EKG Flashcards Preview

CSI > EKG > Flashcards

Flashcards in EKG Deck (52):
1

sinus tach

>100 bpm
if >140-150 (something else going on)

sinus denotes that there is a p-wave

junctional implies absence of p-wave

2

sinus brady

HR less than 60

3

atrial flutter

"saw tooth pattern": flutter/f-waves

comes in specific HRs, (comes with a block)
300/150/75

300: 1:1
every 1 f-wave you are getting a QRS
-v. few things make a HR 300!

*150: 2:1* (most common)
2 f-waves for a QRS
-consider a flutter along with sinus tach

75: 3:1
3 f-waves for a QRS

4

a flutter

rapid succession of identical back to back atrial depolarization waves

identical morphology --> "saw tooth"
tx same as a fib (rate control, anticoag., cardioversion)

definitive tx is catheter ablation: trying to destroy wire? (neural condition) that is causing the arrhythmia

5

know chart of AVL, V1 etc

on slide

6

cheat

print out 2x as fast
spread out rhythm

7

atrial fibrillation

irregularly irregular, Chaotic erratic baseline

no discernable p-waves, Irregularly spaced qrs complexes

usually in response to ventricular response (pulse, HR)

serious if RVR (rapid ventricular response)

8

a fib slide

FA: HTN, CAD, rheumatic heart disease, *binge drinking (“holiday heart”), HF, valvular disease, *hyperthyroidism

can lead to atrial stasis, CVA, thromboembolisms

worse: in and out of a fib! -->atrial "kick"; feels like worms-->thrombus gets knocked out-->stroke

9

a fib tx

rate control (B-blockers, β-blocker, non-dihydropyridine Ca2+ channel blocker, digoxin)

anticoagulation (coumadin/warfarin, pradaxa) (may not need based on RAD score)

rhythm control (class IC, III antiarrhythmics)

cardioversion (electrical or pharmaceutical)

10

what is the concern with a fib with RVR ??

the concern is decreased heart filling (i.e. HR 160)

hypotensive (BP dec.)

if use B-blocker to lower HR, problem: exacerbate hypotension (often still use with hope that lowering HR increases filling time, eventually inc. BP)

ST depression in lateral leads
oxygen delivery to heart is sacrificed: rate-related ischemia
-reversible, need to slow down HR

11

pericarditis

inflammation of heart sac
disease of younger ppl

EKG changes: diffuse ST segment elevation
looks like a "global MI": systemic problem

*KEY: PR depression*
dips below baseline

12

Superventricular tachycardia: SVT

HR 160-170, can be as high as 210, 220

palpitations, SOB, syncope, lightheadedness, etc.

can't make out p-waves

regular rate (vs. afib)

rate-related ischemia:
ST depression

when rhythm interrupted: adenosine was given, or other mechanisms to stop SVT

13

how do you stop SVT

bear down
or carotid massage 1 side

adenosine: will stop heart, unpleasant experience, CP, SOB
-warn them: will feel like you are going to die

if pressure of 80: shock him!
"edison medicine" (unstable pt)

14

how to tx hyperkalemia w/ EKG changes

**calcium: does NOT lower K+ BUT stabilizes cardiac membrane

second: lower K+ with insulin IV

then dextrose to avoid hypoglycemia

more K+ lowering drugs:

albuterol
bicarb
Kayexelate (sucks!)
causes diarrhea, intenstinal ischemia, necrosis
(does not lower K+ much! dead drug)

15

hyperkalemia on EKG

peaked T-waves
similar to early MI (hyperkalemia more common)

will increase if exacerbated/prolonged

16

severe hyperkalemia

widened QRS (bad!!! always)

peaked T waves

PR prolongation

near sinusoidal pattern-->seconds to live

give Ca2+!!! can see QRS narrowing

17

if all drugs not working in hyperkalemia ??

why does this happen??

dialysis


stopped taking diuretic, still K+
noncompliant with dialysis, renal diet

18

V tach

varying presentation
AV dissociation

stable:
A/O, mild symptoms, stable vitals besides tachy, no resp distress, have time!
-tx: drogas

unstable:
hypotensive, confused, lethargic, dead
-tx: shock

tx differently!
can't tell from EKG

19

torsades de pointe

near death, very serious rhythm

polymorphic vtach
sinusoidal waveform

*long QT interval is huge risk factor

can lead to vfib: DEAD!

causes:
drugs, (that inc. QT: macrolides: azithromycin, erythromycin; zofran) (more to come)
low K+, low Mg+

tx: Mg sulfate

if K+ continually low even with tx, check Mg level

20

which drugs cause long QT (can lead to torsades)

ABCDE

antiArrhythmics (class 1A, III)
antiBiotics (macrolides)
antiCychotics (haldol/haloperidol)
antiDepressants (TCA's: narrow window)
antiEmetic (zofran/ondansetron)

21

congenital long QT syndrome: inherited

Romano-ward syndrome:

autosomal dominant, pure cardiac phenotype (no deafness)

Jervell and Lange Nielsen syndrome:

autosomal recessive and *sensorineural deafness*

22

congenital long QT syndrome: others

repolarization abnormality (ion channel defects)

inc. risk of sudden cardiac death due to torsades de pointes

23

1st degree AV block, sinus bradycardia

PR >200 msec (prolonged)
asymptomatic, benign

24

2nd degree type 1
mobitz 1

usually asymp, regularly irregular

PR lengthens then QRS drops! :at least you saw it coming (less sev.)

25

2nd degree type 2
mobitz 2

QRS drop without lengthening PR

tx: pacemaker

frequent, random dropping

present with syncope due to lack of cardiac output

FA: may progress to 3rd degree block

26

3rd degree block

QRS: HR in 30s!
miscommunication btw SA and AV node (intrinsic, slower)

p-waves: all march out (i.e. HR 70)

ZERO relationship btw p waves and QRS
atrial rate faster than ventricular rate-bradycardic rhythm (not sinus bradycardic: p-waves not influencing QRS)

27

3rd degree HB tx

can often be caused by ??

tx: pacemaker needed
often v. symptomatic

*lyme disease* can cause this

28

RBBB

QRS > 100?
"bunny ears": V1, V2, V3 (rSR')

V4, V5, V6: wide S wave

typically asymptomatic
may be acute (rare)

from scar tissue from HA, infection, etc

29

LBBB

*more worrisome than RBBB*

V6: broad R wave with deep S, inverted T-wave

V1, V2, V3: QS pattern

cannot dx acute MI in LBBB

QRS > 120 mS

*need previous EKG to dx this over STEMI:
STEMI unless proven otherwise*

page cardiologist

30

STEMI

ST elevation MI

"tombstone"

some cardiologist require
reciprocal changes:

ST segment depressions
T-wave inversions:
further support MI

31

inferior wall MI

II, III, aVF
reciprocal changes in 1, aVL, V2

32

anterior wall MI

"the widow maker"

V2, V3, V4, V5

reciprocal changes: aVR ??

occlusion of LAD, supplies largest part of heart

the more proximal, the more damage

33

why do ppl die of heart attack?

lethal arrhythmias

necrosis -->source of arrhythmias

34

anterior wall MI: don't confuse with ??

hyperkalemia!

35

Brugada syndrome

autosomal dominant
asian, mostly male (8:1)
pseudo RBBB

ST elevation V1-V3 (all the time, not a STEMI)

*inc. risk of ventricular tachyarrhythmias and sudden cardiac death*

no known CAD or structural abnormality

36

Brugada syndrome tx

implantable cardioverter-defibrillator (ICD)

about 75% increase in survival? (dec. in morb/mort)

37

Vfib

completely erratic rhythm
no waves of any sort
fatal if no immediate CPR/defibrillation
(DEAD)

38

rhythm you go into before death

reasoning behind ??? everywhere

Vfib and Vtach


AEDs

39

inferiolateral ischemia

oxygen deficiency to inferiolateral area

analogous to penumbra in stroke (dead area is necrosis)
-is reversible, can save!

how to fix??:
find the source
i.e. unstable angina (CAD pre-MI)

40

how to ID inferiolateral ischemia

ST segment depression (acute! typically) -dynamic
inferior: II, III, aVF
lateral: V5, V6

ddx from ST depression/T-wave inversion caused by from CAD (can be acute or old!)

41

WPW: Wolff-Parkinson White

most common type of ventricular pre-excitation syndrome

abnormal fast accessory conduction pathway from atria to ventricle (bundle of Kent) *BYPASSES rate-slowing AV node*

ventricles begin to partially depolarize earlier as seen via delta wave and wide QRS and short PR

may result in reentry circuit-->SVT (what kills!)

42

WPW tx

NO DIGOXIN, NO B-BLOCKERS, NO CCBs

43

T-wave inversion lateral leads (ischemia)

inversion: V2, V3, V4, V5, V6 ?

44

slide 86: inferior MI, anything else??

what vessel occluded in inf. MI

RCA : may also lead to posterior MI

45

posterior wall MI

1. (often) in conjuction with inferior wall MI

2. ST depression in V1 or V2 (back of heart)-OPPOSITE/RECIPROCAL of anterior wall MI (so depression vs elevation)

*flip around and read thru back, will look elevated*

46

LAD artery in MI

anterior wall MI (V1-V4)
anteroseptal (V1-V2)
anteroapical (V3-V4) (distal LAD)

47

LCX (circumflex) or LAD in MI

anterolateral (V4-V6)

48

LCX in MI

lateral wall (I, AVL)

49

RCA in MI

inferior wall (II, III, AVF)

50

inferior wall MI (RCA) will present with what type of symptoms ??

GI symptoms: epigastric pain, N/V

*don't miss!

51

how to tx MI

ASA
plavix (clopidogrel)
(both decrease morb/mort)

nitro? (does not dec. mort/morb) will make feel better
*actually give first!* works quickest to decrease preload


52

don't give nitro to pt w. ??

inferior wall MI

RV responsible for pre-load, if knocked out, exacerbates decreased pre-load, weakens pump

ECHO: of MI shows: wall motion abnormality, hypokinesis

*give morphine*