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Internal Medicine > 1) ECGs > Flashcards

1) ECGs Flashcards

1
Q

P wave

A
  • Atrial depolarization
  • Impulse slows as it passes through AV node from atria to ventricles
  • Allows atria time to finish filling ventricles
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2
Q

P-R segment

A
  • P-R interval includes the p wave
  • Impulse then rapidly travels through His-Purkinje system
  • Seen as a flat line following P wave
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3
Q

QRS complex

A
  • Ventricular depolarization

- Depolarization of septum and ventricular walls generates QRS complex and contraction of ventricles

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4
Q

T wave

A
  • Repolarization of ventricles

- Represented on ECG by ST segment and T wave

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5
Q

Typical approach to reading a 12 lead ECG

A
  • Rate
  • Rhythm (P, QRS, and PR intervals)
  • Axis
  • Hypertrophy/Enlargement
  • Ischemia
  • Others: QT interval, T waves, bundle branch blocks etc.
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6
Q

300, 150, 100, 75, 60, 50 method

A
  • If the second R wave does not fall on a bold line the heart rate is approximated
  • Example: if it falls between the 4th and 5th bold line the heart rate is between 60 and 75 BPM
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7
Q

12 lead rhythm check

A
  • “Rhythm strips” are usually Lead II or V5
  • They are often run at the bottom of a 12 lead EKG
  • Telemetry also provides rhythm strips
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8
Q

Normal sinus rhythm

A
  • 60 to 100 BPM
  • P for every QRS, QRS for every P
  • Normal PR < 1 big box
  • Normal P waves: symmetric, <2.5 small boxes
  • Narrow QRS complexes
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9
Q

Narrow QRS complex in normal sinus rhythm

A
  • Less than 0.12 seconds (120ms)=

- Less than 3 small boxes

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10
Q

Sinus bradycardia ECG

A
  • Like NSR, < 60 BPM
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11
Q

Sinus tachycardia ECG

A
  • Like NSR, > 100 BPM, arises from SA node
  • P for every QRS, QRS for every P
  • Normal PR < 1 big box
  • Normal P waves- symmetric, <2.5 small boxes
  • Narrow QRS complexes
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12
Q

Atrial flutter

A
  • Atrial rate 250 to 350
  • Many P waves in a sawtooth appearance
  • QRS complexes (ventricular conduction) could be fast or slow- usually narrow
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13
Q

Atrial fibrillation

A
  • Atrial rate > 350 so P waves may be indiscernible

- Ventricular rate could be fast or slow, usually narrow QRS complexes, almost always irregularly irregular

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14
Q

A fib can cause irregularly irregular ventricular rates

A
  • Ventricular rates can be rapid or “controlled”
  • AF with RVR, AF with controlled VR
  • Can be paroxysmal - PAF
  • Can cause clots to form in atria
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15
Q

If AF with RVR or PAF with RVR, patient may experience

A
  • Palpitations
  • SOB
  • Dizziness
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16
Q

AF is diagnosed with

A
  • EKG

- Holter monitor

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17
Q

AF is treated with

A
  • Anticoagulation to prevent CVA (direct oral anticoagulant like dabigatran or Warfarin with INR 2-3)
  • PLUS rate control (controls Vent rate)
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18
Q

AF my also be treated with restoration of normal sinus rhythm

A
  • Radiofrequency or Cryo-ablation of reentry tract by electrophysiologist with cardiac cath
  • Rhythm control with antiarrhythmic medications
  • Cardioversion
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19
Q

Supraventricular tachyarrythmias

A
  • General term not used if you know the more specific cause of the tachycardia
  • All tachyarrhythmias that originate above the bundle of His technically could be called SVT
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20
Q

SVT characteristics

A
  • Atrial rate must be >150 (V rate may be less if AV block)
  • Narrow QRS (unless BBB or accessory pathway, “aberrant conduction”)
  • May be acute or chronic
  • Slowing down the rate may allow visualization of P waves
  • No discernible P waves
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21
Q

Supraventricular tachyarrhythmias include many narrow complex arrhythmias like

A
  • Paroxysmal supraventricular tachycardia (PSVT)
  • AV reentrant tachycardia (AVRNT)
  • Atrial tachycardia (with buried P waves. If P waves are visible must specify atrial tachycardia rate >150)
  • Atrial fibrillation and flutter that are tachycardic (with rapid ventricular response)
  • Multifocal atrial tachycardia (MAT)
22
Q

Ventricular dysrhythmias key features

A
  • Wide (> 0.12 seconds in duration), 3 small boxes bizarre QRS complexes
  • T waves in the opposite direction of the R wave
  • Absence of P waves
23
Q

Ventricular rhythms

A
  • PVC - “Premature beats”
  • Ventricular escape (idioventricular) 20-40
  • Accelerated Ventricular rhythm 40-100
  • Ventricular Tachycardia 100-250 (Torsades de Pointes is a special VT)
  • Ventricular Fibrillation 300-500, chaotic
24
Q

Torsades de Pointes VT

A
  • Polymorphic VT that twists on itself like a ribbon

- Can result from long QT syndrome

25
Q

Long QT interval

A
  • Predisposes patients to Torsades de Pointes
  • The prolonged interval between ventricular depolarization and repolarization
  • Congenital is rare
  • Acquired, including drug-induced, electrolyte imbalances is common cause
26
Q

Long QT interval symptoms

A
  • Palpitations
  • Presyncope
  • Syncope
  • Sudden death
27
Q

Common causes of increased QT interval

A
  • Hypocalcemia
  • Hypokalemia
  • Hypomagnesemia
  • Quinidine
  • Sotalol
  • Amiodarone
  • Antineoplastics
  • Antipsychotics
28
Q

QT calculation

A
  • By machine

- QT/square root of cycle

29
Q

Ventricular fibrillation is so chaotic there is

A
  • No cardiac output
30
Q

MI progression

A
  • Ischemia
  • Injury
  • Infarction
31
Q

Changes in MI progression

A
  • T wave changes
  • Acute MI, STEMI (ST elevation MI)
  • Acute Q-wave MI
  • Old MI
32
Q

Myocardial ischemia characteristic signs

A
  • T wave changes
  • Inverted T wave
  • Tall, peaked T wave
  • Depressed ST segment
33
Q

Testing for ST changes

A
  • Stress test (rest vs. walk)

- Look for ST depressions

34
Q

ECG tombstoning

A
  • J point for ST elevation
35
Q

Pathologic Q waves

A
  • Indicate presence of irreversible myocardial damage or myocardial infarction
36
Q

MI locations in heart/EKG

A
  • Anterior- V1-4 or 6
  • Lateral I, AVL, and/or V5, V6
  • Inferior II, III, AVF
  • Posterior is different- large R and ST depression in V1 and V23 “reverse anterior”
37
Q

EKG lead-heart locations

A
  • Lateral = I, aVL, V
  • Inferior = II, III, aVF
  • Left main = aVR
  • Septal = V1, V2
  • Anterior = V3, V4
38
Q

Inferior MI lead

A
  • Facing = II, III, aVF

- Reciprocal = I, aVL

39
Q

High lateral MI lead

A
  • Facing = I, aVL

- Reciprocal = II, III, aVF

40
Q

Anterior MI lead

A
  • Facing = V1, V2, V3, V4

- Reciprocal = NONE

41
Q

Posterior MI lead

A
  • Facing = NONE

- Reciprocal = V1, V2, V3, V4

42
Q

Most change seen in EKG with MI

A
  • ST elevations are more concerning than ST depressions
43
Q

Anterior myocardial infarction

A
  • Involves anterior surface of LV

- Best identified in leads V1, V2, V3, and V4

44
Q

Lateral myocardial infarction

A
  • Involves left lateral heart wall

- ST segment elevation, T wave inversion, and the development of pathologic Q waves in leads I, aVL, V5,V6

45
Q

Inferior myocardial infarction

A
  • Involves inferior surface of the heart

- ST segment elevation, T wave inversion, and development of pathologic Q waves in leads II, III, aVF

46
Q

Posterior myocardial infarction

A
  • Involve posterior surface of the heart

- Look for reciprocal changes in leads V1 and V2

47
Q

Posterior STEMI

A
  • Large R in V1 or V2 (like RVH)
  • ST depression in V1
  • Basically, ST depression in V1 or V2 primarily should give you suspicion for acute posterior MI
  • Although usually ST depression indicates ischemia, in these leads it may indicate posterior infarction
48
Q

Pericarditis symptoms

A
  • Chest pain is sudden onset, sharp, retrosternal
  • Pain relieved by leaning forward
  • Fever, myalgia
  • Pericardial friction rub indicates pericarditis
  • EKG changes are diffuse, across most leads
49
Q

ECG changes in pericarditis

A
  • T wave initially upright and elevated but then during recovery phase it inverts
  • ST segment elevated and usually flat or concave
50
Q

ECG findings that warrant cancellation of elective surgery

A
  • Acute axis deviation
  • New bundle branch block
  • Acute ST-segment elevation (STEMI or Pericarditis)
  • Acute ST-segment depression (myocardial ischemia or subendocardial injury
  • Type II second degree atrioventricular block or third degree atrioventricular block
  • Tall peaked T waves (hyperkalemia)
  • Prolonged of the corrected QT (QTc) interval (hypokalemia, hypomagnesemia, hypocalcemia)
  • Narrow complex supraventricular tachyarrhythmias
  • Wide complex supraventricular tachyarrhythmias

Internal Medicine (14 decks)

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