ECG heart rhythm 1/18

Question 1

what info can a 12 lead ECG provide?

Answer 1

HR, rhythm, conduction
areas ischemia and infarction
hypertrophy
electrolyte imbalance
systemic pathologies - COPD, cerebral T-waves, etc.

Question 2

what ECG part represents

atrial depolarization

Answer 2

p wave

Question 3

what ECG part represents

time required for impulse to travel from atria through conduction system to Purkinje fibers

Answer 3

P-R interval

Question 4

what ECG part represents

ventricular depolarization

Answer 4

QRS wave

Question 5

what ECG part represents

beginning ventricular repolarization

Answer 5

ST segment

Question 6

what ECG part represents

ventricular repolarization

Answer 6

T wave

Question 7

what ECG part represents

time for electrical systole

Answer 7

QT interval

Question 8

what are you calculating?

count # intervals between QRS complex in 6 second strip x 10

Answer 8

HR

Question 9

causes of arrythmias?

Answer 9

ischemic conditions of myocarium
electrolyte imbalance
acidosis, alkalosis
hypoxemia
hypotension
emotional stress
drugs, alcohol, caffeine

Question 10

what term?

• premature beat from ventricle
• ocassionally occurs in majority normal pop

Answer 10

PVC premature ventricular contractions

Question 11

ECG:
no P wave
bizarre and wide QRS
long compensatory pause

Answer 11

PVC premature ventricular contractions

Question 12

when to be concerned about PVCs

Answer 12

> 6 per minute of in sequential runs
multtifocal
very early PVC (R on T phenomenon)

Question 13

next step if PVCs increase with activty

Answer 13

stop exercise, review cardiac

Question 14

what term?
3+ PVCs sequentially
very rapid HR 150-200bpm
may have abrupt onset
seriously compromised CO
typical cause?

Answer 14

ventricular tachycardia

cause ischemic ventricle

Question 15

ECG:
no p wave
wide bizarre QRS waves
3+  sequentially
types?

Answer 15

ventricular tachycardia
non sustained terminates spontaneously in <30sec
sustained >30sec

Question 16

what term?

• pulseless emergency situation, need CPR, defibrillation, medication
• multiple foci
• unable to determine rate

Answer 16

ventricular fibrillation

Question 17

ECG:

• bizarre, erratic activity
• no QRS complexes
• no cardiac output

Answer 17

ventricular fibrillation

Question 18

if ventricular fibrillation, cardiac death within how long?

Answer 18

4-6 min

Question 19

what term?

Rapid repetitive firing of one or more ectopic foci in atria outside of sinus node

Answer 19

atrial arrhythmia, supraventricular

Question 20

ECG:
p wave abnormal, variable in shape or not identifiable
- rhythm irregular - chronic or abrupt
- CO maintained if rate maintained

Answer 20

atrial arrhythmia, supraventricular

Question 21

ECG:
p wave abnormal, not identifiable
- rhythm irregular - chronic or abrupt

Answer 21

atrial fibrillation

Question 22

HR?

• atrial tachycardia
• atrial flutter
• atrial fibrillation

Answer 22

tachy 140-250bpm
flutter 250-350bpm
fibrillation >300bpm

Question 23

ECG:

sawtooth appearance

Answer 23

atrial flutter

Question 24

what term? - abnormal delay or failure to conduct through conducting system (node>bundle of his>bundle branch > purkinje fibers)
which is life threatening?

Answer 24

atrioventricular blocks

- third degree, complete block is life threatening

Question 25

what to do if 3rd degree heart block?

Answer 25

complete heart block life threatening

• medication atropine
• surgical implant pacemaker

Question 26

when does ST segment depress?

Answer 26

impaired coronary perfusion- ischemia or injury

Question 27

what is abnormal ST segment change?

Answer 27

• abnormal depress/elevate >1mm in 2 consecutive leads (except V2-V3)
• elevate >2mm men >=40yr
• elevate >2.5mm men <40yr
• elevate >=1.5mm women

Question 28

what pathology?

acute ST elevations in leads over affected part of heart

Answer 28

acute MI

Question 29

hyper/hypokalemia?
ECG:  
wide PR interval
wide QRS
flatten P wave, may disappear
tall T wave
>bradycardia

Answer 29

hyperkalemia, increase K+

Question 30

hyper/hypokalemia?
ECG: 
wide PR interval
wide QT interval 
flatten or inverse T, U wave

Answer 30

hypokalmeia, decrease K+

Question 31

hyper/hypocalcemia?
ECG:  \
wide QRS
short QT interval
increase

Answer 31

hypercalcemia, increase heart action

Question 32

hyper/hypocalcemia?
ECG:
long QT interval

Answer 32

hypocalcemia, depress heart action

Question 33

hyper/hypothermia?
ECG:
elevate ST
slow rhythm, decrease PR interval

Answer 33

hypothermia, decreased body temp, decrease HR

Question 34

ECG: what medication?
depress ST segment
flatten T wave, or invert
QT shortens
shorten PR interval

Answer 34

digitalis - cardiac glycoside
- slow HR
treat congestive heart failure (CHF), heart rhythm problems (atrial arrhythmias).
-works directly on the heart muscle to strengthen and regulate the heartbeat.

Question 35

ECG: what medication?
QRS lengthens
QT lengthens
T wave flattens or inverse

Answer 35

quinidine
antiarrhythmic agent in the heart
causes increased action potential duration, as well as a prolonged QT interval.

Question 36

what medication increase HR?

Answer 36

nitrates, nitroglycerin

Question 37

what medication prolong QRS and QT intervals?

Answer 37

antiarrhythmic agent, eg. quinidine

Question 38

where do V1-V6 precordial chest leads go?

Answer 38

V1 - 4th IC, R sternum
V2- 4th IC, L sternum (Tricuspid auscultation)
V3- between V2 and V4
V4- 5th IC, midclavicular line (Bicuspid auscultation)
V5- 5th IC, anterior axillary line
V6- 5th IC, midaxillary line

Question 39

where do 5 lead ECG leads go?

Answer 39

RA, RL - white snow over green grass
LA, LL - black smoke over red fire
and Chest

Question 40

what do inverted T wave mean?

Answer 40

• Left Ventricular Hypertrophy

* Myocardial ischemia