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Cario-pulm > ECGs both lectures > Flashcards

ECGs both lectures Flashcards

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1
Q

What is the SA node rate?

A

60-100 BPM

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2
Q

What is the aterioventricular node AV/junctional node rate?

A

40-50BPM

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3
Q

What does the P wave signify?

A

atrial depolarization

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4
Q

What does the PR associate with?

A

delay at AV node for ventricular filling

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5
Q

What does the QRS segment/complex assoicate with?

A

ventricular depolarization

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6
Q

What does the T wave assoicate with?

A

ventricular repolarization

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7
Q

what is the rate of the purkinjie fibers?

A

20-40 bpm

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8
Q

on a ECG what does 1 square = to in time?

A

0.04 sec

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9
Q

what is the ST segment associated with?

A

begening of ventricular repolarization, should be flat

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10
Q

How long in time is a large box?

A

0.20 seconds

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11
Q

How long should the P wave be?

A

0.06-0.11 seconds
= 2.5 ish small boxes?

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12
Q

what are the normla charcteristics of the P wave

A
  • round
  • upright
  • symmetrical
  • first ECG deflection
  • present before every QRS complex
  • atrial depolarization
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13
Q

How long is the PR interval duration?

A

0.12-.20 seconds
3-5 small boxes

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14
Q

what is the normal charcteristics of the PR interval

A
  • transmission of electrical activity from atrial to ventricles
  • includes p wave and PR segment
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15
Q

how long is the PR segment?

A

0.02-0.10 less than 3 small boxes

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16
Q

What is the normal charcteristics of the PR segment

A
  • isoelectric activity
  • pause needed for additional 20+% contribution to stroke volume
  • atrial kick
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17
Q

How long is the QRS complex?

A

0.06-0.10 less than 3 small boxes

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18
Q

what is the charcterisitcs of the Q wave

A
  • first downward defelction
  • after P wave
  • Before R wave
  • start of ventricular depolarization
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19
Q

What are Normal the charcteristics of the R wave?

A
  • first upward deflection after the Q wave
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20
Q

what are the normal charcteristics of the S wave?

A
  • a downward defelction immediatly after the R wave
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21
Q

How long should the ST segment be?

A

< 0.20 less than 2-3 small boxes

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22
Q

What are normal characteristics of the ST segment?

A
  • horizontal segment after the QRS complex
  • J point
  • plataue phase
  • start of repolarization of the ventricles
  • any elevation or depression signifies serious pathology
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23
Q

What is the duration of the T wave?

A

<.20 seconds

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24
Q

What are the normal charcteristics of the T wave?

A
  • Broad hump after the ST segment
  • Final phase of “rapid” ventricular repoloraization
  • returning of interior, negative resting charge of cardiac cells
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25
How long is the QT duration
0.32-0.40 varies but ussally half of the R-R interval
26
what is the normal charcterisitcs of the QT interval?
* signifies duration of ventricular systole (contraction) * begenning of QRS to the end of T wave * Good indicator of effective repolarization * Long QT = serious ventricular rhythm (fatal)
27
what is the U wave?
* thought to occue when the ECG machine picks up repoloarization of the perkinji fibers * most often seen with hyopkalemia
28
What is hypokalemia?
low potassium
29
What is the three lead ECG used for?
to interpret rhythm
30
What it the ECG five lead used for?
to interpret rhythm
31
What is the 12 lead ECG for ?
used to diagnose
32
Where to the three leads go for the 3 lead ECG?
RA and LA and LL right shoulder left shoudler and left hip (ish)
33
Where are the 5 leads go for the 5-lead ECG
*RA (White): Under the right clavicle, near the right shoulder, within the rib cage frame. * LA (Black): Under the left clavicle, near the left shoulder, within the rib cage frame. * RL (Green): On the lower right abdomen within the rib cage frame. * LL (Red): On the lower left abdomen within the rib cage frame. * V (Brown): On the chest, typically at the fourth intercostal space, right side of the sternum.
34
What are the 3 ways to determine HR on ecg?
* COUNT NUMBER OF QRS COMPLEXES IN 6 SECONDS AND MULTIPLY BY 10 6 second strips are common and correspond to 1 min (# of beats/ min) This method can only be used if rhythm is regular * LOCATE R WAVE ON A DARK LINE AND COUNT EACH DARK LINE AFTER AS… 300, 150, 100, 75, 60, 50  This method can only be used if rhythm is regular  * DIVIDE 1500 BY NUMBER OF SMALL BOXES BETWEEN EACH R WAVE Recall that one large box = 5 small boxes 
35
What are the cardiac physiologic cycle on the ECG?
* AS THE QRS ENDS AND T WAVE BEGINS = ENDING OF SYSTOLE * SEMILUNAR VALVES CLOSE * ATRIOVENTRICULAR VALVES OPEN = BEGINNING OF DIASTOLE * T WAVE = PASSIVE VENTRICULAR FILLING * END OF P WAVE = ATRIOVENTRICULAR VALVES CLOSE = ENDS DIASTOLE * IMMEDIATE CLOSURE OF ALL VALVES (ISOMETRIC CONTRACTION) * INCREASED FORCE OF BLOOD → BURSTING OPEN SEMILUNAR VALVES INIATING SYSTOLE
36
What is Sinus Bradycardia?
* Electrical impulse started at the SA Node * But the SA Node is pacing at a slower rate * Brady = slow * Rate< 60 bpm * Non-life-threatening
37
What causes sinus bradycardia?
* parasympathetic exess * athletes * beta blockers
38
What is the risk of sinus brady cardia?
* syncope * loss of consciousness * pacemaker
39
What is the systematic interprtation of sinus bradycardia?
* All P waves are present, upright, symmetrical * There’s a P wave before every QRS * Normal PR Interval * QRS is identical * QRS duration is normal * Normal R-R Interval * The only abnormality is a SLOWER pacing SA Node
40
What is sinus tachycardia?
* Electrical impulse started at the SA Node * But the SA Node is pacing at a faster rate * Tachy = fast * Rate>100 bpm * Non-life-threatening
41
What is the cause of sinus tachycardia
* sympathetic excess * exercise induced * caffeine * CHF
42
What are the risks of sinus tachycardia?
* progression to more serious of dysrhymias
43
Treament of sinus tachycardia?
* elimating the underlying cause * beta blockers
44
What is the systematic interprtation of sinus tachycardia?
* All P waves are present, upright, symmetrical * There’s a P wave before every QRS * Normal PR Interval * QRS is identical * QRS duration is normal * Normal R-R Interval * The only abnormality is a FASTER pacing SA Node
45
What is Sinus Block? Cause? Treatment?
* SA Node fails to initiate an impulse - “skipped a beat” * Usually just one lapse in the cardiac cycle * Increased lapse → cardiac (sinus) arrest! * The R-R Interval will be the only abnormal finding * Only where the pause occurred * Still have a variation of normal HR, if frequency of blocks does not increase * Cause: Parasympathetic increase, Sick Sinus (SA Node) Syndrome, Infection * Treatment: Depends on underlying cause
46
What is automaticity foci? Where are they? Why do they occur?
* FOCAL AREAS OF AUTOMATICITY IN THE HEART “Automaticity Foci” (singular form = focus) “Potential pacemakers” “Ectopic” foci * Location Atria AV junction Ventricles * Normally electrically silent ( Can be activated and initiate pacing in emergent situations If SA node fails to pace
47
what is atrial and ventricular specific automaticity foci?
* Potential pacemakers of the atria ”atrial automaticity foci” (Rate = 60-80 bpm) * Potential pacemakers of the AV junction “junctional automaticity foci” (Rate = 40-60 bpm) * Potential pacemakers of the ventricles “ventricular automaticity foci” (Rate = 20-40 bpm)
48
what is a wandering pacemaker? Cause? Treatment?
* Pacemaker activity shifts from focus to focus * Some focus may be from the SA or AV Node * Results in an irregular rhythm * Discharge and speed at which the impulse of focus is released varies * Morphology of each P wave varies * R-R Interval may vary * Heart rate usually normal * Cause: Irritable focus * Treatment: None, unless progresses to atrial fibrillation
49
What are the 4 different atrial arruthmias?
* premature atrial complexes * atrial tachycardia * atrial fibrilation * atrial flutter
50
What is premature atrial complexes (PACS)?
* Ectopic (abnormal) pacing occurring in the atria BEFORE the SA Node * The premature firing is displayed on the ECG as an abnormal P wave * Early P wave will have a different configuration from the normal pacing P’s * A pause may follow the PAC * Depending on heart rate, premature P wave may be buried in T wave
51
What is the cause of PACs and atrial tachycardia?
COPD, stress, caffeine, alcohol, infection, hypoxemia
52
What is the treament of PACs
can progress to atrial fibrilation
53
What is atrial tachycardia?
* ≥ 3 PACs in a row * Heart rate range is >100 bpm * Can lead to supraventricular tachycardia (SVT) * Paroxysmal = sudden onset of heart-racing sensation * P waves’ morphology could change and may not precede QRS * The Intervals will also vary: PR and R-R intervals
54
What is the treament of atrial tachycardia?
underlying cause meds
55
What is atrial flutter?
* Rapid, repetitious atrial depolarization from one ectopic focus * Heart rate range: 250-400 bpm (atria) * P waves will have an identical “sawtooth” pattern * More than one P wave for every QRS R-R interval may vary due to abnormal P:QRS ratio 2:1 or 8:1 firing ratio, depending on rate of rapid atrial firing
56
What is the cause of atrial flutter?
CAD stress pericarditis
57
What is the treatment of atrial flutter?
* digoxin * Beta-blockers * cardioversion
58
What is atrial fibrillation (a-fib)?
* Erratic quivering of atria due to firing of multiple ectopic foci * No true P waves * Absence of true atrial depolarization * Loss of atrial kick * AV Node still controls ventricular activity * Reflected by QRS presence: R-R Interval varies Irregularly irregular rhythm
59
what is the cause of atiral fibrillation?
CHF Stress Age
60
what is the treatment for atrial fibrillation?
Meds
61
What are the 3 junctional arrhythmias?
* premature junctional complexes * junctional rhythm * junctional tachycardia
62
What is premature junctional complex?
* Premature firing arising from the AV Node (AV Junction) * Results in an early beat (early QRS complex) * Since firing does not occur from the primary pacer (SA Node) Presence of inverted, absent, or retrograde P wave for every QRS * Heart rate usually normal
63
What is the cause for premature junctional complex?
* sick SA node
64
What are the three heart blocks?
* First-Degree AV Heart Block * Second-Degree AV Heart Block (Wenckebach, Mobitz I) * Second-Degree AV Heart Block (Mobitz II) * Third- Degree AV Heart Block
65
What is the first degree heart block? Cause? Treatment?
* Impulse originates in the SA Node * Delay occurs en route to the AV Node or initiated in the AV Node * Lengthens delay between atria and ventricular depolarization * Prolonged PR Interval >0.20 sec (increased conductivity) Prolongation is consistent in every cycle * R-R Interval is still regular * Heart rate is typically normal Cause: CAD, med(s) Treatment: Eliminate med(s)
66
What is the 2nd degree mobitz 1 heart block? Cause? Treatment?
* “Wenckebach” * Impulse occurs at the AV Node  * Some impulses en route through AV junction are blocked * Progressively prolonged PR Interval with a sudden drop and subsequent return of QRS complex * P wave will eventually and briefly stand alone * R-R Interval is irregular * Cause: Varies * Treatment: Benign; uncommon to treat
67
What is the 2nd degree Mobitz II? Cause? Treatment?
* Conduction block occurs below bundle of His * Paced atrial depolarization is blocked before conduction to ventricles occur * Series of one normal P-QRS-T cycle precedes a stand-alone P wave (P-R Interval is constant) * P-QRS ratio could be 3:1, 4:1, 5:1 * R-R Interval is irregular * Heart rate range varies * Cause: Infarction (Left anterior descending) * Treatment: Pacemaker, meds, PREVENT PROGRESSION TO 3rd Degree!
68
What is the 3rd degree heart block?
* All impulse from the SA Node/above ventricles are blocked * Two pacing systems Atria and ventricles pace separately Asynchronous, independent communication * P waves are present but have no relationship to QRS (inconsistent PR) * QRS duration may lengthen (widen) if pacing is occurring in ventricles  * R-R Intervals are regular * Heart rate can be abnormally low if ventricular pacing is dominating * Cause: Acute MI * Treatment: Pacemaker (permanent)
69
Heart block tip?
* If the PR Interval is constant = Mobitz II * If the PR Interval is not constant Look at the R-R Interval Is it regular? → 3rd-Degree Block Is it irregular → Mobitz I/Wenckebach
70
What are the 4 ventricular arrhythmias?
* Premature Ventricular Complexes (PVCs) * Ventricular Tachycardia (V-tach) * Torsade de Pointes (form of V-tach) * Ventricular Fibrillation (V-fib)
71
What is a PVCs?
* Ectopic focus occurring within the ventricular walls * Fires prematurely…. BEFORE the SA Node is able to fire  * QRS complex is wide and bizarre * No P wave preceding the early QRS * Presence of a compensatory pause right after early QRS * May see unifocal PVC (identical) or multifocal PVC (>1 and unidentical) Couplet = 2 PVCs together Triplet = 3 PVCs together Bigeminy = every other beat is a PVC Trigeminy = every third beat Quadrigeminy = every fourth…etc. * Other beats usually have normal sinus-paced rhythm
72
What are the causes of PVCs?
* caffine * stress * acute MI * CHF * chronic lung disease
73
What is the treament for PVCs?
depends on underlying cause and frequency, severity
74
When do PVCs become life threatening?
1. PVCs are paired 2. multifocal 3. more than 6 PVCs/minute 4. triplets present
75
What is ventricular tachycardia?
* >3 PVCs in a row * Increased automatic firing by a single ventricular focus * P waves are absent * QRS are wide and bizarre * Ventricular rate = 100 – 250 bpm * Cause: Varies * Medical Emergency: Increasing irritability → V-fib → Death * Symptoms: Weak, thready pulse
76
What is the treatment for ventricular tachycardia?
emergent pharmaceutical injection, defibrillation
77
What is torsades de Pointes?
* French for “twisting of the points” * Polymorphic ventricular tachycardia * Twisting around the isoelectric line * Two competitive, irritable foci in different ventricular areas * Onset and termination spontaneously * Varying amplitude * QT Interval is prolonged (>0.5 sec)
78
What is the cause and treatment for Torsades de Pointes
* Toxicity to anti-arrhythmic med (potassium-blocking meds) * Treatment: Cardioversion
79
What is ventricular fibirrlation? Cause? Treatment?
* Multi focus firing * Erratic quivering of ventricles * Asynchrony NO CARDIAC OUTPUT * Irregular “zigzag” pattern * Cause: Same as v-tach * Treatment: Immediate defibrillation and subsequent CPR ## Footnote Be sure it’s not artifact from lead displacement
80
anterior MI (left anterior desending artery) shows up on what lead? | 12 lead
ST-segment changes or significant Q in leads: V1-V4
81
Septal wall MI (Left Anterior Descending) shows up on what lead?
ST-segment changes or significant Q in leads: V1-V2
82
Inferior MI (Right Coronary Artery) shows up on what lead?
ST-segment changes or significant Q in leads: II, III, aVF
83
Lateral MI (Circumflex) shows up on what lead?
ST-segment changes or significant Q in leads: I, aVL, V5-V6
84
What are shockable rhythms?
* pulseless V-Tach * V-fib * supraventricular tachycardia
85
What is this Rhythm?
first-degree heart block
86
What is this Rhythm?
Atrial Flutter
87
What is this Rhythm?
supraventricular tachycardia ## Footnote Supraventricular tachycardia (SVT) is an extremely fast atrial rhythm with narrow QRS complexes when the impulse originates above the bundle branches (above the ventricles).
88
What is this Rhythm?
Ventricular Tachycardia ## Footnote Ventricular tachycardia (Vtach or VT) is characterized by bizarre widened QRS complexes, no P waves and usually a rate over 100 per minute.  May quickly degenerate to Ventricular fibrillation and death.  VT may be responsive to electrical defibrillation.
89
What is this Rhythm?
Sinus bradycardia
90
What is this rhythm?
Atrial Fibrillation
91
What is this rhythm?
Second degree AV heart block type 1 Wenckebach
92
What is this rhythm?
Sinus tachycardia
93
What type of rhythm is this?
third degree heart block
94
What is this rhythm?
Normal Sinus Rhythm
95
What rhythm is this?
Ventricular fibrillation

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