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MS1 Spring > Cardio Fun Facts > Flashcards

Cardio Fun Facts Flashcards

things I just need to memorize

1
Q

A consistent upright P wave in lead II tells you what?

A

Activation of the atria is right to left and superior to inferior (aka normal)

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2
Q

What does a P wave amplitude > 2.5 mm represent?

A

Right atrial enlargement

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3
Q

What does wide, biphasic P waves in V1 or wide, notched P waves in II and III correlate with?

A

LA enlargement or LA pressure overload

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4
Q

What is the PR interval? What does it measure?

A

Starts at the beginning of the p wave and ends at the beginning of the QRS

It measures the time the electrical stimulus takes to travel from the atria to the ventricles

Also called the AV interval

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5
Q

What is a normal PR interval?

A

< 200 ms (aka one big box)

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6
Q

What does a prolonged PR interval suggest?

A

Delay in the AV node (primary AV block according to Boards) or the His-purkinje system

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7
Q

What two major structures decide the PR interval?

A

AV node and His-purkinje system

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8
Q

What does QRS represent?

A

Time and direction of ventricular deplarizaion

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9
Q

What is a normal QRS range?

A

< 100 msec

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10
Q

What is considered a mild QRS delay?

A

100 - 120 msec

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11
Q

What is considered an abnormal QRS delay? What is this most often called?

A

> 120 msec

Bundle branch block

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12
Q

What does the T wave represent?

A

Ventricular repolarization

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13
Q

What does the ST interval give us insight into?

A

Ischemia and injury

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14
Q

What is the QT interval?

A

Measured from the start of the QRS to the end of the T wave

Reflects both depolarization and repolarization time

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15
Q

What QT interval is normal for men?

A

< 450 msec

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16
Q

What QT interval is normal for women?

A

< 470 msec

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17
Q

What QT interval range is considered “significantly prolonged”?

A

Over 500 msec

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18
Q

Why does QT have to be corrected?

A

Because its rate dependent

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19
Q

What is the formula for QTc?

A

QTc = QT interval in msec / square root of the R to R interval in seconds

Note: At 60 bpm the QT interval = QTc

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20
Q

What will QTc do to HR lower than 60? Greater than 60?

A

Lower than 60: correct shorter

Greater than 60: correct longer

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21
Q

The axis on a 12 lead ECG refers to what?

A

QRS axis since the ventricles overwhelmingly dictate the summed vector due to their mass

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22
Q

What leads are used to determine axis?

A

Only the limb leads (because its done in the frontal plane)

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23
Q

What is considered normal axis?

A

-30 to +110 or so, varies by author and lecturer

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24
Q

What are the important leads for determining the QRS axis?

A

I, II, and aVF

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25
Q

What do leads I, II, and aVF show in left axis deviation?

A

I (+)

II, aVF (-)

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26
Q

What do leads I, II, and aVF show in right axis deviation?

A

I (-)

II, aVF (+)

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27
Q

What do leads I, II, and aVF show in extreme axis deviation?

A

I, II, aVF (-)

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28
Q

Changes in the direction of the QRS axis can suggest what?

A

Myocardial thickening, myocardial enlargement, delay in conduction

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29
Q

How is hypertrophy measured?

A

QRS amplitude

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30
Q

Prominent voltage for R wave in lead v1 suggests what?

A

right ventricular hypertrophy

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31
Q

Prominent voltage (large R or S waves) in the precordial leads suggests what?

A

Left ventricular hypertrophy

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32
Q

Prominent voltage for R wave in the aVL lead suggest what?

A

left ventricular hypertrophy

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33
Q

What is the “strain pattern”?

A

Repolarization abnormality often seen with left ventricular hypoertrophy

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34
Q

What is the Cornell criteria for LVH voltage?

A

Voltage of S wave in V3 (negative direction) + voltage of R wave in aVL (positive direction) added together

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35
Q

What is LVH in men according to Cornell criteria? In women?

A

Men: > 24 mm (2.4 mV)

Women: > 20 mm (2.0 mV)

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36
Q

Higher QRS amplitude or voltage combined with changes in the QRS axis suggest what?

A

thickening or enlargement of the myocardium

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37
Q

How can you identify a left atrial abnormality on an EKG?

A

P wave duration > 120 msec in lead II

P wave notching

Bi-phasic/Negative p wave in V1 at least one small box wide and deep (1mm )

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38
Q

How can you identify a right atrial abnormality on an EKG?

A

P wave amplitude in lead II > 2.5 mm

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39
Q

What QRS duration is indicative of a left or right bundle branch block?

A

Prolonged > 120 msec (incomplete is 100 to 120)

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40
Q

How can you identify a left bundle branch block on an ECG (three things)?

A
  1. rS or QS complex (no R wave) in the right precordial leads V1 and V2
  2. Secondary ST and T wave changes opposite in direction to the major QRS deflection (look for T wave inversion in I, V5, V6 with ST elevation and upright T wave in V1 and V2)
  3. Broad, monophasic R waves in leads I, V5, and V6
41
Q

Left bundle branch block is seen in what pathologies?

A

LVH, MI, organic heart disease, congenital heart disease, degenerative conduction system

Rarely seen in a normal heart

42
Q

How can you identify a right bundle branch block on an ECG (three things)?

A
  1. Secondary R wave (R1) in V1 and V2. R’ is usually taller
  2. Prominent slurred S waves in leads I, aVL, V5, and V6
  3. Secondary ST and T wave changes may or may not be seen in V1 and V2
43
Q

Do we ever seen right bundle branch block in normal hearts?

A

Yes, juveniles often have incomplete RBBB on ECG

44
Q

Right bundle branch block is seen in what pathologies?

A

Hypertensive heart disease, cardiomyopathy, degenerative disease of the conduction system, Cor pulmonale, etc

45
Q

If QRS morphology does not resemble either a typical RBBB or LBBB what do we call this?

A

Non-specific intraventricular conduction delay (QRS > 100 msec)

46
Q

What is the most common intraventricular conduction delay?

A

Left anterior fascicular block

47
Q

How can you identify a left anterior fascicular block on an ECG?

A

QRS delay of 90 to 110 msec; left axis deviation (between -45 and -90 degrees); S wave > R wave in II, III, aVF

48
Q

How can you differentiate a left anterior fascicular block from a posterior block?

A

Posterior has a right axis deviation whereas an anterior has a left axis deviation

49
Q

What is a bifascicular block?

A

RBBB plus fascicular block + either left or right axis deviation

** Must exclude other causes for axis deviation

50
Q

What is ventricular pre-excitation?

A

An electrical connection between the atrium and ventricle that allows an electrical impulse to bypass the AV node

These connections are called accessory pathways & can exist anywhere along the septum and the tricuspid and mitral valve annuli

51
Q

Ventricular pre-excitation is part of what syndrome?

A

WPW (Wolff, Parkinson, White) Syndrome

** Must have palpitations along with pre-excitation to be WPW, otherwise its just WPW pattern

52
Q

What direction does conduction travel in ventricular pre-excitation?

A

Both directions

Atrium to ventricle = antegrade

Ventricle to atria = retrograde

53
Q

When conduction is present in antegrade what do we see on ECG?

A

Delta wave (slurred upstroke of the QRS) and a shortened PR interval

54
Q

What is “orthodromic AV reentrant tachycardia”?

A

Narrow SVT complex

90% of WPW patients will have this

55
Q

What are the three ECG findings for WPW syndrome?

A
  1. Short PR interval < 120 msec
  2. Delta wave (every beat is a fusion beat)
  3. Prolonged QRS
56
Q

What is a delta wave?

A

Seen in pre-excitation; it’s a short PR interval due to conduction through an accessory pathway reaching the ventricle faster than through the AV node. This produces a fused ventricular activation and a short PR interval (< 120msec)

57
Q

90% of accessory pathway mediated tachycardia use what pathway?

A

Orthodromic (antegrade)

10% are antidromic (retrograde)

58
Q

Why are accessory pathways bad?

A

They conduct rapidly and with short refractory periods (unlike the AV node)

The impulses can induce ventricular fibrillation

59
Q

What is a 1st degree AV block?

A

PR interval > 200 msec, P waves are consistently before each QRS

Can happen at any HR

60
Q

What is a Mobitz I (Wenkebach) AV block?

A

Second degree AV block

Progressive PR prolongation with eventual non-conduction (dropped beat)

Subtle shortening in each R to R interval

61
Q

What are the two types of second degree AV block?

A

Mobitz I (Wenkebach) and Mobitz II

62
Q

What is a Mobitz II AV block?

A

2nd degree block

PR interval is stable with intermittent non-conducted (dropped) beats

63
Q

Which 2nd degree AV block is worse?

A

Mobitz II

Higher risk of developing complete AV block

64
Q

What does it mean when we see no QRS complexes on the ECG?

A

3rd degree heart block

Note: will still see p waves because SA node is firing

65
Q

What is complete (3rd degree) heart block?

A

P waves and QRS complexes are happening but there is zero relationship between the two. Just firing on their own

66
Q

What is advanced heart block?

A

SOME relationship between P waves and QRS complexes - aka every once in awhile a P wave conducts to a QRS complex but mostly its just all over the place like complete heart block

67
Q

What is an escape rhythm?

A

A subsidiary pacemaker that arises from the ventricular septum or ventricle itself during complete AV block

68
Q

What is a junctional escape rhythm?

A

Narrow QRS (<120 msec) and a HR 40 - 60 bpm

69
Q

What is a ventricular escape rhythm?

A

Wide QRS (> 120msec) and a HR of 20 - 40 bpm)

70
Q

What is bradycardia with no visible P waves?

A

Sinus arrest (or sick sinus syndrome)

71
Q

What is a premature atrial complex (PACs)?

A

Atrial beats arriving earlier than the expected next sinus beat (looks a little abnormal on ECG)

Typically associated with narrow QRS

72
Q

What is a premature ventricular complex (PVCs)?

A

Ventricular beats arriving earlier than the expected R to R interval

no preceding P wave

wide complex

73
Q

How does supraventricular tachycardia (SVT) appear on ECG?

A

Narrow and fast with no p-wave

74
Q

What condition presents with irregular, narrow QRS tachycardia?

A

Atrial fibrillation

No p waves!!

75
Q

What conditions present with regular narrow QRS tachycardia?

A

AVNRT, AVRT/WPW Syndrome, atrial tachycardia, atrial flutter, sinus tachycardia

76
Q

If you see a “saw tooth” pattern on ECG what should you suspect?

A

atrial flutter

77
Q

How does ventricular tachycardia appear on ECG?

A

Wide QRS, no P wave

78
Q

Two types of ventricular tachycardia?

A
  1. Monomorphic ventricular tachycardia (focal, QRS stays the same)
  2. Polymorphic VT (ischemia or Torsades de Pointe)
79
Q

What causes Torsades de Pointe?

A

Congenital Long QT Syndrome, certain drugs (antibiotics, anti-psychotics, anti-depressants, anti-arrhythmic), and bradycardia-induced long QT

80
Q

Mutations in what two things cause congenital long QT syndrome?

A

potassium and sodium channels

81
Q

What causes Torsades de Pointe?

A

An abnormality in ventricular repolarization

82
Q

How does ventricular fibrillation appear on ECG?

A

Wide, very fast, low amplitude, irregular ventricular rhythm

Causes sudden death unless defibrillated

83
Q

Three causes of ventricular fibrillation?

A
  1. Idiopathic
  2. Ischemia (acute MI)
  3. Cardiomyopathy (“a sick heart”)
84
Q

What is cardiac ischemia?

A

Diminished blood supply to a certain territory of myocardium

85
Q

How does cardiac ischemia manifest on an ECG?

A

Repolarization abnormalities (T wave inversion, ST segment depression)

86
Q

What leads typically correspond to the right coronary artery?

A

II, III, and aVF

87
Q

What leads typically correspond to the left circumflex artery?

A

I and aVL

88
Q

What leads typically correspond to the LAD?

A

V1, V2, V3

89
Q

What leads typically correspond to the left circumflex artery and LAD?

A

V4, V5, V6

90
Q

What amount of ST segment depression is considered significant for ischemia?

A

More than 1mm (1 small box) in at least 2 contiguous leads

91
Q

What is myocardial injury?

A

Absent blood supply to a territory of myocardium

92
Q

How does myocardial injury manifest on ECG?

A

Changes in repolarization (ST segment elevation)

93
Q

What amount of ST segment elevation is considered significant for myocardial injury?

A

Greater than 1mm (1 small box) of elevation in at least 2 contiguous leads

94
Q

What finding on ECG tells you the chronicity of a myocardial infarction?

A

Q waves

95
Q

If you see this on an ECG then you know an MI event is within 1 to 2 hours old

A

ST elevation without Q waves

96
Q

If you see this on an ECG then you know an MI event is within several hours old

A

Q waves associated with ST elevation

97
Q

If you see this on an ECG then you know an MI event is at least half a day old (even years old!)

A

Q waves without ST changes

98
Q

Q waves are considered representative of infarction if they are at least what height and width?

A

1 small box deep and one small box wide in at least 2 contiguous leads

MS1 Spring (10 decks)

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