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1 ECG Flashcards

1
Q

What is Electro-Mechanical Coupling?

A
  • Electrical events cause mechanical events and thier inter-relationship in the heart is important for function
  • Critical for optimal performance
    • Filling/expelling blood
    • output with activity
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2
Q

What is an electrocardiogram?

A
  • Captures electrical activity produced by hearts conduction cycle
  • Impulses generated from flow of charged particles detectable on the surface of the skin
  • ECG
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3
Q

What is the mean cardiac vector and what is the ECG reading in normal?

A
  • Runs from R to L, and superior to inferior to inside out
  • Points Downwards and slightly above the apex
  • QRS: looks at left ventricular activity
  • L has bigger and overpowers the R for ECG activity
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4
Q

How does the mean vector determine the ECG reading?

A
  • Position of the ECG leads determine the signal
  • More in line with mean vector + large tissue = greater magnitude
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5
Q

Describe the heats depolarization and repolarization direction

A
  • Depolarization: R to L, Superior to Inferior and internal to external
  • Repolarization: opposite directiom

QRS COMPLEX (largest in conduction cycle)

Vectors opposite to mean vector in repolarization will be negative

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6
Q

Describe the ECG lead/position and how it captures the signal

A
  • Captures signal from negative terminal to positive terminal
  • “Eye” captures and recieves the signal
  • Magnitude will be positive
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7
Q

What are Bipolar Leads?

A
  • Utilizes a negative and positive electrode and record the elctrical activity between them
  • Limb I II III
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8
Q

What are unipolar leads?

A
  • Utilize a single positve recording electrode and a combination of the other electrodes to serve as a composite negative electode
  • Precordial chest (V1 V2 V3 V4 V5 V6)
  • Unipolar Augmented aVL aVR a VF
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9
Q

What placement direction shows best electrical signal of the heart?

A
  • Goes from negative to positive
  • Diagonol direction with (-) Superior Right arm and (+) Lower Left
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10
Q

What are the Augmented leads?

A
  • Single positive electrode that is referenced aginst a combination of the other limb electordes
  • Same electrodes used for a standard 12 lead
  • no true electrode placement
    • based on cevtors
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11
Q

What is a 2 Lead ECG?

A
  • Uses 3 Electrodes ( RA LA LL)
  • Obtain signal or the bipolar limb leads (I II III)
  • Basic monitoring and research purposes
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12
Q

What is a 5 lead ECG?

A
  • 5 Electrodes (RA RL LA LL and Chest)
  • Monitor diplsays the bipolar leads (I II III) and a single chest/precordial lead
  • Common in Acute care

White on right

Snow over Grass (RA over RL)

Smoke over fire (LA over LL)

Loves Chocolate V1

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13
Q

What is a 12 lead ECG?

A
  • 10 Electrodes
  • on all 4 limbs (RA LL LA RL)
  • Electrodes on precordium (V1-V^)
  • Monitors 12 leads
  • Allows for interpretation of specific areas of the heart
  • used for Diagnostic Purposes/Stress Testing
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14
Q

What are the interpretations for ECG paper?

A
  • Thin lines = 1 mm intervals or .04 seconds
  • Thick lines = 5mm or .2 seconds (5 boxes)
  • 1 THICK box (5 small boxes) = .20 sec or 5mm
  • 5 THICK BOXES = 25 small boxes = 1 second
  • 10mm = 1mV
  • Tick marks on rythm strip = 3 sec
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15
Q

What does the P wave represent? What is the normal amplitude and duration?

A
  • Atrial Depolarization
  • Duration: 0.12s or 3 small boxes
  • Amplitude: <2.5mm or 2.5 small boxes
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16
Q

What is the PR Interval? What is the normal duration?

A
  • The propagation of the cardiac action potental from the atria through the AV node into the ventricles
  • Normal Duration: .12-2seconds or 3-5 small boxes
  • Will shorten as exercise INCREASES
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17
Q

What is the QRS Complex and what are the normal duration/amplitude readings?

A
  • Represents Ventricular Depolarization
  • Normal
    • .06 - .1 seconds or 1.5-2.5 small boxes (some healthy have wider QRS but cut off is .12s)
  • Amplitude
    • ..5mV in at least 1 standard lead (5 small boxes)
    • >1.0 mV in at least 1 precordial lead 10 small boxes
    • Upper limit 2.5-3.0mV (25 small boxes)
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18
Q

What is the S-T segment and what is the normal range?

A
  • Represents the interval between ventricular depolarization and repolarization
  • Normal:
    • A Discrete ST segment distint from the T wave usually absent
    • Often at higher rates )exercise) the ST-T segment is a smooth, continuous line beginning at the J point (end of QRS), slowly rising to the pek of the T wave ›
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19
Q

What is the T wave and what is normal?

A
  • Represents Ventricular Repolarization
  • Normal
    • Should be same direction as QRS wave (R wave)
      • If R wave is positive T wave is positve
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20
Q

What is the R-R Interval? and what is normal?

A
  • Represents
    • Duration between subsequent heart beats
    • Duration used to calculate HR
  • Normal
    • Regular and consisten
      • esp at rest
    • Will shorten with exercise as HR increases
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21
Q

What is the Q- T Interval and what is normal?

A
  • Represents time taken for ventricular depolariation and repolarization
  • Shortens during faster HR and lengthen during slower HR

Normal

  • Men .4-.44s or 10-11 small boxes
  • Women .44-.46s or 11-11.5 small boxes
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22
Q

What is the QT interval corrected?

A
  • QTc = Measured QT interval / Squareroot of R-R interval

Normal <.44 sec

Used becase raw QT is varied and not ofte used

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23
Q

What is the J point and what is normal?

A
  • Represents the initiation of ventricular repolarization
  • Junction between the termination of the QRS complex and the beginning of the ST segment

Normal

  • Shold be in line with the ISOELECTRIC LINE
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24
Q

What is the R wave progression?

A

Small R waves begin in V1/V2 and progress in size in V4/V5

R in V6 smaller than V5

(R wave should get bigger from V1 to V4 and decrease after 5)

Also reduction of S wave

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25
What is normal HR at rest?
60-100 BPM
26
What is normal QRS duration?
cut off is .12 seconds (3 small boxes)
27
How can you tell if the rhythm comes from the SA, AV node or venricles?
* AV node or above = (SA, AV, Atria, nodal tracts = NARROW QRS) * Below AV (ventricles) = WIDE QRS * No pwave bu normal QRS = AV node
28
What is the second method to calculate rate?
* Count number of QRS complexes in a six second interval and multiply by 10 (30 boxes) 5 boxes in 1 second 6 seconds = 60 boxes 10 x QRS
29
Describe this ECG
* Bradycardia * Below 60 BPM * Could be good for someone who is conditioned
30
Describe this ECG
Sinus Tachycardia * Similar to bradycardia (faster than 100BPM) * above 150 at rest (not sinus in nature)
31
What are sinus arrhythmias?
PArasympathetic influence in HR High Parasympathetic tone
32
What is an ectopic pacemaker?
* Abnormal pacemaker sites located outside the SA node that display automaticity * Ectopic Focu can occur within atria or ventricles Typically blocked out via overdrive supression Damage to conduction system, can break out of loop
33
Describe this ECG
Supraventricular Tachycardia (SVT) * No P wave * normal QRS * Rate typically fast * \<150 BPM (above threshold) * Originates above ventricles * Fairly benign SOB, "heart is feeling out of control"
34
Describe this ECG
Atrial Flutter * Regular atrial activity with SAW TOOTH apperances * Ventricular rate 60-100 BPM * Conduction ratio 2:1 * Conduction above ventricles (fast raate) * rare saw tooths dictate how many have fired before one propagates through centricles
35
What is this ECG?
Atrial Fibrilation * Atrial Activity poorly defined * Filbrilation is WORM LIKE (not fully contracting) * Ventricular response is irregularly irregular * Adequate control HR \<110BPM) * Inadequate rate control (HR \> 110bpm) * No P WAVE * Variable R - R * QRS still narrow
36
What is the difference between AFib and Aflutter?
* Aflutter P wave = saw tooth * Fairly regular - abnormal P wave but consistent, R-R consisten * AFIB * Variable R to R * No consistency * Isometric line is variable
37
What are AV Node Blocks?
* Heart blocks * P - R \>.2 sec = AV block present
38
What is a first degree AV Block?
PR \> .2 sec Ok if happens after 6-5 beats
39
What is a second degree AV block and what is Type I?
* Type I: Mobitz/Wenckback): increasing PR interval until a QRS complex is dropped (usually benign) * Prolonged PR Interval
40
What is the 2nd type if AV node block?
* Type II: (Mobitz II) QRS dropped without any progressive increase in PR interval * Patient feels like they lost a beat * patient gets on meds or is prescribed pacemaker * Spotaneously lose complex
41
What is a 3rd degree AV Node block?
* Complete heart block * Atria and ventricles are electrically dissociated * P waves and QRS complexes will occur independent of each other * QRS determines HR VERY CONCERNING Pacemaker urgently
42
What is a Premature Atrial Contraction (PAC)?
* Random Ectopi * amplitude of R wave is smaller * Cause by irritants of myocardium or stress * benign * After QRS and downslope of P wave = Ventricular fibrilation
43
What is a Premature Ventricular Contraction (VPC)?
* Wide/funky QRS that is spontaneous * cocaine abuse, benign
44
What is a Bigeminy?
* Premature VC every other beat * Monomorphic * not ejecting sufficent amount of blood
45
What is a Trigeminy?
Premature VC on every 3rd beat
46
What is Quadrigeminy?
* PVC every 4th beat
47
What is a Couplet?
* 2 PVC in a row * Very concerning * Stop activity if during test * Can lead to more abnormal beats * Pumping without letting heart fill * Can pass out
48
What is ventricular Tachycardia?
* 3 or more PVCs in a row. * Venticles pumping quickly and not sufficent filling * Then goes to normal rhythm * Patient can go into ischemia * Stop and asses when you see this
49
What is sustained Ventricular Tachycardia?
Doesnt revert back to normal rhythm - anything longer than 30 seconds = sustained V Tach Could be no pulse if no blood is coming out
50
What is Ventricular Fibrilation?
* Big problem in the ventricles * not effectively pumping * not moving any blood * no pulse, passed out * Code blue * Patient in Syncope * use Defibrilators
51
What is Torsades de pointes?
* Very Concerning V fib and V Tach * Code Blue
52
What is Aystole?
* Flate line * No electral activity (electrically dead) * DO NOT SHOCK * dead muscle = more damage * Do CPR/Medication
53
How can you tell for Ventricular pacemaker?
* Abornal Rhythm type II * Significant A-Fib * Spikes followerd by ventricular beat * extra tics are from pacemaker Be sure to ask patient if they have one, what is their range of exercise, and use RPE
54
What is a transmural Infaction?
Infarction that goes all the way fhrough subendocardium
55
What is seen on an ECG with ischemia?
* T wave inversions * ST segment changes * Progress to ST elevation - MP completely disrpted (cell death)
56
What is ST depression?
ST segment below the isoelectric lines - V4 V5 V6 ST depression at J point \> 1mm = Ischemia
57
What is a T wave Inversion?
* Due to ischemia * T should be same direction as QRS, if different = ISCHEMIA
58
What is ST - Elevation?
* Most common cause of ST Elevation = MYOCARDIAL ISCHEMIA and Infarction * ST Elevation \> 1 box = concern for ischemic change
59
What is happening in a Deep Q wave?
Possible infarction or has in history
60
What is the location and artery for V1,V2?
Septal - LAD
61
What is the location and artery for V3 V4?
Anterior - LAD
62
What is the artery and location for leads II III avF?
INterior - PDA, RCA LCx
63
What is the artery and location for I V5 V6 avL?
* Lateral - LCx
64
What is a Left Bundle Branch Block?
* Change in conduction sytem in brachnes * shows Ischemia * TWIN PEAK at QRS that are wider * Stop exercise and asses
65
What is a R bundle Branch block?
Twin peaks in ECG
66
What are some non ischemic changes for ST depression?
* RVH (right precordial elads) or LVH (left precordial leads I aVL) * Digoxin effect on ECG * Hypokalemia * Mitral valve prolaspe (some cases) * CNS disease * Secondary ST Segment changes with conduction abnormalities (RBBB LBBB WPW ETC)
67
Non ischemic causes for ST ELEVATION
* LVH (left precordial leads) * Conduction abnormalities * Early repolarization patterns * Aneurysms/old myocardial infarction * Pericarditis/myocarditis * Brugada pattern * Takotsubo * Hyperkalemia * Hyercalcemia
68
What are the 4 ST depression types?
69
What is pericarditis and ST elevation?
Concave upwards ST elevation in most leads except aVR no Reciprocal ST segment depression T waves usually low amplitude and HR increase May see PR segment depression - arterial injury from compression
70

Cardiopulmonary Practice (4 decks)

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