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Fa: Methods 2 > Advanced ECG > Flashcards

Advanced ECG Flashcards

1
Q

cardiac conduction pathway 10

A 
1 sa node
2 anterior internodal fascicle
3 middle internodal fasicle (wenckebach bundle)
4 posterior internodal fascicle (thorels pathway)
5 bachman bundle
6 av node
7 bundle of his
8 RBB
9 LBB
10 Purkinje fibers
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2
Q

phase 4 non pacer action potential electrical conduction cells

A

resting membrane potential -90

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3
Q

phase 0 non pacer action potential electrical conduction cells

A

depolarization

na moves intracellular

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4
Q

phase 1 non pacer action potential electrical conduction cells

A

start repolarization

K moves extracellular

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5
Q

phase 2 non pacer action potential electrical conduction cells

A

plateau phase

Ca moves intracellular

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6
Q

phase 3 non pacer action potential electrical conduction cells

A

finishes repolarization

Ca channel close

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7
Q

SA node action potential phase 4

A

spontaneous repolarization

Na and Ca constantly in

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8
Q

SA node action potential phase 0

A

slow depolarization

Ca in

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9
Q

SA node action potential phase 3

A 
repolarization
ca channel open
k open (out)
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10
Q

what action potential has the fastest repolarization?

A

SA node

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11
Q

limb leads

A

I, II, III, aVR, aVL, aVF

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12
Q

standard/bipolar limb leads

A

I, II, III

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13
Q

augmented/unipolar limb leads

A

aVR, aVL, aVF

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14
Q

in what orientation do the limb leads examine the heart through

A

frontal plane

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15
Q

bipolar limb leads

A

positive and negative electrodes

current moves from neg to pos

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16
Q

Lead I

A

180 to 0

right arm to left arm

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17
Q

Lead II

A

-120 to 60

right arm to left leg

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18
Q

Lead III

A

-60 to 120

left arm to left leg

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19
Q

augmented unipolar leads

A

obtained by modifying the bipolar limb leads

ONLY have positive electrode

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20
Q

naming unipolar limb leads “a” stand for

A

augmented or modified

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21
Q

naming unipolar limb leads “v” stands for

A

vector

vector can point to positive electrode on left or right or foot

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22
Q

naming unipolar limb leads “R,L,F” stands for’?

A

where the postive electrode is

example: aVR - postitive electrode is in right arm

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23
Q

Lead aVR created?

A

modified lead III

left arm and left leg cancel out to create positive electrode going towards right arm

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24
Q

aVR degrees

A

30 to -150

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25
Q

Lead aVL created?

A

modified lead II

right arm and left leg cancel out and create positive electrode going to left arm

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26
Q

aVL degrees

A

150 to -30

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27
Q

lead aVF created?

A

modification of lead I

right arm and left arm cancel out and create positive electrode going to foot

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28
Q

aVF degrees

A

-90 to 90

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29
Q

mean electrical axis

A

main cardiac vector

sum of all of the MANY vectors of electricity that the heart makes

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30
Q

what leads does the mean electrical axis apply to?

A

only limb leads

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31
Q

normal QRS axis (MEA)

A

-30 to 110

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32
Q

left axis deviation

A

cardiac vector falls within -30 to -90 range

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33
Q

possible causes of left axis deviation

A

LVH

inferior wall MI

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34
Q

right axis deviation

A

90 to 180

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35
Q

possible causes of right axis deviation

A

RVH
young age (children have larger RV)
dextrocardia

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36
Q

extreme right axis deviation

A

-90 to -180

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37
Q

if the MEA vector travels the same direction as the lead youre using how will that effect the R wave

A

positive R wave deflection

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38
Q

if the MEA vector travels the opposite direction as the lead youre using how will that effect the R wave

A

negative R wave deflection (inverted)

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39
Q

if the MEA vector travels perpendicular to the lead youre using how will that effect the R wave

A

equiphasic deflection of the r wave

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40
Q

if a pt has a normal QRS axis then the R wave will be ______ in lead aVR

A

negative (inverted)

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41
Q

if a pt has a normal QRS axis then the R wave will be ______ in lead II

A

positive (upright)

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42
Q

if a pt has a normal QRS axis then the R wave will USUALLY be ____ in lead I

A

upright

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43
Q

if a pt has a left axis deviation then the R wave will be _____ in lead I

A

positive (upright)

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44
Q

if a pt has a left axis deviation then the R wave will be ____ in leads II,III, aVF

A

negative (inverted)

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45
Q

if a pt has a right axis deviation then the R wave will be ____ in leads III, AVF

A

positive (upright)

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46
Q

if a pt has a right axis deviation then the R wave will be _____ in leads I aVL

A

negative (inverted)

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47
Q

precordial leads

A

V1-V6

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48
Q

what plane to the precordial leads examine the heart in?

A

horizontal (transverse)

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49
Q

Right precordial leads

A

v1, v2

2nd intercostal space

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50
Q

left precordial leads

A

v3-v6

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51
Q

steps to analyze an ECG 6

A 
1 Rate?
2 Rhythm?
3 P waves?
4 QRS Complexes?
5 All intervals?
6 Signs of Ischemia?
52
Q

SSS

A

tachy brady syndrome

malfunctioning SA node

53
Q

ectopic atrial beat

A

beat that originates from the atrial myocardium

different p wave morphology

54
Q

ectopic atrial tachycardia

A

bunch of ectopic atrial beats rate >100

55
Q

wandering atrial pacemaker

A

ectopic beats that are originating from multiple sites in atria

56
Q

ECG description of wandering atrial pacemaker

A

irregularly irregular with p waves
3 or more different p morphologies
HR <100

57
Q

MAT or CAT

A

mutlifocal atrial tachycardia or chaotic atrial tachycardia

58
Q

ECG description of MAT

A

irregularly irregular rhythm with p waves
multiple p wave morphologies at least 3
HR >100

59
Q

how is MAT treated?

A

antiarrhythmics

cardioversion is NOT effective

60
Q

type 1 atrial flutter

A

atrial Rate <350

61
Q

type 2 atrial flutter

A

atrial rate >350

62
Q

afib with rapid ventricular response (RVR)

A

hr >100

63
Q

controlled afib

A

ventricular rate <100

64
Q

uncontrolled afib

A

ventricular rate >100

65
Q

normal junctional rhythm

A

40-60bpm

66
Q

accelerated junctional rhythm

A

60-100 bpm

67
Q

junctional tachycardia

A

> 100bpm

68
Q

SVT

A

> 150 bpm

69
Q

bigeminy

A

every other beat

70
Q

trigeminy

A

every third beat

71
Q

unifocal

A

same shape (originate from the same place)

72
Q

multifocal

A

different shape (originate from different places)

73
Q

couplet

A

2 in a row

74
Q

salvo

A

3 or more in a row

75
Q

mobitz 2 degree av block type 1

A

p-r interval gradually gets larger then drops beat

76
Q

mobitz 2 degree av block type 2

A

long p-r interval and dropped beat

77
Q

right bundle branch block

A

impulse from bundle of his will only go down LBB and the RV depolarizes by myocardium

78
Q

ECG description RBBB

A

two r waves (rSR) in V1/V2

broad, slurred S waves (ST depression) in V5/V6

79
Q

first R wave in RBBB

A

from left ventricle depolarization

80
Q

second R wave in RBBB

A

right ventricle depolarization

81
Q

LBBB

A

impulse from bundle of his will go down right bundle branch and then the left will depolarize through the myocardium

82
Q

first R wave in LBBB

A

right ventricle depolarization

83
Q

second R wave in LBBB

A

left ventricle depolarization

84
Q

ECG description for LBBB

A

RSR (double r wave) in:
I, aVL, V5-V6
can see deep S wave in V1/V2
St depression and or Twave inversion in I, aVL, V5/6

85
Q

right atrial enlargement

A

also known as right atrial abnormality and has TALL P WAVES

86
Q

ECG criteria for RAE

A

one or more:
tall p waves(>2.5mm) in I, II, III
tall p waves (>1.5mm) in V1/2

87
Q

what is RAE a result of?

A

pulmonary HTN
pulmonic stenosis
tricuspid stenosis/regurg

88
Q

left atrial enlargement

A

known as left atrial abnormality

89
Q

ECG criteria for left atrial enlargement

A

one or both
wide P wave in limb leads >120msec
negative or biphasic p wave in V1/V2 (>1mm in depth and width)

90
Q

what is LAE a result of?

A

aortic stenosis/regurg

mitral stenosis/regurg

91
Q

ECG criteria right ventricular hypertrophy

A

tall r waves V1
deep s waves in V5/6

R(V1)+S(inV5or6)= >10.5mm

92
Q

ECG criteria left ventricular hypertrophy

A

deep s wave V1
Tall R waves V5/6

S(V1)+R (V5or6) >35mm

OR

any precordial R + any precordial S >45mm

93
Q

LVH with repolarization abnormalities

A

repolarization abnormalities or strain when it is accompanied by st depression or t wave inversion

94
Q

r wave progression

A

increase in the magnitude of the r wave from v1 to V4/5

this is normal

95
Q

poor r wave progression

A

often seen after myocardial infarction and suggests myocardial defects

96
Q

electrical alternans

A

alternation of QRS complex amplitude between beats

97
Q

possible causes of electrical alternans

A

cardiac tamponade
pericardial effusion
acute MI
heart wobbles in pericardial sac

98
Q

signs of coronary ischemia 4

A

1 st depression or elevation in 2 or more contiguous leads
2 pathologic Q waves
3 inverted or missing t wave
4 electrical alternans

99
Q

pathologic Q waves

A

> 40msec wide

1/3 height of QRS

100
Q

what is the most sensitive lead for measuring st segment changes?

A

V5

101
Q

treatment of ischemia/infarction

A

increase O2 supply to pt
decrease O2 demand
obtain cardiology consult

102
Q

coronary blood supply 5 main

A 
aorta
right coronary artery
left coronary artery
circumflex coronary artery
left main coronary artery
103
Q

what does the right coronary artery supply blood to? 5

A 
SA node
AV node
inferior wall
posterior wall
inferior 1/3 ventricular septum
104
Q

what does the left anterior descending LAD supply blood to?

A

anterior left ventricle

ventricular septum

105
Q

what does the circumflex artery supply blood to?

A

posterior left ventricle

lateral left ventricle

106
Q

contiguous leads

A

leads that are a group of ECG leads that repressent the same area of the heart that receives similar blood supply

107
Q

inferior wall ecg leads and blood supply

A

II,III, aVF

right coronary artery

108
Q

lateral wall ecg leads and blood supply

A

I, aVL, V5, V6

circumflex artery

109
Q

septum ecg leads and blood supply

A

V1, V2

left anterior descending artery

110
Q

anterior wall ecg leads and blood supply

A

V3 V4

left anterior descending artery

111
Q

anteior MI cause by what

A

block of Left coronary artery

112
Q

how is anterior Mi diagnosed?

A

ischemia in leads V3-4

113
Q

inferior MI caused by what

A

block of the right coronary artery

114
Q

inferior MI diagnosed?

A

ischemia in leads II,III, aVF

115
Q

lateral MI caused by what?

A

block of the circumflex artery

116
Q

lateral MI diagnosed?

A

ischemia in leads I, aVL, V5, V6

117
Q

posterior MI caused by what?

A

block of the circumflex and right coronary arteries

118
Q

posterior MI diagnosed?

A

ischemia in V1-V3

119
Q

septal MI caused by?

A

block of the left anterior descending

120
Q

septal MI diagnosed?

A

ischemia in V1-V2

121
Q

ecg artifact

A

make ecg uninterpretable

122
Q

monitor filter mode

A

filters out electrical iterference

123
Q

low frequency filter

A

eliminates baseline drift associated with patient movement

124
Q

high frequency filter

A

reduces electrical noise

125
Q

ecg artifact related to st segments

A

accuracy of st segment readings on intraoperative ecg monitors are affected if filters are used

Fa: Methods 2 (16 decks)

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