11. Basic ECG Flashcards
1
Q
Cardiac conduction pathway
A
SA node
internodal fascicles
bachmann’s bundle
AV node
Bundle of His
Right Bundle branch
Left bundle branch
purkinje fibers
2
Q
where does the electrical current slow down in the heart
A
AV node
allows for atria to fully contract before the ventricles contract
maximizes ventricular filling
3
Q
pacemaker cells
A
initiate heart beat
set heart rate
SA node
AV node
4
Q
primary pacemaker of heart
A
SA node
5
Q
SA node beats per min
A
60-100 bpm
sinus beats
6
Q
AV node beats per min
A
40-60 bpm
junctional beats
7
Q
ventricular muscle beats per min
A
30-40 bpm
8
Q
p wave
A
atrial contraction
9
Q
QRS
A
ventricular contraction
10
Q
premature atrial contractions
A
heartbeats initiated by atrial myocardium
11
Q
retrograde current is seen in
A
junctional beats initiated by AV node
12
Q
retrograde current on ecg
A
inverted p wave
13
Q
upright p wave
A
heartbeat originated from SA node or atria
ategrade conduction
14
Q
inverted p wave
A
heartbeat originated from AV node
retrograde conduction
15
Q
wide QRS
A
slow ventricular depolarization
heartbeat initiated by ventricular myocardium
16
Q
1 large box
A
0.2 sec
17
Q
1 small box
A
0.04 sec
18
Q
1 second
A
5 large boxes
19
Q
1 min
A
300 large boxes
20
Q
RR interval
A
heart rate
300/#lg boxes
21
Q
intervals include
A
a wave
22
Q
normal p wave
A
3 small boxes
<0.12s
23
Q
normal QRS
A
<0.12s
1.5-3 sm boxes
24
Q
T wave
A
ventricular repolarization
25
normal T wave
<5mm height
26
U wave indicates
hypokalemia
27
J point
point where S wave returns to baseline
28
Delta wave
upward slurring Q wave
wollff parkinson white syndome
29
J wave
hypothermia
bump on S wave
30
PR interval
beginning of P to start of Q
31
normal PR interval
0.12-0.2s
3-5 sm boxes
32
long PR interval
indicates delayed conduction in AV node
33
QT interval
begining of Q wave to end of T wave
34
what prolongs QT interval
zofran
phenergan
subarachnoid hemorrhage
35
PR segment
end of P wave to beginning of Q wave
36
ST segment
J point to start of T wave
37
premature beat
heartbeats happens before expected
"fast"
PAC
PVC
PJC
38
escape beat
heartbeat that comes oafter long pause
"slow"
ventricular
junctional
39
systole
heart contraction
heart is not perfusing
organs are perfused
40
diastole
heart relaxation
heart is perfused
organs are not perfused
41
slower heart rate
increases coronary perfusion
42
faster heart rate
worse coronary perfusion
43
ventricular filling
amount of blood that fills the ventricles prior to ventricular contraction
preload
44
decrease ventricular filling
decreased SV
decreases CO
45
active ventricular filling
during atrial contraction
incr preload
normal SV
normal CO
46
passive ventricular filling
when atria dont contract
decr preload
decr SV
decr CO
47
heart conditions that reduce ventricular filling
1. heartbeat w/o atrial contraction (no p wave)
2. premature heartbeat
3. rapid heart rate
48
do premature heartbeats produce a pulse
no
49
ECG leads detect
electrical difference (voltage) between 2 limbs
50
3 lead ECG limitation
not as sensitive for detecting myocardial ischemia occuring in left ventricle
51
lead 1
white to black
(-): RA
(+): LA
52
lead 2
white to red
(-): RA
(+): LL
53
lead 3
black to red
(-): LA
(+): LL
54
what additional leads are in 5 lead ECG?
green
brown (V5)
55
green lead
neutral grounding lead
56
brown lead
V5
precordial lead
helps detect left ventricular ischemia
57
lead locations
white - right
green - below green
black - left
brown - below black
red - below brown
58
how to get best ECG connection
cleanse site of application w/alcohol
exfoliate skin layer
avoid placing over hair
59
irregular sinus
HR fluctuating w/inspiration and expiration
inspiration: faster
expiration: slower
60
why is inspriation HR faster
decrease intrathoracic pressure
increases preload
increases HR
61
why is expiration HR slower
increase intrathoracic pressure
decreases preload
decreases HR
62
sinus tachy
P wave
HR>100 bpm
63
sinus tachy etilogies
hypovolemia
hypotension
pain/light anesthesia
64
sinus tachycardia causes
incr cardiac O2 demand
decr cardiac O2 supply
hypovolemia
65
sinus tachy treatment
give fluids
deepen anesthetic
beta blocker
66
sinus brady
p wave
HR <60bpm
67
sinus brady is good for what pts
healthy pts who exercise
pts w/CAD
68
lower HR
incr O2 supply
decr O2 demand
69
bradycardia is bad in what pt population
kids
70
what heart rate is always a cause for concern
<=30bpm
71
bradycardia treatment
robinul
atropine
epinephrine
cardiac pacing (unresponsive to meds)
72
temporary transcutaneous pacing
SA node pacing pads via defibrillator
73
pacemaker
implantable device to act as artificial SA node
74
ectopy
any heartbeat that orginates outside the SA node
- AV node
- atrial myocardiaum
- ventricular myocardium
75
PAC
premature beat
upright p wave
normal/narrow QRS
76
when are PACs concerning
when they start occuring frequently
77
PJC
premature beat
missing/inverted p wave
normal QRS
retrograde
78
when are PJCs concerning
when they start occuring frequently
79
PVC
premature beat
no p wave
wide/bizarre/different QRS
80
what can trigger PVC
ischemia
pH imbalance
electrolyte abnormalities
caffeine
stress
abnormal electrical pathways
81
do PVCs produce a pulse
no
82
what is the pulse rate for bigeminal PVCs
half of what the ECG says the pulse rate is
83
bigeminal PVC
every other beat
84
unifocal PVC
same shape = same origin
85
multifocal PVC
different shape = different origin
86
what is more concerning: unifocal or multifocal PVC?
multifocal
87
couplet PVC
2 in a row
88
salvo PVC
3 in a row
89
PVC treatment
antiarrythmics
- lidocaine (100mg)
- amiodarone
robinul (speed HR up)
90
junctional escape beat
escape beat
inverted/missing p wave
normal QRS
91
junctional escape beat physiology
SA node failed
AV node starts heartbeat
SA node starts working again
92
when should we be concerned w/junctional escape beats
if they occur frequently
treat w/robinul/atropine/pacing
93
junctional escape beat treatment
robinul/atropine
pacing
94
ventricular escape beat
long pause
wide QRS
no p wave
95
ventricular escape beat physiology
SA and AV node fail
ventricular myocardium initiates beat
SA node works again
96
atrial flutter
sawtooth p waves (250-350/min)
wide p waves
97
atrial flutter physiology
decr ventricular filling
decr CO
incr O2 demand
98
when are we concerned about atrial flutter
would not do an elective case until pt has been evaluated by a cardiologist
99
type 1 atrial flutter
<350bpm
100
type 2 atrial flutter
>350bpm
101
atrial flutter treatment
amiodarone, sotalol, digoxin
synchronized cardioversion (for hypotensive pts)
102
shocking heart
treats unstable fast rhythms
103
pacing heart
treats unstable slow rhythms
104
Afib
no p waves
narrow QRS
may or may not have fibrillation waves
irregularly irregular rhythm
105
Afib physilogy
atria quivering w/500 atrial impulses/min
106
Afib risks
clot formation in LA (blood pooling)
CO decr
hypotension
107
Afib CO decreases by
25-50%
108
what type of afib is more concerning: chronic or acute?
acute afib is more concerning
suffer significant drop in CO
109
controlled afib
ventricular rate <100bpm
110
uncontrolled afib
ventricular rate >100bpm\
rapid ventricular response
111
afib treatment
medications
synchronized cardioversion
112
how long should a pt be anticoagulated prior to cardioversion
3 weeks prior
4 week post
113
junctional rhythm
inverted/absent P
normal QRS
114
normal junction
40-60bpm
115
accelerated junctional
60-100 bpm
116
junctional tachycardia
>100bpm
117
junctional rhythm concerns
slower HR
reduced ventricular filling
118
junctional rhythm treatment
robinul to incr HR
119
SVT
HR >150bpm
normal QRS
may or may not have P waves
120
SVT concerns
decr ventricular filling
decr CO
121
SVT treatment
vagal maneuvers
adenosine (slows SA/AV)
synchronized csrdioversion
antiarrythmics
122
ventricular escape rhythm (idoventricular)
no p wave
wide WRS
slow HR <60bpm
123
ventricular escape physiology
SA and AV node failed
ventricular myocardium is beating
124
ventricular escape concerns
no active ventricular filling
HR is low
low CO
125
ventricular escape treatment
cardiac pacing
epinephrine
avoid lidocaine (suppresses ventricular beat)
126
accelerates idivoentricular rhythm
60-100bm
127
Vtach
>100bpm
no p waves
wide QRS (same shape)
128
polymorphic Vtach
torsades de pointes
twisting
129
Vtach physiology
ventricular myocardium initiates heart beat at rapid rate
high O2 consumption
minimal ventricular filling
130
does vtach have a pulse?
potentially
131
Vtach treatment
electrical cardioversion
132
monomorphic vtach treatment
amiodarone
lidocaine
133
polymorphic vtach
magnesium
134
amiodarone does what to QT interval
prolongs it
135
Vfib
no real p waves or QRS complexes
shorter deflections
136
Vfib physiology
quivering ventricles
rapid rate
high O2 consumption
no pulse
no CO
137
Vfib treatment
defibrillation
CPR
138
agonal rhythm
slow complex rhythm immediately preceding asystole
139
do agonal rhythms produce cardiac output
nope
140
asystole
cardiac arrest
CPR
epinephrine
do not defibrilate
141
pulseless electrical activity (PEA)
pt has no pulse
ECG shows electrical activity
142
PEA is most likely seen with what rhythms
sinus
bradycardish
ventricularish
AV blockish
slowish type
143
cause of PEA
heart does not contract
insufficient cardiac output to generate pulse and supply blood to organs
144
PEA treatment
CPR
epinephrine
NO defibrillation
145
1st Deg AV block
long PR interval
>200msec (1 lg box)
146
2d Deg AV block
dropped QRS complex
147
2d Deg AV Type 1
dropped QRS
increasingly long PR intervals
148
2d Deg AV Type 2
dropped QRS
unchanging PR intervals
149
where is the block in 2d deg type 2
below the AV node
in bundle of his or bundle branches
150
3d deg AV block
wandering P waves
slow ventricular rate
151
3d deg AV block physiology
AV node completely blocekd
ventricles must initiate heart beat
atria and ventricals are not synchronized
decreased CO
152
treatment for complete heart block
cardiac pacing
epinephrine
AVOID lidocaine
153
pacemaker atrial lead
sense when atria is contracting
154
pacemaker ventricular lead
paces 120-200msec after each atrial beat
155
Ischemia/Infarction ECG indications
ST segment changes
abnormal T waves
abnormal Q waves
156
ST depression indicates
ischemia
157
ST elevation indicates
infarction
158
myocardial ischemia treatment: increase O2 supply
1. 100% FiO2
2. decrease HR
--give beta blockers
3. mx normal BP
---avoid hypotension
4. give NTG
5. give aspirin
159
myocardial ischemia treatment: decrease O2 demand
1. decr HR
--give beta blockers
2. avoid pain/anxiety/tachycardia
--give narcs/sedatives
3. avoid high afterload
--avoid HTN
