Basic & Advanced EKG (Exam I) Flashcards
1
Q
In what leads should a p-wave be positive?
A
- I, II, aVF, V4-V6
2
Q
Lateral leads are:
A
lateral: V5, V6
High lateral: I, aVL
3
Q
Anterior leads are:
A
V3 and V4
4
Q
Inferior leads are:
A
Boot: II, III, aVF
5
Q
Lead I look at what area or rhythms?
A
the atria and atrial arrhythmias
6
Q
Lead III looks at what area of heart?
A
Left ventricle
7
Q
V1 and V2 look at what area?
A
Septum
8
Q
Hyperkalemia signs on ecg
A
QRS widening, fusion of QRS-T, loss of the ST segment, tall tented T-wave
9
Q
A reason why I may see hyperkalemia on ECG
A
Renal pt missed HD
10
Q
Signs of Hypokalemia on ECG
A
ST depression and flattening of the T wave
Negative T waves
A U-wave may be visible
11
Q
What surgery often causes calcium abnormalities?
A
- neck surgeries that disrupt the thyroid or parathyroid
- check PACU Calcium level, check again at 6 hrs and 12 hrs
12
Q
delete
A
13
Q
Hypercalcemia signs on ECG (5)
A
Severe:
- very wide QRS
- low R wave
- disappearance of p waves
- tall peaking T waves
- Could see Osborne J wave
14
Q
Hypocalcemia signs on ECG
A
- narrow QRS
- reduced PR interval
- T wave flattening or inversion
- prolongation of the QT interval
- Prominent U wave
- Prolonged ST and ST depression
15
Q
Osborne J waves signs on ECG
What can cause it?
A
Positive deflection right after the J point at the end of QRS
- Hypothermia
16
Q
What does the RCA perfuse?
A
Inferior LV wall
Posterior LV wall
RV
SA and AV node
Posterior fascicle of LBB
17
Q
What does the Circumflex perfuse?
A
The lateral wall of LV
SA and AV node
Posterior Wall of LV
18
Q
Possible symptoms of an inferior MI?
A
Abdominal pain, especially in females and diabetic pts
19
Q
Intervention plan with an AMI
A
O2, NTG, pain control
ASA, heparin
Thrombolytic prescreen
Thrombolytics given
20
Q
Delta wave causes and signs?
What med to avoid in this pt?
A
- WPW syndrome
- broad QRS from pre-excitation
- Cardizem
21
Q
What could be a dangerous combo after treating an MI?
A
If you gave thrombolytics and they have uncontrolled hypertension
22
Q
What should the duration of a p-wave be?
A
- < 0.12 seconds
23
Q
What should the duration of a PR interval be?
A
- 0.1 - 0.2 seconds
24
Q
What should the duration of a QRS complex be?
A
- < 0.12 seconds
25
Elevation/depression of an ST segment by __ mm is clinically relevant
1
26
T-waves should be positive in which leads?
- I, II, V3-V6
27
What does Paroxysmal mean?
Intermittent
28
Venticular ectopy is usually indicative of what?
- K⁺ imbalances
29
What effects do halothane/enflurane have in regards to arrhythmias?
- Halothane & enflurane sensitize the myocardium
30
What arrhythmia in infants can result from sevoflurane?
- Bradycardia (via oculo-cardiac reflex?)
31
What can desflurane cause during induction?
Prolonged QT
32
What two adverse events can occur from local anesthetic injection into the vasculature?
- Severe bradycardia
- Asystole
33
How would excessive intravascular lidocaine be treated?
- Lipid rescue
34
What is the exhaustive list of conditions that can result in perioperative dysrhythmias?
(11)
(this card sucks)
- General anesthetics
- Local anesthetics
- Abnormal ABG or electrolytes
- Endotracheal intubation
- Autonomic reflexes
- CVP cannulation
- Surgical stimulation of heart/lungs
- Location of surgery
- Hypoxemia
- Cardiac Ischemia
- Catecholamine excess
35
How many electrodes does a 12-lead have?
10 electrodes
36
What anatomic structure (discussed in class) causes dysrhythmias when stimulated during cardiac surgeries?
- Pulmonary arteries
37
What example was given of a surgical location where stimulation results in dysrhythmias?
- Eyes (due to oculo-cardiac reflexes)
- Heart/lungs
38
Where does lead V1 go? V2?
- V1 - 4th ICS, right of sternum
- V2 - 4th ICS, left of sternum
39
Where does lead V3 go?
V4?
- V3 - between V2 and V4
- V4 - 5th ICS, left of sternum
40
Where does lead V5 go?
V6?
- V5 - 5th ICS, left of sternum
- V6 - 5th ICS, left of sternum
41
What wave is the first negative deflection after the p-wave on any lead?
- Q-wave
42
What wave is the first positive deflection after a p-wave?
- R-wave
43
Describe an s-wave.
- Negative deflection below baseline after an R or Q wave.
44
What QRS is denoted by 1 in the figure below?
R
45
What QRS is denoted by 2 in the figure below?
QS
46
What QRS is denoted by 3 in the figure below?
qRs
47
What QRS is denoted by 4 in the figure below?
rS
48
What QRS is denoted by 5 in the figure below?
qR
49
What QRS is denoted by 6 in the figure below?
rSR' which is common in BBB
50
1 small box on an EKG strip equals _____.
1mm or 0.04s
51
1 large box on an EKG strip equals ______.
5mm or 0.2s
52
If healthy, both the QRS complex and T-wave should be ______ in leads I, II, & III.
positive.
53
What is the mean electrical axis of the heart?
59°
54
A clockwise shift of the mean electrical axis shift of the heart is indicative of what?
- Right-axis deviation
55
A counter-clockwise shift of the mean electrical axis shift of the heart is indicative of what?
- Left-axis deviation
56
Regarding Lead I, where is the negative terminal connected? How about the positive terminal?
Negative terminal = Right arm
Positive terminal = Left arm
57
Regarding Lead II, where is the negative terminal connected? How about he positive terminal?
Negative terminal = Right arm
Positive terminal = Left leg
58
Regarding Lead III, where is the negative terminal connected? How about the positive terminal?
Negative terminal = Left arm
Positive terminal = Left leg
59
Which lead can be used as the determinant of posterior vs anterior injury?
V2
60
In which precordial lead does the QRS complex have the most magnitude?
V4
61
What mV is denoted by a small box on an EKG strip?
0.1mV
62
What mV is denoted by a large box on an EKG strip?
0.5mV
63
What angle is viewed utilizing aVF?
90°
64
What angle is viewed utilizing aVL?
-30°
65
What angle is viewed utilizing aVR?
How does this compare to lead II?
-150°
- aVR is essentially opposite lead II. (not exactly though, Lead II's negative terminal is -120°)
66
What are the positive & negative terminals for lead aVR?
Negative = left arm + left leg (+30°)
Positive = right arm (-150°)
67
What are the positive & negative terminals for lead aVF?
Negative = left arm + right arm
Positive = left leg
68
What are the positive & negative terminals for lead aVL?
Negative = left leg + right arm
Positive = left arm
69
What cardiac EKG lead is the least useful in practice but most unique in its position? (this one has a lot of test questions about it)
aVR
70
What is the axis of Lead I?
0°
71
What is the axis of Lead III?
120°
72
What degree change would characterize an extreme axis deviation?
-90° to 180°
73
What would the mV of this QRS complex be?
+1.5mV
74
What would the mV of this QRS complex be?
- 1.0mV ( approximation)
75
Determine the mV of leads I & III and subsequently the degree & axis of deviation noted by these strips.
- Lead I ≈ -2.5mV
- Lead III ≈ +1.75mV
- Deviation ≈ inbetween +180° & +120° ≈ 170° due to greater Lead I magnitude. **Significant right axis deviation**
76
The EKG strips below are indicative of what pathology?
Right Bundle Branch Block (RBBB)
77
A notched, wide R wave on Lead V6 would likely be indicative of what condition?
- Left Bundle Branch Block (LBBB)
78
A positive current of injury noted on V2 would be indicative of what?
Posterior MI
79
A negative current of injury noted on V2 would be indicative of what?
Anterior MI
80
Why is it important to know if a pt has a BBB?
Mortality increases, especially when given common meds in the OR
81
Which BBB L or R is more significant? Why?
LBBB is more significant especially a high LBBB since it now effects anterior and posterior parts of the left bundle
- This directly effects the performance of the LV
82
What axis would be expected with a negative QS deflection in leads I and II and a positive R deflection in Lead III?
Right Axis Deviation
83
What axis would be expected with a negative QS deflection in leads II and III and a positive R deflection in Lead I?
Left Axis Deviation
84
A positive V1 QRS with negative QRS in leads I, II, and III would the resulting axis be?
- Extreme Right Axis Deviation
- Ventricular in origin
85
What block would you expect to present with a right axis deviation?
- Posterior Hemiblock
86
What block would you expect to present with a left axis deviation?
- Anterior Hemiblock
87
What is an MCL1 lead?
How is it placed?
- Modified V1 lead
- Negative on left arm, positive in 4th ICS right of sternum.
88
What would leads I, III, and III look like with normal axis?
- All + QRS
89
Differentiate physiologic left axis and pathologic left axis deviation.
- Physiologic = (+ Lead I & III) & (+ or isoelectric Lead II)
- Pathologic = (+ Lead I) & (- Lead II & III)
90
What is the most common cause of right ventricular hypertrophy?
- **Lung disease**, pulmonary embolus, and pulmonary valve disease.
91
In what situations would you find physiologic left axis deviation?
- Obesity & athleticism
92
Bundle Branch Block diagnosis is dependent on ______.
Hemiblock diagnosis is based on _______________.
- time
- axis deviation
93
What pertinent anatomical features of the heart are fed via the RCA?
- Inferior & posterior wall
- Right ventricle
- SA & AV node
- Posterior fascicle of LBB
94
What pertinent anatomical features of the heart are fed via the LAD?
- Anterior wall of LV
- Septal wall
- Bundle of His & BB
95
What severe outcome should you worry about with septal infarct?
Septal rupture
96
What pertinent anatomical features of the heart are fed via the circumflex artery?
- Lateral wall of LV
- *SA & AV nodes (?)
- Posterior wall of LV
*should be RCA, no?*
97
Why is morphine now avoided in MI's?
- Morphine causes histamine release.
98
What percentage occlusion would be assumed with chest pain on exertion?
70 - 85% occlusion
99
What percentage occlusion would be assumed with chest pain at rest?
90% occlusion
100
What percentage occlusion would be assumed with chest pain unrelieved by nitroglycerin?
100% occlusion
101
What should be administered before nitroglycerin with an acute right-sided MI?
fluid bolus
102
Are EKGs better in regards to sensitivity or specificity?
- Specificity (If MI is shown on the EKG, then it's likely an MI, 90%): Sensitivity is 50% for EKGs, so a negative EKG result doesn't rule out MI.
103
What sign would indicate ischemia?
- Symmetrical inverted T-waves in two or more related leads.
104
What sign would indicate an injury pattern?
- ST segment elevation of more than 1mm in two or more related leads.
*most important thing to look for*
105
What are the three I's of Ischemia
- Ischemia
- Injury pattern
- Infarction
106
What sign would indicate infarction?
- Pathologic Q waves ( >40ms wide or ⅓ the depth of r-wave height) coupled with ST elevation.
107
Which leads indicate a true lateral MI?
Which would indicate a high lateral?
- True lateral = V5 & V6
- High lateral = I, aVL
108
What is the most commonly seen MI?
What is commonly seen with this type of MI?
Do you use nitrates?
- Inferior
- Bradycardia, hypotension, 1st degree or Mobitz 1 blocks, and nausea.
- Caution with nitrates due to RV's being preload dependent w/ inferior MI's - could lead to hypotension
109
What is the most lethal MI?
What dysrhythmias are commonly seen with this type of MI?
Do you use nitrates?
- Anterior Wall (LAD)
- CHB and VF/Vtach
- Yes to nitrates.
110
What would cause one to prepare defibrillation pads for a patient undergoing an anterior MI? (other than vfib/vtach)
- Presence of **BBB or hemiblock** whilst undergoing an anterior MI
111
What condition presents with ST elevation on all leads?
How is it diagnosed?
- Pericarditis
- Patient feels better when they lean forward and there won't be reciprocal ST depression.
- Diagnosed via fever, WBCs, hx of IVDU, etc.
112
What condition looks like myocardial infarction on an EKG but can be fatal if thrombolytics are administered? How would we test and know for sure?
- Dissecting thoracic aorta aneurysm.
- CT scan
113
What four conditions mimic myocardial infarction in their EKG presentation?
- LBBB
- LV hypertrophy
- Pericarditis
- Thoracic aortic dissection
