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Flashcards in EKG Deck (50):
1

The heard depolarizes from _____ to _____

bottom to top

2

EKG

-recording of electrical events in heart
-any area of heart
-picked up by electrodes on skin

3

Depolarization of the SA Node -->

1. bachman's bundles-->R atrium-->L atrium
2. internodal tracts--> AV node --> bundle of His --> R & L bundle branches -->purkinje fibers -->R & L Ventricles

4

Leads

-the sensing electrodes used to monitor electrical activity

5

Standard Limb Lead

Lead I: - electrode R arm; + electr L arm
Lead II: - electr R arm; + electr L leg
Lead III: - electr L arm; + electr L leg
Ground: R leg

(Frontal Plane)

6

Augmented (unipolar) limb leads

-Fills in gaps of standard (frontal)

-aVr= + R arm
-aVl= + L arm
-aVf= + leg (foot)

7

Normal EKG Speed

25mm/sec

8

6 Major EKG Deflections

P
Q
R
S
T
U

9

PR Interval

-beginning of P wave to beginning of QRS
-Atrial contraction + A-V conduction delay

-flat spot=isoelectric
-0.12-0.2 sec

10

Length of PR Interval

-0.12-0.2 sec
-3-5 small boxes

11

R

First + deflection

12

Small box dimensions

-height: 0.1 mV
-width: 0.04 sec

13

Precordial (chest) leads

Transverse Plane

V1: R of sternum; 4th intercostal space
V2: L of sternum; 4th IC space
V3. between 2 & 4
V4: midclavicular; 5th IC space
V5: ant axillary line; 5th IC space
V6: mid axillary line; 5th IC space

14

Big square dimensions

-5x5 small squares
-height: 5mV
-0.2 seconds

15

P Wave

-atrial depolarization
-can be positive/neg/biphasic; but must be the same each time

16

QRS Complex

-Ventricular Depolarization
-Made up of Q, R, S, R^1, S^1 (QS)

Should be <2.5 small boxes

17

Length of QRS Complex

<2.5 small boxes

18

S

neg deflection after R

19

S^1
(S prime)

neg deflection following R prime

20

Q

Initial negative deflection before R

21

R^1
(R prime)

2nd + Deflection

22

QS

Total deflection

23

QT Segment

-beginning of Q to end of T wave
-Should be <1/2 distance of R to R interval (in normal rhythm)
-Prolonged QT bad (increase chance for ectopic foci & arrhythmias

24

QT Segment Length

<1/2 distance from R to R

25

U Wave

-uncertain cause
-(final phase ventricular repol)
-same direction as T wave
-not everyone has U wave

26

PT's use EKG to:

-determine if pt in normal sinus rhythm
-monitor response to ex's

27

Methods to Calculate HR from EKG

-Small box method
-Big Box method
-6 Sec strip

28

ST Segment

-end QRS to beginning of T wave
-represent beginning of ventricular repolarization
-usually isoelectric (Flat)
(-beginning called J point)

29

J Point

-point where ST segment begins
-where thin line becomes thick

30

Small Box Method

bpm=1500/# small boxes between successive R waves

31

6 Second Strip

bpm=# Cycles in 6 Sec X 10

use only fro slow HR

32

How to get HR when Irregular

bpm=# cycles in 15 sec X 4

(5 sections of 3 seconds)
(75 big boxes=15 sec)

33

Sinus Bradycardia

-all perfect except rate
-Atrial rate 40-50bpm (or slower)
-Ventricular Rate: <60 bpm (same as atrial rate)

-PT assess and treat if asymptomatic

34

Sinus Tachycardia

-everything perfect but rate
-Atrial Rate: >100bpm
-Ventricular Rate: >100bpm (same as atrial rate)

PT: assess and treat if asymptomatic

35

Large box Method

-# large boxes between successive R waves

300/150/100/75/60/50/42/35

36

Normal Sinus Rhythm

-Rhythm: normal
-Atrial/Ventricular Rate: 60-100bmp
-P Wave: all same; 1 per QRS; upright in lead II
-PR Interval: 3-5 sm boxes
-QRS: all same; < 2.5 sm boxes; one per P wave
-T wave: same direction as P

37

Third Degree Heart Block (CHB)
a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

a. rhythm: regular but ventr and atrial rates different
b. atrial rate: normal
c. ventricular rate: 20-60bpm
d. P wave: normal (not related to QRS)
e. PR: none
f. QRS: junctional pacemaker=normal QRS; ventricular focus=QRS >0.11 sec
g. T wave: not uniform
h. mechanism: complete block between SA to AV (artia & vent contractions unrelated)
i. PT: no PT, medical emergency

38

Left BBB

Rabbit ears on V6

39

Right BBB

Rabbit ears on V1

40

Asystole
a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

a. rhythm: none
b. atrial rate: none
c. ventricular rate: none
d. P wave: none
e. PR: none
f. QRS: none
g. T wave: none
h. mechanism: no electrical activity in atria or ventr
i. PT: medical emergency; CPR

41

PAC
a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

a. rhythm: irregular @ site of PAC; R-R shorter before, longer after
b. atrial rate: normal
c. ventricular rate: normal
d. P wave: all same but premature; 1 per QRS
e. PR: 3-5 small boxes
f. QRS: normal
g. T wave: same direction as P
h. mechanism: ectopic atrial focus
i. PT: usually OK; high frequency can--> a-fib

42

Atrial Flutter
a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

a. rhythm: regular/irreg
b. atrial rate: 250-300 bpm
c. ventricular rate: depends on ratio of conduction
d. P wave: "F" waves=sawtooth
e. PR: none
f. QRS: usually normal
g. T wave: covered by F waves
h. mechanism: ectopic atrial focus takes over normal pacemaker activity
i. PT: do PT if asymptomatic (chronic fluttter)

43

Atrial Fibrillation
a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

a. rhythm: irregularly irregular
b. atrial rate: >350 bpm; can't count on EKG
c. ventricular rate: normal/slow/fast but irregular
d. P wave: none, jagged baseline
e. PR: none
f. QRS: usually normal
g. T wave: altered/obliterated by fib waves
h. mechanism: chaotic atrial activity-->loss atrial kick-->decr ventr filling--> decr CO by 30%
i. PT: high clot risk

44

PVC
a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

a. rhythm: irregular due to premature beats
b. atrial rate: depends on underlying rhythm
c. ventricular rate: depends on underlying rhythm
d. P wave: none w/ PVC, others normal
e. PR: none w/ PVC, others normal
f. QRS: >0.11 sec, usually >0.16 sec
g. T wave: none after PVC, others normal
h. mechanism: ectopic focus
i. PT: some PVC normal; notify Dr if >6/min or couplets/triplets or every other

45

V-Tach
a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

"picket fence"

a. rhythm: regular
b. atrial rate: none
c. ventricular rate: 100-250bmp
d. P wave: none
e. PR: None
f. QRS: weird/bizzare; 3+ PVC in row diagnoses V-tach
g. T wave: none
h. mechanism: single ventricular focus
i. PT: med emergency; no PT; CPR, Defibrillation

46

V-Fib
a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

a. rhythm: irregular
b. atrial rate: none
c. ventricular rate: none
d. P wave: none
e. PR: none
f. QRS: none; fibrillation fine or coarse
g. T wave: none
h. mechanism: multifocal irritation; chaotic activity
i. PT: medical emergency; no PT; CPR; defibrillation

47

First Degree Heart Block
a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

a. rhythm: regular
b. atrial rate: 60-100bpm (or slower)
c. ventricular rate: same as atrial rate
d. P wave: uniform/normal; 1 per QRS
e. PR: consistent but >0.25 sec (>3-5 sm boxes)
f. QRS: normal
g. T wave: normal
h. mechanism: AV node sick & slow
i. PT: do PT; unless change in EKG

48

Second Degree Heart Block Type I (Wenckebach)
a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

a. rhythm: regularly irregular
b. atrial rate: 60-100bpm
c. ventricular rate: slower than A rate
d. P wave: normal; some don't have QRS (droppped beats)
e. PR: progressively longer until QRS dropped, then start over
f. QRS: normal
g. T wave: normal
h. mechanism: block high in junction
i. PT: do PT with Dr. clearance

49

Second Degree Heart Block Type II (Mobitz)
a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

a. rhythm: regularly irregular
b. atrial rate: 60-100bpm
c. ventricular rate: regular but diff than atrial rate
d. P wave: normal; not a QRS for each
e. PR: normal if QRS present
f. QRS: normal
g. T wave: normal
h. mechanism: block low in bundle of His
i. PT: no PT; CO compromised

PR consistent but too long with dropped QRS

50

BBB
a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

a. rhythm: regular
b. atrial rate: normal
c. ventricular rate: same as atrial rate
d. P wave: normal
e. PR: normal
f. QRS: >0.11 sec
g. T wave: normal
h. mechanism: delay of action potential in one bundle branch
i. PT: do PT unless new or change