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EKG > EXAM 1 > Flashcards

EXAM 1 Flashcards

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1
Q

what three things is imp to use an EKG for?

A

Cardiac rhythm
Conduction system abnormalities
Myocardial ischemia.

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2
Q

what does the small boxes and large boxes correspond to on the horizontal axis?

A

large - 0.20sec
small 0.04sec

4 small boxes make up one large box

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3
Q

what does the small boxes and large boxes correspond to on the vertical axis?

A

large - 10mm
small - 1mm

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4
Q

what is a rhythm strip? what lead is it usually? how long does it last?

A

SINGLE STRIP print out from a particular lead USUALLY LEAD 2

last 6 seconds from a portable device

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5
Q

what is a 12 lead EKG reading?

A

standard reading

shows 3 seconds of all 12 LEADS plus 10 seconds

rhythm strip (one strip_ (normally lead 2)

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6
Q

what are the four laws of EKG?

A
  1. A wave of depolarization flowing TOWARDS a positive electrode will record a positive wave
  2. A wave of depolarization flowing AWAY from a positive electrode will record a negative wave.
  3. A wave of depolarization perpendicular to a positive electrode will record a BIPHASIC wave
  4. All the effects caused by repolarization have the REVERSE effect on the waves.
    –> A wave of repolarization moving AWAY from a positive electrode will result in a positive wave
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7
Q

what is a wave and complex on EKG?

A

+ or - deflection from baseline that indicates a specific electrical event

P Q R S T U waves

complex - several waves tg like the QRS complex

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8
Q

what is the J and U point on the EKG?

A

one point only = J point
where the QRS complex ends and ST segment begins

U = follows after the T wave, represents repolarization of purkinje fibers
–> theroy to why its there is delayed repolarization of purkinje fibers

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9
Q

Explain the non standard waves: QS, R’, S’, U waves.

A

QS wave = if there is only ONE wave and entierly negative

R’ = when there is more than 1 POSTIVE deflection above baseline, the 2nd is called R’

S’ = when theres more than 1 NEGATIVE deflection, 2nd is called S’

U wave = small hump AFTER T wave, usually occurs at rate <65 bpm,

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10
Q

why is the J point so imp?

A

to determine if theres ST elevation of depression on MI since J is where QRS and ST segment meet

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11
Q

what is the normal seconds for PR internval?

A

0.12-0.2 secs

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12
Q

what is the normal seconds for QT interval and QRS ?

A

QT - 0.4-0.44 seconds

QRS: 0.12 seconds (3 little squares)

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13
Q

what lead do you look at for atrial enlargement?

A

LEAD 2 AND LEAD V1

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14
Q

what would you evaluate for a right ventricular hypertrophy in the QRS complex?

A

evaluate LEAD V1: R wave > S Wave
or R wave > 7mm in height

Q waves normally will be wider and deeper than normal

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15
Q

what will the EKG show on the T wave for the following:
hypoK, hyperK, hypoG, hyperG?

A

hypoK - long QU interval, prominent U wave
(U is small hump after T wave)

hyperK - peaked T wave

hypoG - QT prolongation!

hyperG - shortening of the ST segment

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16
Q

how do u perform the EKG?

A

supine or semiflower postion.

IF clip on EKG, put the electrodes on skin first then clip on

if snap button type, put clip on then electrodes on skin

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17
Q

explain the limb leads and its color coloration.

A

Left arm = black (left is hell)
right arm = white

left leg = red (left is hell)
right leg = green

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18
Q

where would you put the V1-V6 leads on the body?

A

V1: 4th IC space on right sternal edge
V2: 4th IC space on left sternal edge
V3: Place half-way between V2 and V4
V4: 5th IC Space at the midclavicular line (at the apex beat)
V5: Anterior axillary line at 5th IC space
V6: Mid-axillary line at 5th IC space

remember: 4th IC is for V1-V3ish
5IC ic for V5-V6

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19
Q

what are limb, augmented, and precordial/V leads?

A

limb leads = I,II,II = using electrodes placed on arms and left leg

augmented leads = 3 leads (aVR, aVL, aVF) = utilize limb leads and augmentation by assigning different polarities to the limb leads and averaging of other leads use of an imaginary negative lead

precordial/V lead = 6 chest leads (V1-V6) reads electrical activity in horizontal plane = ALWAYS A POSTIVE POLE

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20
Q

how do u calcualte rate in rhtyhm strip and 12 lead strip?

A

in both count the # of QRS

in rhtyhm single strip, multiple QRS by 10 = bpm

in 12 lead strip, multiple QRS by 6= bpm

OR U CAN DIVIDE THE # BOXES BY 300

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21
Q

what is a sinus rhythm?

A

it is electrical impulses orignating from the SA node

  • NORMAL P wave precedes each QRS wave
  • P wave will always be upright in leads 1 and 2 and inverted in aVR
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22
Q

explain what you will see in a normal sinus rhythm?

A
  1. rate between 60-100bpm = NORMAL sinus
  2. Regular rhythm coming from SA
  3. P wave must be present and QRS complex must be present 1:1
  4. if there is more QRS than P then it is NOT in sinus
  • P wave is always present and upright in 1-2 and inverted in leads aVR (normal)
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23
Q

what do u see in sinus tachycardia on the EKG and what are some causes?

Study These Flashcards
A
  1. rate more than 100bpm
  2. P waves are present and normal
  3. QRS are usually narrow
  4. has regular rhythm (coming from sinus)

Causes:
- medication, stimulants, excitment, preg pain, fever, sepsis, hypovolmia, pain, anxeity, hyperthermia, hyperthryoidism

24
Q

what are sinus arrythmias characteristics and causes?

Study These Flashcards
A
  • it is a common and benign finding in young healthy kids. SA noes does not pace the heart at regular rate
  1. make sure there is P / QRS 1:1 ration (which means its sinus)
  2. look at R-R interval. Closer means tachy, far means brady
  3. QRS narrow
  4. P are normal

Casues:
- M/C for short term is respiration!!!!!
changes in vagal tone during res cycle:
insipritation = increases in rate
expiration = decreases in rate

25
what do u see in sinus bradycardia on the EKG and what are some causes?
1. rate less than 60bpm 2. regular rhythm 3. QRS is narrow 4. P is normal Cause: increase vagal tone (slow), medication such a BB, CCB, amiodarone, hypothryodiism, hypothermia, increase ICP, MI, hyperkalemia
26
do vectors tend to move towards/away to hypertrophy and infarction?
towards hypertrophy away from infarction
27
when looking at the axis you look at lead 1 and avF. if lead 1 is postive and avF is postive, what is the axis on?
normal = -30 to +90
28
postive Lead 1 and neg avF?
LAD
29
neg lead 1 and postive avF?
RAD
30
negative lead 1 and negative avF?
extreme
31
what is the relationship between narrow QRS and supraventricualr rhythm?
ALL NARROW QRS COMPLEX = are SV in origin but not all SV have narrow complexes if there is a narrow complex QRS, then you can eliminate ventricualr arrhytmias bc IT IS A SUPERVENRICUALR PROBELM such as SVT, Afib, Atachy
32
what is ectopy?
ectopy is when an arrythmias originate from an abnormal place or postion (rather than SA node which is normal) if the ectopic rate is faster than the SA node rate, then it will take over the heart = then abnormalility will take over
33
what is premature atrial complex, PAC? what will you see on the EKG?
- PAC is a common benign arrythmia - it occurs when there is a premature or early activation of the atrial myocardium by an ectopic focus = creating impulse rather from than sinus node EKG: 1. irregular P wave which will make the QRS complex happen too early = premature 2. if the P waves look the same, they are coming from the same foci point (not SA node) 3. P' occurs BEFORE next P wave 4. P' has DIFF appearance than P wave 5. after PAC, there is a prolonged pause before SA node resume control - QRS is usually identical to all the QRS complexes
34
what are the RF for PAC? premature atrial complex
very common!! happens in healthy people - excessive smoking, alc, stress, caffeine, fatigue
35
what are the ABCD's of PAC?
A - abberant/abnormal = abnormal QRS, *often* wide or mimiccs RBBB B - blocked = QRS is blocked so only P' shown C - Conducted = P' occurs when consistet QRS like other occurs D - da preceding T wave = P' may not be obvious on EKG - T wave may show diff morphology than others due to P' and T wave happening at the same time
36
what is uniforcal, multifocal, bigeminy, trigeminy, quadrigeminy, couplet and triplet of PAC?
unifocal = single ectopic focus multifocal = two or more ectopic foci bigeminy = every other beat is a PAC trigemy = every thrid beat is a PAC quadrigeminy = every 4th beat is a PAC couplet = two consecutiove PAC triplet =- three consective PAC
37
what are the three types of arrythmias that are under paroxysmal supraventricualr tachycarida?
1 - AV nodal reentry tachy 2 - AV reentry tachy 3- paroxymal atrial tachy (PAT)
38
what do you see on the EKG for SVT?
1. rate between 140-220 bpm 2. REGULAR RHYTHM 3. QRS is narrow (usually) 4. P waves normal but USUALLY HIDDEN IN QRS since the rate is too FAST (so you will not see P wave in the strip) - ST depression CAN occur - can be an abrupt onset after PAC w prolonged PR interval
39
what is the pathophysiology, RF and tx for SVT?
pathophys = reentry tachy RF = smoke, alc, stimualnts, exercise, increase vagal tone sometimes like sleep squatting TX = #1: vagal maneuver Stable: IV adenosine unstable: CV - surgery for bad episodes: usage of cather ablation of ectopic foci
40
what do you see in paroxysmal atrial tachycardia PAT ? (FAT = focal artrial tachy)?
1. Signal is coming from ONE foci point 2. bpm > 100 3. Regular rhythm!! 4. QRS narrow 5. P' same distinct morphology BUT you will see (at least) THREE *CONSECUTIVE* beats from atrial ecotpic focus
41
what are the risk factors of PAT and tx?
RF: SAME AS SVT so like caffeine, drugs, alc, exercise, or increase in vagal tone like sleeping, squatting TX: find underlying cause, vagal maneuvers and adenosine just like SVT , BB CCB
42
what is multifocal atrial tachycardia? what do u see in EKG? what disease is it usually related to ?
1. caused by multiple ectopic foci in the atria!! 2.bpm over 100 3. narrow QRS - since its a atrial issue 4. 3 or more DISTINCT P' waves so DIFFERENT P WAVES
43
what do you see in wandering atrail pacemaker, WAP? what is the RF for WAP and tx?
in WAP - u see three or more distinct P' waves its the same as MAT, but this is less than 100 bpm whereas MAT is more than 100 bpm RF: elderyl pt w COPD and respiratory failure tx: solve underlying condition
44
which diease will you see with chronic lung diease and COPD?
chronic lung diease = multifocal atrial tachy COPD = wandering atrial pacemaker
45
what happens if SA node fails, what beat or rhythm will occur?
- ectopic areas throughout myocardium conduction sys can take over - it comes form the AV node 40-60bpm Escape beat will happen = SINGLE depolarization of backup ectopic pacer (AV node) escape rhythm = 3 or MORE CONSECUTIVE escape beats
46
what is junctional escape beat / rhythm? what do u see in EKG
junctional beat is when pacemarker depolorzation happen at the AV node since SA node fails 1. rate of 40-60 bpm 2. REGULAR RHYTHM 3. narrow QRS 4. P WAVE ABSENT OR INVERTED junctional rhythm = is just 3 or more consecutive escape beats
47
what is the most common sustained arrythmia in the US?
AFIB - QUIVERRR!!
48
what is AFIB and how would u tx it ?
AFIB is rapidly firing irritbale focus in the atria it can quiver easily any fib is quivering!!! 1. Variable rate, commonly 90 to 170 bpm 2. Irregularly Irregular 3. QRS narrow 4. Absence of isoelectric line 5. No P waves or PR interval tx: nondihydro CCB
49
what is the m/c type of reentrant circuit that usually moves counterclockwise motion? where will u do it more; pt with what diease?
A flutter!! less common than afib! common w pt with heart disease :(
50
what will u see in the AFIB EKG?
1. 90-170bpm 2. irregularly irregular 3. Narrow/ normal QRS 4. NO P WAVE = NO PR INTERVAL = bc atria is contacting too quickly
51
what will u see on the ekg for atrial flutter?
1. SAWTOOTH wave that replace P Waves 2. NO PR INTERVAL m/c atrial to ventricular ratio of 2:1 3. REGUALR OR IRREGUALR! narrow QRS
52
what is wolff parkinson white syndrome?
it is a circit pathway that has *bundle of kent* which bypasses the AV node --> goes straight from A to V so bc of this we have a short PR interval signal can also be retrograde and go back from V to A
53
what do u see in a WPW EKG? what wave do you see?
short PR interval less than 0.12 seconds youll see a DELTA WAVE (sharp turn from P to Q = --> prolong QRS ( casue of delta wave)
54
what is a common thing you see in both AFIB and SVT?
no P wave!!! P wave is often hidden in SVT
55

EKG (2 decks)

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