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EKG Flashcards

(50 cards)

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1
Q

The heard depolarizes from _____ to _____

A

bottom to top

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2
Q

EKG

A
  • recording of electrical events in heart
  • any area of heart
  • picked up by electrodes on skin
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3
Q

Depolarization of the SA Node –>

A
  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

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4
Q

Leads

A

-the sensing electrodes used to monitor electrical activity

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5
Q

Standard Limb Lead

A

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)

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6
Q

Augmented (unipolar) limb leads

A

-Fills in gaps of standard (frontal)

  • aVr= + R arm
  • aVl= + L arm
  • aVf= + leg (foot)
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7
Q

Normal EKG Speed

A

25mm/sec

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8
Q

6 Major EKG Deflections

A 
P
Q
R
S
T
U
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9
Q

PR Interval

A
  • beginning of P wave to beginning of QRS
  • Atrial contraction + A-V conduction delay
  • flat spot=isoelectric
  • 0.12-0.2 sec
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10
Q

Length of PR Interval

A
  • 0.12-0.2 sec

- 3-5 small boxes

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11
Q

R

A

First + deflection

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12
Q

Small box dimensions

A
  • height: 0.1 mV

- width: 0.04 sec

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13
Q

Precordial (chest) leads

A

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
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14
Q

Big square dimensions

A
  • 5x5 small squares
  • height: 5mV
  • 0.2 seconds
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15
Q

P Wave

A
  • atrial depolarization

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

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16
Q

QRS Complex

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

Should be <2.5 small boxes

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17
Q

Length of QRS Complex

A

<2.5 small boxes

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18
Q

S

A

neg deflection after R

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19
Q

S^1

S prime

A

neg deflection following R prime

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20
Q

Q

A

Initial negative deflection before R

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21
Q

R^1

R prime

Study These Flashcards
A

2nd + Deflection

22
Q

QS

Study These Flashcards
A

Total deflection

23
Q

QT Segment

Study These Flashcards
A
  • 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
Q

QT Segment Length

Study These Flashcards
A

<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

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