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Clin Med 2 - CARDS > EKG 1 and 2- fiore (incomplete) > Flashcards

EKG 1 and 2- fiore (incomplete) Flashcards

1
Q

Why do we obtain an EKG?

A

screening: aka asymptomatic
Diagnostic: Assess signs/symptoms
Prognositic/Monitoring

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2
Q

when are EKG screenings typically performed

A

generally, only for those with high cardiac risk:
over 65
screening for “silent” heart attacks, Afib, and hypertrophy
CDL license
Familial history of life-threatening dysrhythmias

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3
Q

when are EKGs used for diagnostic purposes

A

assess signs and symptoms:
chest pain
SOB
Near syncope/syncope
palpitations
confusion/AMS
weakness
exercise intolerance
MOST PTS THAT ENTER THE ER
02, IV, MONITOR

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4
Q

When do we use prognostic/monitoring EKGs

A

telemetry
cardiac risk monitor aka stress test
event vs continuous monitoring: monitor for dysrhythmias
Trauma (CNS, Cardiac)
OD pts
Medication monitoring

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5
Q

What are the two specialized cells within the heart

A

pacemaker cells and myocyte

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6
Q

What is Einthoven’s triangle

A

three leads
bipolar leads (positive and negative side) - go negative to positive

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7
Q

What are augmented leads

A

aVR, aVL, and aVF
unipolar - single positive with reference point
more information about axis and geographic ischemia

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8
Q

What type of lead give us more information about axis and geographic ischemia

A

augmented leads
aVT, aVL and aVF

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9
Q

What are the precordial leads

A

aka “V” leads
unipolar leads- positive
shows the heart in the anterior and LEFT lateral (side) view

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10
Q

what are positive leads

A

the view points

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11
Q

what are the locations of the 12 lead EKG

A

10 leads total:
4 Limb cables (leads)
6 precordial cables (leads)
12 leads (views) on paper

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12
Q

what is the normal QRS duration

A

0.06 to 0.10 seconds

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13
Q

what it the T wave

A

repolarization
slightly asymmetric

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14
Q

what is the PR interval

A

conduction through the AV node
beginning of P wave to the beginning of the QRS
normal: 0.12 to 0.20 seconds (3 to 5 small squares)

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15
Q

when does the PR interval shorten

A

as HR increases

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16
Q

when does the PR interval lengthen

A

as HR decreases

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17
Q

what condition has a short PR interval

A

Wolf Parkinsons White (WPW) syndrome

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18
Q

What is a Delta wave

A

shortened PR interval in Wolff-Parkinson-White syndrome

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19
Q

What is Wenkebach

A

2nd degree Mobitz Type 1 AV block
longer and longer PR interval

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20
Q

what is a complete AV block

A

3rd degree AV block

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21
Q

What is the normal QT interval

A

400-440 milliseconds (0.4-0.44 seconds)

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22
Q

what is artifact

A

distortion of tracing NOT cardiac
loose or missing electrodes
broken cables or machine
tremors
movement
interference

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23
Q

What is the 6 step method to interpreting an EKG

A
  1. Rate
  2. Rhythm
  3. Axis
  4. Intervals
  5. Hypertrophy
  6. Ischemia/Infarct
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24
Q

What is normal heart rate

A

60-100

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25
Q

what is bradycardia

A

< 60bpm

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26
Q

what is tachycardia

A

> 100 bpm

27
Q

What is a regular rhythm

A

same distance between each R wave

28
Q

what is a regularly irregular rhythm

A

repeating PATTERN of irregularity
example: 2nd degree Mobitz type 2

29
Q

what is a irregularly irregular rhythm

A

R to R are not the same and there is NO PATTERN
Example: Afib

30
Q

what is the placement of V1

A

Right side sternum, 4th intercostal space

31
Q

What is the placement of V2

A

Left side sternum, 4th intercostal space

32
Q

what is the placement of V3

A

between V2 and V4

33
Q

What is the placement of V4

A

Left mid-clavicular, 5th intercostal space

34
Q

what is the placement of V5

A

left anterior axillary, 5th intercostal space

35
Q

what is the placement of V6

A

Left mid axillary , 5th intercostal space

36
Q

What part of the heart is the I, AVL, V5 and V6 looking at

A

lateral

37
Q

what part of the heart is the II, III and AVF looking at

A

Inferior

38
Q

what part of the heart is V1, V2, V3 and V4 looking at

A

anterior/septal

39
Q

What is Eintoven’s triangle

A

only using limb leads (bipolar)
I, II, III leads

40
Q

what do leads 1,2 and 3 create

A

Eintovens triangle

41
Q

What is a hexaxial reference system

A

eintovens triangle with augmented leads
- gives different vantage points

42
Q

What is a QRS duration of 0.10-0.12 considered

A

incomplete bundle branch block

43
Q

what is a QRS duration of > 0.12 considered

A

Complete bundle branch block - QRS is WIDE

44
Q

What is RBBB associated with

A

CAD or may be associated with AV block

45
Q

What is LBBB associated with

A

acute (MI) or chronic (CAD, HTN, Dilated Cardiomyopathy)

46
Q

What lead is a RBBB seen in

A

V1

47
Q

what lead is LBBB seen in

A

V6

48
Q

What is seen on ECG with right atrial enlargement

A

Peaked P wave in leads II, III and AVF
Biphasic P wave in V1

49
Q

When is right atrial enlargement seen

A

COPD and Pulmonary hypertension

50
Q

what is seen on ECG with left atrial enlargement

A

2nd part of the P wave is prominent
Notched (saddle) P wave in II, III and AVF
Biphasic P wave in V1 with more prominent negative

51
Q

when is left atrial enlargement seen

A

mitral valve pathology
Left ventricular failure (CHF)
Systemic Hypertension

52
Q

how does ventricular hypertrophy usually present on an EKG

A

increase in amplitude (voltage)
often associated with ST depression and T wave inversion

53
Q

What is the Sokolov-Lyon Criteria

A

S wave depth in V1 + tallest R wave height in V5-V6 > 35 mm.

if >35, considered diagnostic of LVH

54
Q

What is ACS

A

Acute Coronary Syndrome
Transient of permanent obstruction of the coronary arteries

55
Q

what can lead to ACS

A

unstable angina
non-ST-segment elevation Myocardial infarction (NSTEMI)
ST-segment elevation myocardial infarction (STEMI)

56
Q

What presents with an anterior wall STEMI on EKG

A

ST elevation leads to V2 and V4

LAD - aka widowmaker

57
Q

What presents with an inferior wall STEMI on EKG

A

ST elevation INFERIOR leads II, III and AVF

RCA and Left circumflex
need to get a right sided EKG

58
Q

what presents with Lateral Wall STEMI on EKG

A

Leads 1, AVL, V5 and V6 elevations

left circumflex or LAD diagonal branch

59
Q

What is Sgarbossa’s criteria

A

used to identify myocardial infarction in the presence of a LBBB or a ventricular paced rhythm.
Myocardial infarction is often difficult to detect when LBBB is present on ECG.

60
Q

What is Brugada Syndrome

A

Sodium channelopathy M>F
most prevalent in Asian populations
sudden cardiac death about 42 yo

61
Q

What is the treatment of Brugada syndrome

A

internalDefibrilator

62
Q

What is the EKG presentation of Hyperkalemia

A

Mild: peaked T wave, prolonged PR segment
Moderate: Loss of P wave, prolonged QRS complex, ST segmented elevated
Severe: progressive widening of WRS complex
Ventricular fibrillation, Asystole

63
Q

What is an Osborn Wave

A

notch between the J point and the start of ST segment
seen in hypothermia

Gently rewarm
DO NOT JOSTLE THE PTS

Clin Med 2 - CARDS (11 decks)

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