EKG Flashcards
(59 cards)
1
Q
What are the steps to reading an EKG systematically?
A
- Standard
- Rate
- Rhythm
- Axis
- Intervals
- Enlargement/Hypertrophy
- AVB
- BBB and Hemi-block
- Pre-excitation
- Ischemic changes
2
Q
Define bradycardia.
A
<60 bpm
3
Q
Define tachycardia.
A
> 100 bpm
4
Q
1 small box = ?
A
0.1 cm = 0.04 s = 0.1 mV
5
Q
1 large box = ?
A
0.5 cm = 0.2 s = 0.5 mV`
6
Q
Heart rate = ?
A
300/large boxes
7
Q
What is sinus rhythm?
A
- P wave before each QRS
- P wave upright in II, flipped in aVR
- All P waves identical in morphology
8
Q
Normal PR interval = ?
A
0.12 - 0.2 s (3-5 small boxes)
9
Q
Normal QRS interval = ?
A
0.07 - 0.11 s (2-3 small bocks)
10
Q
Normal QT interval = ?
A
0.2 - 0.4 s OR < 40% of total cycle (RR interval)
11
Q
Draw the axis. What is normal?
A
Look it up to confirm you are correct; -30 to 90 degrees
12
Q
What changes are seen in RA enlargement?
A
- P wave amplitude > 2.5 mm (II, III, AVF)
- No change in p wave duration necessary
- Possible right axis deviation of P wave
13
Q
When is RA enlargement seen?
A
Severe lung disease
14
Q
What changes are seen in LA enlargement?
A
- 2nd half of P wave has an amplitude > 1 mm (V1)
- P wave duration > 0.04 seconds (II)
- No axis deviation necessary
15
Q
When is LA enlargement seen?
A
Mitral valve disease
16
Q
What changes are seen in RV hypertrophy?
A
- Right axis deviation > 100 degrees
2. R > S (V1) + S >R (V6)
17
Q
When is RV hypertrophy seen?
A
COPD, congenital heart disease
18
Q
What changes are seen in LV hypertrophy?
A
- R (V5 or V6) + S (V1 or V2) > 35 mm
- R (V5) > 26 mm
- R (V6) > 18 mm
- R (V6) > R (V5)
- R (aVL) > 13 mm (97% specific)**
- R (aVF) > 21 mm
- R (I) > 14 mm
- R (I) + S (III) > 25 mm
- LVH strain - ST depression with asymmetric inverted T waves in lateral leads
19
Q
What indicates ischemia?
A
ST depression
20
Q
What indicates infarction?
A
ST elevation
21
Q
What is a standard EKG?
A
10 mm/mV voltage
25 mm/sec paper speed
22
Q
What defines a first degree AV block?
A
PR >0.2 seconds, but P:QRS ratio still 1:1
23
Q
What defines a second degree AV block?
A
P:QRS not 1:1
24
Q
What are the two types of 2nd degree AV block?
A
Mobitz Type I (Wenckebach) and Mobitz type II
25
How is Mobitz type I defined?
PR widens with each beat until a beat is skipped, P:QRS ratio constant but not 1:1
26
How is Mobitz type II defined?
Skipped beats without constant P:QRS ratio
27
What defines a 3rd degree AV block?
Atria and ventricles electrically dissociated
28
What defines a BBB?
QRS > 0.12 seconds
29
What defines a RBBB?
1. QRS >0.12 seconds
2. RSR' rabbit ears (V1, V2) w/ST depression, T inversion
3. Reciprocal changes in left lateral leads
30
What defines a LBBB?
1. QRS >0.12
2. Broad notched R w/prolonged upstroke (left lateral leads), ST depression and T inversion
3. Reciprocal change V1, V2
4. Possible left axis deviation
31
What defines an anterior hemiblock?
1. Normal QRS, ST, T
2. LAD
3. No other cause for LAD
32
What defines a posterior HB?
1. Normal QRS, ST, T
2. RAD
3. No other cause for RAD
33
What defines a bifasicular block?
1. RBBB + Anterior or Posterior HB
34
What defines atrial flutter?
Saw tooth P waves at 250-350 bpm in lead II
35
What defines atrial fibrillation?
No pattern, no visible p waves, irregularly irregular ventricular rate
36
What is a premature atrial contraction?
Premature beat with a preceding P wave
37
What is paroxysmal supraventricular tachycardia?
Regular rhythm, 150-250 bpm, sudden onset
38
What is ventricular tachycardia?
Run of 3 or more PVCs
39
What is V fib?
Spasmodic EKG, no true QRS
40
What is a PVC?
Wide bizarre QRS
41
What is Accelerated Idioventricular Rhythm?
No p waves
Wide QRS
Inverted T waves
50-100 bpm
42
What is Paroxysmal SVT?
Arrhythmia - regular rhythm, 150-250 bpm, sudden onset, possible retrograde p wave
43
What is a delta wave?
Slurred upstroke in the QRS complex associated with a short PR interval - seen in WPW syndrome
44
What do early peaked T waves indicate?
Ischemia without injury, hyperkalemia
45
What does ST elevation indicate?
Benign early repolarization
Acute MI
Pericarditis
LV aneurysm
46
What does ST depression indicate?
```
Posterior MI
Subendocardial infarction or ischemia
LVH with repol abnl (STRAIN)
Digoxin
Hypokalemia
```
47
Which EKG leads are associated with an anterior wall MI? Which artery supplies this?
V1, V2, V3, V4
Left anterior descending artery
48
Which EKG leads are associated with a lateral wall MI? Which artery supplies this?
I, AVL, V5, V6
Left circumflex artery
49
Which EKG leads are associated with an inferior wall MI? Which artery supplies this?
II, III, AVF
Right coronary artery
50
What indicates a right coronary artery infarct?
ST depression in V1-V3 with upright T waves
51
What does T-wave inversion indicate?
Ischemia, PE, CNS, LV strain
52
What is indicative of an old infarction?
Q wave > 0.04 seconds + Q wave = 1/3 of R wave in same QRS complex = significant Q wave
53
What changes are associated with ischemia and MI?
Hyper-acute T waves (preceding STEMI)
ST elevation (during STEMI; may see reciprocal T-wave inversions in opposite leads)
Inverted T waves (post-MI)
Q waves
54
What EKG findings indicate hyperkalemia?
1. T wave peaking (progressive to all 12 leads)
2. PR becomes prolonged with P wave flattening until it disappears
3. QRS widening (merges w/T wave and appears sinusoidal)
55
What EKG findings indicate hypokalemia?
1. ST segment depression
2. T wave flattening
3. U wave appearance (after T wave and more prominent)
56
What EKG findings indicate hypercalcemia?
1. Shortened QT interval
57
What EKG findings indicate hypocalcemia?
1. Prolonged QT interval
58
What EKG findings indicate hypothermia?
1. Bradycardia and prolongation of all segments/intervals
| 2. J wave/Osborne wave (ST segment elevation with abrupt ascent at J point followed by abrupt plunge back to baseline)
59
What EKG findings indicate the digitalis effect?
1. Changes seen at therapeutic levels
2. ST segment depression (gradual down-slop merged with R wave)
3. T wave flattening/inversion
4. Most prominent in leads w/tall R waves
