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Diagnostic Medicine > 12 Lead EKGs > Flashcards

12 Lead EKGs Flashcards

1
Q

Current moving toward the positive pole will produce a

A

positive deflection on the EKG

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2
Q

Current moving toward the negative pole will produce a

A

negative deflection on the EKG

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3
Q

A lead that has a negative pole and a positive pole is

A

a bipolar lead

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4
Q

Unipolar leads

A

utilize the center of the heart as the negative point and the lead is the positive pole.

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5
Q

When the current is flowing perpendicular to the lead, it produces what kind of wave?

A

biphasic.

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6
Q

What leads are in the heart’s frontal plane and what kind of electrode are they

A

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

Bipolar

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7
Q

What leads are in the heart’s horizontal plane and what kind of electrode are they

A

V1, V2, V3, V4, V5, V6.

Unipolar

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8
Q

What is Eintoven’s Triangle

A

Its made up by leads I, II, and III. (Rule of Ls)

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9
Q

What are the Augmented Limb Leads

A

aVR, aVL, and aVF.

aV stands for augmented vector.

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10
Q

What is the systematic approach to reading EKGs

A
  1. ) Rate
  2. ) Rhythm
  3. ) Axis
  4. ) Intervals
  5. ) Morphology
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11
Q

What is the Axis looking at?

A

The overall direction of electrical conduction through the heart.

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12
Q

What is the normal axis?

A

-30 degrees (aVL) to 90 degrees (aVF). (downward and leftward).

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13
Q

Abnormal axis suggests what?

A

A change in shape or orientation of the heart, or a defect in the conduction system that causes the ventricles to depolarize in an abnormal way.

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14
Q

If I and aVF have positive deflections of a QRS it is a

A

normal axis

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15
Q

If I and aVF do not have positive deflections, what do you do to determine axis?

A

Look at the most isoelectric/eqiphasic lead, and the axis is perpendicular to that lead.

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16
Q

In the rule of thumbs, which lead is which

A

Left thumb is lead I

Right thumb is lead aVF

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17
Q

Left axis deviation can mean what?

A 
Left anterior fascicular block
LBBB
LV hypertrophy
Inferior MI
Ventricular Ectopy
Paced rhythm
WPW
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18
Q

Right axis deviation can mean what?

A 
Can be normal
Left posterior fascicular block Lateral MI
RV Hypertrophy
Acute lung disease (PE)
Chronic lung disease (COPD)
Ventricular ectopy
Hyperkalemia
Na channel blocker toxicity
WPW
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19
Q

P wave can be biphasic in which lead?

A

V1

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20
Q

T wave should always be what direction

A

Should always be upright.

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21
Q

What shows right atrial enlargement?

A

Peaked P wave in V1 or inferior leads.
Greater than 1.5 mm in V1
Greater than 2.5 mm in II

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22
Q

What is the most common cause of right atrial enlargement?

A

Pulmonary hypertension

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23
Q

Left atrial enlargement

A

Wider terminal negative portion of the P wave in V1, at least 0.04
Notched wide P waves in inferior leads (II, 0.12 seconds long)

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24
Q

Biatrial enlargement

A

Peaked and broad Ps in the inferior leads, at least 2.5 mm tall and 0.12 s wide.
V1 is broad and biphasic with terminal negative deflection at least 1mm deep and 0.04 seconds wide.

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25
Q

If a QRS complex is longer than 0.12 seconds there is what present and what lead do you have to look at.

A

a complete bundle branch block

V1

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26
Q

If Q wave is larger than 2mm

A

pathologic finding of old MI.

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27
Q

If the QRS duration is 0.1 to 0.12 seconds, what is most likely going on?

A

an incomplete bundle branch block.

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28
Q

In a right bundle branch block, what should you see on an EKG

A

V1 will be upright

V1-V2 will have “bunny ears” (rSR’)

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29
Q

What are the two R peaks in a right bundle branch block

A

r is the LV depolarizing

R’ is the RV depolarizing

30
Q

Frequently, the axis deviation will be in which direction of the bundle block?

A

The same direction

31
Q

If the patient has a left bundle branch block, what can you not do

A

You cannot reliably evaluate for an ST elevation.

32
Q

The ST segment represents what?

A

The time between ventricular depolarization and repolarization.

33
Q

ST elevation in one spot represents what?

A

an acute myocardial infarction (STEMI)

34
Q

Diffuse ST elevation represents what?

A

Pericarditis

35
Q

ST depression represents what?

A

myocardial ischemia

36
Q

What are the symptoms of a STEMI for males

A

chest pain, SOB, diaphoresis, L arm or jaw pain, back pain between shoulder blades.
May present with syncope, CHR, stroke, or shock.

37
Q

What are the symptoms of a STEMI for females

A

vague, generally feeling poor, indigestion, heart burn, jaw or back pain, nausea.
More likely to be diabetic. May present with CHR, stroke, syncope, or shock.

38
Q

What is a STEMI a result of?

A

An occlusive coronary thrombus at the site of a preexisting atherosclerotic plaque.

39
Q

Treatment of a STEMI

A

ASA/ plavix loading
immediate angiography and percutaneous intervention. (if not available, thrombolytics).
Also morphine, beta blockers, and nitrates.

40
Q

How does the EKG evolve with a STEMI

A

develop Q waves that can be permanent.

T waves are inverted.

41
Q

The T wave should always be what direction

A

Upward

If negative or inverted, suggests ischemia or evolving MI.

42
Q

If T waves are peaked, what does it mean?

A

Hyperkalemia

43
Q

Long QT syndrome

A

QT segment is longer than 0.48 and they aren’t on QT prolonging meds. Congenital. need genetic testing.

44
Q

What are the sudden cardiac death causes

A

Long QT syndrome
Brugada
ARVD

45
Q

Brugada syndrome

A

genetic condition causing RBBB with ST elevation in V1-V3. Need genetic testing.

46
Q

Arrhythmogenic Right Ventricular Displasia ARVD

A

RV myocardium replaced by fibrous and fatty tissue. Leads to VT/SCD of RV origin. Need an MRI to diagnose.

47
Q

Symptoms of SCD

A

Syncope due to VF or sudden death.

48
Q

What is left ventricular hypertrophy?

A

thickening of the myocardium in the left ventricle.

49
Q

What causes left ventricular hypertrophy?

A

HTN

50
Q

Left ventricular hypertrophy

A

Large QRS spikes because lots of voltage in the thickened muscle.

51
Q

Someone with hypertrophy also needs a cardiac echo. Why?

A

EKG is insensitive and not reliable. Needs an echo to measure the thickness of the septum.

52
Q

What are the two common pacemaker leads and what do they cause?

A

RA lead causing the “normal” P wave.

RV lead causes a LBBB. (originating from the RV)

53
Q

What may you see on a strip with a pacemaker

A

pacing spikes.

54
Q

What level is potassium to result in peaked T waves

A

5.5. As the level rises, the conduction system slows, atria first, then ventricles: loss of P waves and then a new BBB and then bradycardia leading to asystole.

55
Q

Hypokalemia

A

Prolonged QT interval
ST depression
T wave inversion
Sometimes large U waves

56
Q

Hypercalcemia

A

Shortened QTcinterval

57
Q

Hypocalcemia

A

Prolonged ST segment and QTc

58
Q

Hypomagnesia

A

Prolonged QT interval

59
Q

Hypermagnesia

A

Prolonged AV conduction, eventual heart block.

60
Q

What is the classic EKG finding for pericarditis

A

diffuse ST elevation and PR depression.

61
Q

Symptoms of pericarditis

A

Pleuritic chest pain, relieved by sitting forward, may have preceding viral syndrome, fever, pericardial rub on exam. SOB

62
Q

Treatment for pericarditis

A

Anti-inflammatories

Possibly drain the effusion.

63
Q

WPW

A

Short PR interval
Delta waves
Widened QRS

64
Q

What happens in the WPW

A

Direct connection to the ventricle through bundle of Kent

65
Q

What is the one instance when WPW can be fatal

A

If there is a bundle of Kent because it can cause Afib.

66
Q

Symptoms of WPW syndrome

A

palpitations
syncope
near syncopy
(Ablation of accessory pathway is indicated).

67
Q

What happens in a PE

A

most commonly caused by an embolus from the deep venous circulation to the pulmonary artery.

68
Q

Risk factors for DVT

A

Virchow’s triad:

Venous stasis, injury to a vessel wall, and hyper coagulability.

69
Q

Symptoms of a PE

A

Dyspnea, tachycardia, Hypoxia, tachypnea, pleuritic chest pain, can be vague.

70
Q

PE

A

Sinus tachycardia

S1Q3T3 abnormalities

71
Q

How do you diagnose a PE

A

CT scan with contrast (pulmonary artery CT angiography)

72
Q

Treatment for PE

A

anticoagulation, may require thrombolytic therapy.

Diagnostic Medicine (4 decks)

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