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EKG Flashcards

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1
Q

EKG Limb leads

A

Standard: I, II, III

Augmented: AVF, AVL, AVF

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2
Q

Precordial Leads

A

V1-V6

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3
Q

Bipolar limb lead charges

A

Lead I: R to L arm, L arm positive = electrical activity over top of heart

Lead II: R arm to L leg, L leg positive

Lead III: L leg to L arm, both leads positive

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4
Q

Augmented Limb Lead charges

A

aVR = right arm positive

aVL = left arm positive

aVF = left leg positive

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5
Q

Lateral leads

A

AVL

I

V5

V6

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6
Q

Inferior leads

A

II

III

AVF

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7
Q

Anteroseptal leads

A

V1-V4

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8
Q

Anterolateral leads

A

V3-V6

I

AVL

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9
Q

Anterior leads

A

V3-V4

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10
Q

Inferolateral leads

A

II

II

AVF

V5-V6

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11
Q

Precordial lead polarity

A

Each lead is positive, all pass through AV node

V1 and V2 are negative deflections

V3-V6 become more positive w/ peak positive ~ V4

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12
Q

Precordial leads and vasculature

A

RCA: II, III, AVF

LAD: I, AVL

V1-V6

CX: I, AVL, V5-V6

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13
Q

Septal leads

A

V1-V2

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14
Q

P wave time interval

A

<0.12

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15
Q

PR interval

A

0.12-0.20

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16
Q

QRS wave

A

<0.12

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17
Q

QT Interval

A

0.34-0.43

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18
Q

Q wave

A

When at least 1/3 as high as the R wave => transmural MI

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19
Q

RS line

A

Activation of posteriobasal ventricle portion

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20
Q

J point

A

Transition point from S wave to T wave

transition from horizontal to verticle axis

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21
Q

ST segment

A

Elevation or depression is a hallmark sign of ischemia, CAD, or STEMI

0.08-0.12 seconds long

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22
Q

Prolonged QT

A

Pathological slowing of electrical activity

May allow for depolarization before complete repolarization -> go into an arrhythmia

Cause by some Abx -> Macrolides, fluroquinolones, azole antifungals

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23
Q

T wave abnormalities

A

Indicate ischemia

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24
Q

U wave

A

Purkinje fiber repolarization

Prominent U waves: hypokalemia, hypercalcemia, thyrotoxicosis, or epiniphrine exposure

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25
Methods to calculate rate
1. Count # R waves in 6 seconds, x10 2. 300-150-100, 75-60-50 3. Count number of small squares between R waves, and divide into 1500
26
SVT
Supreventricular tachycardia 150-200 bpm
27
Prolonged PR interval
AV block - 1st and 2nd degree Type 2
28
Irregular PR interval
Sinus arrhythmia Wandering pacemaker AV block - 2nd degree Type 1
29
Lack of PR interval
A-fib Atrial flutter Complete heart block - 3rd degree Ventricular rhythm
30
Second degree AV block types
Type 1 - Wenckebach -PR interval gets progressively longer until QRS doesn't occur Type 2 -PR interval fixed, but sometimes a QRS doesn't occur
31
Third degree AV block
P waves and QRS complexes are independent of each other Impulses are not traveling past the AV node
32
Conduction delays
Widened QRS (anything \> 0.12) 3 types: - Left bundle branch block - Right bundle branch block - Intraventricular conduction delay
33
Right bundle branch block
R ventricular depolarization occurs more slowly than L vent due to R bundle branch blockage Get "rabbit ears" in leads over RV - V1 and V2
34
Left bundle branch block criteria
QRS \> 0.12 Dominant S in V1 Broad R in I, AVL, V5-V6 Absent Q in I, V5-V6 T wave inversions -Dubin's criteria = QS or rS in V1 w/ RsR in V6
35
Dubin's criteria
For LBBB V1 =\> QS or rS comples V6 =\> RsR Not a definite thing
36
LBBB considerations
Cannot Dx LVH or ischemia w/ a LBBB MI until proven otherwise LBBB on exercise stress test =\> increased mortality rate and cardiac events
37
Bundle branch block causes
LBBB - scar tissue/dead spot RBBB - PE
38
Intraventricular conduction delay (IVCD)
QRS \> 0.12 Doesnt meet criteria for a specific bundle branch block
39
QRS Axis
Shows where the main vector of electrical activity is going Axis goes toward hypertrophy, away from ischemia
40
Dubin's thumb up/thumbs down
To determine axis Look at QRS in leads I (lateral = left) and aVF (inferior = right) Whichever is up wins = axis deviation towards that side Both up = normal
41
Best leads to check for hypertrophy
Atrial leads II, III, AVF, V1 (biphasic)
42
P Pulmonale
R atrial enlargement Lead II -P wave is taller and overlaps more w/ LA as RA takes longer to depolarize V1 - P wave is \>1.5mm
43
P Mitrale
LA enlargement Lead II shows P wave \>0.12 seconds, w/ a possible notch in the middle
44
P wave inversion
Leads II, III, AVF ectopic atrial and junctional rhythms
45
Right ventricular hypertrophy
Large R wave in V1 that gets smaller as you move towards V6 Should accompany RAE and deviated axis (I and AVF)
46
Left ventricular hypertrophy
V1 = deep S wave V5 = Tall R wave S wave (V1) voltage + R wave (V5) \>35mm = LVH Also may have inverted/asymmetrical/depressed T wave in lateral leads (I, AVL, V5-V6)
47
Ventricular strain
Associated w/ ventricular hypertrophy Depression of ST segment RV strain = V1 LV strain = V5-V6
48
EKG analysis
Rate Rhythm Axis (I, AVF) P waves (V1, II) R waves (V1-V6) Hypertrophy (R: V1-V6, L: V1 and V5) Strain (R:V1, L:V5-V6)
49
EKG markers of ischemia
Pathologic Q waves Poor R wave progression (V1-V6) ST segment elevation/depression T wave abnormalities
50
ST elevation or depression
Depressed ST (also inverted T) =\> coronary ischemia ST elevation =\> MI, hypokalemia, or digitalis toxicity
51
Non-ST Elevation Infarction
ST depression and T wave inversion After infaction has resolved/fibrosis occurs, ST returns to baseline but T wave remains inverted
52
ST Elevation Infarction
Initial ischemia shows ST depression, peaked then inverted T waves Infarction shows ST elevation and Q waves appear Fibrosis shows normal T waves and ST segments, but Q waves may persist
53
Sinus Arrhythmia
Only rate changes - synchronizes w/ respiratory cycle No need for treatment
54
Sinus Pause/Arrest
Pause between 2 seconds and 2 minutes Tx: pacemaker, atropine Healthy heart, myocarditis, MI, digitalis toxicity
55
Sinus bradycardia
\<60 bpm Caused by BB, digoxin Only Tx w/ HTN or dizziness Tx: atropine, pacemaker (long-term)
56
Sinus Tachycardia
\>100 bpm Caused by anemia, thyrotoxicosis, fever, pain, exercise Tx underlying cause, CCB, BB
57
Supraventricular Tachycardia
Originates above HIS w/ reentry into AV node Can be caused by PVC/PAC palpitation, dizziness, syncope, SOB, anxiety, angina Tx: vagal maneuvers, Adenosine, Cardioversion, IV BB/CCB Prevent: BB, CCB, digoxin, SVT ablation
58
Paroxysmal supraventricular tachycardia (PSVT)
140-240 bpm P buried in QRS, QRS narrow and normal Tx: BB
59
Wolff-Parkinson-White Syndrome (WPW)
\>200 bpm Electrical pathway shortcut Causes A-fib, can cause V-fib EKG: Delta wave on QRS beginning Tx: Ablation, BB, CCB, Flecainide, Adenosine w/ acute episodes
60
Paroxysmal Atrial Tachycardia (PAT)
150-250 bpm P wave morphology varies from sinus rhythm Usually transient, doesn't need Tx Tx: vagal maneuvers, Adenosine, cardioversion, digoxin
61
Premature Atrial Contractions (PAC)
P waves vary, precursor to A-fib Common w/ MI, Cardiomyopathy, Mitral valve dx Tx: BB
62
Wandering Atrial Pacemaker
45-100 bpm Need 3 or more distinct P waves - multifocal A-tach No Tx Occurs w/ heart dx, COPD
63
Multifocal Atrial Tachycardia (MAT)
\>100 bpm 3 or more distinct P waves, no hemodynamic instability Occurs w/ lung dx, COPD, acute MI, sepsis Tx: BB, CCB
64
Atrial Fibrillation
110-170 bpm, irregularly irregular No P waves, possible ST depression Prevent Thromboemboli ( Warfarin w/ INR between 2-3) Control Rate/Rhythm Rate: CCb, BB, Digoxin Rhythm: Class 1a, 1c, and 3 - usually amiodarone
65
Atrial Flutter
250-350 atria, 150 ventricle - regularly irregular Precipitates CHF, A-fib Tx: ASA, Ablation, Class 1a, BB, CCB, Digoxin
66
Junctional escape/Accelerated junctional rhythm
40-60 bpm escape, 60-100 bpm accelerated Inferior MI, Digoxin toxicity Narrow QRS w/ retrograde/absent P waves No treatment
67
Junctional Tachycardia
150-250 bpm Initiated by PAC, no P wave Acute Tx: Vagal maneuvers, Adenosine Long-term Tx: BB, CCB, Class 1a/1c/3 antiarrhythmics
68
First degree AV block
Inferior MI, Digitalis toxicity, hyperkalemia, increased vagal tone, acute rheumatic fever, myocarditis EKG: PR Interval \> 0.20 Tx: none needed, monitor progression to 2/3 degree
69
Second-degree AV Block
Type 1: Wenckebach - Transient, longer PR interval until QRS dropped - No Tx, monitor - MI, digitalis toxicity Type 2: after acute anterior MI - Rate varies, QRS wide, PR normal until dropped QRS - Tx: permanent pacemaker
70
Third Degree AV Block
Digitalis toxicity, acute infection, MI, Conductive tissue degeneration Vent rate is slower than atrial rate Tx: Pacer
71
Premature Ventricular Contractions (PVC)
Rate varies, P obscured by QRS w/ PVC, QRS wide Tx if: MI, continuously multifocal, \> 6 PVC/min Tx: Lidocaine, procainamide, amiodarone, replace electrolytes R on T phenomenon - R PVC wave lands on normal T wave, causes Torsades
72
Ventricular Tachycardia
Ischemia and electrolyte abnormalities, MI, congenital defect, dilated cardiomyopathy, hypertrophic cardiomyopathy No P wave, Wide QRS, rate regular \>30 seconds = hemodynamic instability - life-threatening Pulse: Cariovert, amiodarone Pulseless: Defibrillate then amiodarone
73
Torsade de Pointes
Lengthened QT, electrolyte imbalance, myocardial ischemia Tx: synchronous cardioversion, replace electrolytes, overdrive pacing
74
Ventricular Fibrillation
Sudden cardiac death - no output Tx: Defibrillate and ACLS, treat underlying cause, ICD
75
Idioventricular rhythm
Dying heart rhythm No P, widened QRS Ischemia/infarction, pacemaker failure, metabolic imbalance Tx: Pacemaker, improve C.O. and rhythm, atropine
76
Pulseless Electrical Activity (PEA)
electrical activity w/ no mechanical response - no pulse Tx: epi, atropine, CPR
77
Posterior MI
Mirror image of septal MI Large R wave, no Q waves ST-segment depression, not elevation Upright T waves
78
Digitalis/Digoxin
Therapeutic levels cause a scooped ST depression across all leads Toxicity = increases automaticity and decreases AV conduction -heart block, A-tach, PAC/PVC, PAT, Atrial/Junctional tachyarrhythmias
79
Hyperkalemia
Peaked "Eiffel tower" T waves Flat and wide P Wide QRS Can cause V-fib
80
Hypokalemia
U waves Flattened/inverted T waves Ventricular foci irritation - Torsades, VT, VF
81
Hypercalcemia
Short QT interval J waves
82
Hypocalcemia
Prolonged QT - T barely finishes before next P
83
Hypomagnesemia
Prolonged QT Torsades Frequent PVC/PAV Ventricular and Atrial tachyarrhthmias
84
Hypothermia
Osborn (J waves) - positive deflection at J site after QRS Slow heart and metabolic rate J waves indicate ventricular depolarization abnormality
85
Pulmonary embolus
Sinus tach most common S1Q3T3 - prominent S in I, Q and T abnormal in III Right axis deviation, RBBB, T inversions in V1-V4

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