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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

5 large boxes =

A

1 second

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11
Q

1 large box =

A

0.2 seconds

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12
Q

what action potential has the fastest repolarization?

A

SA node

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13
Q

limb leads

A

I, II, III, aVR, aVL, aVF

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14
Q

standard/bipolar limb leads

A

I, II, III

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15
Q

which lead has a negative electrode on the R arm

A

1
2

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16
Q

which lead has a negative elctrode on the L arm

A

3

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17
Q

augmented/unipolar limb leads

A

aVR, aVL, aVF

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18
Q

in what orientation do the limb leads examine the heart through

A

frontal plane

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19
Q

bipolar limb leads

A

positive and negative electrodes

current moves from neg to pos

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20
Q

Lead I

A

180 to 0

right arm to left arm

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21
Q

Lead II

A

-120 to 60

right arm to left leg

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22
Q

Lead III

A

-60 to 120

left arm to left leg

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23
Q

augmented unipolar leads

A

obtained by modifying the bipolar limb leads

ONLY have positive electrode

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24
Q

naming unipolar limb leads “a” stand for

A

augmented or modified

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25
naming unipolar limb leads "v" stands for
vector | vector can point to positive electrode on left or right or foot
26
naming unipolar limb leads "R,L,F" stands for'?
where the postive electrode is | example: aVR - postitive electrode is in right arm
27
Lead aVR created?
modified lead III | left arm and left leg cancel out to create positive electrode going towards right arm
28
aVR degrees
30 to -150
29
Lead aVL created?
modified lead II | right arm and left leg cancel out and create positive electrode going to left arm
30
aVL degrees
150 to -30
31
lead aVF created?
modification of lead I | right arm and left arm cancel out and create positive electrode going to foot
32
aVF degrees
-90 to 90
33
mean electrical axis
main cardiac vector | sum of all of the MANY vectors of electricity that the heart makes
34
what leads does the mean electrical axis apply to?
only limb leads
35
normal QRS axis (MEA)
-30 to 110
36
left axis deviation
cardiac vector falls within -30 to -90 range
37
possible causes of left axis deviation
LVH | inferior wall MI
38
right axis deviation
90 to 180
39
possible causes of right axis deviation
RVH young age (children have larger RV) dextrocardia
40
extreme right axis deviation
-90 to -180
41
if the MEA vector travels the same direction as the lead youre using how will that effect the R wave
positive R wave deflection (upright QRS)
42
if the MEA vector travels the opposite direction as the lead youre using how will that effect the R wave
negative R wave deflection (inverted R wave)
43
if the MEA vector travels perpendicular to the lead youre using how will that effect the R wave
equiphasic deflection of the r wave
44
if a pt has a normal QRS axis then the R wave will be ______ in lead aVR
negative (inverted)
45
if a pt has a normal QRS axis then the R wave will be ______ in lead II
positive (upright)
46
if a pt has a normal QRS axis then the R wave will USUALLY be ____ in lead I
upright
47
if a pt has a left axis deviation then the R wave will be _____ in lead I
positive (upright)
48
if a pt has a left axis deviation then the R wave will be ____ in leads II,III, aVF
negative (inverted)
49
if a pt has a left axis deviation then the R wave will be ______ in leads aVL
upright
50
if a pt has a right axis deviation then the R wave will be ____ in leads III, AVF
positive (upright)
51
if a pt has a right axis deviation then the R wave will be _____ in leads I, aVL
negative (inverted)
52
suppose the MEA is 140, the QRS will be _____ in lead 2
upright
53
suppose the MEA is 140, the QRS will be _____ in aVL
inverted
54
suppose the MEA is -60, the QRS will be _____ in lead 1
upright
55
suppose the MEA is -60, the QRS will be ____ in aVF
inverted
56
suppose the MEA is 90, the QRS will be _____ in lead 1
biphasic
57
suppose the MEA is 90, the QRS will be ______ in aVL
upright
58
main criteria to diagnose left axis deviation
negative R deflection in lead II
59
main criteria to diagnose Right axis deviation
negative R deflection in lead I
60
precordial leads
V1-V6
61
what plane to the precordial leads examine the heart in?
horizontal (transverse)
62
Right precordial leads
v1, v2 | 2nd intercostal space
63
left precordial leads
v3-v6
64
steps to analyze an ECG 6
``` 1 Rate? 2 Rhythm? 3 P waves? 4 QRS Complexes? 5 All intervals? 6 Signs of Ischemia? ```
65
SSS
tachy brady syndrome | malfunctioning SA node
66
ectopic atrial beat
beat that originates from the atrial myocardium | different p wave morphology
67
ectopic atrial tachycardia
bunch of ectopic atrial beats rate >100
68
wandering atrial pacemaker
ectopic beats that are originating from multiple sites in atria
69
ECG description of wandering atrial pacemaker
irregularly irregular with p waves 3 or more different p morphologies HR <100
70
MAT or CAT
mutlifocal atrial tachycardia or chaotic atrial tachycardia
71
ECG description of MAT
irregularly irregular rhythm with p waves multiple p wave morphologies at least 3 HR >100
72
how is MAT treated?
antiarrhythmics | cardioversion is NOT effective
73
type 1 atrial flutter
atrial Rate <350
74
type 2 atrial flutter
atrial rate >350
75
afib with rapid ventricular response (RVR)
hr >100
76
controlled afib
ventricular rate <100
77
uncontrolled afib
ventricular rate >100
78
normal junctional rhythm
40-60bpm
79
accelerated junctional rhythm
60-100 bpm
80
junctional tachycardia
>100bpm
81
SVT
>150 bpm
82
bigeminy
every other beat
83
trigeminy
every third beat
84
unifocal
same shape (originate from the same place)
85
multifocal
different shape (originate from different places)
86
couplet
2 in a row
87
salvo
3 or more in a row
88
mobitz 2 degree av block type 1
p-r interval gradually gets larger then drops beat
89
mobitz 2 degree av block type 2
long p-r interval and dropped beat
90
right bundle branch block
impulse from bundle of his will only go down LBB and the RV depolarizes by myocardium
91
ECG description RBBB
two r waves (rSR) in V1/V2 slurred S waves (ST depression) in V5/V6 | broad, slurred S waves (ST depression) in V5/V6
92
first R wave in RBBB
from left ventricle depolarization
93
second R wave in RBBB
right ventricle depolarization
94
intrinsicoid deflection
time from beginning of QRS to the peak of QRS
95
which patients have delayed intrinsicoid deflection
BBB
96
LBBB
impulse from bundle of his will go down right bundle branch and then the left will depolarize through the myocardium
97
first R wave in LBBB
right ventricle depolarization
98
second R wave in LBBB
left ventricle depolarization
99
ECG description for LBBB
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
100
symptoms of BBB
usually asymptomatic
101
treatment for symptomatic BBB
cardiac resynchronization with biventricular pacemaker
102
aberrancy
abnormal conduction in the R or L bundle branches
103
which bundle branch has longer refractory period
RBB refractory is longer than LBB
104
what can SVT with aberrancy present like
VTACH
105
right atrial enlargement
also known as right atrial abnormality and has TALL P WAVES
106
ECG criteria for RAE
one or more: tall p waves(>2.5mm) in I, II, III tall p waves (>1.5mm) in V1/2
107
what is RAE a result of?
pulmonary HTN pulmonic stenosis tricuspid stenosis/regurg
108
left atrial enlargement
known as left atrial abnormality
109
ECG criteria for left atrial enlargement
one or both wide P wave in limb leads >120msec negative or biphasic p wave in V1/V2 (>1mm in depth and width)
110
what is LAE a result of?
aortic stenosis/regurg | mitral stenosis/regurg
111
ECG criteria right ventricular hypertrophy
tall r waves V1 deep s waves in V5/6 R(V1)+S(inV5or6)= >10.5mm
112
ECG criteria left ventricular hypertrophy
deep s wave V1 Tall R waves V5/6 S(V1)+R (V5or6) >35mm
113
LVH with repolarization abnormalities
repolarization abnormalities or strain when it is accompanied by st depression or t wave inversion
114
r wave progression
increase in the magnitude of the r wave from v1 to V4/5 | this is normal
115
poor r wave progression
often seen after myocardial infarction and suggests myocardial defects
116
electrical alternans
alternation of QRS complex amplitude between beats
117
possible causes of electrical alternans
cardiac tamponade pericardial effusion acute MI *heart wobbles in pericardial sac*
118
signs of coronary ischemia 4
1 st depression or elevation in 2 or more contiguous leads 2 pathologic Q waves 3 inverted or missing t wave 4 electrical alternans
119
pathologic Q waves
>40msec wide | 1/3 height of QRS
120
what is the most sensitive lead for measuring st segment changes?
V5
121
treatment of ischemia/infarction
increase O2 supply to pt decrease O2 demand obtain cardiology consult
122
coronary blood supply 5 main
``` aorta right coronary artery left coronary artery circumflex coronary artery left main coronary artery ```
123
what does the right coronary artery supply blood to? 5
``` SA node AV node inferior wall posterior wall inferior 1/3 ventricular septum ```
124
what does the left anterior descending LAD supply blood to?
anterior left ventricle ventricular septum | ventricular septum
125
what does the circumflex artery supply blood to?
posterior left ventricle lateral left venticle | lateral left ventricle
126
contiguous leads
leads that are a group of ECG leads that repressent the same area of the heart that receives similar blood supply
127
inferior wall ecg leads and blood supply
II,III, aVF RCA | right coronary artery
128
lateral wall ecg leads and blood supply
I, aVL, V5, V6 CFlex | circumflex artery
129
septum ecg leads and blood supply
V1, V2 LAD | left anterior descending artery
130
anterior wall ecg leads and blood supply
V3 V4 LAD | left anterior descending artery
131
anteior MI cause by what
block of Left coronary artery
132
how is anterior Mi diagnosed?
ischemia in leads V3-4
133
inferior MI caused by what
block of the right coronary artery
134
inferior MI diagnosed?
ischemia in leads II,III, aVF
135
lateral MI caused by what?
block of the circumflex artery
136
lateral MI diagnosed?
ischemia in leads I, aVL, V5, V6
137
which lead is the most sensitive for detecting lateral wall ischemia
V5
138
posterior MI caused by what?
block of the circumflex and right coronary arteries
139
posterior MI diagnosed?
ischemia in V1-V3
140
septal MI caused by?
block of the left anterior descending
141
septal MI diagnosed?
ischemia in V1-V2
142
ecg artifact
make ecg uninterpretable
143
monitor filter mode
filters out electrical iterference
144
low frequency filter
eliminates baseline drift associated with patient movement
145
high frequency filter
reduces electrical noise
146
ecg artifact related to st segments
accuracy of st segment readings on intraoperative ecg monitors are affected if filters are used

Fa: Methods 2 (16 decks)

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