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

Methods of Anesthesia II (13 decks)

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