EKG Exam #2 Flashcards by Isaac Morrise

Normal Heart Rate

60-100

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Large box HR method

300 divided by number of boxes

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Rhythm strip HR method

Number of QRS multiplied by six (in ten minutes) by ten for 6 minute strip

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Small box method for HR

Divide 1500 by small boxes

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Threshold for large vs. small QRS

> 2.5 boxes (3+)

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4 questions for interpretation of rhythm

Are normal P waves present
QRS complex wide or narrow
P to Q relationship (does everyone have a dance partner?)
Rhythm regular or irregular?

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Normal P waves

Upright in lateral and inferior leads
Negative in AVR
Biphasic in V1

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Max sinus rate

220bpm minus pt age

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Goal heart rate for a stress test

85% of max heart rate

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Sinus arrhymia

Heart rate increases with inhalation and decreases with exhalation

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Sinus arrest

Or sinus exit block - NO P wave
Sinus does not fire

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Junctional escape beat

AV node takes over
Restrograde P wave from AV node

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Faster conducter in the heart

His bundle - travels slower through the atria

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Premature atrial complex

PAC - abrupt contraction right on top of preeceding QRS - trigger happy atrial cell with different looking P waves
Regularly irregular
Shortened TP segment

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Atrial Bigeminy

PAC every other beat

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Nonconducted PAC

Premature atrial complex that does not trigger QRS bc of refractory AV node

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Premature junctional contraction

Starts in the AV node - P wave not visible or AFTER QRS complex

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Accelerated junctional

60-100 - triggered not SA death

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High junctional escape

Atria get junctional signal first resulting in an inverted P wave

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Multifocal atrial tachycardia (MAT)

Abnormal looking P waves that are different from each other. Varying PR segments

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Wandering Atrial Pacemaker

MAT with HR under 100

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Number of boxes in a second

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Most common atrial tachycardia rate

160-180

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PR segment in junctional rhythm

Study These Flashcards

Not present

Onset and termination of atrial tachycardia

Starts and stops on a dime unlike sinus tachycardia

Atrial fibrilation

Irregularly regular rhythm Lack of organized activity may not see P waves at all or highly irregular ones With RVR - With Rapid ventricular response

Proposed origin of A fib

From pulmonary vein triggering at 350 bpm - get to AV node randomly

Atrial flutter

Organized A fib - Goes around in a circuit and eventually gets into the AV node Several P waves then QRS complex top differential for stable HR of 150

Calculating ratio of atrial flutter

Atrial rate over ventricular rate

Paroxysmal supraventricular tachycardia

Cannot prove where it is coming from (150-250 beats per minute) abrupt onset and termination

2 clues to ventricular arrhythmias

Wide QRS QRS to P mismatch

Premature ventricular contraction

Changed axis, wide QRS complex that has no P wave - patient feels like heart is skipping beats

Unifocal PVCs

All look the same on the same leads - means the ventricles are exciting from the same spot

R on T

Danger of PVCs - can lead to V tach

Ventricular tachycardia

3 consecutive ventricular beats at 120-200 bpm

Accelerated idioventricular rhythm

Sustained VT but 50-100bpm

Idioventricular rhythm

Sustained VT under 50 bpm

Torsades de Pointes

Sustained VT with complexes getting larger and bigger - driver travelling along the ventricles

Ventricular fibrilation

Course waveforms around the baseline - DEATH

SVT with aberrancy

V Tach until proven otherwise by cardiology

First degree conduction block

Signal takes time to get through - LONG PR segment

Wincheback block (Second degree type 1)

PR gets longer and longer until there is no QRS

Second degree type 2

Sometimes it goes through, sometimes it does not

3rd degree heart block

Atria and ventricles beating separately - can have a high junctional escape with a narrow QRS - look at individual rates of P and QRS

Automatic ventricular rate

40-20 bpm

Normal PR interval

.12-.2s (3-4) boxes

Right bundle branch block appearance

R axis deviation Bunny ear QRS in V1 may even see a positive AVR to some degree Some S wave in V6 WIDE QRS

Left bundle branch block

Notched QRS in V6 with S wave in V1 WIDE QRS

Hemiblock

Part of a branch blocked - shifts axis a little bit - axis deviation not caused by hypertrophy

Left anterior fascicular block

Left axis deviation

Left posterior fascicular block

Right axis deviation

Bifascicular block

RBBB pattern with LAD T wave inversions in V1

Underachieving blocks

Narrow complex with RBBB pattern

WTW (Wolf-Parkinson-White)

No PR segment with a slurring into the QRS complex called a delta wave

LGL Lown-Ganong-Levine

Short PR segment - bypass of AV node near the AV node

Hypothermia on EKG

Osborne was in L sided leads - curved wave after QRS

Digoxin effect on EKG

Valley after QRS complex

Method for QTc measurement

Bazett method

Upper limit for QTc

Should not be over 500 (550 if BBB)

EKG Exam #2 Flashcards

(59 cards)