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KIN 429 > 5.1 ECG1 > Flashcards

5.1 ECG1 Flashcards

1
Q

What are the 2 main coronary arteries?
Where do they supply blood to?

A

LMCA - supplies blood to left side of heart
- divides into LAD (supplies to front of left side of heart and bulk of LV) and LCx (supples left lateral and posterior)

RCA - supplies blood to right atrium, right ventricle, and SA and AV nodes that regulate heart rhythm

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2
Q

What coronary artery is most likely to contain electrical conduction system?

A

right coronary artery

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3
Q

What are the intrinsic factors of the autonomic control?

A

SA node - pacemaker of the heart

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4
Q

What are the extrinsic factors of the autonomic control?

A

neural function (chronotropic)
- balance of sympathetic and parasympathetic stimulation
- hormonal control (catecholamines)

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5
Q

Sympathetic vs. parasympathetic?

A

sympathetic = fight or flight
parasympathetic = rest and digest

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6
Q

What is the conduction system?

A

special electrical (pacemaker) cells in the heart that are arranged in a system of pathways.

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7
Q

What controls the heart?

A

Normally, the pacemaker site with the fastest firing rate

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8
Q

What is the idea around vectors in the heart?

A

Electrical activity goes off in many different directions - we sum them up to get an average of the vectors

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9
Q

In a healthy heart, the sum of vectors should lead through where?
What is this called?

A

the left ventricle
called the electrical axis

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10
Q

What does lead 2 / rhythm strip look at?

A

Blood going towards the LV

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11
Q

What does p-wave represent?

A

atrial contraction (atrial depolarization)

SA node is firing off

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12
Q

What does the QRS complex represent?

A

ventricular depolarization

(atrial repolarization occurs too, but isn’t seen b/c it is lesser magnitude)

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13
Q

What does the T-wave represent?

A

ventricular repolarization

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14
Q

When does diastole occur in an ECG?

A

between the beats

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15
Q

What are the intrinsic rates of pacing cells?

SA node?
Atrial cells?
AV node?
His bundle?
Bundle branch?
Purkinje cells?
Myocardial cells?

A

SA node = 60-100 BPM
Atrial cells = 55-60 BPM
AV node = 45-50 BPM
His bundle = 40-45 BPM
Bundle branch = 40-45 BMP
Purkinje cells = 35-40 BMP
Myocardial cells = 30-35 BMP

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16
Q

Which direction does a current flowing towards a positive electrode deflect?
Current flowing away from positive electrode?

A

Current flowing towards a positive electrode deflects upward

Current flowing away from positive electrode deflects downward

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17
Q

On an ECG recording paper, what do/does 1 square, 3 small squares, and 5 small squares measure?

A

1 small square = 0.04s
3 small squares = 0.12s
5 small squares = 0.20s

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18
Q

What numbers demonstrate heart rate from thick-lined box to the next thick line?

A

300
150
100
75
60
50
43
38
33
30

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19
Q

What are sinus rhythms?

What are the 7 called?

A

all rhythms whose origin is the sinus node

sinus ryhthm
sinus bradycardia
sinus tachycardia
sinus arrhythmia
sick sinus syndrome
sinus arrest
sinus block

20
Q

What are sinus bradycardia
and sinus tachycardia?

A

sinus bradycardia <60bpm
sinus tachycardia >100bpm

21
Q

How do you calculate atrial rate vs ventricular rate?

A

Atrial rate - calculate from p-wave to p-wave
Ventricular rate - QRS to QRS

22
Q

What is sinus arrhythmia?

Describe rate, regularity, p-wave, QRS ratio, PR interval, QRS width, grouping, and dropped width.

A

Rate: 60-100 bpm
Regularity: changes with breathing; Slower during exhalation and faster during inhalation
P-wave = normal
QRS ratio: 1:1
PR interval = normal; 0.12-0.20s
QRS width: normal
grouping: none
dropped beats: none

23
Q

What is the length for a normal PR interval?

A

0.12-0.20s

24
Q

Sinus arrhythmia has identical features to a normal sinus rhythm except what?

A

except the rate varies more than 10%

(shorter and longer distances between beats / diastole)

25
Q

What is sinus bradycardia?

A

Rate <60bpm
Normal otherwise
PR interval and QRS width are normal to slightly prolonged

26
Q

What can cause sinus bradycardia?

A

vagal stimulation leading to nodal slowing

or medicines such as beta blockers

also seen in some highly conditioned athletes

27
Q

What is sinus tachycardia?

A

Rate >100 bpm
Normal otherwise; PR interval and QRS width may be normal to slightly shortened

28
Q

What has caused sinus tachycardia?

A

can be caused by medications or by conditions that require increased cardiac output, such as exercise, hypoxemia, hypovolemia, hemorrhage and acidosis

29
Q

What is hypoxemia and hypovolemia?

A

Hypoxemia – low level of oxygen in the blood

Hypovolemia – a decreased volume of circulating blood in the body

30
Q

What is premature atrial contraction?

A
  • rate depends on sinus rate
  • irregular
  • p-wave is present but may be in a different shape
  • P-P intervals are different lengths
  • multifocal p-wave stimuli
  • sometimes grouping
31
Q

What are multifocal PACs?

A

premature atrial contractions that are generated in different places of the atria so they have different shapes

32
Q

What is ectopic atrial tachycardia?

A
  • rate of 100-180bpm
  • ectopic = in abnormal place
  • p-wave –> different ectopic focus
  • QRS width can be abnormal
33
Q

What is SVT?

A

supraventricular tachycardia

  • regular rhythm
  • 160-250bpm
  • p-wave is often not visible
  • PR interval is usually not measurable
  • QRS is usually normal
34
Q

What are the causes of supraventricular tachycardia?

A

atrial flutter with rapid ventricular response

atrial fibrillation with rapid vent response

atrial tachycardia

AV node re-entry tachycardia

accessory pathway mediated SVT

35
Q

What is atrial flutter?

A

a single irritated focus of the atria that is firing rapidly; creates a reentry circuit that depolarizes the atria and gains control as pacemaker of the heart

p-wave appears saw-toothed (very peaked)

atrial rate is often 250-250bpm
ventricular rate is commonly 125-175 bpm

variable QRS width

36
Q

Describe how the AV node works as a gatekeeper.

A

AV node = gatekeeper to the ventricle that comes in as it determines how many impulses reach the ventricles

37
Q

What might cause atrial flutter?

A

often occurs in people with heart disease

acute myocardial infarct, congestive cardiomyopathy, hyperthyroidism, cor pulmonale (right-sided heart failure), valve disease

38
Q

What is occurring in atrial fibrillation?

A

multiple ectopic foci in the atria firing, causing the atria to depolarize in a chaotic manner

atria is quivering

AV node is bombarded with many impulses

always irregularly irregular

wavy baseline, can’t see p-wave

39
Q

A-fib versus A-flutter… which is irregularly irregular and which is regularly irregular?

A

A-fib = irregularly irregular

A-flutter = regularly irregular

40
Q

What is a controlled rate of atrial fibrillation?

A

rate <100bpm = controlled with medication

41
Q

What are causes of artifact?

A

Patient Movement
Muscle Tremor
Poor or Lost Electrode Contact
Electrical Interference from Other Electrical Equipment
External chest compressions

Or:
muscle tremor, alternating current (AC) interference, poor electrode contact with the skin, interference related to biotelemetry, and external chest compression

42
Q

What is artifact?

A

Abnormal waves and spikes in an ECG that result from sources other than the electrical activity of the heart and interfere with or distort the components of the ECG.

43
Q

What is the difference between sinus pause and sinus block?

A

sinus pause = varied time period of which there is no sinus pacemaker working; tie interval is not a multiple of the normal P-P interval

sinus block = picks back up on time in some multiple of the P-P interval; after a dropped beat, cycle continues as scheduled
- sinus has fired but the impulse has not made it out of the SA node

44
Q

What is a WAP? What is occurring?

regularly irregular or irregularly irregular?

A

wandering atrial pacemaker - multiple atrial pacemakers are firing at their own pace. Results in an ECG with at least 3 different p-wave morphologies.

100bpm
irregularly irregular
variable PR interval

45
Q

What is multifocal atrial tachycardia?

A

> 100bpm (lower than Afib)
irregularly irregular

clear p-wave but different morphologies

KIN 429 (10 decks)

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