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Principles I > 12 lead EKG > Flashcards

12 lead EKG Flashcards

1
Q

what is the axis?

A
  • the primary direction of electricity flow during depolarization
  • mean QRS vector
  • most of the flow of energy goes toward the left ventricle
  • indicative of long term heart conditions
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2
Q

what leads can determine normal axis or axis deviation?

A

leads I and aVF

  • with a normal axis, both leads have positive deflections (0-+90 degrees)
  • circle divide into four: right side(looking towards LV) + LI, left side (-) LI; bottom + aVF, top - aVF (both cross at bottom right (left side of heart), where both positive)
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3
Q

clockwise movement of QRS vector indicates what?

A
  • right axis deviation (+90-+180 degrees)

* will still see a + aVF but a - lead I

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4
Q

counterclockwise movement of the QRS vector indicates what?

A

left axis deviation (0- -90 degrees)

*will still see a + lead I but a -aVF

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5
Q

what does both a (-)aVF and (-) lead I indicate?

A

extreme right axis deviation (-90 –180 degrees)

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6
Q

what are causes of axis deviation?

A
  • infarct (electricity doesn’t flow well through infarcted tissue, so deviates away)
  • hypertrophy (fatter the muscle the more electricity needed to depolarize so deviates towards)
  • anatomical shifts
  • obesity and pregnancy shift left
  • extremely thin shift right
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7
Q

what indicates a bundle branch block?

A
  • wide QRS complex >.12 sec

- either two R waves OR deep Q wave present

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8
Q

what lead is good to find BBB?

A

V1

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9
Q

what is seen with a right BBB?

A

two upright R waves (rsR wave)

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10
Q

what is seen with a left BBB?

A

deep downward Q wave (Qs wave)

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11
Q

what should be considered with a new Left BBB?

A

-treat as a MI until proven otherwise, especially with CV symptoms

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12
Q

what needs to be considered with a BBB when placing a pulmonary artery catheter?

A
  • if there is a LBBB already in place, the PAC may stimulate a RBBB
  • *LBBB and RBBB combined= complete heart block (3rd)
  • *must remove catheter, transcutaneous pace, and Epi
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13
Q

what leads look at septal wall of LV?

A

V1 and V2

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14
Q

what leads look at anterior wall of LV?

A

V3 and V4

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15
Q

what leads look at lateral wall of LV?

A

I, aVL, V5,V6

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16
Q

what leads look at inferior wall of LV?

A

II,III, aVF

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17
Q

what coronary artery supplies the septal wall?

A

LCA and RCA (V1 and V2)

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18
Q

what coronary artery supplies the anterior wall?

A

LCA-left anterior descending (LAD) (V3 and V4)

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19
Q

what coronary artery supplies the lateral wall?

A

LCA-circumflex (I, aVL, V5 and V6)

20
Q

what coronary artery supplies the inferior wall?

A

RCA (II, III, aVF)

21
Q

what must be identified to determine that ischemia/injury/infarction is present?

A

similar changes in 2 or more leads that represent the same area of the heart

22
Q

what EKG changes indicate ischemia?

A
  • tall T waves or peak T waves
  • inverted symmetrical T waves
  • ST depression
  • O2 demand is greater than supply
  • stress of surgery increases CO, which increases O2 demand
23
Q

what EKG changes indicate injury?

A

ST elevation (above isoelectric line)

24
Q

what EKG changes indicate infarction?

A
  • Q wave formation (not always present in less severe infarction)
  • normal is < 1/3 ht. of R wave
  • if outside parameters, indicative of infarction
25
Q

what are the steps to determine a 12 lead?

A
  • determine baseline rhythm
  • determine any areas of cardiac compromise
  • determine the level of compromise
26
Q

what action is important with any type of ischemia?

A

increase O2 supply and decrease demand

27
Q

the right coronary feeds what parts of the heart?

A
  • SA node
  • inferior wall
  • RV
28
Q

what can be seen with a right coronary artery event?

A
  • prominent EJ
  • increased CVP
  • slowed HR
  • clear bilateral breath sounds (no pulmonary edema)
29
Q

how is a right sided EKG done?

A

V leads are placed anatomically in the same place but on the right sied, V1 and V2 are simply switched

30
Q

what is the purpose of a right sided EKG?

A
  • to evaluate the right ventricle, not normally seen on a 12 lead
  • if RCA is occluded and shown through an inferior event, may be occluded higher in the vessel causing right sided ischemia
  • any ST/T change in the inferior leads is an indication for Right side 12 lead
31
Q

what is different about treatment for a right ventricular infarction?

A
  • same goal: reperfusion
  • because of the reduction in the entire capacity of the heart to pump (LEFT AND RIGHT) significant potential for hypotension
  • NTG used cautiously
  • large bore IV and volume administered
  • may need pacing for SA node MI
32
Q

which lead is best for detecting atrial dysrhythmias?

A

lead II

33
Q

which lead is best for detecting ischemia?

A

lead V5 (detects 75% of events)

34
Q

lead II and V5 added detect how much of ischemia?

A

80%

35
Q

leads V5 and V4 added detect how much of ischemia?

A

90%

36
Q

leads II, V5, and V4 combined detect how much of ischemia?

A

96%

37
Q

what leads detect hypertrophy?

A

V leads

38
Q

what is observed for atrial hypertrophy?

A

p waves

39
Q

what is observed for ventricular hypertrophy?

A

R and S waves

40
Q

what are signs of left atrial hypertrophy?

A
  • notched P wave in V1
  • an up and down shaped (biphasic) or widened (> 2.5 mm wide) P wave
  • best seen in lead I or V1 (can look in Lead II if V1 not good)
  • takes longer to reach and depolarize left atrium
41
Q

what indicates right atrial enlargement?

A

tall peaked P wave (> 2.5 mm high)

42
Q

what is seen with bi atrial enlargement?

A

tall and wide P waves

43
Q

how is left ventricular hypertrophy determined?

A
  • measure the depth of the S wave in V1
  • measure the height of the R wave in V5 or V6
  • if the two measurements added are greater than 35mm, LVH is present
  • look at tallest S wave between V1 and V2 and tallest R wave b/w V5 and V6
44
Q

what may cause LVH?

A
  • long standing extensive HTN
  • aortic valve stenosis
  • idiopathic hypertrophic subaortic stenosis (IHSS)
45
Q

what should be avoided with LVH?

A
  • spinals

- vasopressors that increase HR (if caused by aortic stenosis)

Principles I (18 decks)

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