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Cardiovascular II Exam One > EKG's with Unrein Day one > Flashcards

Flashcards in EKG's with Unrein Day one Deck (60)
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1

What causes the P wave?

Atrial Depolarization

2

What is the difference between a sevment and and interval?

Segments are the distance between waves, and do not include other waves,

Intervals include other waves

3

What should a normal PR interval be?

less than 0.2 seconds (one big or five little boxes)

4

How long should the QRS interval be?

Less than 0.12 seconds

5

How long a time interval are the big and small boxes?

Big = 0.2 seconds

Little = 0.04 seconds

6

If determining rate from the box method, what does each additional box count bring the heart rate to?

300

150

100

75

60

50

 

7

If using a six second strip, multiply by?

10

8

What are the six steps for analyzing an ECG?

  1. –Rate
  2. –Rhythm
  3. –Axis
  4. –Hypertrophy
  5. –Infarction
  6. –Wave interval and segment abnormalities
     

9

Rate and Rhythm?

~75

Normal sinus rythym

10

Unipolar chest leads are in what plane?

Horizontal plane

11

Describe the sequence of ventricular depolarization!

  1. Depolarization starts at the ventricular septum  (Q wave) and the endocardial surfaces.
  2. Average current flows from the base of the heart to the apex (R wave).

  3. At the end of depolarization, the current reverses, flows toward the outer walls of the ventricles near the base (S wave).

12

Describe the P waves and QRS complex in an atrial rythm.

Upright P waves

Narrow QRS

13

Describe the P waves and QRS complexes in Junctional rythms.

P waves will be absent or inverted

Narrow QRS complex

14

describe the P waves and QRS complexes in ventricular rythms

No P waves

QRS complexes are wide

15

What are the QRS complexes like for supraventricular rhythms?

Narrow QRS complexes

16

What is the characteristic description of the Atrial flutter rhythm?

What does it tend to deteriorate into?

"saw tooth"

Deteriorates into Atrial fibrillation

17

A-Fib is classically described as?

Irregularly irregular

 

(Wait, I though Steve and Michael described this as "a fuck"? TIL.)

18

What causes a WPW rhythm, and what does it look like?

D/t accessory conduction pathway - Bundle of Kent

Presence of delta waves - P waves merge into the QRS

Shortened PR interval

19

What is shown here?

20

What do you see here?

Wandering pacemaker

21

Rhythm?

Atrial Flutter

22

What does this patient have?

Atrial Fibrillation

Note lack of P waves, and QRS complexes occuring without pattern

23

Rhythm?

Junctional

No P waves before QRS, so not atrial origin

24

Rhythm?

Junctional Tachycardia

note the inverted P waves

 

25

Rhythm?

WPW

26

Rhythm?

WPW

27

What defines a first degree AV block?

a prolonged PR interval greater than 0.2 seconds

28

Second degree AV blocks have variable penetration of AV conductions, with lone P waves without QRS following.  

What are the types?

Type I - Wenckebach: progressively prolonged PR intervals with a subsequent dropped beat and lone P wave.  Usually in a fixed ratio/pattern

Type II - Mobitz: Failure of AV conduction in a fixed ratio/pattern, the PR inverval is not gradually increasing in length.  Presents with a widened QRS.

29

What goes on in a third degree heart block?


–Complete Atrial and Ventricular dissociation – both are being independently paced
 

30

Rhythm?

First Degree AV Block

31

Rhythm?

Wenckebach (type I second degree heart block)

 

32

Rhythm?

Wenckebach

PR interval becomes progressively longer until it can no longer conduct.  

Described as regularly irregular

 

33

Rhythm?

Mobitz type II

3 P waves per depolarization

34

Rhythm?

Second Degree AV block

Mobitz type II

Two P waves per depolarization

35

Rhythm?

Third degree AV block

Note how the P waves are disconnected from the QRS complex.

The P waves and QRS complexes have their own independent periodicities.

36

What is a typical cause of ventricular tachycardia?


–Irritable focus of a ventricular origin – usually reentry mechanism
 

37

The term "twisted ribbon" would likely refer to what?

Torsades de pointes

38

If you hear "multiple irritable automatic foci depolarization" you should think?

Ventricular fibrillation

39

What is shown here?

Ventricular Bigeminy

40

What is shown here?

Ventricular Tachycardia

41

Rhythm

Torsades de Pointes

42

Rhythm?

Prolonged QT syndrome

43

Rhythm?

Prolonged QT syndrome (hypomagnesemia)

44

Rhythm?

Ventricular Fibrillation

45

Bundle branch blocks are d/t lack of synchronization of the bundle branches.  If the left bundle conducts first then?

Where would this be best viewed (what leads)?

Right bundle branch block

View in V1 and V2

 

46

If the right bundle branch conducts first then?

Best viewed in what leads?

Left bundle branch block

Best viewed in V5 and V6

47

Identify the indicated structures!

48

What do you see here?

Right bundle Branch Block

49

Rhythm?

Right bundle branch block

50

Rhythm?

Left bundle branch block

51

What is the normal cardiac axis?


–0-90 degrees is normal (actually -30 to 110)
 

52

Where would you find the cardiac isoelectric point?

Right angle from the axis plane

53

The limb leades determine what?

Since in the frontal plane, they determine the axis

54

The chest leads determine what?

In the horizontal plane, so they determine rotation

55

What is the axis?

+30

56

Axis?

-90

57

What is the axis?

-60

58

What is the axis?

0

59

Axis?

+100

60