Cardiovascular Assessment Flashcards
Lateral injury
Leads I, aVL, V5, V6
Lead 3
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.
Wolff-Parkinson White Treatment
Treatment is ablation therapy which is usually done via radiofrequency and an intracardiac catheter
Pulseless Electrical Activity
PEA can be any rhythm on the monitor that is pulseless and not Vtach, Vfib or asystole
There is typically a reversible cause!
Frontal Plane
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
Sinus Rhythms
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
How to measure rate when irregular
take the number of QRSs in 6 seconds and multiply by 10
Asystole
Flatline
Sinus Tachycardia
Atrial Tachycardia
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
Wandering Pacemaker
The QRS will be consisent but the p wave will change shape and where it is located (sometime might not be there)
Premature Ventricular Contraction
Will have a normal underlying sinus rhythm and then a random wide QRS complex in the middle of the rhythm
Define underlying rhythm
Idioventricular Rhythm
Will be regular
BPM is 20-40
No p wave
The QRS is greater the 0.12 (wide) and bizarre
First Degree Heart Block
The PRI interval is long
No dropped beats
Ventricular Tachycardia
150-250 bpm
Will look like a bunch of upsidedown U that are all the same shape and rate
Shockable heart rate
Anterior injury
Seen in V3, V4
Lead AVR
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
Trigeminy PVC
Every third beat is a PVC
Junctional Rhythms
Originate in junction, and retrograde conduction in atria
Inverted or absent p-wave
PVC
Wil have an underlying rhythm and then there is a wide intrupting QRS
Normal PRI
0.12-0.20
ECG Y-axis
The y-axis represents voltage
1 mm= 0.1 mV
Second Degree Heart Block (Mobitz II)
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)
Accelerated Junctional
P wave is inverted and rate is 60-100 with bpm
Leads I, II and III
These are bipolar leads, meaning there are 2 electrodes (positive and negative) to record the tracing
Supraventricular Rhythm
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
Quadrigeminy PVC
Every fourth beat is a PVC
Types of PVC
Unifocal
Bifocal
Couplet
Run
Bigeminy
Trigeminy
Quadrigeminy
Bifocal PVC
Different shapes and different foci
Junctional Escape Rhythm
P wave is inverted and rate is 40-60 with bpm
Unifocal PVC
Same shape and focus
How do you find the QRS Complex
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
Left Axis Deviation:
Lead I: positive and Lead II: negative
Causes:
- Abdominal obesity
- Ascites
- Third trimester pregnancy
- Left ventricular hypertrophy
- LBBB
Run PVC
4 or more PVC together
Each of the 12 Leads:
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