EKG continued (B 2: W 1) Flashcards Preview

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Flashcards in EKG continued (B 2: W 1) Deck (62):
1

What does this ECG show?

ST elevation MI (inferior)

  • See ST elevation in inferior leads

2

What does this ECG show?

Atrial fibrillation, with PVCs

  • Irregular rhythm
  • No defined P wave
  • Large, ugly QRS waves 

2

What does this ECG show?

Regularly irregular rhythm

  • P wave: present on the first, then absent on the next because it happens so quickly
    • PAC - premature atrial complex
  • PR interval is normal
  • QRS is normal
  • QT is normal

2

What is a 3rd degree AV block?

Complete block in the AV node

Atrial and ventricular rhythms are completely independent

3

What is a premature atrial complex?

  • P wave present, looks different than sinus beats
  • Comes in early
  • QRS complex no different from baseline
  • Bigeminy, trigeminy, couplets, triplets, etc.

3

What does this ECG show?

Wenkebach - Second degree AV block, type 1

  • Progressive elongation of PR
  • PR after dropped beat is shorter than PR before 

4

What is a normal QRS interal?

Less than 3 small squares

4

What is junctional rhythm?

  • Impulses originiate at AV node with retrograde and antegrade direction
    • P wave is often inverted, may be under or after QRS
  • HR is slow
  • Can cause bradycardia or tachycardia
  • Narrow QRS suggests "high" junction: stable
  • Wide QRS suggests "low" junction: unstable

5

6

What does this ECG show?

Complete heart block 

3rd degree AV block

7

How do you determine the axis of the heart from the EKG?

Leads I and II:

Both positive: normal axis

-I and +II: Rightward axis

+I and -II: Leftward axis

8

What does this ECG show?

Paced rhythm

  • Long QRS
  • Small spike form the P wave means that there is a pacemaker

9

What does this ECG show?

Right bundle branch block

  • Long QRS
  • V1 and V2 have a positive deflection

10

What does this ECG show?

Junctional escape

  • No P wave - no SA nodal activity
  • Some sinus rhythm
  • QRS is wide

12

What is the placement of the limb leads, and what is their charge?

Right arm: negative

Left arm: positive/negative

Left foot: positive 

13

What are some indications that a person should get an EKG?

  • Chest pain
  • Shortness of breath
  • Dizziness, syncope

13

What is a 1st degree AV block?

  • PR interval is >200 m sec
  • 1:1 conduction is maintained

14

What is indicated by ST elevation? 

Elevation = infarction

15

Which leads are considered the vertical leads?

I, II, III, aVR, aVL, aVF

16

Which are considered the horizontal leads?

V1 - V6

17

How is a premature ventricular complex (PVC) recognized?

  • Wide random, "ugly" QRS
  • Usually come in "early" 
  • Can be unifocal (all look the same), or multifocal
  • Can be multiple
    • Couplet
    • Triplet
    • Non-sustained ventricular tachycardia

18

What is an ectopic atrial rhythm?

  • P wave present
  • Focus of atrial activity is not the sinus node
  • Can occur in R or L atria
  • Negative P waves in inferior leads 

 

18

What is a type 1, 2nd degree AV block (Wenckebach)?

  • Progressive prolongation of the PR interval
  • Eventually, there is a transient block of AV conduction resulting in a dropped beat
  • PR interval before the dropped beat is longer than PR interval after

19

What does this ECG show?

Lots of PVCs: non sustained ventricular tachycardia

  • We have P waves
  • HR is normal
  • Normal axis
  • PR interval is a little long
  • QRS is normal 
  • We want to see Q in 2 inferior leads - II has it 

20

What does this ECG show?

Prior anteroseptal infarct

  • Large Q waves in anterior and septal leads

21

What does this ECG show?

Prior Inferior infact

  • Inferior leads have Q wave
  • Wide, large

23

What would be considered a pathologic Q wave? 

40 m sec wide

1/3 the height of the QRS

24

What does this ECG show?

Left bundle branch block

  • Long QRS
  • Compare V1/V2 and V5/V6
    • V5 and V6 have a positive deflection

25

What drugs can be used to terminate supraventricular tachycardia?

Drugs that affect the AV node - adenosine

26

Which leads are considered to be septal? Lateral?

Septal: V1, V2

Lateral: V5, V6

28

What is the plane of the chest leads? Are they positive or negative?

Horizontal plane, positive leads

28

What is supraventricular tachycardia?

  • Regular tachycardia
  • Narrow QRS complex (assuming normal underlying conduction system)
  • Typcially at a rate of 150 bpm
  • Re-entrant tachycardia involving the AV node

30

What is a normal QT interval?

Less than 3 large squares

31

What is indicated by ST despression?

Depression = Ischemia

32

What are the intervals of bpm for large squares?

1: 300 bpm

2: 150 bpm

3: 100 bpm

4: 75 bpm

5: 60 bpm

6: 50 bpm

32

What does a pathological Q wave indicate?

Prior myocardial infarction

  • Should be in at least two sonsecutive anatomic leads
  • Should be 40 m sec wide
  • Should be about 1/4 to 1/3 of the total QRS voltage
  • Q waves are normal in III and V1

33

What does this ECG show?

Supraventricular Tachycardia

  • Narrow QRS
  • Rate of 150 bpm
  • Hard to find p wave

34

How would you explain bigeminy and trigeminy PVCs?

Bigeminy: every other beat is PVC

Tirgeminy: every 3rd beat is PVC

35

What does this ECG show?

ST elevation MI (anterolateral)

  • See ST elevation in anterolateral and anteroseptal leads

36

What is indicative of a normal sinus rhythm?

  • P waves present
    • P waves positive in the inferior leads 
  • P:R should be 1:1
  • Regular rhythm
    • R to R intervals should be the same

36

What does this ECG show?

Junctional rhythm

  • Slow HR
  • P wave after QRS

37

What does this ECG show?

Atrial fibrillation

  • Irregular rhythm strip
    • Irregular rhythm
  • No defined P wave

38

Which are considered the inferior leads?

II, III, aVF

39

What is a type 2, 2nd degree AV block?

Random, intermittent block i the AV node, resulting in a dropped beat

40

What does this ECG show?

Right bundle branch block

  • Wide QRS
  • Positive deflection in R leads V1 and V2

42

What does this ECG show?

Atrial flutter (variable)

  • HR is variable
  • QRS is normal
  • No T wave to measure

43

44

What does this ECG show?

Atrial fibrillation with ischemia

  • Irregular, fast rhythm
  • No P wave
  • PVCs
  • ST depression (ischemia)

46

What does this ECG show?

Ectopic atrial rhythm

  • P wave: yes
    • Positive in I
    • Negative in inferior leads (II, III, aVF)
  • HR: 120 
    • Atrial tachycardia
  • PR is short - conduction is fast
  • QRS is fast
  • QT short

47

What is atrial flutter?

  • Saw tooth P waves
    • Usually at a rate of 300
  • Variable conduction
    • 2:1, 3:1, etc
  • Macro-reentrant tachycardia, amenable to ablation

48

What is a normal PR interval?

Less than one large square

49

What is atrial fibrillation?

  • Irregularly irregular rhythm
    • R to R intervals vary without any pattern
  • No P waves
    • Atrial HR can run 400-500
  • Tends to have a rapid ventricular response

51

What does this ECG show?

Sinus Tachycardia

  • There is a P wave, but it is fast
  • HR is high - 150
  • ST is slightly depressed

51

What is pathological about a long QRS interval?

  • Should be less than 120 m sec (3 small squares)
  • For QRS that is greater than 120 m sec
    • L bundle branch block: terminal forces positive in V5 and V6
    • R bundle branch block: terminal forces positive in V1 and V2
    • Paced ventricular rhythms 
    • Indeterminate IVCD

52

What does this ECG show?

2nd Degree AV block, Type 2

  • Random occurance
  • Right bundle block
    • QRS long in V1
    • Also positive

54

What is ventricular tachycardia?

  • Wide complex, fast

56

How is ventricular tachycardia treated?

If it is stable, initial treatment is medical

If it is unstable, fatal rhythm is treated emergently with cardioversion

58

What does this ECG show?

3rd degree (complete) heart block

  • P waves: yes, but some irregular
  • P waves don't relate to QRS complex
  • Junctional escape

59

What is the time indicated by 1 small square, 1 large square, and 5 large squares?

1 small square = 0.04 sec (40 m sec)

1 large square = 0.2 sec (200 m sec)

5 large squares = 1 sec (1000 m sec)

60

What does this ECG show?

Left bundle branch bock

  • Wide QRS
  • No pacing spikes
  • Left side of leads have positive deflection

61

What does this ECG show?

Ventricular tachycardia

  • Wide, fast QRS complexes

62

What is the significance of a prolonged QT interval?

  • Long QT associated with ventricular dysrhythimias and sudden death
  • Can be congenital or acquired (medications)
  • Normally it is approximately 450 m sec
  • QT should be less than half of the R to R interval