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DNURS 827 Advanced Physiology/Pathophysiology for Anesthesia I > 12 Lead EKG - Quiz 8 - THIS DECK WILL NOT HELP AT ALL - YOU WILL FAIL > Flashcards

12 Lead EKG - Quiz 8 - THIS DECK WILL NOT HELP AT ALL - YOU WILL FAIL Flashcards

1
Q

What does the EKG Record?

A

Electrical Activity of the Heart Beat

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2
Q

What is the Dominant Pacemaker of the Heart?

A

Sino-Atrial Node

@ SVC & RA Junction

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3
Q

What is Automaticity?

A

Ability of Cardiac Cells to spontaneously generate Action Potentials

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4
Q

List 1 - 9

A
  1. P
  2. Q
  3. R
  4. S
  5. T
  6. PR Interval
  7. QRS Interval
  8. ST Segment
  9. ST Interval
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5
Q

Slowing of depolarization at the AV node allows for what to happen?

A

Allows for the Atria to contract right before the Ventricles

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6
Q

What is the QT Interval a physiological marker for?

A

QT Interval represents Ventricular Depolarization & Repolarization

Risk markers for Arrythmias & Sudden Death

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7
Q

What are the Limb Leads on a 12-Lead EKG?

A

Leads I, II, III, aVF, aVR, aVL

Up-Down, Right-Left

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8
Q

What are the chest leads/precordial leads?

A

V1 - V6

Back-Front, Right-Left

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9
Q

What is Einthoven’s Triangle?

A

Triangle formed by the Limb Leads

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10
Q

What info can we get by looking at the multiple leads?

A

Region of the heart effected

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11
Q

What are two different ways to measure heart rate on a EKG?

A
  1. Since EKG is 10 seconds, Count QRS complex and multiply by 6
  2. Measure RR interval using the big boxes: 300-150-100-75-60-50

(So if its only 1 big box, then HR 300, 2 big box HR 150, and so on)

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12
Q
A

Sinus Arrhythmia

  • Irregular Rhythm that varies w/ respiration
  • All P-waves identical
  • Considered Normal
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13
Q
A

Wandering Pacemaker

  • Irregular Rhythm
  • P-Waves Change Shape
  • Rate < 100 bpm
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14
Q
A

Multifocal Atrial Tachycardia

  • Irregular Rhythm
  • P-Waves change shape
  • Rate > 100 bpm
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15
Q
A

A-Fib

  • Irregular Rhythms
  • No P-Waves
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16
Q
A

Atrial Escape Beat

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17
Q
A

Junctional Escape Beat

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18
Q
A

Ventricular Escape Beat

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19
Q
A

Atrial Escape Rhythm

  • 60-80 bpm
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20
Q
A

Junctional Escape Rhythm
or
Idiojunctional Rhythm

  • 40-60 bpm
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21
Q
A

Ventricular Escape Rhythm
or
Idioventricular Rhythm

  • 20-40 bpm
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22
Q
A

NSR w/ PACs

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23
Q
A

Premature Junctional Beat

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24
Q
A

Premature Ventricular Contraction

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25
Q
A

SVT
or
Paroxysmal Atrial Tachycardia

  • 150-250 bpm
26
Q
A

Ventricular Tachycardia

  • 150-250 bpm
27
Q
A

Torsades de Pointes

28
Q
A

Ventricular Flutter

  • 250-350 bpm
29
Q
A

Ventricular Fibrillation

30
Q
A

Sinus (SA) Block

31
Q
A

First Degree AV Block

  • PR Interval > 0.2 seconds
32
Q
A

Second Degree AV Block - Type I
or
Wenckebach

  • PR longer, longer, then drops = Wenckebach
33
Q
A

Second Degree AV Block - Type II

  • PR Constant
  • Intermittent Drop QRS
34
Q
A

3rd Degree (Complete) Heart Block
or
AV Dissociation

35
Q
A

Left Bundle Branch Block

  • Dominant S-wave in V1
  • Broad “M”-shaped R-wave in V6
36
Q
A

Right Bundle Branch Block

  • Broad QRS > 0.12 sec
  • RSR pattern in V1-3
  • Wide, Slurred S-wave in lateral leads (I, aVL, V5-6)
37
Q

What wave might you see on an EKG with Hypokalemia?

A

U-wave

38
Q

What EKG changes would you expect with Hyperkalemia?

A

Tall, Peaked T-waves

39
Q

When would you see a Delta wave on an EKG?

A

Wolf Parkinsons White Syndrome

Slurring Upstroke on QRS

40
Q

What are the different phases of Coronary Artery Disease?

A
  • Asymptomatic - insignificant plaque
  • Stable Angina - known disease, collateral circulation, predictable symptoms
  • Accelerating Angina - unstable plaque, unpredictable symptoms
  • ACS - NSTEMI, STEMI
41
Q

What happens with NSTEMIs?

A
  • Partiall__y blocked artery
  • Small portion of heart tissue dies
  • Difficult to distinguish from unstable angina - need cardiac enzymes
42
Q

What happens with STEMIs?

A
  • Complete Block of Artery
  • Lots of cardiac tissue dies
  • Needs early intervention
43
Q

How do you work up chest pain?

A
  1. Assess the kind of chest pain
  2. 12-Lead EKG - primary study for decision making
  3. Cardiac Enzymes
44
Q

What are permanent markers of heart damage on an EKG?

A

Q Waves

More leads with abnormal Q’s = More heart damage

45
Q

What is the criteria for abmnormal Q-Waves?

A

> 0.04 seconds wide

> 25% height of R-Wave

Permanent

46
Q

How does depolarizaton happen in Left Bundle Branch Blocks?

A

Spreads from Right-to-Left instead of normally Left-to-Right

Impulse goes first to RV then LV

47
Q

What are some causes of LBBB?

A

Anterior MI
Aortic Stenosis
HTN
Dilated Cardiomyopathy
Hyperkalemia
Digoxin Toxicity

48
Q

What is Normal R-Wave Progression?

A

R waves should get bigger as you progress thru the precordial leads V1–> V6

49
Q

What happens on the EKG w/ Myocardial Ischemia?

A

ST Segment and/or T Wave Inversion

(Can return to normal if O2 supply returns to normal)

50
Q

Which lead is NOT useful and can be ignored when looking for ischemia, injury, or infarction?

A

aVR

51
Q

What are abnormal levels of:

CK: ?

CK/MB: ?

Troponin I: ?

A

CK: > 170 IU/L

CK/MB: > 6 mg/mL

Trop I: > 2 ng/mL

52
Q

Would Transient Myocardal Ischemia result in elevated Cardiac Markers?

A

There would be changes in ST-T waves, but the patient will NOT have elevated Cardiac markers b/c there is no actual heart cell damage

53
Q

When would you see abnormal Q develop?

A

1-4 Days after STEMI

54
Q

What are the Major Branches of the Coronary Arteries?

A

Right Coronary Artery (RCA)

Left Main Coronary Artery (LM)

Left Anterior Descending (LAD)

Circumflex Artery (CX)

55
Q

Which part of the heart does the RCA supply?

A

Right Atrium

Right Ventricle

Posterior Wall

AV Node

PDA –> Inferior Wall

56
Q

Which Leads represent the Anterior Wall?

A

V1-V4

57
Q

Which Leads represent the Inferior Wall?

A

II, III, aVF

58
Q

Which Leads represent the Lateral Wall?

A

I, aVL, V5-V6

59
Q

Which Leads represent the Posterior Wall?

A

V1-V2

60
Q

What does the Left Anterior Descending branch supply?

A

Anterior Wall

Septum

Left Bundle Branch

Right Bundle Branch

Papillary Muscles to Mitral Valve

61
Q

What does the Left Circumflex supply?

A

Latereral and Posterior Left Ventricle

DNURS 827 Advanced Physiology/Pathophysiology for Anesthesia I (11 decks)

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