FPC: EKG interpretation

Question 1

What is the general naming system for arrhythmia?

Answer 1

The first word is the location and the second is the type of arrhythmia

Question 2

In sinus arrhythmia, what effect does inspiration have on heart rate?

Answer 2

Increases it

Question 3

What effect does expiration have on heart rate?

Answer 3

Decreases it

Question 4

Describe sinus arrhythmia.

Answer 4

The diaphragm contracts, negative intrathoracic pressure pulls air into the lungs, lowering arterial pressure, activating baroreceptors, and decreasing vagal input to the SA node

Question 5

What does a Valsalva maneuver do?

Answer 5

Activates the vagus nerve to slow heart rate and break up tachyarrhythmia

Question 6

What is a benefit of sinus arrhythmia?

Answer 6

It maximizes blood flow during maximum oxygenation

Question 7

What arrhythmia is common in young athletes?

Answer 7

Sinus arrhythmia

Question 8

What extra heart sound can occur with hypertension?

Answer 8

S4

Question 9

What will the P wave look like in the right atrium in an instance of hypertrophy/enlargement?

Answer 9

Greater than 2.5 mm tall in lead II

Question 10

What will the P wave look like in the left atrium in an instance of hypertrophy/enlargement?

Answer 10

Terminal negativity in lead V1 or -mitral in lead II

Question 11

What will the QRS look like in left ventricular hypertrophy?

Answer 11

S in V1 + R in V5 or V6 is greater than 35 (or 25 if single lead)

Question 12

What will the QRS look like in right ventricular hypertrophy?

Answer 12

V1 R wave bigger than S wave

Question 13

What is a premature atrial contraction?

Answer 13

Premature p wave followed by a narrow QRS

Premature atrial contractions (PACs) are early heartbeats originating in the atria.

Question 14

What characterizes a premature ventricular contraction?

Answer 14

Wide QRS due to lack of conduction system use, typically not preceded by a p wave

Premature ventricular contractions (PVCs) can disrupt the normal heart rhythm.

Question 15

What is a non-compensatory pause?

Answer 15

The RR interval will be less than normal due to the SA node being reset

This can occur in PACs.

Question 16

What is a compensatory pause?

Answer 16

The RR remains the same due to SA node firing when it has to

This can be seen in PVCs.

Question 17

What is syncope?

Answer 17

Transient complete loss of blood flow to the brain

Syncope can result from various cardiovascular issues.

Question 18

A heart rate over 150 could be indicative of what?

Answer 18

SVT (AVNRT)

Supraventricular tachycardia (SVT) is often associated with elevated heart rates.

Question 19

What does an irregular heart rate indicate?

Answer 19

Atrial fibrillation (a-fib)

A-fib is characterized by a lack of consistent P waves.

Question 20

What is indicated by a wide and regular heart rate?

Answer 20

Ventricular tachycardia (VT)

VT can be life-threatening and requires immediate attention.

Question 21

What type of tachycardia has a P wave before the QRS complex?

Answer 21

Sinus tachycardia

This indicates that the heart’s natural pacemaker is functioning properly.

Question 22

If you see 3 P waves during tachycardia, what is it called?

Answer 22

Multifocal atrial tachycardia (MAT)

MAT is characterized by varying P wave morphology.

Question 23

What are the requirements for atrial fibrillation (a-fib)?

Answer 23

Requires a trigger and a susceptible substrate (left atrial dilation)

Inflammation near the atrium can also cause a-fib.

Question 24

What characterizes atrial flutter?

Answer 24

200-300 in atrium, 100-150 in ventricle, narrow QRS, sawtooth pattern

Atrial flutter typically originates in the right atrium.

Question 25

Which leads are looked at for atrial flutter?

Answer 25

Leads II and III ## Footnote These leads help identify the characteristic patterns of atrial flutter.

Question 26

What is a 1st degree AV block?

Answer 26

PR interval is larger but RR interval is the same ## Footnote This indicates a delay in conduction through the AV node.

Question 27

What is a 2nd degree AV block?

Answer 27

Wenckebach (mobitz I): progressive lengthening of PR with dropped QRS Mobitz II: fixed PR with dropped QRS and wide QRS ## Footnote These blocks indicate varying degrees of AV node dysfunction.

Question 28

What is a 3rd degree AV block?

Answer 28

Complete dissociation of P and QRS; they occur independently ## Footnote This is a severe form of heart block requiring immediate medical intervention.

Question 29

What is a 3rd degree AV block?

Answer 29

Complete dissociation of P and QRS; they both happen but not in relationship to each other ## Footnote This condition indicates a complete block in the electrical conduction from the atria to the ventricles.

Question 30

Which heart blocks need a pace maker?

Answer 30

Mobitz II and 3rd degree ## Footnote These blocks are significant enough to require pacing to maintain adequate heart function.

Question 31

What does a long QT interval indicate risk for?

Answer 31

Ventricular tachycardia ## Footnote A prolonged QT interval can lead to dangerous arrhythmias.

Question 32

What will hypokalemia show on EKG?

Answer 32

Long QT interval ## Footnote Low potassium levels can affect the heart's electrical activity.

Question 33

What will hyperkalemia do on EKG?

Answer 33

Peaked (taller) T wave ## Footnote High potassium levels can lead to characteristic changes in the EKG.

Question 34

What happens to the ST segment during a heart attack?

Answer 34

Elevation ## Footnote ST elevation is a key indicator of myocardial infarction.

Question 35

What happens to the ST segment during ischemia?

Answer 35

Depression ## Footnote ST depression indicates that the heart muscle is not receiving enough oxygen.

Question 36

What will happen to ST during ischemia?

Answer 36

Depression ## Footnote This indicates a lack of blood flow to the heart muscle.

Question 37

What causes subendocardial ischemia?

Answer 37

An oxygen supply/demand mismatch not specific to a single blocked coronary artery ## Footnote This type of ischemia can occur in various conditions affecting the heart.

Question 38

Describe ventricular fibrillation.

Answer 38

No clear QRS or other repeating pattern ## Footnote This is a life-threatening arrhythmia requiring immediate intervention.

Question 39

What are the characteristics of Ventricular Tachycardia (V-tach)?

Answer 39

Fast, wide, and regular ## Footnote V-tach can be monomorphic or polymorphic and often requires urgent treatment.

Question 40

What is Torsade de Pointes?

Answer 40

Pleomorphic V-tach with twisting of the points ## Footnote This arrhythmia is characterized by a distinctive EKG pattern and can lead to sudden cardiac arrest.

Question 41

What are the underlying causes of Ventricular Tachycardia?

Answer 41

* Ischemia * Infarct * Irritation of myocardium * Dilated cardiomyopathy ## Footnote These conditions can lead to instability in the heart's rhythm.

Question 42

What is the heart rate in Ventricular Tachycardia?

Answer 42

Rate > 100 bpm ## Footnote This indicates a rapid heart rhythm originating from the ventricles.

Question 43

What is the characteristic shape of the QRS complex in monomorphic V-tach?

Answer 43

All same shape (in each lead) ## Footnote This homogeneity in shape differentiates it from other forms of tachycardia.

Question 44

True or False: Carotid massage can break up Ventricular Tachycardia.

Answer 44

False ## Footnote Carotid massage is not effective in terminating V-tach.

Question 45

Give the run-through for tachycardiaa

Answer 45

1. How fast is the RR 2. Regular vs irregular 3. Wide vs narrow 4. P wave? 5. 3 different P waves?? 6. Flutter?

Question 46

Give the steps for determining Brady/blocks

Answer 46

1. Regular or irregular QRS 2. P wave relationship 3. PR interval

Question 47

Give the criteria and vessel for an anterior MI

Answer 47

ST elevation V1-V4; LAD

Question 48

Give the criteria and vessel for a lateral MI

Answer 48

ST elevation V5-V6 or I and AVL; circumflex

Question 49

Give the criteria and vessel for an inferior MI

Answer 49

II, II, AVF; RCA

Question 50

Give the criteria and vessel for a posterior MI

Answer 50

ST depression V2 or V3; PDA

Question 51

Describe EKG findings of pericarditis

Answer 51

ST elevation, PR depression, spodicks sign, no reciprocal changes, and a concave QT shape