EKG / Arrhythmia Flashcards
(168 cards)
1
Q
EKGs are normal set at a speed of ___ mm/sec
A
25
2
Q
A full EKG is __ seconds
A
12
3
Q
Each little box on an EKG is _.__ seconds and __ mm tall
Each big box on an EKG is _.__ seconds and ___ mm tall
A
0.04 seconds
1 mm
0.20 seconds
5 mm
4
Q
_______ standard EKGs are used when voltage is so high complexes run into each other.
A
Half Sandard
5
Q
______ ___ is used when there is normal amplitude but the speed is set to 50 mm/sec.
A
Double box
6
Q
When measuring rate and counting boxes the pattern is as follows…..
300-___-100-___-60-__-50-__-37
A
300-150-100-75-60-50-43-37
7
Q
A rate greater than 100 bpm is considered ________
A rate less than 60 bpm is considered _______/
A
Tachycardic
Bradycardic
8
Q
P waves on an EKG are indicative of ______ or supraventricular activity.
A
Atrial
9
Q
If P waves are not the same (have varying morphological) then what is liking occurring?
A
Additional pacemaking cells are firing, liking in the atrium.
10
Q
If each QRS complex does not have a P wave then it is likely an ___ nodal block.
A
AV
11
Q
T/F: The PR interval should be constant throughout the EKG.
A
True
12
Q
A QRS complex is considered wide when it is greater __.___ seconds.
A
0.12
13
Q
If the QRS complexes are in groups of two, it is often described as being _________.
If they’re in groups of three, it is often described as ______.
A
Bigeminal
Trigeminal
14
Q
T/F: The P wave in lead aVl is inverted in normal sinus rhythm
A
False
It is inverted in lead aVR in NSR
15
Q
PR segment depression greater than 0.8mm is indicative of _______.
A
Pericarditis
16
Q
A normal PR interval is __.___ - __.___ seconds.
A
0.12 - 0.20
17
Q
A shortened PR interval with an inverted P wave indicates a ________ rhythm.
A
Junctional
18
Q
T/F: WPW Syndrome will have a lengthen PR interval
A
False
It’ll be shortened
19
Q
A prolonged PR interval is indicative of a _____ _____.
A
Heart Block
20
Q
A normal QRZ complex should be less than __.___ seconds.
A
0.12 seconds
21
Q
Higher amplitude in QRS complexes (a result of more vectors being present) is indicative of _______.
A
Hypertrophy
22
Q
Unopposed waves occur when eletrical impulses can not pass through scar tissue likely indicated an ______ has occurred.
A
Infarct
23
Q
Fluid or fat around the heart would likely lead to a ___ voltage EKG.
A
Low
24
Q
What are common causes of a wide QRS complex?
Theres a lot! - EIGHT
A
- Hyperkalemia
- Medications (tricyclics)
- V Tach
- Idioventricular Rhythms
- WPW
- BBB
- PVC
- Pacemaker
25
T/F: Q waves can be benign or pathologic depending on size
True
26
A significant Q wave (>1/3 the total height of the QRS) is indicative of what?
An old infarct
27
The __ point is the point at which the QRS complex ends and the ST segment begins.
J-point
28
The J-point should be no less than __ mm away from the baseline.
1 mm
29
Hyperkalemia would result in ______ T waves.
peaked
30
A normal QT interval should be less than __.___ seconds
0.42 seconds
31
What are the two key leads in determining axis using "The Thumb Method"?
Lead 1
| Lead aVf
32
if Lead I is negative but aVF is positive, then there is ______ ____ _______
if Lead I is positive but aVF is negative, then there is _____ ____ _________
If lead I is positive and lead aVF is positive, then the axis is ______.
if Lead I is negative and aVF is negative, then there is______ _____ ____ _________
Right Axis Deviation
Left Axis Deviation
Normal
Extreme Right Axis Deviation
33
What are the THREE RBBB criteria?
In what lead would you always expect to see positive complexes?
1. R-S-R prime (Bunny Ears) in lead V1
2. Prolonged QRS
3. Slurred S wave in 1 and V6
V1
34
What are the THREE LBBB criteria?
1. QRS prolongation of > 0.12 seconds
2. Broad, monomorphic R waves in I and V6
3. Broad, monomorphic S waves in V1; may have small R wave
35
T/F: A new onset LBBB is assumed to be a AMI until proven otherwise
True
36
A ____ _______ ______ occurs when the conduction through the left anterior fasicular fibers is blocked.
Left Anterior Hemiblock
37
T/F: LAD is seen in patients with a LAF
True
38
What are the THREE criteria for LAH?
1. Left axis deviation with the axis at -30º to -90º
2. Either a qR complex or an R wave in lead I
3. An rS complex in lead III, and probably II & aVF
39
A ____ _______ ______ occurs when the conduction through the left posterior fasicular fibers is blocked.
Left Posterior Hemiblock
40
What are the THREE criteria for LPH?
1. Right axis deviation of 90º to 180º
2. An s wave in lead I and q in III
3. Exclusion of RAE and/or RVH
41
In left atrial enlargement, the P wave in lead 2 is >0.12 second and is often has a ___-shape.
What is a common term for the shape of this P wave in lead 2?
M Shape (THINK: Camel Hump)
"P Mitale"
42
In left atrial enlargement, the P wave in lead V1 is often _________.
Is the negative of positive half taller?
Bipahsic
Negative half is taller
43
In right atrial enlargement, the P wave in lead 2 is >2.5 mm tall, and this peaked shape is often called "__-_______".
P-Pulmonale
44
In right atrial enlargement, the P wave in lead V1 is often _________.
Is the negative of positive half taller?
Biphasic
Positive
45
Describe the criteria for LVH
Deepest S wave in V1 or V2
PLUS
Tallest R wave in V5 or V6
EQUAL
>35 mm
46
LVH with the presence of ST depression and inverted T waves may indicate what?
Heart strain
47
T/F: EKG criteria to diagnose LVH may be used in the presence of a LBBB?
False
| It CANNOT be used
48
Area of ischemia more negative than surrounding normal tissue causes ST _____ and T wave ______.
Depression
Inversion
49
A zone of injury that remains more positive than the surrounding tissue causes ST _______ while the T waves remain inverted
Elevation
50
T/F: Infarcted tissue doe not generate action potentials
True
51
How would you expect an EKG to progress in an acute MI?
1. T-wave inversion begins early
2. ST elevation (flat to "tombstoning" --> T wave disappears)
3. Q waves appear
52
_______ changes occur when two electrodes view an AMI from opposite angles
(Think: Mirrored Images")
Reciprocal Changes
53
In a lateral MI, what leads would you expect to see reciprocal changes?
In an anterior MI?
In an inferior MI?
Lateral: 3, aVf
Anterior: 2, 3, aVf
Inferior: aVl (+/- Lead 1)
54
ST Elevation in leads 1, aVL, V5, and V6 would be concerning for a _________ MI.
ST Elevation in leads 2, 3, aVf would be concerning for a _________ MI.
ST Elevation in leads V1 and V2 would be concerning for a _________ MI.
ST Elevation in leads V3 and V4 would be concerning for a _________ MI.
Lateral
Inferior
Septal
Anterior
55
What coronary artery is likely occlude in an anterior STEMI?
What coronary artery(s) is likely occlude in an Inferior STEMI?
What coronary artery is likely occlude in an anteroseptal-lateral STEMI?
What coronary artery is likely occlude in an anterolateral STEMI?
Anterior: LAD
Inferior: RCA, LCx
Anteroseptal-lateral: Proximal LAD
Anterolateral: LCx
56
S1Q3T3 seen on EKG is indicative of what?
Pulmonary Embolus
57
Global ST elevation is indicative of what?
Pericarditis
58
Low voltage in the limb leads and alternating QRS amplitudes is indicative of what?
Pericardial Effusions
59
A rounded "Osborn Wave" at the J-point is indicative of what?
Hypothermia
60
Prominent "U-Waves" leading to flattens T waves, ST depression, and a prolonged QT are indicative of what?
Hypokalemia
61
Hypocalcemia can lead to a prolonged ___ interval?
Hypercalcemia can lead to a shortened ___ interval?
QT Interval
62
A prolonged QT interval can progress to what arrhythmia?
Torsades
63
A "spike" prior to the P wave is indicative of a ______ paced rhythm.
A "spike" prior to the QRS complex is indicative of a _______ paced rhythm.
Atrial
Ventricular
64
This arrhythmia occurs as a normal variant during inspiration
Sinus Arrhythmia
65
T/F: Sinus Arrhythmia is considered a regular rhythm
False
| Regularly Irregular
66
This is a normal sinus rhythm that is less than 60 bpm.
Common causes include....
Beta-blockers
Disease of the SA node
Ischemia
Increase vagal influence
Sinus Bradycardia
67
What are symptoms of sinus bradycardia?
What is important to rule out in patients who are bradycardic?
Should HR increase with exercise?
How can sinus bradycardia be treated?
Sx:
1. Weakness
2. Pre-syncope / syncope
3. SOB
R/O:
1. Electrolyte imbalance
2. Toxicitiy
3. Hypothyroidism
HR should increase with exercise
Tx:
1. Remove toxin/medications
2. Replace electrolytes
3. Epinephrine, Atropine, Dopamine
4. Pacemaker
68
This is a variant of normal sinus rhythm in which the rate is greater than 100 bpm.
Sinus Tachycardia
69
T/F: Sinus tachycardia is almost always do to an underlying cause.
True
These include.....
```
Exercise
Hyperthyroidism
Fever
Hypovalemia
Anxiety
Sepsis
Hypotension
PE
```
70
What are the symptoms of sinus tachycardia?
How can this be treated?
Sx:
1. Palpitations
2. Dizziness
3. SOB
4. Angina
Tx:
1. Vagal maneuvers
2. Removal/Decrease of stimulants
3. Nodal Blocking agents
71
This is described as a variable time period during which there is no sinus pacemaker working.
Sx include:
Dizziness
Pre-syncope / syncope
Rarely Death
Sinus pause/arrest
72
Is sinus pause considered a regular or irregular rhythm?
Are there "dropped beats" present?
Irregular
Yes
73
Impulses that originate from tissues outside the SA node are considered to be ________.
Ectopic
74
Another pacemaker cell fires at rate faster than SA node is considered a ________ beat
Slowing of SA node rate allowing faster foci to take control is considered an _______ beat
Premature
Escape
75
What are three types of ectopic beats?
Where is the pacemaker located in each of the above?
1. Premature Atrial Contraction (PAC): pacemaker site is in atria
2. Premature Junctional Contraction (PJC): pacemaker site is in AV Junction
3. Premature Ventricular Contraction (PVC): pacemaker site in the ventricles
76
T/F: Typically PACs are not treated pharmacologically.
True
| But beta-blockers can be used
77
Are PACs considered a regular or irregular rhythm?
Irregular
78
T/F: The PR interval is constant throughout the EKG in a patient with PACs
False
| It is variable
79
This arrhythmia is a run of PACs that can be as high as 180 bpm.
Ectopic atrial tachycardia
80
Is ectopic atrial tachycardia considered a regular or irregular rhythm?
Regular
81
What three arrhythmias are considered 'irregularly irregular'?
1. Atrial Fibrillation
2. Wandering Atrial Pacemaker
3. Multifocal Atrial Tachycardia
82
This irregularly irregular arrhythmia is created by multiple atrial pacemakers firing at their own pace.
P waves in this case would have varying morphologies (How many varying morphologies would need to be present?)
The rate would be 100 bpm or less.
Wandering Atrial Pacemaker
3 different P wave morphologies would need to be present
83
This irregularly irregular arrhythmia is similar to WAP however is tachycardic (>100 bpm)
Multifocal Atrial Tachycardia
84
MAT is predominately related to what pulmonary disease?
COPD
85
How would MAT be treated?
1. Improve underlying disease
2. Manage Mg2+ and K+
3. Verapamil or Beta-blockers
4. Ablation
86
This is a regular rhythm with a rate of 150 - 250 bpm.
Sx include (typical abrupt)....
Palpitation
Angina
SOB
Paroxysmal Supraventrivular Tachycardia
87
Where are the P waves in PSVT?
Buried in the preceding T wave
88
How is PSVT treated mechanically?
Pharmacologically?
Additional treatment options?
Mechanically:
Valsalva Maneuver
Coughing
Head between knees
Carotid Massage
Pharmacologically:
Adenosine (avoid in reactive airway disease)
Cardizem
Verapamil
Cardioversion
Catheter ablation
89
Should cardioversion in a patient with PSVT be synchronized?
Yes
90
This is a regularly irregular rhythm with an atrial rate of 250-350 and a ventricular rate of 125-175
Sx present similar to atrial fibrillation
Atrial Flutter
91
Atrial Flutter is said to have a "____-______" appearance on EKG.
What gives it this appearance?
Saw-tooth
A variable P to QRS ratio, most commonly 2:1
92
What P-QRS ratio is most dangerous in atrial flutter?
What can this lead to?
1:1
Can lead to ventricular fibrillation
93
How is atrial flutter treated?
1. Control rate with CCB/Beta blocker, diogixin in HF patients, or amiodarone
2. Convert to NSR (Ablation, Synchronized cardioversion)
3. Prevent systemic embolism
94
This irregularly irregular arrhythmia is the choatic firing of multiple pacemaker cells in the atria and is the most common cardiac arrhythmia.
Atrial Fibrillation
95
Is there atrial contraction in atrial fibrillation?
Is there a P wave?
No
96
What are three concerning complications of atrial fibrillation?
1. CVA (increased risk of stroke 5% a year)
2. CHF
3. MI
97
_________ atrial fibrillaion that terminates spontaneously or with intervention within seven days of onset.
Paroxysmal
98
___________ atrial fibrillation that fails to self-terminate within seven days. Episodes often require pharmacologic or electrical cardioversion to restore sinus rhythm
Persistent
99
__________ atrial fibrillation that has lasted for more than 12 months.
Long-standing persistent
100
_________ atrial fibrillation occurs following a joint decision by the patient and clinician has been made to no longer pursue a rhythm control strategy.
Permanent
101
___________ atrial fibrillation AF in the absence of rheumatic mitral stenosis, a mechanical or biprosthetic heart valve, or mitral valve repair.
Non-valvular
102
What are the Sx of atrial fibrillation?
| Can be asymptomatic
1. Palpitation
2. Tachycardia
3. Fatigue
4. Weakness
5. Dizziness
6. SOB
7. Angina
8. Pre-syncope / Syncope
103
A stress test should be ordered in a patient in whom you suspect ____.
CAD
104
In what three circumstances should urgent cardioversion be considered in a patient with Afib with RVR?
1. Active ischemia
2. Evidence of of organ hypoperfusion
3. Severe HF manifestation
105
Afib for longer than 48 hours or of unknown duration increases the risk of stroke.
What should be done prior to cardioversion (TWO OPTIONS)?
A TEE because you are at risk for dislodging a clot
OR
Anticoagulants for at least three weeks
106
How should new STABLE new onset atrial fibrillation be treated?
1. Rate control (GOAL: <85bpm with symptoms, <100 asymptomatic) with Beta-blockers, CCB, or amiodarone
2. Restoration of NSR (Everyone should have one attempt at cardioversion)
107
What is the name of the "scoring system" used to determine anticoagulant use in patients with Afib?
CHADS-VASc
108
In a patient with Afib longer than 48 hours, what three steps should be taken regarding treatment in terms of anticoagulant use prior to cardioversion, after cardioversion, and long-term?
1. 3 weeks prior to cardioversion
2. 4 weeks following cardioversion
3. CHADS-VASc to determine long term use
109
This syndrome occurs due to an accessory pathway in the electrical conduction pathway (Bundle of Kent) causing the ventricles to prematurely contract.
WPW Syndrome
110
What is the unique EKG finding in a patient with WPW?
What would this cause in terms of PR interval and a QRS complex?
Delta Wave
Shorten PR
Wide QRS
111
T/F: WPW is present at birth
True
112
Is WPW a regular or irregular rhythm?
Regular
113
This arrhythmia occurs when the normal pacemaking function of the atria and SA node is absent and another pacemaker takes over (usually AV node)
Junctional Rhythm
114
What happens to the P waves in a junctional rhythm?
P waves are either inverted or absent prior to the QRS complexes in a junctional rhythm
115
What is the typical rate of a junctional rhythm?
40-60 bpm
116
This arrhythmia is similar to a junctional rhythm, however, the rate is 60-100 bpm.
Accelerated junctional rhythm
117
A junctional rhythm greater than 100 bpm is referred to as ________ ________.
Junctional Tachycardia
118
This arrhythmia results because of a premature firing of a ventricular cell usually from the Purkinje fibers.
Premature Ventricular Contraction (PVCs)
119
T/F: The underlying pacing schedule is not altered so the next beat will arrive on time.
If true.... what is this referred to as?
True
Compensatory pause
120
Are PVCs considered a regular or irregular rhythm.
Irregular
121
Are P waves present in PVCs?
No
122
Is bigeminy or trigeminy possible with PVCs?
Yes
123
2 PVC complexes is referred to a _______.
Couplet
124
Greater than 3 PVCs or PVCs lasting less than 30 seconds is considered _____________ _____________ ___________
Unsustained ventricular tachycardia
125
This arrhythmia occurs when SA node fails to fire and next available pacemaker cell is in the ventricle.
Ventricular Escape Beat
126
In a ventricular escape beat the original pacemaker ____ ____ fire so the next beat will not arrive on time.
What is this called?
does not
Non-compensatory pause
127
When would a pacemaker be indicated as treatment in a patient with ventricular escape beats?
If it becomes the primary rhythm
128
Is a ventricular escape beat considered a regular or irregular rhythm?
Irregular
129
This arrhythmia occurs when ventricular foci act as primary pacemaker for the heart (everything above has failed).
Idioventricular rhythm
130
What is the rate in an indioventricular rhythm?
In an accelerated idioventricular rhythm?
20-40 bpm
40-100 bpm
131
Are P waves present in an idioventricular rhythm?
Why?
No
There is no atrial activity
132
_____________ ventricular tachycardia occurs when there are runs three or more ventricular beats lasting less 30 seconds and terminating spontaneously
Non-sustained
133
_________ ventricular tachycardia occurs when there are ventricular beats lasting longer than 30 seconds and require intervention to terminate.
Sustained
134
____________ ventricular tachycardia occurs when the appearance of all beats match each other in each lead.
What can this rapidly deteriorate into?
Monomorphic
Ventricular Fibrillation
135
____________ ventricular tachycardia occurs when the morphology of the ventricular beats varies.
The above in the context of a prolonged QT interval can result in what arrhythmia?
Polymorphic
Torsades
136
What medication should be avoided in V Tach in the setting of CAD?
What medication should be avoided in V Tach following an MI?
Lidocaine
Amiodarone
137
Is ventricular tachycardia typically a regular or irregular rhythm?
Regular
138
Are the QRS complexes narrow or wide in ventricular tachycardia?
Wide
139
This arrhythmia occurs from a polymorphic ventricular tachycardia with an underlying prolonged QT interval
Torsades de Pointes
140
What classes of drugs have Torsades as an ADR?
Anti-arrhythmics
| Antibiotics
141
Tosades can lead to ventricular _________ or ________
Ventricular fibrillation
| Death
142
How is Torsades treated?
IV Magnesium/Potassium
| Defibrillation
143
This arrhythmia is a very fast tachycardia in which you can no longer determine QRS complexes, T waves, or ST segments.
Ventricular Flutter
144
Ventricular Fibrillation is often referred to as "_____ ____".
Cardiac Chaos
145
What is the main cause of sudden cardiac death?
Ventricular fibrillation
146
What are three common causes of ventricular fibrillation?
1. MI
2. Hypokalemia
3. Drug Toxicity
147
How is V Fib treated?
1. Non-synchronized defibrillation (120-200 joules)
2. Amiodarone for 24-48 hours
3. Revascularization
4. ICD
148
This is also referred to as "flatline".
Asystole
149
This is electrical activity seen on the monitor however the patient does not have a pulse.
Pulseless Electrical Activity (PEA)
150
This is a delay or interruption in the transmission of an impulse from the atria to the ventricles?
AV Blocks
151
AV blocks typically occur at the _____ __ ______ and below.
Bundle of His
152
A _____-______ heart block occurs when there is a prolonged block in the AV Node.
First-Degree Heart Block
153
What would you expect the PR interval to be in a patient with a first-degree heart block?
> 0.20 seconds
154
Are pacemakers commonly used in the treatment of a First-Degree Heart Block?
Rarely
155
A ______ _ ______ _____ block is caused by a diseased AV node with a long refractory period that results in a lengthening PR interval with the eventual failure of a QRS complex (dropped beat).
What is another name this is referred to as?
Mobitz 1 Second Degree Block
Wenkenbach
156
T/F: Lyme Disease is a common cause of a Mobitz 1 second degree block
True
157
Is it common to see a Mobitz 1 second degree block in young athletes?
Yes
158
How is a Mobitz 1 second degree block treated in unstable patients?
Stable patients
Usstable:
1. Atropine
2. Cardiac Pacing
Stable:
1. Place pacing pads
2. Revascularization
3. Remove Toxins
159
What is the rhythm described as in a Mobitz 1 second degree block?
P-QRS ratio?
PR Interval?
Regularly Irregular Rhythm
Variable P-QRS ratio
Widening (Then dropped beat)
160
A ______ __ _____ _____ block typically occurs in the bundle of His and has the presence of a non-conducted beat without progressive PR interval lengthening.
Mobitz II Second-Degree Block
161
A Mobitz II Second-Degree Block may ultimately lead to a ______ _____ ____.
Complete Heart Block
162
T/F: A Mobitz II Second-Degree Block is a regularly irregular rhythm
True
163
Describe the P-QRS ratio/relationship in a Mobitz II Second-Degree Block
Group (P with QRS)
Dropped (P w/o QRS)
Group (P with QRS)
Dropped (P w/o QRS)
164
A _____ _______ heart block is a complete block of the AV node in which the atria and ventricle are firing at their own rates.
Third-degree heart block
165
T/F: A third degree heart block is not a medical emergency
False
| It is
166
What is REQUIRED in terms of treatment for a third degree heart block?
Pacemaker
167
Describe the rate in a Third-Degree heart block?
Rhythm?
P-QRS ratio?
PR Interval?
Separate rates between the atria (60-100 bpm) and the Ventricle (30-50 bpm)
Rhythm is regular however, the P and QRS rates are different
P-QRS ratio is variable
PR Interval is variable without a pattern
168
________ syndrome involves T wave inversion throughout the precordium (Leads V1 - V4) and is typically a sign of ____ stenosis.
T/F: These T-waves can often be somewhat biphasic
Wellen's Syndrome
True
