EKG

Question 1

purpose of EKG

Answer 1

non-invasive test that measures electrical activity of the heart

Question 2

what is important in an EKG for PT

Answer 2

cardiac rhythm
conduction abnormalities
evidence of myocardial ischemia
drug treatment effects

Question 3

who are the people credited with EKG creation

Answer 3

augustus walker
- electrical activity of the heart

willem einthoven
- named the PQRST waves
- standard limb leads (einthoven’s triangle)

Question 4

what is important to understand about EKG leads

Answer 4

always moves from negative toward positive pole

Question 5

explain the einthoven triangle
- location of leads
- number of leads

Answer 5

Right Arm (both negative)
Left Arm (neg/positive)
Left Leg (both positive)

1 = from RA To LA
2 = RA to LL
3 = LA to LL

Question 6

difference between standard and modified leads

Answer 6

standard = LA, RA, LL
modified = no LL, where limb attaches into trunk

Question 7

what is the normal amount of waveforms and electrodes in standard-12 lead ECG

Answer 7

12 waveforms
10 electrodes

Question 8

what does a standard 12-lead ECG tell you

Answer 8

rhythm captured over short periods of time

Question 9

what does cardiac telemetry tell

Answer 9

electrical activity over long periods of time

Question 10

what can cardiac telemetry NOT tell us

Answer 10

right or left bundle block
ventricular tachycardia
supraventricular tachycardia
ischemia

Question 11

explain the normal set up of cardiac telemetry

Answer 11

3 to 5 electrode
- bipolar and modified precordial leads

Question 12

what is a holter monitor

Answer 12

a portable monitor that is worn for 24-48 hrs
- pt is to record symptoms and then it is compared with activity recorded by the monitor

Question 13

what does the holter monitor do vs not do

Answer 13

does = helps assess presence of frequent daily symptoms

does not = provide real time information

Question 14

what is an event/loop monitor?
- time frame?
- at occurrence of symptoms?

Answer 14

portable monitor for patients in presence of less frequent symptoms

• 2 to 4 weeks
• pt can activate the monitor to record at onset of symptoms

Question 15

explain what a patch monitor is
- time frame?
- symptom occurrence?
- potential advantages?

Answer 15

kind of what it sounds like, patch with single lead adhesive, no leads, or batteries

• 30 days
• patient or auto triggered when symptoms occur
• allows for real time monitoring

Question 16

what is a mobile cardiac output telemetry unit
- time frame?
- potential advantages?

Answer 16

3 lead sensor that can be worn up to 30 days

• auto or patient triggered
  allows for real time monitoring of symptoms with daily summary reports

Question 17

what is an oscillometry device?

Answer 17

automated BP monitor

Question 18

conduction pathway of the heart

Answer 18

SA node
AV node
Bundle of His
Right/Left bundle branch
Purkinje fibers

Question 19

how do purkinje fibers fire

Answer 19

begin deep in the heart, start firing at the endocardium and move outward

Question 20

what is the PSNS control of the heart

Answer 20

Vagus nerve that controls SA / AV node
–> is the primary system of control

Question 21

explain SNS control of the heart

Answer 21

sympathetic cardiac nerve via cardiac splanchnic nerve

Question 22

what does SNS work on in the heart

Answer 22

ventricular muscle
AV node
SA node

Question 23

if the SA and AV node fail, what happens

Answer 23

ventricular muscle starts to beat to keep you alive (40-60bpm)

Question 24

what is the definition of a “lead”

Answer 24

a view of the heart

Question 25

explain the count of limb electrodes, limb leads, and precordial electrodes

Answer 25

4 limb electrodes that produce 6 limb leads I, II, III, aVR, aVL, aVF 6 precordial electrodes V1 - V6

Question 26

location of RA / LA / LL RL leads

Answer 26

right arm (forearm/wrist) left arm (forearm/wrist) left lower leg (proximal to ankle) right lower leg (proximal to ankle)

Question 27

location of V1

Answer 27

4th intercostal space, right sternal angle

Question 28

location of V2

Answer 28

4th intercostal space, left sternal angle

Question 29

location of V3

Answer 29

midway between V2 / V4

Question 30

location of V4

Answer 30

5th intercostal space, midclavicular line

Question 31

location of V5

Answer 31

anterior axillary line - straight in line with V4

Question 32

location of V6

Answer 32

mid-axillary line - straight in line with V4/V5

Question 33

explain the plane of aVR, aVL, aVF

Answer 33

frontal plane

Question 34

explain the plane of V1-6

Answer 34

transverse plane

Question 35

what leads read the lateral aspect of the heart

Answer 35

aVL V1 V5 V6

Question 36

what leads read the inferior aspect of the heart

Answer 36

V2 V3 aVF

Question 37

what leads read the right side of the heart

Answer 37

aVR V1

Question 38

what leads read the anterior aspect of the heart

Answer 38

V2 V3 V4

Question 39

what are the lateral leads? what artery do they look at?

Answer 39

V1 aVL V5 V6 circumflex branch of left coronary artery

Question 40

what are the anterior leads? what do they look at?

Answer 40

V3 V4 LAD - right and left ventricle

Question 41

what are the septal leads? what artery do they look at?

Answer 41

V1 V2 LAD - intraventricular septum

Question 42

what are the inferior leads? what do they look at?

Answer 42

V2 V3 aVF right coronary artery

Question 43

what information is gained from a 12-lead EKG

Answer 43

heart rate heart rhythm presence of ischemia or infarct heart size electrolyte imbalance drug effects

Question 44

P wave indicates

Answer 44

atrial depolarization

Question 45

normal timing and amplitude of p-wave

Answer 45

<0.12 seconds <3 mm

Question 46

explain the curve of a p-wave

Answer 46

smooth hump ;) no notching or peaking

Question 47

what does QRS complex indicate

Answer 47

ventricular depolarization travel down the interventricular septum to purkinje fibers

Question 48

normal duration and amplitude of QRS Complex

Answer 48

time = <0.10 seconds amplitude = 5mm in lead 2 / 9mm in V3&4

Question 49

explain wave deflection of Q,R,S waves

Answer 49

Q = negative R = positively S = negatively

Question 50

ST segment indicated

Answer 50

early ventricular repolarization

Question 51

explain the wave deflection of the ST segments

Answer 51

on isoelectric line

Question 52

what is the amplitude of the ST wave

Answer 52

not depressed more than 5 mm from isoelectric line

Question 53

what do ST segment elevation/depression indicate

Answer 53

elevation = myocardial damage depression = myocardial ischemia

Question 54

T wave represents

Answer 54

ventricular repolarization

Question 55

explain amplitude for T wave in - limb leads - precordial leads

Answer 55

limb = 5 mm precordial = 10 mm

Question 56

what does PR interval indicate? how is it measured?

Answer 56

AV conduction time - beginning of P to beginning of QRS

Question 57

normal PR interval time length

Answer 57

0.12-0.20 seconds (<5 boxes)

Question 58

what does QT interval indicate? how it is measured?

Answer 58

ventricular depolarization and repolarization start of Q to end of T wave

Question 59

what happens during QT interval in terms of electrolytes

Answer 59

sodium influx potassium efflux

Question 60

what is the normal time frame of QT interval? explain the regularity of it?

Answer 60

less than 1/2 of R-R interval varies with heart rate

Question 61

what is the timeframe associated with QRS waveform complex

Answer 61

0.04-0.1

Question 62

what are the four components of ECG analysis

Answer 62

Rate Rhythm Conduction Configuration

Question 63

when assessing rhythm, what do you look for?

Answer 63

P-P intervals equal? - atrial rhythm normality R-R intervals equal? - ventricular rhythm normality

Question 64

when assessing conduction, what is asked?

Answer 64

is every QRS complex preceded by a P wave? is the P-R interval normal? each time? is the QRS width normal?

Question 65

when assessing configuration, what are the questions to ask?

Answer 65

is the P wave normal shaped/duration is the QRS normal shaped/duration?

Question 66

how to assess HR via ECG?

Answer 66

if normal, can use methods taught if not, must have 1 full minute strip

Question 67

on the EKG paper, what do small and large boxes count as? what about ticks?

Answer 67

small = 1 mm (0.04 sec) large = 5 mm (0.2 sec) five large = 1 sec -- ticks are every 3 sec

Question 68

how to count atrial rate

Answer 68

if rhythm is regular, count boxes between P waves if irregular, count # of P waves for a full minute

Question 69

how to count ventricular rate

Answer 69

if regular rhythm, count number of boxes between peak of QRS wave to the next if irregular, count number of QRS complexes for a full minute

Question 70

what numbers are used to count HR if the EKG represents a regular rhythm? schroder method

Answer 70

300 150 100 75 60 50

Question 71

explain sinus brady or tachycardia

Answer 71

sinus = normal rhythm bradycardia - <60bpm tachycardia - >100bpm

Question 72

what can possibly explain brady/tachycardia if not normal?

Answer 72

medication recent surgery electrolyte imbalance

Question 73

what is the time related to P-R interval conduction

Answer 73

0.12-0.2 seconds 3-5 boxes

Question 74

what is the time related to QRS complex conduction

Answer 74

0.04-0.1 seconds