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PMI AS > Basic ECG > Flashcards

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
Q

ECG paper 1 large box

A

200msec

5mm

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26
Q

1 small box= ____ mseconds

A

40 msec

1mm

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27
Q

5 large boxes

A

1 second

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28
Q

300 large boxes

A

1 min

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29
Q

two ways to estimate the HR?

A
  • 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
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30
Q

do segments or intervals of the ECG have waves?

A

intervals

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31
Q

P wave

A

atrial depolarization

duration <120msec (3 small boxes)

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32
Q

QRS complex

A

ventricular depolarization

duration <120msec (3 small boxes)

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33
Q

premature ventricular contractions are causes by what?

A

if the heart gets irritated and the ventricles start their own heart beat

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34
Q

ventricular escape rhythm

A

electrical conductance fails and ventricles take over as pacemaker

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35
Q

potential cause for wide QRS complex (not irritation or electrical failure)

A

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
Q

T wave

A

ventricular repolarization

height <5mm in leads I,II,III

37
Q

U wave

A

follows t wave

not seen unless hypokalemia

38
Q

J point

A

point at which S wave returns to baseline

39
Q

Delta wave

A

upward slurring of Q wave seen in WPW syndrome

40
Q

J wave (osborne wave)

A

“bump” on the S wave

seen in hypothermia

41
Q

PR interval start

A

beginning of p wave

42
Q

PR interval end

A

start of Q wave

43
Q

PR interval normal time

A

120-200msec (3-5 small boxes)

44
Q

Why is the PR interval time important?

A

shows conduction is delayed in the AV node and allows atria to finish contract before ventricles contract
OPTIMAL VENTRICLE FILLING

45
Q

QT interval start

A

q wave

46
Q

QT interval end

A

end of the t wave

47
Q

What medications prolong the QT interval? When should these be avoided?

A

Zofran and Phenergan (antiemetics)

avoided in pts with prolonged QT syndrome

48
Q

PR segment start

A

end of p wave

49
Q

PR segment end

A

beginning of Q wave

50
Q

ST segment start

A

J point

51
Q

ST segment end

A

start of T wave

52
Q

premature beat

A

heart beat that happens before it is expected to

53
Q

examples of premature beats

A

premature atrial contraction
premature junctional contraction
premature ventricular contractions

54
Q

escape beat

A

heart beat that comes after a long pause

55
Q

examples of escape beats

A

ventricular escape beat

junctional escape beat

56
Q

during systole what is and is not perfused?

A

Perfused: organs of the body

Not perfused: the heart (coronary arteries are closed by valve)

57
Q

During diastole what is and is not perfused?

A

Perfused: the heart (coronary arteries drain blood from backflow)
Not perfused: everything else

58
Q

Do patients with high or low heart rates have better coronary perfusion? why?

A

slower HR

  • longer time coronary arteries open
  • greater diastolic filling time
59
Q

What is cardiac output determined by?

A

ventricular filling prior to contraction

60
Q

What are the two ways that ventricular filling occurs and which is better?

A 
active filling (atria contract)** BETTER
passive filling (atria dont contract)
61
Q

If the ventricular filling is passive will the volume be lower or higher than active filling?

A

lower

62
Q

factors that can reduce ventricular filling (3)

A

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
Q

what happens when atria contract too quickly?

A

not enough time to fulling contract so reduces amount of blood forced to ventricles

64
Q

What happens when ventricles contract too quickly?

A

dont have enough time to fill before contraction

65
Q

Rapid heart rate leads to (3)

A

decreased cardiac output
hypotension
pulseless pt

66
Q

ECG description of sinus bradycardia

A

p wave present

HR <60bpm

67
Q

benefits of sinus bradycardia

A

normal/good for these patients:
healthy pt who exercises
CAD patients

68
Q

sinus brady cardia in healthy patients

A

higher stroke volume

maintains adequate cardiac output

69
Q

sinus brady cardia in patients with CAD

A

increased oxygen supply (diastolic filling)

decreased oxygen demand

70
Q

What do patients with CAD normally take to maintain a slow HR?

A

beta blockers

71
Q

what does the level of concern with sinus bradycardia depend on? (3)

A

1- age (children very bad)
2- severity (50 could be normal; 30 always concern)
3- how fast the drop in HR occured

72
Q

treatment for bradycardia

A

1- drugs (glyco, atropine, epi)

2- if unresponsive to drugs then initiate cardiac pacing with pacemaker

73
Q

temporary transcutaneous pacing

A

use defibrillator to pace the heart

set a HR and it will stimulate at that pace

74
Q

permanent implantable pacemaker

A

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
Q

ECG description of sinus tachycardia

A

P wave present

HR > 100 bpm

76
Q

etiology (causes) of sinus tachycardia

A

hypovolemia/hypotension

pain/light anesthesia

77
Q

anesthetic concerns with sinus tachycardia (3)

A

increased cardiac oxygen demand (bad in CAD)
decreased cardiac oxygen supply (decreases diastolic filling; bad CAD)
indicates possible hypovolemia

78
Q

treatment for sinus tachycardia

A

depends on cause:
1- fluids if bc hypovolemia
2- deepen anesthetic if light
3- consider beta blocker if not hypovolemic or light

79
Q

ECG description of irregular sinus rhythm

A

looks like sinus but rate is irregular
faster during inspiration
slower during expiration

80
Q

during spontaneous inspiration what happens to the intrathoracic pressure and preload

A

intrathoracic pressure decreases
preload increase
HR speeds up to pump excess out

81
Q

during spontaneous expiration what happens to the intrathoracic pressure and preload?

A

intrathoracic pressure increases
preload decreases
HR slows does bc it doesnt have to pump out as fast

82
Q

anesthetic concerns with irregular sinus rhythm

A

not as concerned

seen in healthy pts with deep breaths

83
Q

ectopy

A

any heart beat that originates outside the SA node

84
Q

ectopy is activated where? (3)

A

AV node
atrial myocardium
ventricular myocardium

85
Q

Supraventricular ectopy (6)

A 
premature atrial contraction (PAC)
atrial flutter
atrial fibrillation (Afib)
Premature junctional contraction (PJC)
Junctional rhythm
junctional escape beat
86
Q

ventricular ectopy (5)

A 
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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