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Assessment Test 1 > Basic EKG interpretation > Flashcards

Basic EKG interpretation Flashcards

1
Q

What are the two types of cardiac cells?

A

Pacemaker
Contractile

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2
Q

What is automaticity? What type of cell does this?

A

the heart’s innate ability to generate its own spontaneous action potentials without any external stimuli

Pacemaker cells

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3
Q

Another name for cardiac muscle cells

A

Cardiac myocytes

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4
Q

The ____ cells create the electrical pathway of the heart, as known as:

A

Pacemaker
Conduction system

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5
Q

As the action potential travels through the conduction system and myocardium, it will lead to:

A

atrial and ventricular depolarization and contraction

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6
Q

The rate at which the pacemaker cells fire is:

A

heart rate

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7
Q

The pacemaker cells are located within:

A

the SA node, AV node, bundle of His, right and left bundle branches, and Purkinje fibers

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8
Q

What % of the myocardium is contractile cells?

A

99%

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9
Q

What type of channels cause cell-to-cell conduction?

A

Sodium

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10
Q

Release of _____ to interior myocytes causes contraction

A

Calcium

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11
Q

_____ ion outflow causes repolarization

A

Potassium

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12
Q

What lacks in a-fib d/t the lack of atrial kick?

A

Preload

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13
Q

Ineffective squeeze leads to bad what?

A

Cardiac output

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14
Q

One of the biggest reasons we cancel OR cases is because of what?

A

Electrolyte abnormalities

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15
Q

What electrolyte is involved in the clotting cascade?

A

Calcium

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16
Q

What 3 things cause cells to burst and release potassium?

A

Crush injuries
Massive tissue trauma
Amputation

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17
Q

SA node info:

A

Automaticity
Primary pacemaker
ANS/hormones modify timing/strength
PNS dominant

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18
Q

What is the normal HR of the SA node?

A

60-100 bpm

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19
Q

Where is the SA node located?

A

the back of the right atrium near the superior vena cava entry

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20
Q

The conduction system of the heart can be influenced by:

A

the sympathetic nervous system to speed up the heart rate by activating cardiac beta receptors

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21
Q

What can facilitate slowing of the heart rate?

A

Parasympathetic nervous system

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22
Q

Atrial depolarization is represented by what wave on the EKG?

A

P wave

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23
Q

What meds can we give to block parasympathetic system?

A

Atropine
Glycopyrrolate

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24
Q

What is another name for the interatrial pathway?
What does the internodal pathway consist of?

A

Bachman’s bundle
Internodal (Anterior, middle, posterior)

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25
Q

Bachman’s bundle facilities depolarization from the right atrium to:

A

Left atrium

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26
Q

AV node info:

A

Inherent pacemaker
Delays conduction 0.1 second
End part of PR interval

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27
Q

Where is the AV node located?

A

the base of the right atrium near the interventricular septum

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28
Q

Key difference in SA and AV node

A

the pacemaker cells within the AV node generate their action potentials at a slower rate than the SA node

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29
Q

If the SA node were eliminated or stopped functioning properly:

A

it would be up to the AV node to spontaneously depolarize the heart.

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30
Q

Bundle of His has how many branches?

A

2

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31
Q

Where is the bundle of his?

A

Interventricular septum

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32
Q

The bundle of his has pacemaker cells that can generate action potentials at how many beats per min?

A

40-60

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33
Q

Where does the action potential travel after the bundle of his?

A

Right and left bundle branches

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34
Q

The bundle branches consist of pacemaker cells that can generate spontaneous action potentials at what rate?

A

20-40 bpm

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35
Q

If an action potential originates in the ventricle, what is this called?

A

Idioventricular rhythm

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36
Q

Where does the action potential travel after the bundle branches?

A

Purkinje fibers

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37
Q

As the action potential travels through the bundle of His, the bundle branches, and the Purkinje fibers, the ventricular contractile myocytes depolarize and contract.

This is called:

A

Systole

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38
Q

Ventricular depolarization is represented by what on EKG?

A

QRS complex

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39
Q

Purkinje fibers can generate spontaneous action potentials at what rate?

A

20-40 bpm

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40
Q

If a heart rate is less than 20, this is known as an:

A

Agonal rhythm

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41
Q

If you had a wide QRS with a HR of 10-20, this probably originated where?

A

Purkinje fibers

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42
Q

Normal rate of AV node:

A

40-60 bpm

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43
Q

Where does the rhythm generate in a 2nd degree heart block?

A

Ventricles

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44
Q

What do the boxes represent on normal EKG paper?

A

6 second strip
Big box: 0.2 seconds
Little box: 0.04 seconds

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45
Q

Duration of a normal P wave:

A

<0.12 seconds

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46
Q

If a P wave is longer than it’s normal time, this is what rhythm?

A

First degree heart block

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47
Q

P wave will be upright in what leads?

A

I
II
aVF
V4-V6

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48
Q

PR interval represents:

A

AV conduction

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49
Q

Duration of PR interval:

A

0.10-0.20

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50
Q

Why is the later part of the PR interval flat?

A

Due to the delay as it travels through AV node

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51
Q

Duration of QRS complex:

A

<0.12 seconds

52
Q

ST segment represents:

A

Early stages of ventricular repolarization

53
Q

When is elevation/depression significant?

54
Q

What can an elevated T wave indicate?

A

Hyperkalemia

55
Q

What can an elevated ST segment indicate?

56
Q

What does the T wave represent?

A

Ventricular repolarization

57
Q

T waves are positive in what leads?

58
Q

Things that delay repolarization:

A

Electrolyte abnormalities
Myocardial injury

59
Q

Why can’t you see atrial repolarization?
Where is it masked?

A

It occurs during ventricular depolarization

QRS

60
Q

Inherent pacemakers of the heart:

A

SA node
AV node
Ventricular tissue

61
Q

What is this rhythm?

A

Sinus rhythm

62
Q

When looking at strips, what do we need to be looking at?

A
  • Look at heart rate then rhythm: is it regular?
  • Is there a P wave with every QRS?
  • Do you have a fixed PR interval?
  • Look at QRS: is it wide?
  • Look for any funny beats … are they appropriate shape? Extra beats? PVCs, PACs?
  • Is R-R interval fixed?
63
Q

What is this rhythm? Describe?

A

Sinus bradycardia

  • HR 40
  • P wave: not perfectly rounded; conduction problem in SA node
  • PR normal
  • QRS normal
  • P with every QRS
  • Fixed R-R interval
64
Q

What is this rhythm? Describe?

A

Sinus tachycardia

  • P wave appears smaller than normal ; not as round; but uniform
  • Heart rate - 140
  • P for every qrs
  • Pr interval and r-r fixed
  • Qrs normal
65
Q

What is the range for sinus tachycardia?

66
Q

If the HR is over 150, we consider what type of rhythms?

A

Supraventricular rhythms

67
Q

What is the rhythm? Describe?

A

Junctional

  • Heart rate 50 - gives clue to origin, probably not following SA node
  • P wave is inverted/ retrograde - its travelling away from natural conduction pathway
  • Pr interval fixed
  • Qrs fixed
  • R-r fixed
  • No strange beats
  • This is junctional because of inverted/retrograde p wave
68
Q

If a junctional rhythm is below 40, it’s called:

A

Junctional bradycardia

69
Q

Normal junctional rate:

70
Q

What is this rhythm? Describe?

A

Junctional tachycardia

  • P wave is weird little notch looking thing before QRS
  • P waves not consistent shape
  • Pr interval hard to calculate
  • Heart rate: 80 (This is faster than normal junctional rhythm ,so this is junctional tachycardia)
71
Q

If you don’t see P waves in a junctional rhythm, consider:

72
Q

What is the rhythm? Describe?

A

SVT

  • P wave - may or may not see
  • Rhythm regular
  • With SVT, common to not be able to see origin; but this is okay
73
Q

What is the difference in SVT and PSVT?

A

PSVT starts and stops (paroxysmal)
SVT stops but we do not see it start again

74
Q

If you have a narrow QRS in SVT, where does it originate?

75
Q

If you have a wide QRS in SVT, where does it originate?

A

Ventricles

76
Q

What is this rhythm? Describe?

A

Premature atrial contraction

  • HR 70
  • PR interval fixed
  • QRS normal width but not fixed R-R interval
  • When you compare the amplitude of some of the QRS, you can see some of the QRS have reduced amplitude
77
Q

If you have a heart beat that occurs too early, you may not have ______ or ________

A

Total filling
Complete repolarization

78
Q

PACS are not really a problem, but what can be?

79
Q

What is this rhythm? Describe?

A

A-fib

  • Rate: 150-300 for above
  • Cant calculate PR
  • QRs narrow
80
Q

A-flutter has a HR below:

81
Q

Meds we can use to treat a fib:

A

Amio: K+ channel blocker, delays repolarization
Cardiazem: CCB, causes delay

82
Q

What rhythm is this? Describe?

A

Atrial flutter

  • HR 70
  • P wave with every qrs; have extra p waves
  • Pr-interval not fixed
  • Qrs slightly wide but within normal parameter
  • “Sawtooth” pattern in atrial flutter
  • Varying conductions ex. 2:1, 3:1, and even 7:1
83
Q

What is something that can cause a flutter?

A

Caffeine/stimulants

84
Q

What is this rhythm? Describe?

A

PVCs

  • PR interval fixed
  • P wave nice and round
  • QRS within normal limits
  • P with every QRS
  • Then we have weird beats.. (Its wide QRS - so it came from ventricles; Takes a while for repolarization afterwards)
85
Q

What does multifocal mean?

A

Multiple cells are causing it

86
Q

PVCs are dangerous when there is:

A

Ventricular irritability

87
Q

What could be causes of PVCs?

A

Electrolyte abnormalities
Lack of oxygen
Ischemia

88
Q

To treat PVCs, we need to treat:

A

Underlying cause

89
Q

What can we use to treat runs or Tach or frequent PVCs?

A

Lidocaine or amio

90
Q

What is the rhythm? Describe?

A

1st degree AVB

  • Normal p wave
  • Fixed p-r interval
  • When you count, you can see it has passed the 0.2 threshold - so wide/prolonged p-r interval
  • Clinically insignificant
91
Q

What is this rhythm? Describe?

A

2nd degree, type I

  • Underlying HR: 50
  • P wave upright
  • P waves look identical - so atrial okay
  • As you move through the strip, you notice pr interval is getting longer and longer due to delayed conduction
  • At the end you don’t conduct a beat at all
92
Q

What is this rhythm? Describe?

A

2nd degree, type II

  • P-r interval is fixed in second degree!
  • Heart rate 50
  • P wave uniform and upright
  • For some reason, the conduction does not make it to the ventricle – so lack of ventricular conduction; can be 1:1, 2:1, etc.
93
Q

What is the difference in 2nd degree type I and type II?

A

Generally, type 1 is not symptomatic, but once at type 2, then we need to intervene

94
Q

In a heart block, what drug will the heart not respond to?

95
Q

What is this rhythm? Describe?

A

3rd degree AVB

  • HR 30
  • All p waves are similar
  • Pr interval are not the same
  • QRS complex is wide and varied
  • Atria and ventricles are not communicated
96
Q

What is it called when the atria and ventricles are not talking to each other?

A

Atrioventricular dissociation

97
Q

Dyssynchrony in a 3rd degree AVB can cause:

A

Decreased CO

98
Q

What is this rhythm? Describe?

A

V-tach

  • HR 182
  • Wide QRS
  • No identifiable atrial activity b/c its masked
  • Regular rhythm
  • All ventricular impulses look the same - so one mad cell sending this impulse
  • Patients can be stable in vtach!!
99
Q

What is this rhythm? Describe?

A

V fib

  • Ventricular rhythm coming from multiple different cells/foci
  • Cells are doing whatever they want
  • Polymorphic - spreading cell to cell around the ventricle - causing very amplitudes
  • Wide and fast ; HR 247
100
Q

Volatile agents can cause:

A

Sensitivity to the myocardium

101
Q

Meds we give that decrease HR that are not specifically targeted to decrease heart rate:

A

Pain meds
Precedex
Neo– should cause reflex bradycardia

102
Q

Sevo can cause:

A

bradycardia in infants

103
Q

What is the oculocardiac reflex?

A

a physiological response that causes a decrease in heart rate (bradycardia) when pressure is applied to the eyeball or traction is exerted on the extraocular muscles

104
Q

What volatile prolongs QT interval?

A

Desflurane

105
Q

Zofran can cause:

A

QT prolongation (risk of torsades)

106
Q

Large amounts of anesthetic can cause:

A

Bradycardia

107
Q

Norepi reuptake inhibitors:

A

Cocaine
Ketamine

108
Q

Hyperkalemia causes:

A

Succs
Blood

109
Q

What is another consideration when giving blood?

A

Blood also has citrate which is going to chelate calcium.. So your calcium is going to decrease

110
Q

Hemodynamic disturbances during endotracheal intubation:

A
  • If do not adequate put them to sleep, the stimulation will cause heart rate to go up; can also see vagal stimulation causing bradycardia – this is due to stimulation from laryngoscope
  • Bradycardia can also be caused in kids due to hypoxia – kids become bradycardic before hypoxic
111
Q

If you are working on carotids, this can cause:

How do you treat it?

A

Bradycardia

Infiltrate area with lido

112
Q

If working on thyroid, you may see:

A

Decreased HR

113
Q

If you are filling the abdomen with CO2, you are decreasing ____ due to ____

A

Venous return
Increased pressure

114
Q

Direct stimulation of what organs can cause bradycardia?

A

Abdominal organs
Vagina
Cervix

115
Q

If you are placing swan/central line, you can see PVCs due to what? What can this cause?

A

“Tickling” the ventricle with the wire

Prolonged ventricular arrythmia

116
Q

Surgical manipulation of cardiac structures can cause:

A

Arrhythmias

117
Q

Eyes surgeries may stimulate:

A

Oculocardiac reflex

119
Q

Hypoxemia can cause:

A

Tachycardia

In kids, they can become bradycardic in later stages of hypoxemia

120
Q

Cardiac ischemia can happen in OR because:

A

Everything we give in OR can decrease CO

121
Q

Ketamine increases _____ and __________

A

HR
Oxygen demand of heart

122
Q

Catecholamine excess can cause:

A

Elevated HR

123
Q

How would excessive intravascular lidocaine be treated?

A

Lipid rescue

124
Q

What two adverse events can occur from local anesthetic injection into the vasculature?

A

Severe bradycardia
Asystole

125
Q

What anatomic structure (discussed in class) causes dysrhythmias when stimulated during cardiac surgeries?

A

Pulmonary arteries

Assessment Test 1 (6 decks)

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