Chapter 7 PowerPoint Flashcards

1
Q

What leads to look at for axis deviation?

A

Lead I
aVf

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2
Q

+ lead 1 and + aVf?

A

Normal QRS axis

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3
Q

+ lead 1 and - aVf?

A

Left axis deviation

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4
Q
  • lead 1 and + aVf?
A

Right axis deviation

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5
Q
  • lead 1 and - aVf?
A

Extreme axis deviation

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6
Q

Chamber enlargements can be seen on ____?

A

ECG’s

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7
Q

How do chamber enlargements present themselves on ECGs?

A

Changes are noted in Amplitude, morphology, and duration of P wave, QRS complex, T wave or ST segments

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8
Q

What are the 3 different ways a chamber can be enlarged?

A

Increases in Tissue mass, Chamber Diameter, Intracardial Blood Volume

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9
Q

What is RAE?

A

Right Atrial Enlargement
Any condition that increases pressure to the right atria

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10
Q

4 different causes/pathophysiology of RAE?

A

Pulmonary system usually causing the pressure increases
-Atrial stenosis
-Pulmonary dysfunction
-Myocardial tissue scarring
-Atrial shunts

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11
Q

How does RAE appear on an ECG?

A

ECG appearance
Tall, symmetrical, peaked P waves in lead 2, >2.5mm
Biphasic P wave in V1
Pos > Neg portion

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12
Q

7 causes of RAE?

A

COPD
Obstructive Sleep Apnea
Tricuspid Valve Disease
Pulmonary Embolism
Cystic Fibrosis
Scarring of lung Tissue
Severe Kyphoscoliosis

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13
Q

Treatment for RAE (3)?

A

Benign
Focus is on treating Pulmonary conditions
Preventing clots
-Small clots are not deadly but damaging
-Large clots can lead to quick death

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14
Q

Pulmonary embolism has same signs and symptoms of ____?

A

MI

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15
Q

What does LAE result from (5)?

A

Left Atrial Enlargement
Results from Pressure overload associated with increased LV filling.
High Cardiac Output, Mitral Valve regurgitation, Arteriovenous fistula, L to R Shunt

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16
Q

How does LAE appear on an ECG?

A

ECG appearance
Wider than normal P wave, >.12 sec in Lead II
Biphasic P wave in V1, Neg>Pos, >1mm, >1mm Deep

17
Q

4 causes of LAE?

A

Chronic hypertension
Heart failure

Mitral valve insufficiencies
Atrial Fibrillation

18
Q

What typically occurs before LAE?

19
Q

Treatment for LAE?

A

BP meds to stabilize LAE, manage by preventing enlargement
(No other specific treatment)

20
Q

People who are ____ are at an increased risk of stroke?

21
Q

Signs and symptoms of RVH?

A

Right ventricular hypertrophy (Often benign and asymptomatic)

If symptomatic, often respiratory issues: dyspnea, dizziness, syncope, edema of ankles & feet, frequent episodes of sinus tachycardia

22
Q

How does RVH appear on an ECG?

A

R axis deviation >100°
Tall R waves in V1 & V2 > 7mm
RS ratio > 1 in V1 & V2
R Ventricular strain pattern [V1 and V2}
Down slopping ST segment w/ inverted T wave
(May be seen in Limb Leads II, III, aVf)
Deep s wave in L chest leads

23
Q

What may or may not be present with RVH?

A

RAE may or may not be present

24
Q

6 causes of RVH?

A

RV must work harder to circulate Blood to Pulmonary Artery
-COPD
-Pulmonary Valve Stenosis
-Pulmonary Hypertension
-Chronic Mitral Stenosis
-Congenital Lesions
-Tetralogy of fallot

25
Treatment for RVH?
ID underlying condition Medications focused on breathlessness and respiratory restrictions Pacemaker if HR needs regulated
26
With pulmonary disease, everything ____ goes ____?
With pulmonary disease, everything Right goes wrong
27
What four things can go wrong? (Clinical Tip: With pulmonary disease, everything Right goes wrong)
Right Axis Deviation Right Atrial Enlargement Right Ventricular Hypertrophy Right Bundle Branch Block
28
What is LVH?
Left ventricular hypertrophy Myocardial Blood Flow issues Development of Diastolic dysfunction -Increase in Diastolic pressure at rest and exercise -Decrease in ejection fracture leading to congestive heart failure
29
What does LVH lead to if untreated?
If untreated LVH leads to Ventricular Arrythmias leading to sudden death
30
The appearance of ECG with LVH?
QRS complex increase Taller than normal R waves Deeper than normal S waves S wave in V1 or V2 plus R wave in V5 or V6 > 35mm LV strain pattern (Down slop ST segment and w/ inverted T wave) Back up criteria R wave > 11mm in aVL S Wave in Lead I plus R Wave in Lead III > 25mm
31
Why does an ECG with LVH look the way it does?
ECG Appearances – As walls thicken, electrical impulses take longer to cross and arrive at epicardium
32
What is Romhilt-Estes Score?
A unique composite ECG criterion that determines probability of LVH
33
8 causes of LVH?
Stimulus of SNS Chronic Systolic Hypertension Elevated afterload Aortic stenosis and insufficiency Increased filling of LV Coronary artery disease Genetics Mitral insufficiency
34
Treatment for LVH?
Control hypertension Angiotensin II receptor blocker (ARB) Angiotensin- Converting enzyme inhibitor (ACE)