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Final Review > Cardiovascular Assessment > Flashcards

Cardiovascular Assessment Flashcards

1
Q

Wenckebach

A

Type I

Going, Going, Gone (PRI Interval)

AV node “getting tired” and delays are longer each time until a beat is not conducted

Results in a specific pattern in the PRI: longer, longer, (longer)…then a dropped beat

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2
Q

Lateral injury

A

Leads I, aVL, V5, V6

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3
Q

Lead 3

A

Lead three has perpendicular movement to the dominant electrical current in the heart (from base to apex) therefore flattened more not as high of a deflection.

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4
Q

Wolff-Parkinson White Treatment

A

Treatment is ablation therapy which is usually done via radiofrequency and an intracardiac catheter

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5
Q

Pulseless Electrical Activity

A

PEA can be any rhythm on the monitor that is pulseless and not Vtach, Vfib or asystole

There is typically a reversible cause!

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6
Q

Frontal Plane

A

While the electrodes are RA, LA, RL and LL they are often placed in the corresponding positions on the anterior chest wall.

This is more convenient and reduces artifact due to movement.

All 6 frontal plane leads (limb leads) use a combination of the same three electrodes attached to the arms and legs

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7
Q

Sinus Rhythms

A

All originate in the sinus node and therefore all have upright, round P-waves throughout the strip. There is one P wave per QRS.

Differences in Sinus Rhythms

  • Rate: differentiates NSR from sinus brady from sinus tachy
  • Regularity: sinus arrhtymia is irregular

Sinus Rhythms:

  • Normal sinus rhythm
  • Sinus bradycardia
  • Sinus tachycardia
  • Sinus arrhythmia
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8
Q

How to measure rate when irregular

A

take the number of QRSs in 6 seconds and multiply by 10

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9
Q

Asystole

A

Flatline

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10
Q
A

Sinus Tachycardia

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11
Q

Atrial Tachycardia

A

Usually between 150-250 bpm

the p wave is flattened, peaked, and diaphasic and may be hidden

If the p wave is hidden it is a SVT

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12
Q

Wandering Pacemaker

A

The QRS will be consisent but the p wave will change shape and where it is located (sometime might not be there)

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13
Q

Premature Ventricular Contraction

A

Will have a normal underlying sinus rhythm and then a random wide QRS complex in the middle of the rhythm

Define underlying rhythm

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14
Q

3rd Degree Heart Block

A

P Wave and QRS Complex have no relation

Atria depolarizing as normal but no signal gets through; either junction or ventricles takes over pacing of ventricles (at inherent rate and associated QRS width)

These two events (atrial and ventricular depolarization) occur simultaneously but independently, thus, the apparent PRI is random and unrelated to the QRS

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15
Q

Idioventricular Rhythm

A

Will be regular

BPM is 20-40

No p wave

The QRS is greater the 0.12 (wide) and bizarre

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16
Q

First Degree Heart Block

A

The PRI interval is long

No dropped beats

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17
Q

Ventricular Tachycardia

A

150-250 bpm

Will look like a bunch of upsidedown U that are all the same shape and rate

Shockable heart rate

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18
Q

Anterior injury

A

Seen in V3, V4

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19
Q

Lead AVR

A

AVR=right arm is postive electrode

The direction of electrical activity in the heart is almost exactly opposite to this vector

This results in negative deflections on the ECG

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20
Q

Trigeminy PVC

A

Every third beat is a PVC

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21
Q

Junctional Rhythms

A

Originate in junction, and retrograde conduction in atria

Inverted or absent p-wave

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22
Q

PVC

A

Wil have an underlying rhythm and then there is a wide intrupting QRS

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23
Q

Normal PRI

A

0.12-0.20

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24
Q

ECG Y-axis

A

The y-axis represents voltage

1 mm= 0.1 mV

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25
Q

Second Degree Heart Block (Mobitz II)

A

When there is a PRI it will be constant but every so often a P wave will just not be there

AV node is unreliable results in dropped beats without warning; can be random or in a pattern (e.g. every third beat)

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26
Q

Accelerated Junctional

A

P wave is inverted and rate is 60-100 with bpm

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27
Q

Leads I, II and III

A

These are bipolar leads, meaning there are 2 electrodes (positive and negative) to record the tracing

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28
Q

Supraventricular Rhythm

A

Technically in order to classify the type/origin of the tachycardia you need to be able to see the p-wave

At rates greater than 150 bpm it is unlikely that you will be able to see p waves as they will be hidden in the t wave

SVT is a descriptive term applied to tachycardias that cannot be differentiated because the P waves are not able to be visualized

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29
Q

Quadrigeminy PVC

A

Every fourth beat is a PVC

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30
Q

Types of PVC

A

Unifocal

Bifocal

Couplet

Run

Bigeminy

Trigeminy

Quadrigeminy

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31
Q

Bifocal PVC

A

Different shapes and different foci

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32
Q

Junctional Escape Rhythm

A

P wave is inverted and rate is 40-60 with bpm

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33
Q

Unifocal PVC

A

Same shape and focus

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34
Q

How do you find the QRS Complex

A

Look for the biggest QRS complex on a frontal plane lead and use the lead to determine.

Note: If the biggest deflection is negative then the axis is directly opposite of that l

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35
Q

Left Axis Deviation:

A

Lead I: positive and Lead II: negative

Causes:

  • Abdominal obesity
  • Ascites
  • Third trimester pregnancy
  • Left ventricular hypertrophy
  • LBBB
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36
Q

Run PVC

A

4 or more PVC together

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37
Q

Each of the 12 Leads:

A

View the electrical activity of the heart from different angles

Have both a positive and negative component

Monitor specific parts of the heart.

Always done from the point of view of the positive electrode in that lead

38
Q

V1

A

4th intercostal, right sternal border

39
Q

QRS Axis

A

The QRS axis is the direction of the electrical current during depolarization of the ventricles

Normally lead 1 and 2 are positive meaning the majority of QRS will be positive (above isoelectric sign), if this is not true than there is an axial deviation

40
Q

Right Axis Deviation

A

Lead I: negative and Lead II: positive

Causes:

  • Cor Pulmonale
  • RV hypertrophy
  • PE
  • RBBB
41
Q

ECG X-axis

A

The x-axis is a representation of time

1 mm (1 little square) = 0.04 s

5 mm = 0.20 s

42
Q

Ventricular Rhythm

A

Originates outside normal conduction pathway, resulting in a wide bizarre QRS

AV Node acs as a one way valve and thus no depolarization of the atria occurs and no p-wave are visualized

43
Q

Pulseless Electrical Activity (PEA)

A

Will be no electrical activty on the ECG monitor

Is any pulseless rhythm except for V fib, V tach, or asystole

44
Q

Leads AVR, AVL and AVF

A

These are unipolar leads (records only from one electrode)

The center of the heart will be the negative reference point

All precordial (chest) leads are unipolar

Called augmented leads as the ECG machine must amplify the signal

These signals are created by making one of the limb leads positive and the other limb leads negative

Gives a horizontal view of the heart

Very useful in diagnosing the location of an MI

45
Q

Premature Junctional Contraction

A

P Waves will be inverted

Underlying Rhythm

46
Q

Different Types of Tahycardia

A

Sinus Tachycardia 100 – 160 bpm

Atrial Tachycardia 150 – 250 bpm

Atrial Flutter (atrial rate) 250 – 350 bpm

Junctional Tachycardia 100 – 180 bpm

47
Q

Lead AVF

A

Foot is positive electrode

48
Q

Septal injury

A

V1, V2

49
Q

V4

A

5th intercostal, mid-clavicular line

50
Q

Idioventriculat Rhythm

A

20-40 bpm

no p wave

51
Q

Amplitude of R Waves from V1-V6

A

From V1-V6 the amplitude of R waves should increase and the amplitude of S waves should decrease

52
Q

LEAD 2

A

This is the most commonly monitored lead

Direction of heart’s electrical activity is towards the positive electrode \ results in the most positive deflection for all ECG activity

53
Q

QRS Height

A

QRS will change in height between different leads

All 6 frontal plane leads (limb leads) use a combination of the same three electrodes attached to the arms and legs!

If electricity flows towards the positive electrode it results in an upright image on the ECG

If the electricity flows towards the negative electrode (or away from the positive) it results in an inverted image on the ECG-a negative deflection is seen

What do you think happens when the electrical impulse travels perpendicular to this axis? Perpendicular=straight line=no deflection

54
Q

Wolff-Parkinson White

A

A congential malformation resulting in a accessory atrioventricular pathway which allow the AV nose to activate ventricles prematurely

The risk is the potential rapid ventricular response

Atrial fibrillation will occur in 1/5 to 1/3 of WPW patients

More common in men

55
Q

Premature Atrial Contraction (PAC)

A

Will have an ectopic beat that intruppts the underlying regular rhythm

The P wave of the premature beat will look different than that of the underlying rhythm (this also may change the PRI interval as well)

56
Q

Einthoven’s Triangle

A

Named after an early pioneer in electrocardiography

The vector direction of Leads I, II and III form a triangle

57
Q

When is an ST elevation consider pathological

A

If it occurs in two or more anatomical continguous leads

58
Q

12 Lead ECG

A

A 12 lead ECG has 4 limb electrodes, and six chest electrodes.

6 are STANDARD limb leads

6 are PRECORDIAL (chest) leads.

59
Q

Sinus Tachycardia

A

Rate is over than 100 bpm

P wave before very QRS

PRI is 0.12-0.20

QRS is less than 0.12

60
Q

Direction of Heart

A

From the base of the heart (Upper) the apex if in a RIGHT TO LEFT direction

Think apex is nearer the armpit, base is closer to the breast bone.

For a normal healthy heart the direction is always the same

61
Q

V6

A

5th intercostal, mid-axillary line

62
Q

R and S waves in V3 or V4

A

In V3 or V4 the R and S waves should be approximately equal size

63
Q

Atrial Flutter

A

Atrial rate between 250-350

Sawtooth patteren

QRS will be between 0.12-0.20 and all the same shape

64
Q

Normal Sinus Rhythm

A

Rate between 60-100

PRI is between 0.12-0.20

QRS less than 0.12

65
Q

V3

A

placed between V2 and V4

66
Q

Couplet

A

2 PVC together

67
Q

Sinus Bradycardia

A

Rate is less than 60 bpm

P wave before very QRS

PRI is 0.12-0.20

QRS is less than 0.12

68
Q

Wolff Parkinson White ECG

A

Patient is usually in as normal sinus rhythm but re-entry causes a tachycardia

PR is usually < 0.12s

QRS complex > 0.11

Has a characteristic “slur” (delta wave)

69
Q

Where do most myocardial infarctions occur?

A

Most myocardial infarction occur in the left ventricle which is why most leads look at the left ventricle

70
Q

Ventricular Fibrillation

A

Shockable heart rhythm

Completely irregular

71
Q

Bigeminy PVC

A

Every Second beat is a PVC

72
Q

V2

A

4th intercostal, left sternal border

73
Q

Atrial Tachycardia

A

Bpm will usually be between 150-250

The shape of the p wave will be flattened, peaked, or diaphasic and can blend into the T wave

Unlike atrial flutter will still and an isoelctrical baseline (stright line where they originate from)

74
Q

Premature Atrial Contraction

A

Will have an ectopic beat that will intrupt the underlying rhythm (it is a premature p wave). In order for a premature beat to be considered an PAC there must be an upright P wave.

Remeber to name the uderlying rhythm

75
Q

Atrial Rhythms

A

Impulse originate in atria

Funny p waves (peaked, notched, flattened, or biphasic)

76
Q

Wandering Pacemaker

A

60-100 bpm (may be slower)

The p wave keeps changing

77
Q

V5:

A

placed between V4 and V6

78
Q

How to measure Rate

A

Count the little square between a QRS complex and then divide by 1500

79
Q

Paroxysmal SVT

A

PSVT = paroxysmal SVT, it occurs and ends without warning

80
Q

Normal QRS

A

Less than 0.12

81
Q

Junctional Tachycardia

A

P wave is inverted and rate is 100-180 with bpm

82
Q

ECG Recording

A

All ECG will use the same paper which runs through the at the same speed (25 mm/sec)

Small Squares- 1 mm2

83
Q

Lead AVL

A

Again=perpendicular to hearts electrical activity so… flattened view.

Tip to remember= a means augmented V means voltage R=right,L=left,F=foot!!

So AVL means positve electrode is Left, where is the positive electrode for avF?

84
Q

Atrial Fibrillation

A

No true P wave only a squiggly line

QRS will be between 0.12-0.20 and all the same shape

85
Q

Inferior injury

A

Leads II, III, aVF

86
Q

Pulseless Rhythms

A

There are 4 pulseless rhythms

  1. Ventricular Tachy
  2. Ventricular Fib
  3. Asystole
  4. PEA
87
Q

First Degree Heart Block

A

the PRI will be more than 20 secs

88
Q

Sinus Arrhythmias

A

Will look like a normal rhythm wilth P waves, PRI, and QRS

The distinguishing factors rhythm and time between beats will vary as a person inhales and exhales (will be a regular irregular pattern)

The rate will usually be between 60-100 but can be slower

89
Q

LEAD I

A

Goes toward the positive therefore + deflection on ECG

Remember electrical flow through the heart goes from base to apex!!!!

90
Q

Heart Blocks

A

Delay in conduction to the ventricle or may block it completely

Final Review (27 decks)

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