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assessment > advanced ekg > Flashcards

advanced ekg Flashcards

1
Q

hyperkalemia can turn into what waves

A

sine

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2
Q

QRS complex:
QRS widening
fusion of QRS-T
loss of the ST segment

A

hyperkalemia

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3
Q

ST depression and flattening of the T wave

Negative T waves

A U-wave may be visible

A

hypokalemia

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4
Q

P-waves are widened and of low amplitude due to slowing of conduction

A

hyperkalemia

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5
Q

Severe: extremely wide QRS, low R wave, disappearance of p waves, tall peaking T waves.

A

hypercalcemia

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6
Q

hypercalcemia causes

A

tumor lysis in cancer

stimulation from PTH periop
(get baseline/ postop labs)

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7
Q

hypocalcemia

A

Narrowing of the QRS complex

Reduced PR interval

T wave flattening and inversion

Prolongation of the QT-interval

Prominent U-wave

Prolonged ST and ST-depression

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8
Q

most commonly associated with hypothermia, may also occur in hypercalcemia.

A

osborn J wave

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9
Q

changes will appear as a reciprocal, negative deflection in aVR and V1.

A

osborn J wave

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10
Q

causes of delta wave

A

WPW and abherrnat pathway

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11
Q

a slurred upstroke in the QRS complex. It relates to pre-excitation of the ventricles, and therefore often causes an associated shortening of the PR interval

A

delta wave

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12
Q

cautious with what two drugs with delta wave

A

adenosine and CCBs

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13
Q

Lead I is therefore an ___ tracing.

Lead 1 good for looking at?

A

Lead I is therefore an upright tracing.

Lead 1 for atria

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14
Q

lead III is better for looking at?

A

ventricles

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15
Q

Lead II is also the recommended lead of choice for

A

Lead II is also the recommended lead of choice for electrical cardioversion.

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16
Q

12 lead views from 10 electrodes why?

A

augmented leads

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17
Q

Note that in lead III the baseline wanders up and down. This is due to

A

due to the positive electrode being located on the diaphragm.

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18
Q

how to improve lead placement

A

Supine position is recommended

Clip or shave chest hair if necessary

Wipe diaphoretic skin with a towel

Consider using benzene, alcohol, betadine

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19
Q

Shoulders do NOT count

A

Shoulders do NOT count as limbs!

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20
Q

4th intercostal space, right of sternum

A

v1

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21
Q

4th intercostal space, left of the sternum

A

v2

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22
Q

between V4 and V2

A

v3

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23
Q

5th intercostal space, the mid-clavicular line.

A

v4

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24
Q

5th intercostal space, anterior axillary line

A

v5

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25
Q

5th intercostal space, the mid-axillary line

A

v6

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26
Q

first negative deflection after P wave in any lead

A

Q wave

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27
Q

first positive deflection after P wave in any lead

A

R wave

28
Q

negative deflection below the baseline after an R or Q wave

A

s wave

29
Q

where the qrs complex ends and ST segment begins

A

J point

30
Q

An RSR prime complex is a classic pattern for

A

a right bundle branch block in lead MCL1

31
Q

The R prime wave represents

A

the second time the complex goes above the isoelectric line.

32
Q

The J point is important for two reasons

A

One, it is the point of reference for determining bundle branch blocks; and

two, it is the point of reference for measuring the ST segment elevation.

33
Q

lead I upright
lead II down
lead III down

A

pathological left axis

34
Q

lead I down
lead II down
lead III down

A

extreme right axis
ventricular in origin
prolly Vtach

35
Q

lead I down
lead II indeterminate
lead III upright

A

right axis

36
Q

Point out that a left bundle branch block ______ a right bundle branch block because _______

A

Point out that a left bundle branch block is worse than a right bundle branch block because it involves two out of three fascicles.

37
Q

Also mention that you do not look for ST segment elevation in the presence _____ due to ______

A

the presence of a left bundle branch block due to the late repolarization of the left ventricle distorting the ST segment.

38
Q

drugs such as Lidocaine and Procainamide are contraindicated.

A

bifasicular blocks

39
Q

RCA supply

A

Inferior Wall (LV)
Posterior Wall (LV)
Right Ventricle
SA and AV Node
Posterior fascicle of LBB

40
Q

Left anterior descending LAD supply

A

“Widow Maker”
Anterior Wall of LV
Septal Wall
Bundle of His and BB

41
Q

Circumflex supply

A

Circumflex

Lateral Wall of LV
SA and AV nodes
Posterior Wall of LV

42
Q

Chest Pain on Exertion =
Chest Pain at Rest =
Chest pain unrelieved by nitroglycerin =

A

Chest Pain on Exertion = 70 - 85% occlusion
Chest Pain at Rest = 90% occlusion
Chest pain unrelieved by nitroglycerin = 100% occlusion

43
Q

heparin and ASA dosage for acute MI

A

5000 units
325mg

44
Q

A normal 12 lead doesnt rule out?

A

An MI

45
Q

Symmetrical inverted T waves in 2 or more related leads

A

Ischemia

46
Q

Can cause__ transiently with induction

A

ischemia

47
Q

ST segment elevation of more than 1mm in 2 or more related leads

A

injury pattern

48
Q

In the absence of ST elevation, then ST depression generally means

A

ischemia or subendocardial injury

49
Q

inferior RCA infarct what leads

A

II, III, F

recip: I, aVL

50
Q

septal LAD infarct what leads

A

V1, V2

51
Q

anterior LAD infarct what leads

A

V3, V4

recip: II, III, aVF

52
Q

lateral CIRC infarct what leads

A

V5, V6, I, aVL

recip: II, III, aVF

53
Q

posterior RCA infarct what leads?

A

V8, V9

54
Q

Right vent RCA infarct what leads

A

V4R

55
Q

Pathologic Q waves
> 40 ms wide or 1/3 depth of r wave height

A

infarction

56
Q

Point out that 50% of the time an inferior has___, and 30% of the time the _______

A

Point out that 50% of the time an inferior has posterior involvement, and 30% of the time the right ventricle is involved

57
Q

Clinical signs of a right ventricular infarction include

A

include hypotension, JVD, and clear lung sounds

58
Q

Patients may have bradycardia and hypotension
Could also have 1st degree or Mobitz 1 blocks

what infarct?

A

inferior MI

59
Q

Most common seen. Can be fatal
Nausea is common, antiemetics
Use nitrates with caution, may need fluids

what infarct?

A

inferior MI

60
Q

most lethal (highest mortality)
can suddenly develop, CHB, VF or VT

A

anterior wall MI

61
Q

this MI can extend to septum or lateral

nitrates are great, fluids are spared

A

anterior wall MI

62
Q

if seen with hemiblocks or BBB, place quick combo pads on the patient and prepare for the worst

what MI?

A

anterior MI

63
Q

Patient feels better when they lean forward

will not have reciprocal ST depression

A

pericarditis

64
Q

This condition can have ST segment elevation, however it will not have reciprocal changes

A

Dissecting Thoracic Aortic Aneurysm

65
Q

Heparin could prove fatal if given to this patient. Nitroglycerin is given with caution, if at all, due to the heart’s attempt to compensate for decreased afterload by increasing heart rate and contractility. This would cause undue stress on a weakened area of the aorta.

A

Dissecting Thoracic Aortic Aneurysm

assessment (4 decks)

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