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CARD 2201 > Basics of ECG Interpretation > Flashcards

Basics of ECG Interpretation Flashcards

1
Q

How many steps are in the systematic analysis of ECG Interpretation?

A

Nine

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2
Q

What are the 9 steps of ECG analysis?

A
  1. determine atrial and ventricular rates
  2. assess rhythm. Regular or Irregular?
  3. identify and examine the p-waves
  4. examine and measure the PR interval
  5. identify, examine and measure the QRS complex
  6. locate and examine the ST segment
  7. locate and examine the T-wave
  8. locate and measure the QT interval
  9. interpretation
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3
Q

Describe the 6 second method in calculating heart rate. Pros and Cons?

A

Count the number of QRS complexes in a 6 scedon period, and multiply x10 to get number of complexes in one minute
Pro: quick and easy
Con: least accurate method

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4
Q

Describe the Sequence method in calculating heart rate.

What is the numerical sequence?

A

300-150-100-75-60-50
Locate R-wave that falls on a dark line. Starting on the NEXT dark line, number them with the sequence above. Note where the next R-wave falls between 2 dark lines. Calculate the HR.

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5
Q

Describe the ruler method in calculating HR.

A

be sure to follow instruction on ruler
place arrow along ECG strip at QRS complex. Count the 3rd QRS complex (sometimes 2nd) and locate rate on ruler. Indicates ventricular rate - can be done with P-P interval as well to calculate atrial rate

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6
Q

What is the MOST accurate method of calculating HR from the rhythm strip?

A

Small Square Method

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7
Q

What is the LEAST accurate method of calculating HR from the rhythm strip?

A

Six Second Method

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8
Q

Describe the Large Square Method in calculating HR.

A

Count number of large squares between 2 consecutive R-waves. Divide number INTO 300
ex. 5 large squares. 300/5 = 60 bpm

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9
Q

Describe the Small Square Method in calculating HR.

A

Count number of small squares between 2 consecutive R-waves. Divide number INTO 1500
ex. 23 small squares. 1500/23 = 65 bpm

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10
Q

How many methods are there for calculating heart rate? List them

A

5 methods.

  1. 6 second method
  2. sequence method
  3. ruler method
  4. large square method
  5. small square method
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11
Q

What step takes place after calculating heart rate? Describe this step

A

Next step: Assess the Rhythm. Is it Regular or Irregular?

Use caliper, measure distance between R-R interval. ‘Walk’ caliper to determine if complex occurs at regular intervals

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12
Q

After assessing rhythm, what comes next?

A

Identify and Examine P-wave

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13
Q

What do you ask yourself when locating P-waves?

A
  • Is it smooth and rounded?
  • Is it upright or inverted? (originates in SA node or other focus)
  • Does a p-wave precede each QRS complex? (sinus origin)
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14
Q

What are normal p-wave characteristics?

Location, Amplitude, Duration, Configuration, Deflection

A 
Location - precedes QRS complex
Amplitude - 2-3mm high
Duration - 0.06-0.12 seconds 
Configuration - rounded and upright 
Deflection - positive/upright in Lead II
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15
Q

What does the PR Interval represent?

A

The time for the electrical impulse to leave the SA node, depolarize the atria and pass through the AV junction

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16
Q

What are the normal PR Interval characteristics?

Location and Duration

A

Location - from beginning of P-wave to beginning of QRS complex
Duration - 0.12-0.20 seconds

17
Q

PR Interval Facts

A
  • interval ends when ventricular depolarization begins
  • should be consistent throughout rhythm strip
  • tells you if the beat is transmitted to the ventricle in a normal manner
18
Q

What does it mean when it’s said that the PR Interval is rate-related in duration?

A

If HR is faster = PR interval is shorter

If HR is slower = PR interval is longer

19
Q

What does the QRS complex represent?

A

Ventricular depolarization

20
Q

What is the normal duration of the QRS Complex? What is the max duration before it is considered abnormal?

A

Normal duration - 0.10 sec

A QRS complex greater than 0.12s in duration is abnormal

21
Q

What does a widened QRS complex indicate?

A

a delay in ventricular depolarization

22
Q

What is happening during a ‘normal’ QRS complex?

A

Represents the wave of electrical activity that proceeds in a normal, orderly fashion from the junction, through the remainder of the conduction system (Bundle of His, RBB, LBB, fasicles and Purkinje fibers), and over the left and right ventricles

23
Q

What does the ST Segment represent?

A

the time when ventricles are completely depolarized and repolarization begins

24
Q

What are you looking for with regards to the ST segment?

A

NOT length/duration
Looking at it’s relationship/orientation to the isoelectric line (PR segment)
ST segment ABOVE iso line = elevated
ST segment BELOW iso line = depressed

25
Q

What measurement is considered significant when determining ST elevation or depression?

A

> 1 mm

26
Q

What does the T-wave represent?

A

Ventricular repolarization

27
Q

What are the typical t-wave characteristics?

A

Positive/upright deflection.
Same direction as QRS complex
Gently sloping, asymmetrical shape (symmetrical wave can indicate pathology)

28
Q

What can impact interpretation of T-wave? What steps to take to determine start?

A

ST elevation/depression can make it difficult to determine start of T-wave. Look at ST segment for point where wave abruptly gets steep.
If no ST segment seen - T wave begins at end of QRS

29
Q

What does the QT Interval represent? How do you measure it?

A

Total ventricular activity. Measured from start of QRS complex to end of T-wave

30
Q

Most common concern with prolonged QT interval

A

life threatening arrhythmias

31
Q

QT interval varies with HR. True/False?

A

TRUE

32
Q 
QT Interval (Normal: Range)
HR: 40
HR: 60
HR: 80 
HR: 100
A 
QT length (Normal: Range) in seconds
HR: 40 --  0.46:  0.41-0.51
HR: 60 --  0.39:  0.35-0.43
HR: 80 --  0.35:  0.32-0.39
HR: 100 --  0.31:  0.28-0.34
33
Q

QT Interval (Normal: Range)
HR: 120
HR: 150
HR: 180

A

QT length (Normal: Range) in seconds
HR: 120 – 0.29: 0.26-0.32
HR: 150 – 0.25: 0.23-0.28
HR: 180 – 0.23: 0.21-0.25

34
Q

Describe a quick method to determine if the QT interval is prolonged

A

Measure R-R interval. If QT interval > 50% of interval then it is considered prolonged

CARD 2201 (2 decks)

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