Chapter 2: Recording the EKG

Question 1

The smallest divisions on EKG graph paper are…

Answer 1

…one millimeter (mm) squares.

p. 31

Question 2

Between the heavy black lines are __ small squares.

Answer 2

5

p. 31

Question 3

The height and depth of a wave are measured vertically from the baseline in millimeters, and this vertical _________ represents a measure of _______.

Answer 3

amplitude
voltage
(p. 32)

Question 4

Ten millimeters vertically represents ___ _________ (__), however, in practice, one usually speaks of millimeters.

Answer 4

one millivolt (mV)
(p. 32)

Question 5

The amount of time represented by the distance between 2 heavy black lines is…

Answer 5

… 0.2 sec.

p. 34

Question 6

Each small division between two fine lines represents…

Answer 6

… 0.04 of a sec (four hundredths of a second)

p. 34

Question 7

The conventional standard for where to place limb electrodes is on the…

Answer 7

…right arm, left arm, and left leg.

p. 37

Question 8

The placement of these 3 limb electrodes is the same as originally used by…

Answer 8

…Willem Einthoven.

p. 37

Question 9

Recording a lead…

Answer 9

…requires at least two electrodes.

p. 37

Question 10

Because one electrode is ________ and one is ________, these leads are called “_______” limb leads.

Answer 10

positive, negative, bipolar

p. 38

Question 11

Lead I is horizontal, and its ____ arm electrode is ________, while its right arm electrode is ________.

Answer 11

left, positive, negative

p. 38

Question 12

When looking at lead III, the ____ arm electrode is now ________, and the left leg electrode is ________.

Answer 12

left, negative, positive

p. 38

Question 13

The EKG machine permits us to make any skin electrodes…

Answer 13

…positive or negative depending on which lead the machine is recording.
(p. 38)

Question 14

The bipolar limb lead configuration is sometimes called…

Answer 14

…“Einthoven’s triangle”.

p. 38

Question 15

The three bipolar limb leads can be moved to the center of the imaginary triangle, producing…

Answer 15

….3 intersecting lines of reference, which remain at the same angles relative to each other.
(p. 39)

Question 16

The AVF lead uses the ____ ____ electrode as ________ and both arm electrodes as a common ground (________).

Answer 16

left foot
positive
negative
(p. 40)

Question 17

Who designed and introduced the augmented limb leads?

Answer 17

Dr. Emanuel Goldberger

p. 40

Question 18

Dr. Goldberger discovered that in order to record a lead in this manner, he had to _______ (augment) the voltage in the EKG machine to match the wave _________ of leads I, II, and III.

Answer 18

amplify, magnitude

p. 40

Question 19

Where did the name AVF originate?

Answer 19

A (Augmented), V (Voltage), (left Foot)

p. 40

Question 20

AVF is essentially a combination of…

Answer 20

…leads II and III.

p. 40

Question 21

For the AVR lead, the _____ arm electrode is ________, and the remaining two electrodes are ________.

Answer 21

right, positive, negative

p. 41

Question 22

For the AVL lead, the _____ arm electrode is ________, and the remaining two electrodes are ________.

Answer 22

left, positive, negative

p. 41

Question 23

How do you remember which lead is positive in each of the augmented leads?

Answer 23

AVR - right arm positive
AVL - left arm positive
AVF - foot (left foot) positive
(p. 41)

Question 24

These augmented limb leads are sometimes called the “________” limb leads, stressing the importance of the ________ electrode.

Answer 24

unipolar, positive

p. 41

Question 25

The augmented limb leads intersect at __ degree angles.

Answer 25

60

p. 42

Question 26

All 6 limb leads meet to form six intersecting leads that lie in the “_______” plane on the patient’s chest.

Answer 26

frontal

p. 43

Question 27

Which leads are considered the inferior leads?

Where is the positive electrode for these leads?

Answer 27

leads II, III, and AVF
positive left foot electrode
(p. 47)

Question 28

Which leads are considered the lateral leads?

Where is the positive electrode for these leads?

Answer 28

I and AVL
positive left arm electrode
(p. 47)

Question 29

Are the V1 - V6 electrodes positive or negative?

Answer 29

positive

p. 48

Question 30

In general, each of the chest leads (V1 - V6) is oriented through the __ ____ and projects through the patient’s ____ which is negative.

Answer 30

AV node, back

p. 49

Question 31

If leads V1 through V6 are imagined to be the spokes of a wheel, the center of the wheel is the…

Answer 31

…AV node.

p. 49

Question 32

The chest (precordial) leads were introduced by…

Answer 32

…Dr. Frank Wilson.

p. 49

Question 33

On the V1 chest lead, the QRS complex is mainly…

Answer 33

…negative.

p. 50

Question 34

On the V6 chest lead, the QRS complex is mainly…

Answer 34

…positive.

p. 50

Question 35

When looking at V6, we know that the mainly _______ QRS complex is produced by ventricular depolarization moving toward the ________ chest electrode of V6.

Answer 35

positive; positive

p. 50

Question 36

Leads V1 and V2 are oriented over the…

Answer 36

…right side of the heart.

p. 51

Question 37

Leads V5 and V6 are oriented over the…

Answer 37

…left side of the heart.

p. 51

Question 38

Leads V3 and V4 are generally oriented over the…

ALERT!! NOTE THIS INFORMATION FOR THE EXAM

Answer 38

…interventricular septum.

THAT SAID, Dr. Miller’s PPT states that V1 and V2 best record electrical activity of the septum. This is different from what is presented in Dubin’s book.
(p. 52)

Question 39

The interventricular septum is the common ____ shared by the right and left ventricles. It also contains the _____ and ____ ______ ________.

Answer 39

wall, right and left bundle branches

p. 52

Question 40

The six limb leads lie in the _______ plane, while the six chest leads lie in the __________.

Answer 40

frontal, horizontal

p. 53