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NP 730 Diagnostic Measures > Cardiac Interpretation > Flashcards

Cardiac Interpretation Flashcards

1
Q

Order of the electrical conduction system of heart

A

SA node → inter-nodal pathways → AV node → Bundle of His → L + R bundle branches → Purkinje fibers

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2
Q

12 Lead EKG and views

A
  • 10 electrodes used → 12 different perspectives
  • Limb leads - Vertical view
    • RA, LA, RL (neutral or grounding lead), LL
  • Precordial Leads - Horizontal view
    • V1 to V6
    • Chest
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3
Q

5 different views of heart (sections)

A
  • Anterior wall
  • Inferior wall
  • Lateral wall
  • Posterior wall
  • Septal wall
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4
Q

Limb leads + where each lead is placed? How is each lead read (L → R)

which one is the neutral lead?

A
  • Einthoven’s triangle
  • Limb leads - VERTICAL VIEW
    • RA, LA, RL (grounding lead), LL
  • Lead 1: R arm → L arm
  • Lead 2: R arm → L leg
  • Lead 3: L arm → L Leg

Reads negative → positive

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5
Q

Which limb lead corresponds to which part of the heart?

A
  • STANDARD LIMB LEADS
    • I: R arm → L arm - lateral wall
    • II R arm → L leg - inferior wall
    • III L arm → L leg - inferior wall
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6
Q

Augmented Limb Leads view

A
  • AVR - junk lead, non-specific view
  • AVL - lateral wall
  • AVF - inferior wall
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7
Q

Limb leads cheat sheet chart

A

aVR - square root of SQUAT

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8
Q

Precordial lead placement

Which view in general vs Limb lead view?

A
  • Limb leads → vertical view
  • Precordial leads → horizontal view
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9
Q

Views of heart on EKG - Precordial Leads (chart)

A

Again, LOOKING AT HORIZONTAL PLANE

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10
Q

Views of heart on EKG

*Contiguous leads*

A

Limb leads and chest leads together

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11
Q

Contiguous leads (slide 12)

A
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12
Q

EKG waveforms: P wave

What does it indicate when this wave is abnormal?

A
  • Atrial DEpolarization (contraction)
  • Starts in SA node
  • P wave absent or abnormal - atria malfunction
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13
Q

EKG wave forms: QRS complex

What does it indicate when this wave is abnormal?

A
  • Ventricular DEpolarization
  • Atrial REpolarization
  • Abnormal → ventricular issue
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14
Q

EKG wave forms: T wave

What does it indicate when this wave is abnormal?

A
  • Ventricular repolarization
  • Same - heart has trouble relaxing and filling with blood - diastole issue
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15
Q

Isoelectric line

A

Considered baseline

EKG waveforms should ALWAYS return to straight and flat level in between complexes

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16
Q

What makes a wave positive or negative?

A
  • A wave of electrical depolarization moves parallel to the direction of a lead.
  • If it moves towards the (+) pole of the lead, a (+) deflection occurs on the EKG.
  • If it moves away from the (+) lead, towards the (-) pole of the lead, a (-) deflection occurs onEKG.
  • Positive wave form → goes up from isoelectric line
    • (-) lead → (+) lead
  • Negative wave form → goes down from isoelectric line
    • (+) lead → (-) lead
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17
Q

What does Lead II mimic?

A
  • REMEMBER: LEAD II = R ARM → L LEG li>
  • Trajectory mimics the natural conduction system of the heart (impulse/conduction of heart)
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18
Q

What is the Axis of the heart?

A

Overall direction of the electrical activity of the heart

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19
Q

What is the correct positioning of the axis?

A

Should be downward and to the left

Between -30 and +90 degrees

20
Q

What does it indicate if the axis is deviated?

Think about the Axis chart of positives and negatives!

A

If axis is deviated, it can indicate various problems such as hypertrophy, BB, tissue damage, conduction abnormalities

Positive = above isoelectric line

Negative = below isoelectric line

RAD = R axis deviation

LAD = left axis deviation

21
Q

Easiest way to determine axis? Which leads would you look at?

A

Look at Leads I (R arm → L arm) and aVF (interior portion of LV)

22
Q

EKG graph paper, what two things does it measure?

A

Time (rate) - horizontal line

Amplitude (voltage) - vertical line

23
Q

EKG squares = what numbers?

A
  • Horizontal:
    • 1 small square = 0.04s (40msec)
    • 1 Large square = 0.2s (200msec)
    • 5 Large squares = 1s (1000msec)
  • Vertical:
    • 1 small square = 1mm (0.01mV)
    • 1 Large square = 5mm (0.5mV)
    • 2 Large squares = 1mV
24
Q

Steps to reading EKG

A
  • Rate
  • Rhythm: regular or irregular
  • Does it look uniform? P wave present?
  • Intervals? PR, QRS
  • Basic rhythm/origin
  • Hypertrophy
    • For now concentrate on ventricular
  • ST segment abnormalities
25
Q

How many seconds is the bottom lead on the EKG paper? Complete Lead II

A

10 seconds

26
Q

Counting the Rate

A
  • Sinus rhythm: count QRS complexes
  • In general
    • count R waves in 6s EKG strip (30 big boxes) X 10
27
Q

Quick Read method order (numbers)

How to utilize method

A
  1. Look at BIG BOX LINES
  2. Look for R wave that is the closest to a BIG BOX LINE
  3. Count L → R
    1. 300 → 150 → 100 → 75 → 60 → 50
  4. Count until next R wave
28
Q

How to determine rhythm on EKG paper?

Which method is the most accurate? Most convenient?

A
  • March it out - pen and paper method
    • Draw two lines on index paper on two R waves
    • March the index card along EKG reading to see if it’s equidistant from each other
  • Calipers - MOST ACCURATE
  • Counting small squares - time consuming
29
Q

What does a lack of uniform or normal appearing P wave mean?

A

Atrial arrhythmia or AV block

PACs - premature atrial contractions

30
Q

Premature atrial contraction (PAC)

A

Dips below isoelectric line

Beat is early and biphasic

31
Q

If PR interval not same length throughout?

A

Think AV block!

PR = atria

32
Q

Normal EKG interval ranges

KNOW THESE NUMBERS

A
  • PR: 0.12 - 0.20s
  • QRS: 0.07 - 0.11s
  • QTc: = < 0.40
33
Q

PR Interval

How it’s measured? What influences it to change?

A
  • Measured from beginning of P wave to beginning of QRS complex
  • Will change w/HR (fast HR = shorter PR)
34
Q

What does the PR interval include in the conduction system

A
  • Includes atrial depolarization, conduction from atria → ventricles through AV node + conduction through His-Purkinje system
  • AKA communication between atria dn ventricles
35
Q

Shortened PR interval VS. Lengthened PR

A
  • Shortened PR = < .12s
    • Conduction bypasses AV node → WPW
  • Lengthened PR
    • Heart block → delayed or lack of conduction through AV node
36
Q

QT interval

Which waveforms does it include? How is it measured? What measurement is it dependent on?

A
  • QRS complex, ST segment, T wave
  • Measure of ventricular repolarization (technically JT segment but usually QT is used)
  • HEART RATE - shorter at faster HR
37
Q

Lengthened QT means?

Which meds will elongate?

A
  • Widened QRS → BBB
  • Sudden cardiac death
  • Elongation can be caused by these meds:
    • Antipsychotics
    • Celexa
    • Quinolones, Zithromax, Cipros
38
Q

QRS complex

What does it indicate? Wide?

A
  • Ventricular depolarization
  • Wide > 110ms = slower conduction time through ventricles - conduction not occurring in Bundle of His
    • Occurs w/BBB, other conduction delays
39
Q

PVCs

A
  • Widened QRS complex appearing earlier than normal
  • QRS often goes in opposite direction (coming from ventricles up)
  • Occasional PVCs not concerning
    • > 3+ = VTach
  • May increase w/hypokalemia
40
Q

T wave

Inverted? Flattened? Peaked? Biphasic?

A
  • Inverted = Ischemia
  • Flattened = Hypokalemia
  • Peaked = Hyperkalemia
  • Biphasic - ischemia

Usually a positive deflection above isoelectric line

41
Q

LVH Equation?

A
  • REMEMBER → each small box = 1mm
  • S wave in V1 (or V2) + R wave in V5 (or V6)
  • If sum > 35mm

OR

  • R wave in aVL > 11mm

count up!!

42
Q

Cause of LVH repolarization changes

What can these result in?

A
  • Can be dx on EKG w/good specificity
  • Thick myocardium → need more electricity to conduct → higher amplitude in ventricular depol.
  • QRS widening too! due to longer travel through whole heart
  • Can result in abnormal ST segments or T waves = LVH w/strain or LVH w/repolarization abnormality
43
Q

ST segment

What is measures? What if it’s abnormal?

J-point?

A
  • After ventricular depolarization and before repolarization
  • Should be flat
    • Elevation → infarction
    • Depression → ischemia
  • Sometimes have a normal rapid upsloping, esp in tachy
  • J-point: intersection of end of QRS and start of ST segment
44
Q

Infarct location corresponding to Coronary artery

A
45
Q

Which leads correspond to which heart?

Slide 62

A

NP 730 Diagnostic Measures (11 decks)

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