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Diagnostic Med > EKGs > Flashcards

EKGs Flashcards

1
Q

What does the P wave stand for?

A

Atrial Depolarization

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2
Q

What is the PR interval?

A

Time between atrial and ventricular depolarization
(SA Node –> AV Node pause)
Ventricles fill with blood

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3
Q

What does the QRS complex stand for?

A

Ventricle depolarization before contraction

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4
Q

What is the QT interval?

A

Ventricle systole

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5
Q

What is the ST segment?

A

Absolute refractory period- time between ventricle depolarization and repolarization

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6
Q

What does the T wave stand for?

A

Rapid phase of ventricle repolarization

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7
Q

What is the electrical pathway through the heart?

A

SA Node–> AV Node –> Bundle of His –> Right or Left Bundle Branches (Left has anterior and posterior)–> Purkinje Fibers

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8
Q

What is the rate which the SA Node fires?

A

60-100 bpm

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9
Q

What is the rate which the AV Node fires?

A

40-60 bpm

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10
Q

What is the rate which the ventricles fire?

A

20-40 bpm

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11
Q

What is the J point?

A

where he QRS ends and ST segment starts

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12
Q

What is the normal P wave interval duration?

A

120 milliseconds

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13
Q

What is the normal PR interval duration?

A

120-200 milliseconds

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14
Q

What is the normal QRS interval duration?

A

80-120 milliseconds

wider/longer = slower signal/bpm

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15
Q

What is the normal QT duration?

A

340-460 milliseconds

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16
Q

What do uppercase letters mean?

A

large deflection- greater than 2 small boxes

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17
Q

What do lowercase letters mean?

A

small deflection- less than 2 small boxes

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18
Q

If there is more than one of a wave what is it called?

A

Prime ex. R’

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19
Q

How does heart rate affect the QT segment?

A 
Up = shorter QT
Down = longer QT
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20
Q

What are the 5 main areas of an EKG?

A 
Rate
Rhythm
Axis
Block
Infarction
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21
Q

How fast is Tachycardia?

A

over 100 bpm

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22
Q

How slow is Bradycardia?

A

less than 60 bpm

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23
Q

What is an escape rhythm?

A

Somewhere other than the SA node is setting the rate

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24
Q

What charge do all cardiac cells have at rest?

A

Negative

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25
Q

What are properties of cardiac cells?

A

Automaticity
Excitability
Conductivity

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26
Q

What is element is responsible for depolarization?

A

Na+ rushes into the cell

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27
Q

What does the U wave stand for?

A

Repolarization of Purkinje fibers- not usually seen

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28
Q

What is Lead I?

A

Right to left arm

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29
Q

What is lead II?

A

Right arm to left leg

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30
Q

What is lead III?

A

Left arm to left leg

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31
Q

What are the 2 large box methods for counting rate?

A
  1. Count the number of large boxes between R-R interval then divide by 300.
  2. Count down between on each big box- 300, 150, 100, 75, 60, 50, 43, 37
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32
Q

What is the small box method for counting rate?

A

Count the number of small boxes between R-R interval then divide by 1,500

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33
Q

What is the 6 second method for counting rate?

A

Count the number of QRS complexes in strip then multiply by 10

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34
Q

What is irregularly irregular?

A

variation between R-R interval is greater than .04 seconds with no repeating pattern

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35
Q

What is the significance of a tall, peaked T wave?

A

Hyperkalemia/ high Potassium

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36
Q

What is the significance of ST depression?

A

Ischemia

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37
Q

What is the significance of ST elevation?

A

Infarction

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38
Q

What makes a rhythm sinus?

A

Has a p, qrs, t wave form

can be sinus rhythm, sinus brady, sinus tachy, sinus arrhythmia

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39
Q

What happens in sinus block/ sinus exit block?

A

SA node fires but is blocked as it exits the SA node

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40
Q

What vessels supply the Right Atria with blood?

A

Superior Vena Cava
Inferior Vena Cava
Coronary Sinus
(deoxygenated)

41
Q

What vessels supply the Left Atria with blood?

A

Pulmonary veins (oxygenated)

42
Q

What typically causes Sinus Arrhythmia?

A

Respiration- inspiration increases rate

-related to Vagal tone

43
Q

What are the major causes of Bradycardia?

A
  1. Fibrosis of the conduction system (as part of a normal aging process)
  2. Acute injury to the conduction system (acute MI)
  3. Side effects of medications
  4. Combination of those mechanisms.
44
Q

What are symptoms of Bradycardia?

A

Generalized fatigue, dyspnea, dizzy spells, near syncope and syncope.

45
Q

What do you do if somebody is Sinus Bradycardic?

A

Young and athletic people can be an asymptomatic- just let them be. Only treat if symptomatic
If symptomatic and no reversible cause- pacemaker

46
Q

What is indicative of Sinus Node Exit Block?

A

SA node fires, but doesn’t go anywhere
No P Wave before QRS complex- otherwise sinus rhythm (retrograde p wave)
-typically untreated- asymptomatic

47
Q

What is indicative of Sinus Arrest?

A

SA Node doesn’t fire- pause of greater than 2 sec. Symptoms and/or pause greater than 6 seconds warrant permanent pacemaker placement

48
Q

What is indicative of Junctional Rhythm?

A

SA Node doesn’t fire- AV node takes over (40-60 bpm)
No P waves before any QRS complex (wider)
-treatment- remove offending agents, or pacemaker

49
Q

What is indicative of TachyBrady Syndrome?

A

AKA Sinus Node Dysfunction
Most common pacing indication
Periods of Tachycardia and Bradycardia , may also have periods of A Fib

50
Q

What is indicative of First Degree AV Block?

A

PR interval longer than 200 milliseconds

  • usually asymptomatic- no treatment
  • ventricles are filling too much/too long
51
Q

What is indicative of Second Degree AV Block Mobitz I?

A

AKA Wenkebach
Progressively longer PR interval followed by a dropped beat (p wave then no QRS, T)
-blockage site is in AV node

52
Q

What is indicative of Second Degree AV Block Mobitz II?

A

Fixed PR interval followed by a dropped beat (p wave then no QRS, T)

  • blockage site is in His
  • emergent- can lead to complete heart block- indicative of pacemaker
53
Q

How many seconds/millimeters is a big box?

A

.2 sec, 5 mm

54
Q

How many seconds/millimeters is a small box?

A

.04 sec, 1 mm

55
Q

What is indicative of complete heart block?

A

AKA 3rd degree AV Block
p waves separate from QRS
p waves are regular and QRS is regular, however they have no relationship
-medical emergency! NEED a pacemaker

56
Q

Where does impulse formation take place?

A

SA Node

57
Q

Where does impulse conduction take place?

A

AV Node

58
Q

What is indicative of a Premature Atrial Contraction?

A

P wave looks different than others- QRS complex comes quicker than normal sinus rhythm
Impulse comes from upper chamber- but not SA Node
-typically asymptomatic

59
Q

What is indicative of Sinus Tachycardia?

A

Rate of 100-150bpm, but P, QRS, T in regular 1:1 fashion

-rarely over 200 bpm- in response to stressor

60
Q

What is indicative of Supraventricular Tachycardia?

A

Narrow QRS complex rate of 150-240 bpm
abrupt onset and offset, p wave typically buried in QRS complex
-can be caused by accessory pathway connecting atria and ventricles
Ex. of SVT- AVNRT, AVRT, WPW, Atrial Tachycardia
-terminated with Adenosine (causes heartblock)

61
Q

What is indicative of AV Reentry Tachycardia?

A

Appears as SVT
Short PR interval, initiated with PAC
Conduction from Bundle of Kent
AV node and Ventricles are activated at the same time through accessory pathway. After ventricles contract the AV node fires and has the contract again.
*can be a concealed pathway- appears as normal EKG

62
Q

What is indicative of Wolff Parkinson White?

A

Delta wave in QRS- slurred upstroke, Narrow PR interval

MUST have SVT and Delta wave- without SVT it is just called pre-excitation, in tachy the delta wave disappears

63
Q

What is indicative of AV Nodal Reentry Tachycardia?

A

Retrograde P wave instead of before QRS complex
Dual AV Nodal pathways (fast and slow)
PAC sends signal through slow pathway–>reaches the fast pathway and sends signal retrograde up to atria
*Most common occurring PSVT

64
Q

What is indicative of Atrial Tachycardia?

A

Rate of 150-220 bpm
p wave typically buried in t wave
*not stopped with Adenosine
*may be a precursor for A Fib due to scarring or Digoxin

65
Q

What is indicative of Multifocal Atrial Tachycardia?

A

lots of different p wave morphology
heart rate 100-150 bpm
*most common cause is COPD

66
Q

What is indicative of Atrial Fibrillation?

A

“irregularly irregular” no discernible pattern
no p waves- atria 300-600 bpm if could calculate ventricles over 100 bpm
*most common chronic arrhythmia
*strokes happen due to blood pooling in left atrial appendage

67
Q

What is indicative of Atrial Flutter?

A

“saw tooth pattern” in leads II, III, aVF

flutter rate is about 300 bpm

68
Q

What is indicative of Preventricular Contractions?

A

Wide QRS beats usually without preceding P wave

  • can cause palpitations
  • treated w/ beta blocker or Ca2+ channel blocker, or ablation
69
Q

What is indicative of Ventricular Tachycardia?

A

3 or more consecutive PVCs, 160-200 bpm
Nonsustained- less than 30 sec. terminates spontaneously
Sustained- over 30 sec. requires cardioversion

70
Q

What is Wide Complex Tachycardia?

A

Always treat it as Ventricular Tachycardia until proven otherwise (SVT)

71
Q

What is indicative of Torsades de Pointes?

A

Form of Polymorphic Ventricular Tachycardia- QRS complex wide and changes between upright and inverted
*Requires emergent defibrillation; leads to sudden cardiac death. Magnesium also used after defib

72
Q

What is indicative of Ventricular Fibrillation?

A

No discernible ventricular activity, if you could count, 200-300 bpm
Patient is pulseless
*requires defibrillation

73
Q

What is an ICD?

A

Implantable cardioverter defibrillators

74
Q

What leads does aVR use?

A

I and II

right arm positive

75
Q

What leads does aVL use?

A

I and III

left arm positive

76
Q

What leads does aVF use?

A

II and III

left foot positive

77
Q

What is the placement of V1?

A

right of sternum 4th ICS

78
Q

What is the placement of V2?

A

left of sternum 4th ICS

79
Q

What is the placement of V3?

A

between V2 and V4

80
Q

What is the placement of V4?

A

left of sternum, 5th ICS at midclavicular line

81
Q

What is the placement of V5?

A

even with V4 at anterior axillary line

82
Q

What is the placement of V6?

A

even with V4 and V5 at mid axillary line

83
Q

What is indicative of right atrial enlargement?

A

peaked p wave:
over 1.5 mm in V1
over 2.5 mm in II
typically due to pulmonary hypertension

84
Q

What is indicative of left atrial enlargement?

A

Wide terminal portion in V1- greater than .04

Notched, wide p in II- greater than .12 sec

85
Q

What is indicative of biatrial enlargement?

A

peaked and broad p’s in inferior leads- at least 2.5 mm tall and .12 sec wide
V1- broad, biphasic w/ terminal negative deflection at least 1 mm deep and .04 sec wide

86
Q

What is indicative of a Right Bundle Branch Block?

A

QRS greater than .12 sec

In V1 and V2- upright “bunny ears”

87
Q

What is indicative of a Left Bundle Branch Block?

A

QRS greater than .12 sec

In V1 and V2- big q wave down

88
Q

What are the lateral leads?

A

I, aVL

89
Q

What are the anterior leads?

A

V1, V2, V3, V4

90
Q

What are the inferior leads?

A

II, III, aVF

91
Q

What are the anterio-lateral leads?

A

V5, V6

92
Q

What is indicative of a Myocardial Infarction?

A

elevated ST segments in one area of the heart/leads

93
Q

What is indicative of ischemia?

A

depressed ST segments

94
Q

What is indicative of Pericarditis?

A

diffuse elevated ST segments

-chest pain alleviated with sitting forward

95
Q

What is indicative of Hyperkalemia?

A

peaked T waves

96
Q

What are the classes of antirhythmic drugs?

A 
Class I- Na channel blockers
Class II- Beta Blockers
Class III- K channel blockers
Class IV- Ca channel blockers 
Digoxin, and Adenosine
97
Q

What is left ventricle hypertrophy and how is it shown?

A

thickening of the myocardium

add up S in V1, plus R in V5 and V6- if over 35 mm it needs to be followed up with echo

98
Q

What is indicative of a Pulmonary Embolism?

A

S1Q3T3- deep S in lead I, deep Q in lead III, inverted T in III

Diagnostic Med (2 decks)

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