cardio EKG Flashcards
Telemetry can tell you
Rate and rhythm, but a 12 lead is required for diagnosis.
SA node conduction rate
60-100
The flow is towards the electrode what form will it show?
Deflected above the line
Isoelectric line
Lack of electrical flow
If flowing away from the electrode, what form will it show?
Deflected below the line.
Ventricular conduction rate
20-40
EKG can assess
- Heart Rate
- Rhythm (in great detail)
- Hypertrophy
- Infarction (incipient, acute or old) st depressed or elevated
- Axis (general direction of electrical flow) retrograde or usual waves
What is required for diagnosis?
A 12 lead.
AV node conduction rate
40-60
How do you rate?
300,150,100,75,60,50 or the counting and multiplying by 10.
Wondering baseline
It is NSR but the isoelectric line is shifting, why is this line shifting, because of a moving lead
Artifacts,
Crazy movements on the paper that really does not make it in line with anything else that we see.
No wave pform
Asystoli, flat line, dead
How can you figure out the exact number of beats per minute?
Count the small boxes in between two beat and divide 1500 by that number.
1500/25=60
Nverted P wave think…
Junctional rhythm, that the signal is coming from the AV node and going up towards that electrode that the SA node usualy does conduct to.
Unifocal vs multifocal
Uni, ypu see the same shaped anamoly, but multi, you know it is the same type of arrhythmia, but it just look flipped, so you know that it is the same but just originating from a different spot in the heart, so the electrodes display it differently.
What would shorten the PR wave?
If there is something coming other than the SA node, that since the PR section is how long it takes to get from the AV node to the BoH, so if something else starts activating close to the BoH, then the PR wave will lessen,
Sinus bradycardia:
Everything is normal but the rate is slower than 60
Sinus tachycardia:
Everything is normal but just the rate is more than 100.
Sinus arrhythmia:
rate is within normal limits, rhythmis irregular and corresponds to inspiration.
SINUS PAUSE OR BLOCK:
SA fails to generate impulse
I wonder if this is related to heart blocks, try to keep this in mind until I reach the heart block section.
When you breath more it raises yor heart rate because of inhibition of the vagus nerve.
Like at Vegas, they pump O2 into the casinos, you breath more, your HR goes up, all because of the breathing and how it affects your vagal input.
PREMATURE ATRIAL COMPLEXES(PAC)
A complex, a thing, this word, din’t pay too much attention.
But premature atrial, this is key.
That the atrium fires from somewhere else, not that you will get additional Ps, thats something else, but that the P that you expect to get will look different.
Is it spell,ed Pack or PAC, wow, PAC, thats different right there. So I know that the P is different.
So what do you call strange Ps one after another that they each look different? Not PACs those are once in a while strange Ps, but here each P is strange and different from each other.
WANDERING ATRIAL PACEMAKER
Take the E away from pacemaker and you have PAC maker, so it is a wondering, like by everywhere, atrial, having to do with the atrium, PAC-maker, that each P is strange.
ATRIAL TACHYCARDIA
Not atrial flutter, since there you have the saw tooth multiple Ps for each QRS.
Not Sinus tachycardia, since there the Ps are more well defined.
Here you have one P per QRS, but it loos weirds, it looks like the same as the PACs, but just that you habe one after another at high rates.
A-tach is indeed PACs one after another.
Whats the difference between Atrial Tachycardia and wondering atrial pacemaker?
Atrial Tachycardia is three or more PAC in a row, and PACs are a different type of P wave, but maybe we can say that all the P waves of the Atrial Tachycardia are to look the same, but by wondering Atrial pacemaker, it is just confused, wondering, should I be this type of P wave or should I be that type of P wave.
So it will have each of its P waves looki g different, but Atrial Tachycardia, it is fast and repeared PACs. Are PACs all dofferent P waves? I will say no.
PAROXYSMAL ATRIAL TACHYCARDIA
Only way to differnetiate this from atrial tachycardia is to know the history, that it was sudden onset, but other than that, they look the same.
ATRIAL FLUTTER
Saw tooth, more Ps than QRSs. Like a bird flutters its wings.
Atrial fibrillation.
The artiums are like eheheheheheheh, and the ventricles are irregular, like you are freaking out, I will also freak out, but I will maintain form better than you, since you go eheheheheh.
JUNCTIONAL ESCAPE ARRHYTHMIA
Regular NSR but just missijg the P wave.
Something has escaped us, what could it be?
The P!
Classic sign of the junctional arrythmias are?
Retrograde or non-existant P waves.
JUNCTIONAL TACHYCARDIA
Similar to junctional escape but just faster, usually over 100 BPM
Heart blocks how many
One Ist degree
Two IInd degree
One IIIrd degree
Blocks are like unwanted pauses, and each dufferent variation has a specific name and description.
FIRST DEGREE AV HEART BLOCK
Benign but can progress to higher forms of AV block.
What is happening is that the P wave is very long. That from P to QRS it takes very long to happen.
So the first degree heart block, blocks, or pauses, the first part of the heart rhythm, the P to QRS section.
SECOND DEGREE AV HEART BLOCK
TYPE I – MOBITZ I or Wenckebach
A progression of the first degree, at the P wave lengthens so much that a QRS is dropped.
SECOND DEGREE AV HEART BLOCKTYPE II – MOBITZ II
There will be more Ps than QRSs because the QRS will be droped but the distamces between the P are all the same.
By 2nd degree type I there was dropped QRSs but the Ps were not all distanced equaly from each other.
Here the QRS are droped and not because of the fault if the Ps. But all QRS will have a P.
THIRD DEGREE AV HEART BLOCK COMPLETE HEART BLOCK
AV DISSOCIATION
The atriumsa nd the ventricles are all firing at their own rates.
So all the P are equidistant all the QRS are equidistant, but they are not linked to each other.
By second degree type II the Ps are firing and QRSs usually follow, but sometines do not, here it is, hey I do what I want and you do what you want, choas!
BUNDLE BRANCH BLOCK
QRS WIDE > .12 with development of an R andR′ wave, (notched or peaked ) looks like rabbit ears or letter “M”
The rabbit ears, the notched top, twin mountain peaks.
PVC
No p wave is before the PVC, its like, the ventricles fire all on their own and so when did the atriums indeed fire. They did not. So you will seew idea nd bizzare QRS.
If two PVC look alike, unifocal, if different, multifocal.
BIGEMINY
Every other complex is a PVC
Trigeminy
Every third complex is a PVC
COUPLET
Two PVCs together
TRIPLET
beats of V-Tach,
The ventricles are going.
Reason to stop exercising.
PVCs
Serious if:
• paired (couplet) or alternating (bigeminy)
multifocal
- > 6 per minute
- lands directly on the T wave
- present in runs of 3 or >3
VENTRICULAR ESCAPE
We said by junctional escape that the P wave has escaped, and now we have another escape. A ventricular escape. Are we to only have atrial contraction without ventricular contraction? No, here we also do not have P waves, but we are also having a wacky QRS, looks like the QRS has also escaped us.
VENTRICULAR TACHYCARDIA
Alligator teeth, over and over again.
How many types of VENTRICULAR FIBRILLATION do we have?
Two, coarse and fine.
Coarse VENTRICULAR FIBRILLATION
Looks like a crazy wacky disorganized ventricular tachycardia.
VENTRICULAR FIBRILLATION• Fine
Do not confuse this with A-Flut, A-Flut, has QRSs, but here it is just the QRS going outy, so because they are in general more amplitudious than the P wave, so the ven-fib may look like the a-flut.
AGONAL
• Last stop on way to asystole • Less regular than ventricular escape • Progression is either: • • V-fib→ Agonal → Asystole or Ventricular Escape → Agonal → Asystole
But we see that either way it is agonal to asystole. Either v-fib or v-esc.
• No cardiac output, does not respond to rx
ASYSTOLE
Flatline
Pacing Spikes
Solid lines due to the kick from a pacemaker
Q wave Δ =
INFARCTION
ST ↓ =
ST ↑ =
ISCHEMIA
Infarction
Q Wave
• Widens and Deepens Post MI
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