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Basic ECG Flashcards

1
Q

pacemaker cell

A

determine heart rate and initiate heart beats

SA and AV

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2
Q

electrical conducting cell

A

deliver the impulse to the myocardial cells

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3
Q

mycardial cells

A

contract and pump blood out of the heart

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4
Q

SA node

A

primary pacemaker of the heart (sets HR)

60-100 bpm

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5
Q

AV node

A

becomes the pacemaker if for some reason the SA node fails

AV node rate= 40-60bpm

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6
Q

narrow QRS complex means what for conduction

A

rapid conduction

normal pathway of conductance

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7
Q

do electrical conducting cells transmit current slow or fast?

A

quickly

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8
Q

What is the electrical conducting cells pathway? (6)

A 
SA node
anterior, posterior, middle fascicles
AVN
Bundle of His
RBB and LBB
Purkinje fibers
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9
Q

myocardial cells can initiate heat beats in what two situations?

A

1- SA and AV nodes fail

2- myocardium is irritated

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10
Q

what causes the myocardium to become irritated?

A

ischemia
electrolyte abnormality
acidosis
caffine

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11
Q

Do myocardial cells or electrical conducting cells transmit current quickly and more effectively?

A

electrical conducting cells

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12
Q

Wide QRS complex means what for conductance

A

slow conductance

current travels through the muscle, not normal pathway

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13
Q

what do ECG leads detect?

A

the electrical difference (voltage) between two limbs

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14
Q

Lead I provides a picture from what angle?

A

180 degrees

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15
Q

lead II provides a picture from what angle?

A

60 degrees

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16
Q

Where are the leads on a 3 lead ecg?

A

right arm, left arm, left leg

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17
Q

what is the limitation for the 3 lead system?

A

not as sensitive for detecting myocardial ischemia in the left ventricle

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18
Q

What does Lead I detect? What is the color-to-color for Lead I?

A

detects electrical difference between the right arm (-) and left arm (+)
white to black

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19
Q

What does Lead II detect? What is the color-to-color for Lead II?

A

electrical difference between right arm (-) and left leg (+)

white to red

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20
Q

What does Lead III detect? What is the color-to-color for Lead III?

A

electrical difference between the left arm (-) and left leg (+)
black to red

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21
Q

The green lead

A

neutral or ground lead

completes electrical circuit and doesn’t have anything to do with the EKG itself

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22
Q

brown lead

A

additional precordial lead

more sensitive for detecting LV ischemia

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23
Q

what helps make higher quality signal for the ECG electrodes

A

better connection
conductive gel on electrode
can clean skin
try not to place on hair

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24
Q

ECG paper 1mV= ___ small boxes?

A

10small boxes

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25
ECG paper 1 large box
200msec | 5mm
26
1 small box= ____ mseconds
40 msec | 1mm
27
5 large boxes
1 second
28
300 large boxes
1 min
29
two ways to estimate the HR?
- count number of beats within a certain number of time (2 sec or 6 sec) and multiply to get number of beats in minute - count # large boxes between beats
30
do segments or intervals of the ECG have waves?
intervals
31
P wave
atrial depolarization | duration <120msec (3 small boxes)
32
QRS complex
ventricular depolarization | duration <120msec (3 small boxes)
33
premature ventricular contractions are causes by what?
if the heart gets irritated and the ventricles start their own heart beat
34
ventricular escape rhythm
electrical conductance fails and ventricles take over as pacemaker
35
potential cause for wide QRS complex (not irritation or electrical failure)
current travels across myocardium instead of through purkinje fibers Wolf Parkinson White Syndrome (WPW) Right bundle branch block (RBBB) Left bundle branch block (LBBB)
36
T wave
ventricular repolarization | height <5mm in leads I,II,III
37
U wave
follows t wave | not seen unless hypokalemia
38
J point
point at which S wave returns to baseline
39
Delta wave
upward slurring of Q wave seen in WPW syndrome
40
J wave (osborne wave)
"bump" on the S wave | seen in hypothermia
41
PR interval start
beginning of p wave
42
PR interval end
start of Q wave
43
PR interval normal time
120-200msec (3-5 small boxes)
44
Why is the PR interval time important?
shows conduction is delayed in the AV node and allows atria to finish contract before ventricles contract OPTIMAL VENTRICLE FILLING
45
QT interval start
q wave
46
QT interval end
end of the t wave
47
What medications prolong the QT interval? When should these be avoided?
Zofran and Phenergan (antiemetics) | avoided in pts with prolonged QT syndrome
48
PR segment start
end of p wave
49
PR segment end
beginning of Q wave
50
ST segment start
J point
51
ST segment end
start of T wave
52
premature beat
heart beat that happens before it is expected to
53
examples of premature beats
premature atrial contraction premature junctional contraction premature ventricular contractions
54
escape beat
heart beat that comes after a long pause
55
examples of escape beats
ventricular escape beat | junctional escape beat
56
during systole what is and is not perfused?
Perfused: organs of the body | Not perfused: the heart (coronary arteries are closed by valve)
57
During diastole what is and is not perfused?
Perfused: the heart (coronary arteries drain blood from backflow) Not perfused: everything else
58
Do patients with high or low heart rates have better coronary perfusion? why?
slower HR - longer time coronary arteries open - greater diastolic filling time
59
What is cardiac output determined by?
ventricular filling prior to contraction
60
What are the two ways that ventricular filling occurs and which is better?
``` active filling (atria contract)** BETTER passive filling (atria dont contract) ```
61
If the ventricular filling is passive will the volume be lower or higher than active filling?
lower
62
factors that can reduce ventricular filling (3)
1- heart beat that occurs without an atrial contraction (no P wave; passive) 2- premature heart beats (ventricles contract before being filled) 3- rapid HR (atrial or ventricular)
63
what happens when atria contract too quickly?
not enough time to fulling contract so reduces amount of blood forced to ventricles
64
What happens when ventricles contract too quickly?
dont have enough time to fill before contraction
65
Rapid heart rate leads to (3)
decreased cardiac output hypotension pulseless pt
66
ECG description of sinus bradycardia
p wave present | HR <60bpm
67
benefits of sinus bradycardia
normal/good for these patients: healthy pt who exercises CAD patients
68
sinus brady cardia in healthy patients
higher stroke volume | maintains adequate cardiac output
69
sinus brady cardia in patients with CAD
increased oxygen supply (diastolic filling) | decreased oxygen demand
70
What do patients with CAD normally take to maintain a slow HR?
beta blockers
71
what does the level of concern with sinus bradycardia depend on? (3)
1- age (children very bad) 2- severity (50 could be normal; 30 always concern) 3- how fast the drop in HR occured
72
treatment for bradycardia
1- drugs (glyco, atropine, epi) | 2- if unresponsive to drugs then initiate cardiac pacing with pacemaker
73
temporary transcutaneous pacing
use defibrillator to pace the heart | set a HR and it will stimulate at that pace
74
permanent implantable pacemaker
permanent, under clavicle, delivers current to the pacing wires that are inside the heart only works when the HR falls below a certain point
75
ECG description of sinus tachycardia
P wave present | HR > 100 bpm
76
etiology (causes) of sinus tachycardia
hypovolemia/hypotension | pain/light anesthesia
77
anesthetic concerns with sinus tachycardia (3)
increased cardiac oxygen demand (bad in CAD) decreased cardiac oxygen supply (decreases diastolic filling; bad CAD) indicates possible hypovolemia
78
treatment for sinus tachycardia
depends on cause: 1- fluids if bc hypovolemia 2- deepen anesthetic if light 3- consider beta blocker if not hypovolemic or light
79
ECG description of irregular sinus rhythm
looks like sinus but rate is irregular faster during inspiration slower during expiration
80
during spontaneous inspiration what happens to the intrathoracic pressure and preload
intrathoracic pressure decreases preload increase HR speeds up to pump excess out
81
during spontaneous expiration what happens to the intrathoracic pressure and preload?
intrathoracic pressure increases preload decreases HR slows does bc it doesnt have to pump out as fast
82
anesthetic concerns with irregular sinus rhythm
not as concerned | seen in healthy pts with deep breaths
83
ectopy
any heart beat that originates outside the SA node
84
ectopy is activated where? (3)
AV node atrial myocardium ventricular myocardium
85
Supraventricular ectopy (6)
``` premature atrial contraction (PAC) atrial flutter atrial fibrillation (Afib) Premature junctional contraction (PJC) Junctional rhythm junctional escape beat ```
86
ventricular ectopy (5)
``` premature ventricular contraction (PVC) escape ventricular contraction ventricular escape (idioventricular) rhythm ventricular tachycardia (Vtach) ventricular fibrillation (Vfib) ```

PMI AS (15 decks)

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