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CPPT II > COMPS:Unit 1: EKG Extra Stuff You Need to Know!!! > Flashcards

COMPS:Unit 1: EKG Extra Stuff You Need to Know!!! Flashcards

1
Q

What is ECG of EKG???

A
  • Represents the electric impulses of the heart
    • hearts functioning SHORT TERM
  • Halter/Telemetry
    • LONG TERM
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2
Q

ECG ===

A
  • Graphic rep of hearts electrical activity
  • provides info about hearts function
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3
Q

Why do PTs need to learn EKG??

4 Reasons:

A
  1. Basic anatomy & phys of heart–> norm vs. patho
  2. PT implications of rhythms –> norm vs. patho
  3. Diff b/w benign vs. life-threatening arrhythmias
  4. Read physicians notes on 12 lead EKG AND understand implications
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4
Q

Myocytes….

What are they?

A

cells of myocardium

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5
Q

3 Properties of Myocytes

A
  1. Automaticity
  2. Rhythmicity
  3. Conductivity
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6
Q

Properties of myocytes

1. Automaticity

explain…

A

*Discharge e-stim w/out nerve impulse (automatic)

  • SA Node (natural pacemaker of heart) ​
    • ​60-100bpm
  • AV Node (backup pacemaker)
    • ​40-60bpm
    • kicks in to keep adequate HR
  • Perkinje (next backup Pacemaker)
    • ​30-40bpm
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7
Q

Properties of myocytes

2. Rhythmicity

explain…

A

*Spontaneous depolarization/repolarizatoin

*rhythmically fires

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8
Q

Properites of Myoctyes

3. Conductivity

explain..

A

*Carry rhythmic control from cell to cell (W/in OWN cells)

*Carry muscle to muscle

*NO NEURAL INPUT NEEDED

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9
Q

A DEPOLARIZATION wave will be a ________deflection

*Influx of Na+

A

POSITIVE deflection

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10
Q

A REPOLARIZATION wave will be _______ deflection

A

NEGATIVE deflection

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11
Q

ECG and Electrical Activity of the Myocardium

The Conduction System

A

see pics

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12
Q

ECG and Electrical Activity of the Myocardium

The Conduction System

A

More pics

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13
Q

Conduction System

P Wave===

A

Atrial Depolarization

*SA node fired B/L Atria

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14
Q

Conduction System

QRS Complex ====

A

Ventricular depolarization AND contraction

*AV node fired

NOTE: Atrial Repolarization hidden in QRS complex

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15
Q

Conduction system

T wave===

A

Ventricular Repolarization

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16
Q

Conduction system

A

Pics

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17
Q

Conduction System

All ECG components broken down

A

see pics

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18
Q

What lead is MOST COMMONLY recorded in an ECG?

A

Lead 2 !!!

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19
Q

Lead II:

Wave of Depolarization moving toward positive electrode==

A

+ Deflection

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20
Q

Lead II:

Repolarization moving towards positive electrode==

A

- Deflection

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21
Q

Lead II is used to determine ______ and ______

A

Rate and Rhythm

*Matches the angle of the heart along the axis of depolarization

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22
Q

Off of Lead II…

What do we interpret?

A
    1. Rate
      * 3 methods
      * ONLY METHOD 1 FOR IRREGULAR RHYTHMS
    1. Regularity
    1. P wave
      * Y/N?
      * Upright?
      * 1 for ea. QRS?
    1. PR interval
      * tiny boxes x.04
    1. QRS width
      * tiny boxes x.04
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23
Q

Off of 12 Lead

What do we interpret?

A
  1. Axis
  2. Hypertrophy
  3. Ischemia/Infarction
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24
Q

PR Interval

What is NORMAL?

A

.12 (3 sm. boxes)–.20 (5 sm. boxes)

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25
Q

QRS width

What is NORMAL?

A

.06 (1.5 sm. boxes)–.10 (2.5 sm. boxes)

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26
Q

Rate

3 methods to determine rate

A
  1. R waves per 6sec strip x 10==Rate
  2. 300, 150, 100, 75, 60, 50…(make sure one of the QRS is right on the line)
  3. 300/# of Lg. boxes w/in 2 R waves
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27
Q

Measuring PR interval

Where to Where?

A

see pics

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28
Q

QRS Width

Where to Where ?

A

see pics

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29
Q

Normal Rhythms:

What are they

5

A

*ALL FROM SA NODE*

  1. NSR
  2. Sinus Tachy
  3. Sinus Brady
  4. NSR w/ Pause
  5. Sinus Arrhythmia
    1. ​arrhythmia literally means “irregular rhythm”
    2. all else will be NORMAL
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30
Q

Normal rhythms

Whats Different

Whats Normal

A
  • NORMAL
    • ​PR interval
    • QRS width
  • DIFFERENT
    • ​rate
    • regularity
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31
Q

Sinus Bradycardia

Keep in mind…

A

NORMAL BUT Rate <60

*In high lvl athletes this is normal

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32
Q

Sinus Tachycardia

Keep in mind…

A

NORMAL BUT Rate >100bpm

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33
Q

Sinus Arrhythmias OR aka…

A

The Inspiration (faster) vs. Expiration (slower) one

*IRREGULAR so must use Method 1***

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34
Q

Sinus Pause OR

Other names ?

A

Sinus Block

Sinus Arrest

NSR w/ pause

*skipped beat/pause

*SA node fails to fire

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35
Q

Atrial Arrhythmias

*Occur in Atria!

5:

A
  1. Wandering Atrial Pacemaker
    1. @ least 3 diff. P-wave shapes!
  2. PAC
    1. has a P wave! diff. shape OR inverted
  3. Atrial Tachycardia (SVT)
  4. Atrial Flutter (Sawtooth)
  5. A-Fib

**ALL ectopic==> SA fires when should NOT

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36
Q

ONLY NORMAL THING W/ ATRIAL ARRHYTHMIAS

A

QRS Width bc QRS complex is ventricles and Atrial Arrhythmias are occurring in the Atria

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37
Q

Wandering Atrial Pacemaker

Keep in mind…

A
  • Random ectopic foci
  • P-wave constantly changing
    • @ least 3 diff.
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38
Q

PAC

Keep in mind

A
  • P-wave embedded in the T (Tall T)==PAC
  • OR
  • Tall T==PAC
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39
Q

Premature Beats

Compensatory (use 3 line rule)

match 1 and 3 up w/ 1 and 3 w/ premature beat in the middle and 1 and 3 should still line up….if NOT==NON-comp

A
  • Pause following ectopic beat which allows reg rhythm to resume w/ next normal beat @ its orig. projected timing
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40
Q

Premature Beats

NON-compensatory

1 and 3 will NOT line up!!!

A
  • Pause not long enough to allow rhythm to resume its original rhythm and timing
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41
Q

Which PAC compensation (NON-comp vs. COMP) represents a healthier SA Node?

A

Complete COMPENSATORY Pause

*SA goes back to firing Normal

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42
Q

3+ PAC in a row====

A

Atrial Tachycardia OR SVT

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43
Q

Atrial Tachycardia

3+ PAC in a row*

Other names?

A

Paroxysmal Atrial Tachy

Paroxysmal Junctional Tachy

Supraventricular Tachy (SVT)

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44
Q

Atrial Tachycardia or SVT

*remember this is w/ NO ACTIVITY we call it SVT otherwise WITH Activity we call it Sinus Tachy

Keep in mind…

A
  • Tachy occurs ABOVE AV node
    • ​rate always elevated
  • common
  • NOT benign
  • Usually older adults w/ comorbidities
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45
Q

Rate for SVT (Tachycardia)

A

150-250bpm

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46
Q

EXAMPLE

NSR into SVT

A

see pics

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47
Q

Rate for “Flutter”

A

250-350bpm

48
Q

Atrial Flutter

Keep in mind…

A
  • Atrial rate will be > ventricular rate
  • Usually has a RATIO (report it!)
    • ​ex. 4:1 Atrial Flutter ​

​

49
Q

Fibrillation Rate

A

350+

SUPER FAST!

50
Q

RATES LISTED

SVT

A-Flutter

A-Fib

A
  • SVT==150-250
  • A-Flutter==250-350
  • A-Fib==350+
51
Q

Atrial Fibrillation

Keep in mind

A
  • Chaotic, squiggly line MESS b/w QRS complexes
  • Rate: 350+
  • Irregular MUST use method 1

​

52
Q

A-Fib and Ejection Fraction

A
  • Norm EF==60%
  • W/ A-Fib
    • ​EF is diminished (by ~15%) w/ significant blood remaining in atrium
53
Q

A-Fib

Keep in mind w/ CLOTS

A-fib you are @ risk for CLOTS!!!

A
  • The atria are filled w/ ectopic foci
  • The atria will shake like Jello
    • Pooled blood builds up in jello atria
      • ​== HIGH RISK FOR DVT
54
Q

PT Implications A-Fib

*****

A
  • Check t/o sessions for s/s of Low CO
  • Neuro screen regularly
    • ex. smile @ me
  • CV/Pulm screen regularly
    • PulseOX
    • chest pain
    • VITALS!!!
55
Q

PT Implications of A-Fib

When the Ventricular Rate goes ABOVE 100

Rate >100bpm w/ A-Fib

A
  • A-Fib w/ Rapid Ventricular Rate (A-fib w/ RVR)
    • ​Pot. for LOW CO
56
Q

Rates:

Tachy vs. Flutter vs. Fibrillation

A
  • Tachy (Atrial Tachy/SVT)
    • 150-250 Atrial AND Vent
  • Flutter
    • 250-350 Atrial rate
  • Fibrillation
    • 350+ Atrial rate
57
Q

Junctional Rhythms

*Only @ AV NODE*** so it will have that AV Node rate (40-60bpm)

3:

A
  1. PJC — NO P Wave
  2. Junctional (Idiojunctional)
  3. Accelerated Idiojunctional (SVT)
    1. ​Tachy occurs @ or ABOVE AV node or OUTSIDE VENTS
58
Q

ONLY NORMAL THING W/ JUNCTIONAL ARRHYTHMIAS

A

QRS Width

59
Q

PJC

A

NO P OR INVERTED P

*Also “Same ht. T==PJC”

60
Q

Junctional Rhythm

Idiojunctional

Keep in mind..

A
  • NSR of AV Node
  • NO SA Node so AV node takes over as Backup Pacemaker
    • _​_These will have that AV Node rate of 40-60bpm
  • R. CA MI, Necrosis
61
Q

Accelerated Junctional Rhythm

OR aka

A

Accelerated Idiojunctional

Nodal (Junctional) Tachycardia

62
Q

Accelerated Junctional Rhythm

Keep in mind w/ Rate

A
  • Accelerated junctional rhythm rate will be Faster than the normal junctional rhythm rate
    • ​Accelerated will be >60
    • normal junctional remember is b/w normal AV node 40-60bpm
  • Junctional SVT will be >100
    • ​remember SVT == 150-250bpm
    • STILL NO Pwave though!
      • ​embedded into the T (same Ht. T)
63
Q

EXAMPLE Junctional SVT

A

see pic

64
Q

Sinus Tachycardia vs. Paroxysmal Atrial Tachycardia (SVT)

SAME thing EXCEPT if there is a known cause for Tachy

DIFFs broken down

A
  • SINUS TACHYCARDIA
    • ​Doing Exercise!!!
  • Atrial Tachycardia or SVT
    • ​150-250 for no apparent reason!!!
65
Q

Accelerated Idiojunctional Rhythm vs. Nodal Tachycardia (SVT)

Same thing EXCEPT if known cause for Tachy

DIFFs broken down

A
  • Accelerated IJR
    • ​AV node >60bpm
    • DOING EXERCISE
  • Nodal Tachycardia or SVT
    • ​100-250 for NO REASON
66
Q

Straight up SVT

A

“P wave BURIED in the T==SVT”

67
Q

ALL Premature Beats (PAC, PJC, PVC) NEED what?

A

Underlying rhythms!!!!!

68
Q

PVCs and counting RATE

A

NO CO from PVC —DO NOT COUNT PVC IN RATE!!!

**PAC and PJC you DO COUNT

69
Q

Normal Rhythms come from

A

SA Node

70
Q

Atrial Arrhythmias come from

A

ABOVE AV Node

*IN Atria

71
Q

Ventricular Arrhythmias come from

A

VENTRICLES

72
Q

Ventricular Arrhythmias

7:

A
  1. PVC—DO NOT COUNT IN RATE
  2. V-Tach
  3. V-Flutter (Torsades de Pointe)
  4. V-Fib
  5. Idioventricular (NOT ON TEST)
  6. Asystole (Flatlining)
  7. PEA** (NO PULSE)
73
Q

PVC Unifocal

A

SAME SHAPE

74
Q

PVC Multifocal

A

DIFFERENT SHAPE

75
Q

PT Implications of PVC

A

Check 02sats regularly

76
Q

Significant PVCs

HIGH PT IMPLICATIONS

*Terminate PT!!!

5:

A
  1. Multifocal PVCs
  2. 6-10 or MORE PVCs/Minute
  3. Bigeminy
    1. PVC every other (2nd) beat
  4. Trigeminy
    1. PVC every 3rd beat
  5. >3 PVC’s in a row==> V-TACH
77
Q

PAC

PJC

PVC

>3 IN A ROW

A
  • >3 PAC==SVT OR Atrial Tachycardia
  • >3 PJC==SVT OR Accelerated Idiojunctional
  • >3 PVC==V-TACH

***KEEP IN MIND for SVT vs. Sinus Tachy or SVT vs. Accelerated IJR if they are EXERCISING or NOT DOING ANYTHING!!!!

78
Q

3 PVCS in a row==V-TACH

Causes:

A

Acute MI

CAD

HTN

Rxn to meds

Electrolyte imbalance

79
Q

CLASSIC V-TACH Strip

“Pyramids”

A

see pics

Still regular***

  • Remember >3 PVCs in a row!!! == VTACH
  • SUPER WIDE BIZARRE QRS
80
Q

WORSENING of V-Tach

A

Torsades de Pointes/V-Flutter

  • Looks like ribbon
  • need AED to save them
  • No pulse OR thready pulse
81
Q

WORSENING of A-Flutter

-Disorganized, just a squiggly line

-Ventricles like jello

A

Ventricular Fibrillation

*remember 350+ bpm

82
Q

V-Fib

Causes:

A
  • CAD
  • Acute MI
  • Toxicity from drug
  • Electrolyte imbalance
83
Q

HEART BLOCKS OR…..

A

The “Detours” one!!!!

*Heart Blocks b/w communication from SA—> AV Node

84
Q

1st Degree Heart Block

Things to know:

A
  • Detour one!!!
    • ​impulse has to go thru detour so LOOOOOOOONG PR intervals
  • Very benign
  • older people
85
Q

2nd Degree Heart Block Type I

Mr. Weckenbach

Sketchy!!! Loves to be LATE, LATER, LATER, NOT COME HOME!!!

A
  • *NO IMPLICATIONS FOR PT
  • Progressive elongation of PR interval
    • Mr Weckenbach comes home later, later, later each night spending time w/ his mistress THEN DOES NOT come home and spends the night with his mistress
  • Block b/w SA and AV Node
86
Q

2nd Degree Heart Block Type II

Mr. Morbitz!

A
  • Mr Morbitz plays it safe by being on time multiple nights then one night DOES NOT COME HOME
  • Mr Morbitz is On time, On time, On time, then DOESN’T COME HOME (DROPPED QRS)
  • **AV blocks @ lvl of Bundle of HIS OR @ B/L bundle branches of trifascicular
87
Q

2nd Degree Heart Block Type II

Mr Morbitz

RISKS

A
  • Risk of going into more severe heart cond.
  • Dx AFTER acute MI
88
Q

3rd Degree Heart Block

A
  • *Atria and Vents fire completely isolated of ea. other ==> NO COMMUNICATION
  • VARYING PR intervals AND SO MANY P’S!!!
  • LIFE-THREATENING ARRHYTHMIA
89
Q

1st Degree Heart Block vs.

2nd Degree Heart Block Type I (Mr Weckenbach) vs.

2nd Degree Heart Block Type II (Mr Morbitz) vs.

3rd Degree Heart Bloc k

A

see pics

90
Q

Pacemaker

What are the precautions?

A

NO LIFTING w/ UE w/ PM

*up to 2wks

91
Q

The SA Node is the Pacemaker for

A

Atria

92
Q

The AV Node is the Pacemaker for

A

Ventricles

93
Q

Pacemaker

What is it?

A

electronic device used to generate an artificial action pot in the Atrium (SA PM) and/ or Ventricles (AV PM)

94
Q

Pacemaker may be used temporary or permanent

If permanent: placed where?

A

Implanted under skin just below L. Clavicle

*may be adjusted EXTERNALLY

95
Q

Pacemaker

Extra details

A
  • Used for Brady or Dysrhythmias (arrhythmias)
  • Pulse from PM firing results in a distinctive VERTICAL DEFLECTION called a Spike
  • Pacer spike followed by a P for Atrial pacing and by a QRS for Ventricle pacing
96
Q

Dual chamber Pacemaker

A
  • 2 Leads
    • One connected to Rt. Atrium
      • ​for SA
    • Other connected to Rt. Ventricle
      • ​for AV
97
Q

12 Lead EKG

V1-V6

A

physically put on

Picks up (+) deflections

98
Q

Bundle Branch Blocks or…

A

The ones w/ TWO R waves

  • Must be dx’d on 12 lead ECG
  • Causes one ventricle to depolarize and contract LATER than the other due to the delay/block of the impulse w/in the bundle branch (after the AV node)
  • 2 R waves–> one W/IN QRS
  • QRS will be .12s or WIDER
    • ​Wider==any issue w/ vents
99
Q

Bundle Branch Blocks–RIGHT

A
  • Rt. Vents fire late
  • R/R’ in leads V1 or V2
100
Q

Bundle Branch Blocks LEFT

A
  • L. vent fires late
  • R/R’ in leads V5 & V6
101
Q

12-Lead EKG: Hypertrophy

Right Vent Hypertrophy

vs.

Left Vent Hypertrophy

A
  • Shift of the axis so you will pick up TALLER R-wave in:
    • ​V1–Right
    • V5–Left
  • Loc. of side the R wave is GREATER (higher) on==side of hypertrophy
102
Q

12 Lead EKG: Hypertrophy==

A

*INC in thickness of cardiac muscle OR chamber size

103
Q

12-Lead EKG: Hypertrophy

Rt. Vent Hypertrophy vs. Left Vent Hypertrophy

A
  • R. Vent
    • ​V1: LG R Wave bc mm BIGGER so takes LONGER
    • R wave becomes progressively smaller in V2-V5
  • L. Vent–more common
    • ​Lg. R wave in V5

*V1==Right

*V5==Left

104
Q

12 Lead EKG: Ischemia

A
  • ==> reduced blood flow to myocardium due to occlusion of CA’s from:
    • ​Vasospasm
    • atherosclerotic occlusion and/or Thrombus
105
Q

12 Lead EKG

How is Ischemia demo’d?

A

3 Options:

  1. T wave INVERSION

2. ST segment ELEVATION

3. ST segment DEPRESSION

106
Q

12 Lead EKG: Infarction

A
  • ==> Cell DEATH resulting from complete occlusion of Coronary Artery
107
Q

12 Lead EKG: Ischemia

Transmural Infarction

vs. NON-Transmural Infarction

A
  • Transmural (Completely covered) ​
    • Cell necrosis or death COMPLETELY COVERS entire Myocardial wall of heart
  • NON-Transmural (Only one part)
    • ​just occurs in one part—> still @ risk for FULL

NOTE: ST Segment depression in absence of ischemia or angina may be due to digitalis toxicity

108
Q

12-Lead EKG: Ischemia

Leads that demo presence of T wave inversion, ST segment changes, or Q waves identify Location of ischemia, injury, or infarction

A

see pics

109
Q

Significant Q wave and/or ST elevation in leads V1, V2, V3, V4

indicates—–

A

ANTERIOR INFARCTION

110
Q

ANTERIOR INFARCTION

A

Significant Q wave and/or ST elevation in leads V1, V2, V3, V4

111
Q

Significant Q wave and/or ST elevation in Leads II, III, and aVF

indicates

A

INFERIOR INFARCTION

*notice the aVF (Feet==inferior)

112
Q

INFERIOR INFARCTION

*notice the aVF (Feet==inferior)

A

Sig. Q wave and/or ST elevation leads II, III, aVF

113
Q

Sig. Q wave and/or ST elevation in chest leads I or aVL indicates…

A

LATERAL INFARCTION

*notice aVL (L means Lateral)

114
Q

LATERAL INFARCTION

*notice aVL (L means Lateral)

A

Sig Q wave and/or ST elevation in chest leads I or aV_L_

115
Q

DIRECT OPPOSITE tracing of Anterior Infarction in V1 an V2

indicates….

A

POSTERIOR INFARCTION

V1/V2 FLIPPED CONCEPT

116
Q

POSTERIOR INFARCTION

V1/V2 FLIPPED CONCEPT

A

DIRECT OPPOSITE tracing of ANTERIOR INFARCTION in V1/V2

117
Q

***From NPTE

What condition could explain why the HR of an exercising pt abruptly drops to half the value that was pre-recorded?

A

2nd Degree Heart Block

(Nrml–>block–>Nrml–>block)

Cuts CO by 50% bc of DROPPED QRS’s

CPPT II (6 decks)

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