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Diagnostics > 12 Lead EKGs > Flashcards

12 Lead EKGs Flashcards

1
Q

Class I anti arrhythmic drugs

A

Na channel blockers

  • 1a: Qiudinine, procainamide, disopyramide (prolong QT, prolong QTc)
  • 1b: Lidocaine, phenytoin, mexiletine (minimal to no EKG changes)
  • 1c: Flecainide, propafenone (widened QRS, prolong PRI, sinus node suppression)
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2
Q

Class II anti arrhythmic drugs

A

Beta blockers

  • Metoprolol, carvedilol
  • Decrease sinus rate, prolong PR, *may contribute to heart block
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3
Q

Class III anti arrhythmic drugs

A

K channel blockers (depolarization)

  • Sotalol, dofetilide, dronedarone (prolonged QT)
  • Amiodarone (prolonged QTI)
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4
Q

Class IV anti arrhythmic drugs

A

Ca channel blockers

  • Verapamil, diltiazem
  • Decrease sinus rate, prolonged PR, *may contribute to heart block
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5
Q

Other anti arrhythmic drugs

A

Digoxin, adenosine

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6
Q

What does a negative/inverted T wave indicate?

A

Ischemia or evolving MI

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7
Q

What part of the T wave is the heart most susceptible to arrhythmias caused by PVCs?

A

Second part

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8
Q

Normal QTC

A

Less than .46

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9
Q

Left ventricular hypertrophy

A
  • Thickening of myocardium

- Often left axis deviation, wide QRS, LBBB

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10
Q

Most common cause of LVH?

A

HTN

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11
Q

Variation of LVH

A

Hypertrophic cardiomyopathy

- May cause sudden death

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12
Q

Pericarditis findings

A
  • Diffuse ST elevation

- PR depression

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13
Q

Pericarditis sx

A
  • Pleuritic chest pain, relieved by sitting forward
  • May have preceding viral syndrome, fever common
  • May have pericardial rub on exam
  • SOB if effusion is present
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14
Q

Pericarditis tx

A
  • Anti-inflammatories
  • Tx of underlying cause
  • Drain any effusion present
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15
Q

Pericardial effusion

A
  • Can cause global low voltage or electrical alternans

- Can lead to pericardial tamponade

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16
Q

Hyperkalemia

A
  • Peaked T waves
  • As K increases, conduction system slows (in atria 1st, then ventricles) –> loss of p waves –> new bundle branch block –> bradycardia –> asystole, PEA or VF
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17
Q

Hypokalemia findings

A
  • Prolonged QTI
  • ST depression
  • T wave inversion
  • Sometimes large U waves
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18
Q

WPW EKG findings

A
  • Short PR interval
  • Delta wave
  • Widened QRS
19
Q

WPW

A

Direct connection to ventricle though bundle of Kent

20
Q

WPW tx

A

If pt has sx, ablation of accessory pathway is necessary

21
Q

What are pulmonary embolisms caused by?

A

An embolus from the deep venous circulation

22
Q

Risk factors for DVT

A

Virchow’s triad:

  • Venous stasis
  • Injury to the vessel wall
  • Hypercoagulability
23
Q

Sx of pulmonary embolism

A
  • Dyspnea
  • Tachycardia
  • Tachypnea
  • Pleuritic chest pain
  • Sx can be vague
24
Q

Dx of pulmonary embolism

A

CT scan w/ contrast

25
Q

Tx of pulmonary embolism

A

Anticoagulation, thrombolytic therapy

26
Q

Axis

A
  • Overall direction of electrical conduction
  • Found via limb leads
  • Normal = -30 to 90 degrees
27
Q

Left axis deviation

A

-30 to -90 degrees

28
Q

Right axis deviation

A

90 to 180 degrees

29
Q

What does an abnormal axis suggest?

A

Change in shape/orientation of heart OR defect in conduction system

30
Q

Right atrial enlargement findings on EKG

A
  • Peaked P wave, V1 or inferior leads (greater than 1.5mm in V1, greater than 2.5mm on II)
31
Q

Most common cause of right atrial enlargement?

A

Pulmonary HTN

32
Q

Left atrial enlargement findings on EKG

A
  • Wide terminal negative portion of the P in V1 (at least 1 small box)
  • Notched wide P in inferior leads, esp. lead II (at least 3 small boxes)
33
Q

Biatrial enlargement

A
  • Peaked & broad Ps in inferior leads (2.5mm tall & 1.2 seconds wide)
  • V1 broad & biphasic, w/ terminal negative deflection at least 1mm deep & .04 seconds wide
34
Q

Bundle Branch Blocks

A
  • May be complete or incomplete through one of the bundles
  • QRS of .1-.12 could mean incomplete or hemiblock
  • QRS of .12 or greater is likely CBBB (if it does not fit the pattern for RBBB or LBBB, then it is an inter ventricular conduction delay)
35
Q

LBBB

A
  • V1 will be negative, w/ big Q wave or rS complex
  • V6 will be positive
  • May also have left axis deviation
36
Q

What is LBBB associated with?

A

Underlying cardiac disease

37
Q

RBBB

A
  • V1 will be upright & V1-2 will have “bunny ears” appearance
  • First R wave = LV activation, 2nd R wave is RV activation
38
Q

Lateral leads

A

I & avL

39
Q

Inferior leads

A

II, III, & avF

40
Q

Anterior leads

A

V1, V2, V3, V4

41
Q

Anterio-lateral leads

A

V5 & V6

42
Q

Sx of STEMIs

A
  • Chest pain (may be vague or absent)
  • SOB
  • Diaphoresis
  • Left arm or jaw discomfort
  • Back pain btw shoulder blades
43
Q

STEMIs are a result of what?

A

An occlusive coronary thrombus at site of preexisting atherosclerotic plaque

44
Q

STEMIs tx

A
  • ASA/plavix
  • Immediate angiography & percutaneous intervention (including stent if needed)
  • If angiography not available, then thrombolytics are next best option
  • Morphine, beta blockers, nitrates

Diagnostics (11 decks)

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