CCT Flashcards
1
Q
In the context of ECG, what does electrical alternans primarily suggest?
A
Pericardial effusion
2
Q
How should the electrode be placed to monitor the posterior wall of the heart?
A
In the V7 to V9 positions along the left posterior axillary line
3
Q
What does the presence of Q waves in leads V1 to V3 suggest on an ECG?
A
Anteroseptal myocardial infarction
4
Q
What is the clinical significance of observing tall R waves in lead V1 on an ECG?
A
Right ventricular hypertrophy
5
Q
In which condition is an ECG most likely to show ST-segment elevation in all leads?
A
Acute pericarditis
6
Q
When assessing an ECG, what does a monophasic R wave progression in the precordial leads suggest?
A
Ventricular aneurysm
7
Q
What is the clinical significance of an
ECG showing Osborn waves (J waves)?
A
Hypothermia or hypercalcemia
8
Q
In stress testing, a ‘false positive’ result refers to:
A
An indication of coronary artery disease when none exists
9
Q
The appropriate action if a patient experiences severe shortness of breath during a stress test is to:
A
Terminate the test and monitor the patient
10
Q
What is the significance of a downsloping ST-segment during a stress test?
A
It may indicate myocardial ischemia
11
Q
In the context of ambulatory monitoring, what is the significance of a prolonged QT interval?
A
It indicates an increased risk of torsades de pointes.
12
Q
What is the significance of a U wave on an ECG?
A
It can be associated with conditions like hypercalcemia or hypokalemia.
13
Q
mnemonic FOR LBBB
A
WiLLiaM (w lead 1& m in lead 6
14
Q
mnemonic for RBB
A
MaRRoW (m lead 1 & w in lead 6
15
Q
When instructing a patient on how to prepare for a tilt table test, what is the most critical piece of information to convey?
A
The importance of fasting for several hours before the test
16
Q
When instructing a patient on how to prepare for a tilt table test, what is the most critical piece of information to convey?
A
to fast hours before test
17
Q
What is the appropriate action if a patient experiences a vasovagal reaction during an ECG procedure?
A
Elevate the patient’s legs and monitor vital signs
18
Q
What is the significance of ensuring that the ground electrode is properly attached during an ECG recording?
A
It minimizes interference and enhances signal clarity
19
Q
When performing a 12-lead ECG, what is the impact of incorrectly placing the limb leads?
A
could be a misdiagnosis
20
Q
When analyzing an ECG, what does a prolonged QT interval indicate?
A
Risk of ventricular arrhythmias
21
Q
What adjustment should be made when the ECG trace shows small and low voltage QRS complexes throughout the leads?
A
Increase the gain or amplitude setting
22
Q
In the context of ECG, what does the term ‘electrical axis’ refer to?
A
The primary direction of the heart’s electrical activity
23
Q
What is the primary concern when an ECG shows a ‘tombstone’ appearance in the ST segment?
A
Acute myocardial infarction
24
Q
What is the implication of an inverted U wave on an ECG?
A
Myocardial ischemia
25
During an ECG, why is it crucial to avoid electrode placement over bony prominences?
To reduce impedance and improve signal quality
26
In which scenario would you use a right-sided ECG lead placement?
Evaluation of a right ventricular infarction
27
The heart is divided into ______ chambers:
4
28
What supplies blood to the arterial system after contraction?
The left ventricle
Goes through the aorta and delivers oxygen rich blood to the rest of the body
29
The sensitivity switch controls the:
amplitude
30
Which of the following is a poor conductor of electric current?
Dry skin
31
Pacemaker AV Sequential characteristics
P wave spike
Ventricular spike
Wide QRS complex
32
Biventricular pacing involved placement of
Three leads to allow pacing of both ventricles with a pacer lead in the left atrium
33
A patient has a dual chamber pacemaker due to complete heart block.
What ecg findings indicates that both the atrial and ventricular wires are having an effective action on the patients heart?
P wave after the atrial spike and QRS complex after the ventricular spike
34
Which pacemaker code indicates that a ventricle is sensed, paced, and synchronous with atrial contraction?
DDD
35
Transcutaneous pacemakers can be
Used as an emergency treatment
36
What are the characteristics of a leadless permanent pacemaker?
The pulse generator and electrodes are contained within one smaller device, which is placed inside a chamber of the heart through transvenous insertion
37
The purpose for placing one of the exploring leads of the Holter monitor on or near the V5 position is to
maximizing QRS configuration
38
Which leads in a 12 lead ECG are referred to as augmented limb leads?
avr, avf, avl
39
what is an agonal rhythm
when all of the pacemakers in the heart have ceased to function and the QRS complexes are wide and bizarre with a rate of less than 20 beats per minute?
40
beta blockers do what to an ecg
increase R R interval
41
What is the correct placement for lead V6 when applying chest leads for a 12 lead ECG?
fifth intercostal space, mid axillary line
42
Junctional rhythms occur because the electrical impulse comes from the AV nodal tissue instead of the
SA Node
43
Which of the following is an absolute contraindication to administering Lexiscan (regadenosine)?
3rd degree heart block
44
what does lexiscan do?
increases blood flow in the hearts arteries, like exercise does
45
what meds are used for stress tests
lexiscan
adenosine
dipyridamole
dobutamine
46
Which of the following is a normal ECG response to exercise stress testing?
J point depression
47
Which waveform on an ECG represents ventricular repolarization?
T wave
48
Right ventricular hypertrophy can be identified on a 12 lead ECG by what characteristics? .
Right axis deviation
positive inflection of the t wave
49
What is a common cause of somatic tremor?
patient movement
50
Which atrioventricular block is characterized by PR intervals that remain constant?
second-degree block type II
(Mobitz II
51
The PR interval results from a delay in conduction at what level of the conduction system?
AV node
52
A positive chronotropic effect will result in
increase in heart rate
53
How long does a patient usually wear a Holter monitor?
1-2 days
54
Which rib articulates with the angle of Louis?
2nd rib
55
what is the Angle of Louis
angle between sternum and manubrium, at the junction
56
A normal Q wave represents
depolarization of the interventricular septum.
57
Lead placement for V4R is located where on the patient?
Right 5th int space, mid clavicular line
58
Why might an ECG be performed?
diagnose heart rhythm changes
check for electricity problems
59
While performing a 12 lead ECG, a marked ST elevation appears in leads V1 - V4. Which area of the myocardium is most likely effected?
anteroseptal
60
Vasodilation with exercise will result in
decreased systemic vascular resistance
61
what is Vasodilation
when blood vessels widen, allowing more blood to pass through
62
what does V4R detect
right ventricular infarction
63
What is the proper lead placement for a right side 12 lead ECG?
chest leads only placed in a mirror image of a standard 12 lead ECG
63
Which of the following factors is used in the formula to predict the maximal heart rate for an exercise stress test?
age
63
what is dextocardia
heart is in the right side of your chest and points to the right.
64
Which ECG would you expect the doctor to order when the patient has dextrocardia?
right side 12 lead
65
What should be checked on the ECG machine to ensure it is working properlv?
check for paper
inspect cables for damage
66
During an exercise stress test, a 2.0 mm down sloping ST segment was observed 6 minutes into the Bruce protocol. This would be considered a...
positive test
because this is what the bruce prtocol is supposed to detect
67
When the excitation impulse is propagated from cell to cell within the heart, it is known as
conductivity
68
With exercise, cardiac output increases due to increases in
heart rate and stroke volume
69
Which dysrhythmia is indicated when more than 3 PVC's occur in a row with a ventricular rate of more than 100 beats per minute?
ventricular tachycardia
70
What rhythm has a normal atrial depolarization and a wide QRS complex with QR-R's pattern?
sinus rhythm with RBBB
71
When is it appropriate to contact a patient's family member?
only if the patient has signed a HIPAA form giving permission
72
What cells have the GREATEST automaticity?
SA Nodal Officer
73
Pacemaker stimuli is recorded on the ECG as a(n)
narrow vertical spike
74
A prolonged QT interval due to drug toxicity has an increased risk of
ventricular arrythmias
75
76
Best Leads for Left Atrial Enlargement
Lead II (broad, bifid p wave)
Lead V1 (biphasic p wave)
77
What is a biphasic wave
Wave with a positive and negative deflection
78
What is a bifid wave?
Wave with two peaks
79
Causes of LAE
Mitral Stenosis
Systemic Hypertension
Aortic Stenosis
Mitral Incompetence
Hypertrophic cardiomyopathy
80
Causes of RAE
Pulmonary Hypertension
Heart Valve Disease
Congenital Heart Disease
81
Cause of RVH
Pulmonary Conditions (COPD/Embolism)
Heart Valve Disease (Tricuspid Regurgitation/Pulmonary Stenosis)
Congenital Heart Diseases (ASD/VSD/Tetralogy)
82
Causes of LVH
Hypertension
Aortic Valve Stenosis
Hypertrophic Cardiomyopathy
Intense Training
Diabetes
83
Stenosis meaning
Narrowing
84
Myopathy meaning
Condition that affects the muscles
85
The normal QRS axis of the heart is
-30 degrees and +90 degrees
86
Which two leads are referenced when interpreting axis deviation?
Lead I and aVF
87
Left ventricular hypertrophy is indicated when the combined measured amplitude is greater than or equal to 35 mm in which of the following leads?
V1 or V2 S-wave, V3 or V4 R-wave
88
e
Severe aortic stenosis
Uncontrollable arrhythmias
89
An anterior wall myocardial infarction occurs when anterior myocardial tissue supplied by the _ artery suffers injury due to lack of blood supply.
left anterior descending
90
An anterior wall myocardial infarction occurs when anterior myocardial tissue supplied by the _ artery suffers injury due to lack of blood supply.
left anterior descending
91
Exercise stress testing is MOST OFTEN used to evaluate
ischemic changes due to coronary artery disease
92
What is the heart rate of an ECG with a constant R-R interval of 30 mm recorded at a standard paper speed?
30mm/25mm = 1.2
60/1.2= 50 bpm
(60 seconds)
93
The ability of a positive exercise stress test to correctly identify patients with documented coronary artery disease is known as the test
Sensitivity
94
In stage 3 of the Bruce protocol the treadmill is set at
3.4 14%
95
You are beginning the warmup stage of a treadmill stress test and you observe a 3mm ST segment depression in leads I and aVL. What is the first thing you should do?
stop the treadmill and notify the physician
96
A patient with dextrocardia will need which of the following modifications made to a standard 12-lead ECG? Choose two modifications.
The right arm lead is placed on the left arm.
The left arm lead is placed on the right arm.
97
What is indicated by a PR interval shorter than 120 ms on an ECG?
Accelerated AV nodal conduction
98
In which condition is an ECG most likely to show ST-segment elevation in all leads?
Acute pericarditis
99
Phases in action potentials, that ensure the heart beats in a coordinated rhythm
1. Resting
2. Depolarization
3. Plateau Phase
4. Repolarization
5. Refractory Period
100
Lub (S1)
Mitral and Tricuspid valve closing shut
101
Lub (S1)
Mitral and Tricuspid valve closing shut
102
When does S1 occur?
Beginning of ventricular contraction
(systole)
103
Dub (S2)
Aortic and Pulmonary valves close
104
When does S2 occur?
Beginning of ventricular relaxation
(Diastole) ventricles filling
105
Rhythm
pause, massive QRS with no P, Sinus resumes pacing after one beat
Ventricular Escape Beat
106
Rhythm
pause, P’ with pacing of 60-80
Atrial Escape Rhythm
107
Rhythm
pause, *usually no P wave, pacing of 40-60
Junctional Escape Rhythm
108
Rhythm
(idioventricular) pause, no P wave, massive QRS, pacing 20-40
Ventricular Escape Rhythm
109
an irritable automaticity focus suddenly discharges a single stimulus
Premature Beat
110
one of the ventricles has not depolarized yet, creating a wide QRS,
premature P’ with widened QRS (SA pacing one cycle length)
PAB with aberrant ventricular conduction
111
Hypertrophy Method:
Check V1: P wave for atrial hypertrophy
R wave for right ventricular hypertrophy
S wave depth in V1 + R wave height in V5 for left ventricular hypertrophy
112
AV node is in refractory phase, therefore no QRS
Non conducted PAC
113
How does Lidocaine work?
suppresses ventricles by decreasing automaticity
114
How does Epinephrine work?
Works like adrenaline.
Open airways, stimulate the heart, and increase blood pressure
115
What does Lidocaine inhibit
NA+
116
What 2 things does Epinephrine cause?
Increase HR and contractility
117
What 2 things does Epinephrine cause?
Increase HR and contractility
118
VT, VF, Asystole, PEA, Symptomatic Bradycardia
119
How does Atropine work?
increases SA and AV node activity by blocking vagal reflex
120
When is Atropine used?
Brady, 1st AVB, Wencke, Arrest
121
How does Verapamil work?
blocks CA and NA
122
How does Verapamil work?
blocks CA and NA
123
treats VT and VF
124
Verapamil causes
increased vasodilation
125
Verapamil causes
increased vasodilation
126
What 2 affects does Isuprel have on the body?
control brady and increase CO
127
What does Amiodarone treat?
AT, VT, VF, and SVT
128
What do Direct Arteriolar Vasodilators do?
Widen the small arteries
129
Nitrates are a
venodilator
130
Nitrates work by
relaxing the smooth muscles and decreasing blood flow
131
Acute angina preferrably is treated with
Nitrates
132
Vasodilators do what 3 things?
lower BP
improve patency of coronary arteries
decrease work load
133
Vasodilators are used to mangage what 3 cardiac situations?
hypertension
Congestive heart failure
Coronary Artery Disease
134
4 Classes of Antihypertensives
Alpha Adrenergic Blockers
Diuretics
Ace Inhibitors
Vasodilators
135
3 Antiarrhythmic Types
NA Blockers
Beta Blockers
CA Blockers
136
Lidocaine works by
blocking sodium channels, calming erratic and irregular rhythms (particularly in the ventricles)
137
Beta Blockers are used when arrhythmias are caused by
sympathetic response (stress and anxiety)
138
Beta Blockers are used when arrhythmias are caused by
sympathetic response (stress and anxiety)
139
increasing the duration of the refractory period
140
Class IV antiarrhythmics are
CA blockers
141
ACE Inhibitors have what affect on the body?
lower BP
142
Beta Blockers have what 2 affects on the body?
decrease HR and BP
143
Beta Blockers end in
lol
144
CA Channel Blockers have what 2 affects on the body?
decrease HR and BP
145
CA Channel Blockers end in
pine
146
Digoxin has what affect on the heart rate?
decreases HR
147
Dilators cause the arterial system to
vasodilate
148
Diuretics have what affect on the blood pressure?
decrease BP (K+washing)
149
Intropic affects
contractility
150
Chronotropic affects
HR
151
What effect does Dromotrophic have
The conduction speed of electrical impulses
152
Beta Blockers are an antagonist to
Beta 1 receptors
153
Beta blockers are used to manage what 3 cardiac conditions?
CAD, arrhythmias, and increased BP
154
4 affects of Beta Blockers on the cardiac system
increased R-R
Decrease HR
Decrease BP
Decease contractility
155
Diuretics work by
increasing water loss and decreasing sodium absorption
156
Examples of CA Channel Blockers
Diltazem
Nifedipine
Amiodipine
Verapamil
157
This type of artifact is known for its thick baseline due to continuous electrical activity coming from an external source.
AC INTERFERENCE
158
A regular rhythm at a rate of 40-60 beats per minute, with narrow QRS complexes, and no visible P waves, is consistent with the presence of
Junctional
159
What would be the MOST APPROPRIATE technique when performing a 12 lead ECG on a patient with Parkinson's disease?
Have the patient tuck their backs
160
What would be the MOST APPROPRIATE technique when performing a 12 lead ECG on a patient with Parkinson's disease?
Have the patient tuck their backs
161
What would require a need for chest lead modification for a 12 lead ECG?
Excessive breast tissue
162
Which dysrhythmia is indicated when the pacemaker site shifts between the SA node, AV junction and various locations within the atria?
Wandering pacemaker
163
A portable AED is at the scene of a witnessed sudden cardiac arrest in a public place. What preparation is necessary before you apply the electrodes to the patient's skin?
Quickly wipe the patients skin of dampness and apply electrodes
164
The fifth intercostal space, left midclavicular line is a landmark for what precordial electrode placement?
V4
165
What is the standard calibration for an ECG machine compared to the standard sweep speed while performing ekg
10 mm/mV for calibration compared to 25 mm/mV for performing ECG
166
Metabolic equivalents (METS) are commonly used in exercise protocols to express the
workload in various stages
167
"Classic heart block" is also known as
Third degree block
168
Where would you place the electrodes during a Holter hookup to reduce artifact produced by muscular movements?
Over the ribs
169
Which of the following is a normal response to exercise?
Increased arterial pressure
170
What rhythm has a normal atrial depolarization and a wide QRS complex with QR-R's ?
Sinus w/ RBBB
171
Most common cause to wandering baseline
Poor skin prep
172
What does the vagal reflex do for the heart?
The vagus nerve sends signals to slow down the heart
173
Beta blocker functions
Slow down the heart
Lower blood pressure
Reduce hearts workload
174
NA stands for
Sodium
175
CA stands for
Calcium
176
K stands for
Potassium
