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Cardiopulmonary Practice > 1 ECG > Flashcards

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
Q

What is normal HR at rest?

A

60-100 BPM

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26
Q

What is normal QRS duration?

A

cut off is .12 seconds (3 small boxes)

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27
Q

How can you tell if the rhythm comes from the SA, AV node or venricles?

A
  • AV node or above = (SA, AV, Atria, nodal tracts = NARROW QRS)
  • Below AV (ventricles) = WIDE QRS
  • No pwave bu normal QRS = AV node
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28
Q

What is the second method to calculate rate?

A
  • 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

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29
Q

Describe this ECG

A
  • Bradycardia
  • Below 60 BPM
  • Could be good for someone who is conditioned
30
Q

Describe this ECG

A

Sinus Tachycardia

  • Similar to bradycardia (faster than 100BPM)
  • above 150 at rest (not sinus in nature)
31
Q

What are sinus arrhythmias?

A

PArasympathetic influence in HR

High Parasympathetic tone

32
Q

What is an ectopic pacemaker?

A
  • 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
Q

Describe this ECG

A

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
Q

Describe this ECG

A

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
Q

What is this ECG?

A

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
Q

What is the difference between AFib and Aflutter?

A
  • 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
Q

What are AV Node Blocks?

A
  • Heart blocks
  • P - R >.2 sec = AV block present
38
Q

What is a first degree AV Block?

A

PR > .2 sec

Ok if happens after 6-5 beats

39
Q

What is a second degree AV block and what is Type I?

A
  • Type I: Mobitz/Wenckback): increasing PR interval until a QRS complex is dropped (usually benign)
  • Prolonged PR Interval
40
Q

What is the 2nd type if AV node block?

A
  • 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
Q

What is a 3rd degree AV Node block?

A
  • 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
Q

What is a Premature Atrial Contraction (PAC)?

A
  • 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
Q

What is a Premature Ventricular Contraction (VPC)?

A
  • Wide/funky QRS that is spontaneous
    • cocaine abuse, benign
44
Q

What is a Bigeminy?

A
  • Premature VC every other beat
  • Monomorphic
  • not ejecting sufficent amount of blood
45
Q

What is a Trigeminy?

A

Premature VC on every 3rd beat

46
Q

What is Quadrigeminy?

A
  • PVC every 4th beat
47
Q

What is a Couplet?

A
  • 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
Q

What is ventricular Tachycardia?

A
  • 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
Q

What is sustained Ventricular Tachycardia?

A

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
Q

What is Ventricular Fibrilation?

A
  • Big problem in the ventricles
  • not effectively pumping
  • not moving any blood
  • no pulse, passed out
    • Code blue
    • Patient in Syncope
    • use Defibrilators
51
Q

What is Torsades de pointes?

A
  • Very Concerning V fib and V Tach
  • Code Blue
52
Q

What is Aystole?

A
  • Flate line
  • No electral activity (electrically dead)
  • DO NOT SHOCK
    • dead muscle = more damage
  • Do CPR/Medication
53
Q

How can you tell for Ventricular pacemaker?

A
  • 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
Q

What is a transmural Infaction?

A

Infarction that goes all the way fhrough subendocardium

55
Q

What is seen on an ECG with ischemia?

A
  • T wave inversions
  • ST segment changes
  • Progress to ST elevation - MP completely disrpted (cell death)
56
Q

What is ST depression?

A

ST segment below the isoelectric lines

  • V4 V5 V6

ST depression at J point > 1mm = Ischemia

57
Q

What is a T wave Inversion?

A
  • Due to ischemia
  • T should be same direction as QRS, if different = ISCHEMIA
58
Q

What is ST - Elevation?

A
  • Most common cause of ST Elevation = MYOCARDIAL ISCHEMIA and Infarction
  • ST Elevation > 1 box = concern for ischemic change
59
Q

What is happening in a Deep Q wave?

A

Possible infarction or has in history

60
Q

What is the location and artery for V1,V2?

A

Septal - LAD

61
Q

What is the location and artery for V3 V4?

A

Anterior - LAD

62
Q

What is the artery and location for leads II III avF?

A

INterior - PDA, RCA LCx

63
Q

What is the artery and location for I V5 V6 avL?

A
  • Lateral - LCx
64
Q

What is a Left Bundle Branch Block?

A
  • Change in conduction sytem in brachnes
  • shows Ischemia
  • TWIN PEAK at QRS that are wider
  • Stop exercise and asses
65
Q

What is a R bundle Branch block?

A

Twin peaks in ECG

66
Q

What are some non ischemic changes for ST depression?

A
  • 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
Q

Non ischemic causes for ST ELEVATION

A
  • LVH (left precordial leads)
  • Conduction abnormalities
  • Early repolarization patterns
  • Aneurysms/old myocardial infarction
  • Pericarditis/myocarditis
  • Brugada pattern
  • Takotsubo
  • Hyperkalemia
  • Hyercalcemia
68
Q

What are the 4 ST depression types?

A
69
Q

What is pericarditis and ST elevation?

A

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
Q
A

Cardiopulmonary Practice (4 decks)

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