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EKG basics Flashcards

1
Q

each small square

A
  1. 04 sec duration

0. 1 mV amp

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2
Q

5 small squares

A

make 1 large box

  1. 2 sec duration
  2. 5 mV amp
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3
Q

P wave meaning and duration

A

initiation of impulse in SA node, depolarization of RA and LA, impulse passing through AV junction

Duration: 0.06 to 0.10 seconds
amplitude 0.5-2.5

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4
Q

PR interval

A

from start of P wave to start of QRS complex
denotes depolarization of heart from SA node through atria, AV node and His-Purkinje system
duration: 0.12-0.2 sec

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5
Q

PR segment

A

isoelectric line bw end of P wave and start of QRS complex

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6
Q

QRS complex

A

normal duration: 0.06 - 0.11 sec

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7
Q

ST seg

A

isoelectric line following QRS to beginning to T wave

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8
Q

T wave

A

ventricular repolarization; slightly asymmetrical

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9
Q

J point

A

where QRS complex meets ST segment

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10
Q

QT interval

A

onset QRS to end of T wave
measures time of ventricular depolarization and repolarization
Normal duration 0.36-0.44 sec
varies depending on HR (slower HR, longer QT)

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11
Q

Bipolar leads (*note: all move - to +)

A

Lead I: RA to LA
Lead II: RA to LL
Lead III: LA to LL
*bipolar bc record difference bw positive and negative electrode; use 3rd electrode called ground

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12
Q

Unipolar leads

A

*use 1 + electrode and reference point (center of heart); waveforms enhanced by machine bc small
*augmented limb leads: aVR, aVL, aVF
aVR: augmented vector right
aVL: augmented vector left
aVF: augmented vector foot
*precordial leads (“chest” or V leads)
V1-6 horizontal plane, all +; V4-6 on same plane

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13
Q

specifics of augmented leads

A

aVR: RA + views base of heart -atria and great vessels
aVL: LA + views lateral wall of left ventricle
aVF: LL + views inferior wall of left ventricle

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14
Q

Precordial leads

A

provide anterior and lateral views of heart

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15
Q

Leads that view anterior surface of heart

A

V1-4

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16
Q

Leads that view lateral surface

A

Lead I, aVL, V5-6

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17
Q

Leads that view inferior surface of heart

A

Lead II, III; aVF

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18
Q

5 step process for analyzing ECG

A

Rate, regularity/rhythm, P waves, QRS complex, PR interval

19
Q

Normal sinus rhythm

A

rate: 60-100
rhythm: regular
P wave: upright and round, 1:1 ratio with QRS
QRS: narrow, 0.06-0.11 sec duration
PR interval: 0.12-0.2 sec
T wave: upright and slightly asymmetrical

20
Q

methods for calculating HR

A
  1. # QRS complexes in 6 sec interval x10 (fast and easy but not as accurate) *15 large boxes in 3 sec
  2. R to R wave 300, 150, 100, 75, 60, 50 method (quick, decent accuracy, can’t use with irregular rhythms)
  3. 1500/# small sq bw two consecutive R waves (most accurate)
  4. Rate calculator: R to R wave (easy but not always available, doesn’t work for irregular rhythms)
21
Q

Methods for determining rhythm

A
  1. Caliper
  2. Paper and Pen
  3. Counting small squares
22
Q

Types of Irregular rhythms

A
  1. occasional or very
  2. slightly: “wandering atrial pacemaker” HB initiated from different sites in atria changing appearance of P waves
  3. sudden acceleration in HR: paroxysmal tachycardia (ectopic site from above ventricles fires rapidly taking over as pacemaker)
  4. Patterned/cyclical: ex = sinus dysrhythmia, 2nd deg AV block, type I
  5. Totally: no pattern i.e. a fibrillation
  6. Variable conduction ratio: not all impulses conducted through AV node –> more P waves than QRS i.e. a flutter
23
Q

Tall peaked sinus P waves

A

may indicated increased RA pressure and RA dilation

> 2.5 amp = RAE, p pulmonale

24
Q

notched, wide, or biphasic sinus P waves

A

seen in LA presure and LA dilation

width > 0.10 sec suggests LAE, p mitrale

25
Premature atrial complex
P wave of early beat differs in appearance from underlying rhythm; continuously change in appearance
26
Peaked, notched or larger than normal T waves
happens in rapid rates such as atrial tachycardia, P wave likely buried in T wave due to short P-P interval
27
Flutter waves
seen instead of normal P waves when atria fire rapidly from one site 250-350 BPM - more P than QRS "saw toothed" pattern "F" waves or Flutter
28
Fibrillatory "f" waves
absence of discernable P waves and chaotic looking baseline due to atria firing >350 bpm *only some atrial impulses conducted through AV node
29
Inverted P waves
when P wave arises from lower RA near AV node, in LA or in AV junction --> retrograde depolarization of atria * may immediately precede, occur during or follow QRS complex * associated with dysrhythmias that originate from AV junction
30
More P than QRS
indicates impulse initiated in SA node or atria but was blocked and didn't reach ventricles
31
QRS configurations
* can be more than one R and/or S but just one Q | * second is R' or S'.. if small it is r or s
32
QRS complex should appear normal if
* Rhythm initiated from site above ventricles * Normal conduction from Bundle of His --> r and L bundle branches --> purkinje * Normal depolarization of ventricles has occurred
33
Production and pacemaker sites for abnormal QRS complexes
due to abnormal depolarization of ventricles *pacemaker site can be: SA node, ectopic pacemaker in the atria, AV junction, bundle branches, Purkinje network, or ventricular myocardium
34
Various possible causes of abnormal QRS complexes
- ventricular hypertrophy - intraventricular conduction disturbance - aberrant ventricular conduction - ventricular pre-excitation - ventricular ectopic or escape pacemaker - ventricular pacing by cardiac pacemaker
35
Tall QRS complexes
usually caused by: * hypertrophy of one or both ventricles * abnormal pacemaker * aberrantly conducted beat
36
Low voltage QRS complexes
seen in: obese pt, hypothyroid pt, pericardial effusion
37
wide bizarre QRS complexes (supraventricular origin)
result form intraventricular conduction defect; usually R or L bundle branch block
38
Aberrant Conduction
when electrical impulses reach bundle branch while still in refractory after conducting previous electrical impulse --> causes impulse to travel down unaffected bundle branch first followed by stimulation of other bundle branch
39
Abnormal PR interval classifications
1. shorter than 0.12 sec 2. longer than .2 sec 3. absent 4. vary
40
when do shorter PR intervals occur
when impulse originates in atria close to AV junction or in AV junction *can occur when impulse arises from supraventricular site but travels through abnormal accessory pathways (ie bundle of kent) to ventricles --> premature ventricular depolarization called pre-excitation, delta waves
41
Longer PR intervals
occur when delay in impulse conduction through AV node (ex: 1st deg AV block)
42
when do varying PR intervals occur
In wandering atrial pacemaker, pacemaker site moves from beat to beat causing P waves to appear different and PR intervals to vary
43
common cause of varying PR intervals
2nd deg AV block, Type I: has PR intervals that are progressively longer until QRS complex is dropped and cycle repeats
44
when do absent PR intervals occur?
1. a flutter 2. a fib 3. ventricular dysrhythmias 4. 3rd deg AV heart block (PR interval not measurable, atria and ventricles beating independently of each other)

ECG (3 decks)

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