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Pathophysiology > Cardio- Airey (EKG) > Flashcards

Cardio- Airey (EKG) Flashcards

1
Q

upward vs downward deflection on EKG

A

An upward deflection is from electrical activity coming toward a positive electrode
A negative deflection is from electrical activity going away from a positive electrode

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2
Q

P wave

A

depol of atria (repol not seen)

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3
Q

PR interval

A

time from initial atria depol to initial depol of ventricles

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4
Q

QRS complex (what are the upward wave(s) )?

A

depol of ventricle

two upward waves? - R and R’

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5
Q

T wave

A

repol of ventricle

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6
Q

QT interval

A

first ventricle depol to final repol

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7
Q

lead I , lead II, lead III

A

Lead I: RA (-) to LA (+) (Right Left, or lateral)
Lead II: RA (-) to LL (+) (Superior Inferior)
Lead III: LA (-) to LL (+) (Superior Inferior)

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8
Q

V1 location

A

4th intercostal space, R sternal border

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9
Q

V2 location

A

4th intercostal space, L sternal border

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10
Q

V3 location

A

between V2 and V4

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11
Q

V5 location

A

horizontally even w/ V4, but in anterior axillary line (more lateral)

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12
Q

V6 location

A

even w/ V4 and V5 but in midaxillary line (more lateral)

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13
Q

place a total of ___ electrodes to get a ___ EKG. where are these placed?

A

10 electrodes for 12 lead EKG

4 on extremities:Anywhere as long as 10cm from heart [One of theses is a ground lead- prevents AC interference- ignore it, usually right leg]

6 electrodes are placed across the chest

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14
Q

where are the 12 leads from

A

6: extremities (I, II, III, AVR, AVL, AVF)
6: chest (V1-V6)

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15
Q

what do the letters in AVR, AVL, AVF mean?

A 
A: augmented
V: voltage
R: right arm
L: left arm
F: left foot
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16
Q

which leads are over the interventricular septum?

A

V3 and V4

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17
Q

what part of the heart are you looking at ? leads I, II, III?

A

I- lateral

II and III: inferior

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18
Q

what part of the heart are you looking at? leads AVR, AVL and AVF?

A

AVR: none
AVL:lateral
AVF: inferior

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19
Q

what part of the heart are you looking at? V1-V6?

A

V1 and V2: septal
V3 and V4: anterior
V5 and V6: lateral

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20
Q

elongated PR interval?

A

heart block in AV node (normal is 0.12 -0.2 seconds) >0.2 is 1st degree AV block

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21
Q

elongated QRS?

A

electricity if spreading through the system slowly or abnormally (normal is <0.12 seconds)

22
Q

how big are the small blocks on EKG? what about the bolded lines?

23
Q

how much time does each block represent on the EKG graph paper?

A

Single square 0.04 sec, 0.20 seconds between 2 heavy lines

24
Q

what would sinus tachy or sinus brady be?

A

Sinus bradycardia- a rate less than 60 beats per minute

Sinus tachycardia- sinus rate more than 100 beats per minute

25
Q

Rate: automaticity foci in atrial foci, AV junction and ventricles?

A

Atrial foci= 60-80/min
AV Junction= 40-60/min
Ventricles= 20-40/min

26
Q

arrhythmia of sinus origin

A

usual conduction pathway, but either too fast, too slow or irregular

27
Q

ectopic arrhythmia

A

rhythms starting at a place OTHER than the SA node

28
Q

reentry arhythmia

A

elec. activity is going on in circles instead of forward through the normal pathway

29
Q

conduction blocks

A

starts normal at SA node but has a block or delay

30
Q

preexcitation syndrome

A

type of arhytmia : elec. activity follow alternate pathway allowing for shortcut through the system.

31
Q

Pwave : QRS complex should be ….

A

one to one

32
Q

hypertrophy (enlarged chamber) can cause what 3 things (seen on the EKG) ?

A
  1. increase the duration of the depolarization: EKG wave will be wider
  2. generate more electrical energy: EKG wave will have greater amplitude
  3. A larger percentage of TOTAL electrical current will move through the chamber which will change the average of the main vector (QRS Axis)
33
Q

what is the QRS axis? how is it measured ?

A

The direction in which most of the electricity is traveling through the ventricles
Measured as a circle superimposed on the chest and given in degrees

34
Q

abnormal QRS axis…

A

With certain abnormalities the QRS axis will point in the wrong direction. E.g. if one ventricles wall is thicker than other, more electricity is running through QRS orientation changes from normal

35
Q

normal axis vs axis deviation

A

Normal: 0 to +90
Right axis deviation (RAD): +90 to 180
Left axis deviation (LAD): 0 to -90
Extreme axis deviation: -90 to 180

36
Q

right axis deviation

A

Negative in I & positive in AVF

Happens in children, tall adult, pulmonary embolism, chronic lung disease

37
Q

left axis deviation

A 
I positive and AVF negative
Look at lead II as a tiebreaker
Positive normal
Negative-left axis  deviation
With left ventricular hypertrophy and inferior MI
38
Q

elongated QT interval?

A

> 0.44 seconds, signals an arrhythmia

39
Q

1st, 2nd and 3rd degree AV blocks

A

AV blocks slow or eliminate the conduction from the atria to the ventricles
1st degree: Lengthens the delay between atrial and ventricular depolarization (PR >0.2seconds)
2nd degree: Some get through , some don’t
3rd degree: Completely blocks conduction of atrial stimulation to ventricles

40
Q

sinus block

A

skip a cycle (flat line on graph then back to normal)

41
Q

block in the AV node vs block in the bundle of His/purkinje system

A

AV node: wenkelbach: progressive lengthening of PR interval until QRS drops,
bundl system: mobitz : normal cycle followed by series w.out QRS

42
Q

3rd degree block

A

P waves made but not passed through ventricle

43
Q

BBB (bundle branch blocks) - right vs left shown on EKG

A

The resulting QRS is a combination of the two ventricles depolarizing and so has “two” R waves. R and R’ (R-prime) in a RBBB and a widened, notched QRS in a LBBB.

44
Q

what leads do you look at for BBB?

A

chest leads: 1 and 2 are right, 5 and 6 are left

45
Q

how would atrial enlargement be seen?

A

See in P wave, best in V1
Two ways:
P wave above and below baseline, biphasic
P wave > 2.5 boxes= right atria enlarged

46
Q

where would ventricular enlargement be seen?

A

QRS complex in chest leads

47
Q

infarction vs ischemia

A

Infarction- heart muscle is dead

Ischemia-heart muscle not getting enough blood

48
Q

where on the EKG can infarction/ischemia be seen?

A

T waves (if inverted)
ST segments: look if its above (infarction) or below (ischemia) baseline and for sloping
Q waves: > One small square wide or 1/3 of QRS amplitude. think MI > 7 days old

49
Q

If isolated T, ST, or Q changes (just in one lead) or in leads that are not in adjacent area of heart then the changes might not be due to _____ could be wrong _____

A

MI or ischemia, could be wrong lead placement

50
Q

what is WPW: wolf-parkinson-white syndrome) ?

A

Extra bundle of tissue (accessory) in AV conduction pathway
Depolarization can go through here faster
Called pre-excitation
Gives a Delta wave on QRS
Looks like a short PR

51
Q

what are you at risk for with WPW?

A

SVT (surpraventricular tachy) w/ rapid conduction

Pathophysiology (28 decks)

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