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ECG Both Exams don't delete (A,S,L) > Basics: Waves, Complexes, Intervals, And Heart Rate (Lauren) > Flashcards

Basics: Waves, Complexes, Intervals, And Heart Rate (Lauren) Flashcards

1
Q

One small box is ___mV and ____seconds

A

.1 mV

0.04 seconds

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2
Q

One large box is ____mV and ____seconds

A
  1. 5 mV

0. 2 seconds

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3
Q

What is an isoelectric line?

A

Flat line (no electrical activity is occurring)

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4
Q

What is the normal length of a P wave

A

0.06-0.10 seconds (1.5-2.5 boxes)

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5
Q

What is the normal appearance of a P wave?

A

Upright and rounded

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6
Q

What is the normal height of a P wave?

A

0.5-2.5 mm

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7
Q

The PR interval begins and ends where

A

Start of the P eave to beginning of QRS complex

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8
Q

What is the normal length of a PR interval?

A

0.12-0.2 seconds (3-5 boxes)

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9
Q

Where does the PR segment begin and end?

A

It is the flat line between the the end of the P wave and the start of the QRS complex

(Not the same thing as PR Interval)

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10
Q

What is the normal length of the QRS complex?

A

.06 to 0.12 seconds (1.5-3 boxes)

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11
Q

What is the ST segment?

A

The flat line that follows the QRS complex

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12
Q

What is the J-point?

A

The point where the QRS complex meets the ST segment

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13
Q

Where does the QT interval begin and end?

A

Start of QRS complex to end of T wave

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14
Q

What is the normal length of the QT interval?

A

0.36-0.44 seconds (9-11 boxes)

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15
Q

As the heart rate slows, the QT interval ______

A

Increases

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16
Q

How big is the calibration mark that ensures the ECG machine is properly calibrated?

A

10 small squares high

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17
Q

What is this:

“Markings on ECG that are not a product of the heart’s activity. May be caused by patient movement”

A

Artifact

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18
Q

Lead I is between which two electrodes?

A

RA negative

LA positive

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19
Q

Lead II is between which two electrodes?

A

RA negative

LL positive

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20
Q

Lead III is between which 2 electrodes?

A

LA negative

LL positive

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21
Q

What is meant by “augmented” limb leads in aVR, aVL, and aVF?

A

They are augmented/enhanced by the ECG machine because the waveforms produced by these leads are normally very small

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22
Q

Which electrode does aVR use?

A

RA positive

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23
Q

Which electrode does aVL use?

A

LA positive

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24
Q

Which electrode does aVF use?

A

LL positive

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25
Q

What does aVR view?

A

Base of heart (atria and great vessels)

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26
Q

What does aVL view?

A

Lateral wall of LV

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27
Q

What does aVF view?

A

Inferior wall of LV

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28
Q

Where do you place V1?

A

4th ICS on right of sternum

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29
Q

Where do you place V2?

A

4th ICS on left of sternum

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30
Q

Where do you place V3?

A

Halfway between V2 and V4

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31
Q

Where do you place V4?

A

5th ICS in mid clavicular line

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32
Q

Where do you place V5?

A

Anterior axillary line, same horizontal plane as V4

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33
Q

Where do you place V6?

A

mid axillary line, same horizontal plane as V4

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34
Q

The Precordial/chest leads give you what views of the heart?

A

Anterior and lateral views in a horizontal plane

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35
Q

What are modified chest leads?

A

Leads the are used for patient monitoring in ED, telemetry and ICU. Uses 3 electrodes.

36
Q

Which electrodes are used in modified chest leads (MCL)and where are they placed?

A

There are two options:

MCL1: Right arm (RA), Left arm (LA) and LL placed where you would normally put V1

MCL6: Right arm (RA), Left arm (LA), and LL placed where you would normally place V6

37
Q

Which leads would you look at to view the anterior surface of the heart?

A

V1-V4

38
Q

Which leads would you look at to view the lateral surgfaces of the heart?

A

I, aVL, V5-V6

39
Q

Which leads would you look at to view the inferior surface of the heart?

A

II, III, aVF

40
Q

What is the 5 step process for analyzing ECG tracings?

A
  1. Determine regularity
  2. Calculate rate
  3. Evaluate P waves
  4. Evaluate QRS complexes
  5. Evaluate PR intervals
41
Q

How do you determine if the heart rate is regular?

A

Make sure that the distance of the R-R intervals is the same as the P-P intervals

(Atria and ventricles are contracting at the same rate)

42
Q

What are the 3 methods for determining regularity?

A
  1. Caliper method
  2. Paper and pen
  3. Counting the small squares
43
Q

What is it called when the pacemaker changes location from site to site, producing a slightly irregular rhythm?

A

Wandering atrial pacemaker

44
Q

What is it called when the heart rate suddenly accelerates, producing an irregularity in the rhythm?

A

Paroxysmal tachycardia

45
Q

What is it called when a rhythm irregularity repeats itself in a cyclin fashion?

A

Patterned irregularity

Ex: rate increases during inspiration and decreases during expiration

46
Q

What is the classic condition that causes an irregularly irregular rhythm

A

Atrial fibrillation

47
Q

What are the 4 methods for calculating heart rate?

A

6 second interval x 10

Large box estimate (300, 150, 100, 75, 60, 50 method)

1500 method

Rate calculator

48
Q

How do you estimate heart rate using the 6 second interval x 10 method?

A

Count the number of QRS complexes in a 6 second portion of ECG and multiply by 10

(Quick and easy, but not as accurate)

49
Q

How do you calculate heart rate using the large-box estimate method?

A

Find an R wave located on or near a bold line.

Count down along each bold line until the next consecutive R wave

The bold lines represent heart rates of 300, 150, 100, 75, 60, and 50

The bold line it falls on represents the Heart Rate

50
Q

When is the large-box estimate method less accurate for calculating HR?

A

Irregular rhythms

51
Q

What is the most accurate method to calculating HR?

A

1500 method

52
Q

When can you NOT use the 1500 method to calculate HR?

A

Irregular rhythms

53
Q

How do you calculate HR using the 1500 method?

A

Count the number of small boxes between 2 R waves and divide 1500 by that number

54
Q

Heart rate less than ____ bpm is bradycardia

A

60

55
Q

Heart rate greater than _____ bpm is tachycardia

A

100

56
Q

When might you see “Tall Rounded” or “Tall Peaked” P waves?

A

Increased right atrial pressure

Right atrial dilation

57
Q

A P wave amplitude over 2.5 mm suggests_______

A

Right atrial enlargement aka “P pulmonale”

58
Q

What can cause wide, notched, or biphasic P waves?

A

Increased left atrial pressure

Left atrium dilation

59
Q

A P wave longer than 0.10 seconds (2.5 boxes) suggests ________

A

Left atrial enlargement aka “P mitrale”

60
Q

Biphasic P waves are normal in which lead?

A

V1

61
Q

What causes P waves that look different from sinus P waves?

A

Impulses that arise from the atria, but NOT the SA node:

Premature atrial complexes (PACs)

Wandering atrial pacemaker

Atrial tachycardia

62
Q

What can cause the P wave to be buried in the T wave of the preceding beat?

A

Rapid rates (atrial tachycardia)

when this happens, the T waves are often peaked, notched, or larger than normal.

63
Q

What do flutter waves look like?

A

“Saw toothed” pattern

64
Q

What causes flutter waves/ F waves?

A

Atria fire rapidly at rate of 250-350 bpm aka atrial flutter

65
Q

What do Fibrillatory waves look like?

A

Absence of discernible P waves, and instead you just get a chaotic looking baseline preceding the QRS complexes

66
Q

What causes Fibrillatory waves?

A

Atria firing rapidly from ~many~ sites at a rate >350 bpm

aka a fib

67
Q

What causes inverted P waves?

A

Retrograde depolarization of the atria. Caused when a P wave originates from the:

lower Right atrium near AV node

Left atrium

AV junction

(May immediately precede, occur during, or follow the QRS complex)

68
Q

Inverted P waves are associated with dysrhythmias that originate from the ______

A

AV junction

69
Q

What would it mean if you had more P waves than QRS complexes?

A

Impulse was initiated in the SA node or atria, but was blocked and didn’t make it to the ventricles

70
Q

Does a QRS complex always have on Q wave, one R wave, and one S wave

A

No there can be a missing Q or R wave (QS complex or RS complex)

Can be more than one R or S wave

71
Q

What would we call a second R or S wave?

A

R’ or S’

R-prime or S-prime

72
Q

What would we call a small R or S wave?

A

r wave or s wave (lowercase)

73
Q

What will the QRS complex look like if there was a dysrhythmia that originated from above the ventricles?

A

Normal

74
Q

What can cause tall QRS complexes?

A

Ventricular hypertrophy

Abnormal pacemaker

Aberrantly conducted beat

75
Q

What can cause low-voltage QRS complexes?

A

Obese patient

Pericardial effusion

Hypothyroidism

76
Q

What can cause wide-bizarre QRS complexes of supraventricular origin?

A

Intraventricular conduction defect, usually a R or L BBB

77
Q

What causes aberrant conduction?

A

An electrical impulse reaches the bundle branch while it is still refractory after a previous impulse

(Impulse travels down unaffected bundle branch first, followed by the other)

78
Q

Will the QRS complex be wider or narrower in aberrant conduction?

A

Wider

79
Q

What part of the ECG represents the depolarization of the heart from the SA node through the atria, AV node, and His-Purkinje system?

A

PR interval

80
Q

What causes short PR intervals?

A

Impulse originated in the atria close to or in the AV junction

Travels through abnormal accessory pathways to the ventricles, leading to premature ventricular depolarization called pre-excitation

81
Q

What causes longer PR intervals?

A

Occurs when there is a delay in impulse conduction through the AV node.

For example: 1st Degree AV heart block

82
Q

What can cause varying PR intervals?

A

Wandering atrial pacemaker

2nd-Degree AV Heart Block type I

83
Q

What happens to the PR intervals in 2nd Degree AV heart block, type I?

A

PR intervals get longer and longer until a QRS complex is dropped and the cycle repeats

84
Q

What causes PR intervals to be absent ?

A

Atrial flutter

Atrial fibrillation

3rd degree AV heart block

85
Q

Why is there no PR interval in 3rd degree heart block?

A

Atria and ventricles are beating independently of each other

ECG Both Exams don't delete (A,S,L) (3 decks)

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