Rhythmicity
explain…
A
*Spontaneous depolarization/repolarizatoin
*rhythmically fires
8
Q
Properites of Myoctyes
3. Conductivity
explain..
A
*Carry rhythmic control from cell to cell (W/in OWN cells)
*Carry muscle to muscle
*NO NEURAL INPUT NEEDED
9
Q
A DEPOLARIZATION wave will be a ________deflection
*Influx of Na+
A
POSITIVE deflection
10
Q
A REPOLARIZATION wave will be _______ deflection
A
NEGATIVE deflection
11
Q
ECG and Electrical Activity of the Myocardium
The Conduction System
A
see pics
12
Q
ECG and Electrical Activity of the Myocardium
The Conduction System
A
More pics
13
Q
Conduction System
P Wave===
A
Atrial Depolarization
*SA node fired B/L Atria
14
Q
Conduction System
QRS Complex ====
A
Ventricular depolarization AND contraction
*AV node fired
NOTE: Atrial Repolarization hidden in QRS complex
15
Q
Conduction system
T wave===
A
Ventricular Repolarization
16
Q
Conduction system
A
Pics
17
Q
Conduction System
All ECG components broken down
A
see pics
18
Q
What lead is MOST COMMONLY recorded in an ECG?
A
Lead 2 !!!
19
Q
Lead II:
Wave of Depolarization moving toward positive electrode==
A
+ Deflection
20
Q
Lead II:
Repolarization moving towards positive electrode==
A
- Deflection
21
Q
Lead II is used to determine ______ and ______
A
Rate and Rhythm
*Matches the angle of the heart along the axis of depolarization
22
Q
Off of Lead II…
What do we interpret?
A
- Rate
* 3 methods
* ONLY METHOD 1 FOR IRREGULAR RHYTHMS
- Rate
- Regularity
- P wave
* Y/N?
* Upright?
* 1 for ea. QRS?
- P wave
- PR interval
* tiny boxes x.04
- PR interval
- QRS width
* tiny boxes x.04
- QRS width
23
Q
Off of 12 Lead
What do we interpret?
A
- Axis
- Hypertrophy
- Ischemia/Infarction
24
Q
PR Interval
What is NORMAL?
A
.12 (3 sm. boxes)–.20 (5 sm. boxes)
25
QRS width
## Footnote
**What is NORMAL?**
.06 (1.5 sm. boxes)--.10 (2.5 sm. boxes)
26
**Rate**
**3 methods to determine rate**
1. R waves per 6sec strip x 10==Rate
2. 300, 150, 100, 75, 60, 50...(make sure one of the QRS is right on the line)
3. 300/# of Lg. boxes w/in 2 R waves
27
Measuring PR interval
## Footnote
**Where to Where?**
see pics
28
QRS Width
## Footnote
**Where to Where ?**
see pics
29
Normal Rhythms:
## Footnote
**What are they**
**5**
\***ALL FROM SA NODE\***
1. **NSR**
2. **Sinus Tachy**
3. **Sinus Brady**
4. **NSR w/ Pause**
5. **Sinus Arrhythmia**
1. ****arrhythmia literally means "irregular rhythm"
2. all else will be NORMAL
30
Normal rhythms
## Footnote
**Whats Different**
**Whats Normal**
* **NORMAL**
* ****PR interval
* QRS width
* **DIFFERENT**
* ****rate
* regularity
31
Sinus Bradycardia
## Footnote
**Keep in mind...**
NORMAL BUT Rate \<60
\*In high lvl athletes this is normal
32
Sinus Tachycardia
## Footnote
**Keep in mind...**
NORMAL BUT Rate \>100bpm
33
Sinus **Arrhythmias OR aka...**
The **Inspiration (faster) vs. Expiration (slower) one**
## Footnote
**\*IRREGULAR so must use Method 1\*\*\***
34
Sinus Pause OR
## Footnote
**Other names ?**
Sinus Block
Sinus Arrest
**NSR w/ pause**
**\*skipped beat/pause**
**\*SA node fails to fire**
35
**Atrial Arrhythmias**
**\*Occur in Atria!**
**5:**
1. Wandering Atrial Pacemaker
1. **@ least 3 diff. P-wave shapes!**
2. PAC
1. has a P wave! diff. shape OR inverted
3. Atrial Tachycardia (SVT)
4. Atrial Flutter (Sawtooth)
5. A-Fib
## Footnote
**\*\*ALL ectopic==\> SA fires _when should NOT_**
36
ONLY NORMAL THING W/ **ATRIAL ARRHYTHMIAS**
QRS Width bc **QRS complex is ventricles and Atrial Arrhythmias are occurring in the Atria**
37
Wandering Atrial Pacemaker
## Footnote
**Keep in mind...**
* Random ectopic foci
* P-wave constantly changing
* **@ least 3 diff.**
38
PAC
## Footnote
**Keep in mind**
* P-wave embedded in the T (Tall T)==**PAC**
* **OR**
* Tall T==PAC
39
Premature Beats
## Footnote
**Compensatory (use 3 line rule)**
**match 1 and 3 up w/ 1 and 3 w/ premature beat in the middle and 1 and 3 should still line up....if NOT==NON-comp**
* Pause following **ectopic beat** which allows **reg rhythm to resume w/ next normal beat** @ its orig. projected timing
40
Premature Beats
## Footnote
**NON-compensatory**
**1 and 3 will NOT line up!!!**
* Pause **not long enough** to allow rhythm to resume its original rhythm and timing
41
Which PAC compensation (NON-comp vs. COMP) represents a **healthier SA Node?**
Complete COMPENSATORY Pause
\***SA goes back to firing Normal**
42
**3+ PAC in a row====**
Atrial Tachycardia OR SVT
43
Atrial Tachycardia
## Footnote
**3+ PAC in a row\***
**Other names?**
Paroxysmal Atrial Tachy
Paroxysmal Junctional Tachy
Supraventricular Tachy (**SVT)**
44
Atrial Tachycardia or SVT
\***remember this is w/ NO ACTIVITY we call it SVT otherwise WITH Activity we call it Sinus Tachy**
**Keep in mind...**
* Tachy occurs **ABOVE AV node**
* **rate always elevated**
* **common**
* **NOT benign**
* **Usually older adults w/ comorbidities**
45
**Rate for SVT (Tachycardia)**
150-250bpm
46
EXAMPLE
## Footnote
**NSR into SVT**
see pics
47
Rate for **"Flutter"**
250-350bpm
48
Atrial Flutter
## Footnote
**Keep in mind...**
* **Atrial rate will be \> ventricular rate**
* **Usually has a RATIO (report it!)**
* **ex. 4:1 Atrial Flutter** ****
## Footnote
****
49
**Fibrillation Rate**
350+
SUPER FAST!
50
RATES LISTED
**SVT**
**A-Flutter**
**A-Fib**
* SVT==150-250
* A-Flutter==250-350
* A-Fib==350+
51
Atrial Fibrillation
## Footnote
**Keep in mind**
* Chaotic, squiggly line MESS b/w QRS complexes
* Rate: 350+
* **Irregular MUST use method 1**
## Footnote
****
52
A-Fib and **Ejection Fraction**
* Norm EF==60%
* **W/ A-Fib**
* **EF is diminished (by ~15%) w/ _significant blood remaining in atrium_**
53
A-Fib
## Footnote
**Keep in mind w/ CLOTS**
**A-fib you are @ risk for CLOTS!!!**
* The atria are filled w/ **ectopic foci**
* The atria will shake like Jello
* **Pooled blood builds up in jello atria**
* **== HIGH RISK FOR DVT**
54
PT Implications A-Fib
\*\*\*\*\*
* Check t/o sessions for s/s of **Low CO**
* Neuro screen regularly
* ex. **smile @ me**
* CV/Pulm screen regularly
* **PulseOX**
* **chest pain**
* **VITALS!!!**
55
PT Implications of **A-Fib**
## Footnote
**When the Ventricular Rate goes ABOVE 100**
**Rate \>100bpm w/ A-Fib**
* A-Fib w/ **Rapid Ventricular Rate (A-fib w/ RVR)**
* **Pot. for LOW CO**
56
Rates:
**Tachy vs. Flutter vs. Fibrillation**
* Tachy **(Atrial Tachy/SVT)**
* 150-250 **Atrial AND Vent**
* Flutter
* 250-350 **Atrial rate**
* Fibrillation
* 350+ **Atrial rate**
57
**Junctional Rhythms**
**\*Only @ AV NODE\*\*\* so it will have that AV Node rate (40-60bpm)**
**3:**
1. PJC --- NO P Wave
2. Junctional (Idiojunctional)
3. Accelerated Idiojunctional (**SVT)**
1. **Tachy occurs @ or ABOVE AV node or OUTSIDE VENTS**
58
ONLY NORMAL THING W/ JUNCTIONAL ARRHYTHMIAS
QRS Width
59
PJC
NO P OR INVERTED P
\***Also "Same ht. T==PJC"**
60
Junctional Rhythm
**Idiojunctional**
**Keep in mind..**
* NSR of **AV Node**
* **NO SA Node so AV node takes over as _Backup Pacemaker_**
* **__These will have that AV Node rate of 40-60bpm**
* **R. CA MI, Necrosis**
61
Accelerated Junctional Rhythm
OR aka
Accelerated Idiojunctional
Nodal (Junctional) Tachycardia
62
**Accelerated** Junctional Rhythm
Keep in mind w/ **Rate**
* **Accelerated** junctional rhythm rate will be **Faster** than the normal **junctional rhythm rate**
* **Accelerated will be \>60**
* **normal junctional remember is b/w normal AV node 40-60bpm**
* **Junctional SVT will be \>100**
* **remember SVT == 150-250bpm**
* **STILL NO Pwave though!**
* **embedded into the T (same Ht. T)**
63
EXAMPLE **Junctional SVT**
see pic
64
Sinus Tachycardia vs. Paroxysmal Atrial Tachycardia (**SVT)**
## Footnote
**SAME thing EXCEPT if there is a _known cause for Tachy_**
**DIFFs broken down**
* **SINUS TACHYCARDIA**
* ****Doing Exercise!!!
* **Atrial Tachycardia or SVT**
* ****150-250 **for no apparent reason!!!**
65
**Accelerated Idiojunctional Rhythm vs. Nodal Tachycardia (SVT)**
**Same thing EXCEPT if** **_known cause for Tachy_**
**DIFFs broken down**
* **Accelerated IJR**
* **AV node \>60bpm**
* **DOING EXERCISE**
* **Nodal Tachycardia or SVT**
* **100-250 for NO REASON**
66
Straight up **SVT**
**"P wave BURIED in the T==SVT"**
67
ALL Premature Beats (PAC, PJC, PVC) NEED what?
Underlying rhythms!!!!!
68
PVCs and counting RATE
NO CO from PVC ---**DO NOT COUNT PVC IN RATE!!!**
## Footnote
**\*\*PAC and PJC you DO COUNT**
69
Normal Rhythms come from
SA Node
70
Atrial Arrhythmias come from
ABOVE AV Node
\***IN Atria**
71
Ventricular Arrhythmias come from
VENTRICLES
72
**Ventricular Arrhythmias**
**7:**
1. PVC---DO NOT COUNT IN RATE
2. V-Tach
3. V-Flutter (Torsades de Pointe)
4. V-Fib
5. Idioventricular (NOT ON TEST)
6. Asystole (Flatlining)
7. PEA\*\* (NO PULSE)
73
PVC **Unifocal**
SAME SHAPE
74
PVC **Multifocal**
DIFFERENT SHAPE
75
PT Implications of **PVC**
Check 02sats regularly
76
**Significant PVCs**
**HIGH PT IMPLICATIONS**
**\*Terminate PT!!!**
**5:**
1. **Multifocal** PVCs
2. 6-10 or MORE PVCs/Minute
3. **Bi**geminy
1. **PVC every other (2nd) beat**
4. **Tri**geminy
1. **PVC every 3rd beat**
5. \>3 PVC's in a row==\> **V-TACH**
77
PAC
PJC
PVC
**\>3 IN A ROW**
* \>3 PAC==**SVT OR Atrial Tachycardia**
* \>3 PJC==**SVT OR Accelerated Idiojunctional**
* \>3 PVC==**V-TACH**
**\*\*\*KEEP IN MIND for SVT vs. Sinus Tachy or SVT vs. Accelerated IJR if they are EXERCISING or NOT DOING ANYTHING!!!!**
78
3 PVCS in a row==**V-TACH**
## Footnote
**Causes:**
Acute MI
CAD
HTN
Rxn to meds
Electrolyte imbalance
79
CLASSIC **V-TACH Strip**
## Footnote
**"Pyramids"**
see pics
**Still regular\*\*\***
* Remember **\>3 PVCs in a row!!! == VTACH**
* **SUPER WIDE BIZARRE QRS**
80
WORSENING of V-Tach
Torsades de Pointes**/V-Flutter**
* **Looks like ribbon**
* **need AED to save them**
* **No pulse OR thready pulse**
81
WORSENING of A-Flutter
**-Disorganized, just a squiggly line**
**-Ventricles like jello**
Ventricular Fibrillation
\*remember 350+ bpm
82
V-Fib
## Footnote
**Causes:**
* CAD
* Acute MI
* Toxicity from drug
* Electrolyte imbalance
83
HEART BLOCKS OR.....
The **"Detours" one!!!!**
**\*Heart Blocks b/w communication from SA---\> AV Node**
84
1st Degree Heart Block
## Footnote
**Things to know:**
* **Detour one!!!**
* **impulse has to go thru detour so _LOOOOOOOONG PR intervals_**
* Very benign
* older people
85
2nd Degree Heart Block **Type I**
## Footnote
**Mr. Weckenbach**
**Sketchy!!! Loves to be LATE, LATER, LATER, NOT COME HOME!!!**
* \*NO IMPLICATIONS FOR PT
* **Progressive elongation of PR interval**
* Mr Weckenbach comes home later, later, later each night spending time w/ his mistress THEN DOES NOT come home and spends the night with his mistress
* Block b/w SA and AV Node
86
2nd Degree Heart Block **Type II**
## Footnote
**Mr. Morbitz!**
* Mr Morbitz plays it safe by being **on time multiple nights then one night DOES NOT COME HOME**
* **Mr Morbitz is On time, On time, On time, then DOESN'T COME HOME (DROPPED QRS)**
* **\*\*AV blocks @ lvl of _Bundle of HIS_ OR @ B/L bundle branches of trifascicular**
87
2nd Degree Heart Block **Type II**
## Footnote
**Mr Morbitz**
**RISKS**
* Risk of going into more severe heart cond.
* Dx AFTER acute MI
88
3rd Degree Heart Block
* \***Atria and Vents fire** **_completely isolated of ea. other_ ==\> NO COMMUNICATION**
* **VARYING PR intervals AND SO MANY P'S!!!**
* **LIFE-THREATENING ARRHYTHMIA**
89
1st Degree Heart Block vs.
2nd Degree Heart Block **Type I (Mr Weckenbach)** vs.
2nd Degree Heart Block **Type II (Mr Morbitz)** vs.
3rd Degree Heart Bloc k
see pics
90
Pacemaker
## Footnote
**What are the precautions?**
NO LIFTING w/ UE w/ PM
\*up to 2wks
91
The **SA Node is the Pacemaker for**
Atria
92
The **AV Node is the Pacemaker for**
Ventricles
93
Pacemaker
## Footnote
**What is it?**
electronic device used to **generate an artificial action pot in the Atrium (SA PM) and/ or Ventricles (AV PM)**
94
Pacemaker may be used **temporary** or **permanent**
## Footnote
**If permanent: placed where?**
Implanted under skin **just below L. Clavicle**
**\*may be adjusted EXTERNALLY**
95
Pacemaker
## Footnote
**Extra details**
* Used for **Brady or Dysrhythmias (arrhythmias)**
* Pulse from PM firing results in a **distinctive VERTICAL DEFLECTION** called a **Spike**
* **Pacer spike followed by a P for _Atrial pacing_** and **by a QRS for _Ventricle pacing_**
96
Dual chamber Pacemaker
* 2 Leads
* One connected to **Rt. Atrium**
* **for SA**
* Other connected to **Rt. Ventricle**
* **for AV**
97
12 Lead EKG
## Footnote
**V1-V6**
physically put on
**Picks up (+) deflections**
98
Bundle Branch Blocks or...
**The ones w/ TWO R waves**
* **Must be dx'd on 12 lead ECG**
* Causes one ventricle to depolarize and contract **LATER than the other** due to the delay/block of the impulse w/in the **bundle branch (after the AV node)**
* **2 R waves--\> one W/IN QRS**
* **QRS will be .12s or WIDER**
* **Wider==any issue w/ vents**
99
Bundle Branch Blocks--**RIGHT**
* Rt. Vents fire late
* R/R' in leads V1 or V2
100
Bundle Branch Blocks **LEFT**
* L. vent fires late
* R/R' in leads **V5 & V6**
101
12-Lead EKG: **Hypertrophy**
**Right Vent Hypertrophy**
**vs.**
**Left Vent Hypertrophy**
* Shift of the axis so you will **pick up TALLER R-wave in:**
* **V1--Right**
* **V5--Left**
* Loc. of side the **R wave is GREATER (higher) on==side of hypertrophy**
102
12 Lead EKG: **Hypertrophy==**
\*INC in **thickness** of **cardiac** **muscle** OR **chamber size**
103
12-Lead EKG: **Hypertrophy**
## Footnote
**Rt. Vent Hypertrophy vs. Left Vent Hypertrophy**
* **R. Vent**
* **V1:** LG R Wave bc mm BIGGER so takes LONGER
* R wave becomes progressively smaller in V2-V5
* **L. Vent--more common**
* ****Lg. R wave in **V5**
## Footnote
**\*V1==Right**
**\*V5==Left**
104
12 Lead EKG: **Ischemia**
* ==\> **reduced blood flow to _myocardium_ due to _occlusion of CA's from:_**
* **__**Vasospasm
* atherosclerotic occlusion and/or Thrombus
105
12 Lead EKG
## Footnote
**How is _Ischemia_ demo'd?**
3 Options:
1. **T wave INVERSION**
**2. ST segment ELEVATION**
**3. ST segment DEPRESSION**
106
12 Lead EKG: **Infarction**
* ==\> Cell DEATH resulting from **complete occlusion of Coronary Artery**
107
12 Lead EKG: **Ischemia**
## Footnote
**Transmural Infarction**
**vs. NON-Transmural Infarction**
* **Transmural (Completely covered)** ****
* Cell **necrosis or death COMPLETELY COVERS** entire Myocardial wall of heart
* **NON-Transmural (Only one part)**
* ****just occurs in _one part_---\> **still @ risk for FULL**
**NOTE:** ST Segment depression **in absence of ischemia or angina** may be due to **digitalis toxicity**
108
12-Lead EKG: **Ischemia**
## Footnote
**Leads that demo presence of T wave inversion, ST segment changes, or Q waves identify *_Location of ischemia,_ _injury_, or _infarction_***
see pics
109
Significant Q wave and/or ST elevation in leads **V1, V2, V3, V4**
## Footnote
**indicates-----**
**ANTERIOR** INFARCTION
110
**ANTERIOR** INFARCTION
Significant Q wave and/or ST elevation in leads **V1, V2, V3, V4**
111
Significant Q wave and/or ST elevation in **Leads II, III, and aVF**
## Footnote
**indicates**
**INFERIOR** INFARCTION
\***notice the aVF (Feet==inferior)**
112
INFERIOR INFARCTION
\*notice the aVF (Feet==inferior)
Sig. Q wave and/or ST elevation **leads II, III, aVF**
113
Sig. Q wave and/or ST elevation in **chest leads I or aVL indicates...**
**LATERAL** INFARCTION
\***notice aVL (L means Lateral)**
114
**LATERAL** INFARCTION
**\*notice aVL (L means Lateral)**
Sig Q wave and/or ST elevation in **chest leads I or aV_L_**
115
DIRECT OPPOSITE tracing of **Anterior Infarction in V1 an V2**
## Footnote
**indicates....**
POSTERIOR INFARCTION
## Footnote
**V1/V2 FLIPPED CONCEPT**
116
**POSTERIOR** INFARCTION
V1/V2 FLIPPED CONCEPT
DIRECT OPPOSITE tracing of **ANTERIOR INFARCTION in V1/V2**
117
\*\*\*From NPTE
What condition could explain why the **HR** of an **exercising pt** abruptly drops to **half the value** that was pre-recorded?
2nd Degree Heart Block
(Nrml--\>block--\>Nrml--\>block)
**Cuts CO by 50% bc of DROPPED QRS's**
