Day 6.2 Cardio Flashcards
EKG P wave
atrial depolarization
EKG PR interval
conduction delay through AV node
usu < 200msec
EKG QRS complex
ventricular depolarization
usu <120 msec
EKG QT interval
mechanical contraction of ventricles
EKG T wave
ventricular repolarization
T-wave inversion indicates recent MI
Why isn’t atrial repolarization on an EKG?
it’s masked by QRS complex
EKG ST segment
isoelectric, ventricles are depolarized
EKG U wave
can be caused by hypokalemia or bradycardia
On EKG: what waves are up, what are down?
P is up Q is down R is up high S is down T is up
What is the PR interval?
From the beginning of the P wave to the start of the QRS complex (so until the Q wave)
Prolonged in AV block. Prolonged means >200 msec
Torsades de pointes
Ventricular tachycardia, see shifting sinusoidal waveforms on EKG.
Can progress to v-fib
Anything that prolongs the QT interval can predispose to TdeP
Rx: Mg2+
What drugs prolong the QT interval (and therefore predispose to TdeP)?
Macrolides (erythromycin) Antimalarials (chloroquine, mefloquine) Haloperidol Risperidone Methadone Protease inhibitors (HIV) Anti-arrhythmics (Class 1A, Class III)
Congenital long QT interval
usu due to defects in cardiac Na+ chnls or K+ chnls.
Can px w severe congenital sensorineural deafness (Jervell and Lange-Nielsen syndrome)
Wolf Parkinson White
Ventricular pre-excitation syndrome.
Accessory pathway (bundle of Kent) from atria to ventricle, which bypasses AV node
So, ventricles partially depolarize earlier–>
classic delta wave on EKG.
Can result in reentry current, leading to SVT
Rx procainamide or amiodarone
Where is a delta wave?
After P wave, right at start of QRS should be.
It’s leading up to the R, you don’t really see a Q
Classic WPW.
Where is the ST segment?
After QRS until the beginning of T wave
So from end of S wave to T.
EKG Segment vs Interval
Segment = flat part bt 2 waves
Interval = includes one segment (flat part) and at least one wave.
How many leads are on an EKG? What are they?
12 leads:
aVR, aVL, aVF
I, II, III (bipolar)
V1,2,3,4,5,6
aVR
points from heart to right arm
aVL
points from heart to left arm
aVF
points from heart to foot
limb lead I
points from right arm to left arm
limb lead II
points from right arm to foot
limb lead III
points from left arm to foot
Normal net electrical signal
Down and to the left
aVR net signal
negative deflection of QRS
aVL net signal
positive deflection of QRS
Limb lead I net signal
positive deflection of QRS
means that signal is going to left
Limb lead II net signal
positive deflection of QRS
means that signal is going down and left
T/F you can combine limb leads I and II and their overlap is the direction that the signal is going
True
Positive QRS deflection in aVL and in aVR
Left axis deviation
Causes of left axis deviation
Interior wall MI Left anterior fasicular block LVH (sometimes) LBBB High diaphragm
Positive QRS in limb lead III
Right axis deviation (probably)
Causes of right axis deviation
RVH
Acute R heart strain (ex massive pulm embolism)
Left posterior fascicular block
RBBB
Dextrocardia (heart pointed toward right/on right side of body)
Quickest way to know if heart has normal axis
Look at limb leads I and II
If they both have positive QRS then it’s normal.
Positive deflection in aVR
almost always abnormal- completely the opposite way of where the heart should be pointing.
EKG: amt of time in 1mm (little) box
0.04sec (40msec)
EKG: amt of time in 5mm (big) box
0.2 sec (200 msec)
Length of normal PR interval
Beginning of P wave to start of QRS complex should be less than 200 msec (1 big box)
Length of normal QRS
the ventricular depolarization should happen to both ventricles at the same time, so it should be quick- less than 120 msec (3 tiny boxes).
If both ventricles are depolarizing at the same time, it will take longer. This could be a ventricular rhythm- one that is originating from the ventricles rather than the AV node.
What ion do T waves give info about?
Potassium levels
Peaked T waves = hyperkalemia
Flat T waves = hypokalemia
Speed of conduction- which places have fast conduction? Slow conduction?
Fastest to slowest: Purkinje (v fast) Atria Ventricles AV node (v slow)
What is the pacemaker? What serves as the pacemaker if it stops working?
SA node.
If no SA, then AV node
If no AV, then bundle of His & purkinje fibers
^These will all cause normal narrow QRS. If ALL fail, then ventricles will take over- and will have wide QRS
Atrial fib
Irregularly irregular
No distinct P waves
No pattern to how often there is a QRS, can’t see P waves bt QRS.
No distinct SA nodes. (A-fib is common if there is atrial enlargement.)
No coordinated atrial contraction (that’s why there are no distinct P waves)
Can result in atrial stasis and lead to stroke (pooling of blood leads to clots –> pulm embolism, or if patent FO, then anywhere in body –> stroke)
Predisposes to SVT
>300bpm
Rx for A-fib
If new A-fib ( drugs- K+ chnl blockers (sotalol or amiodarone)
Prophylax against thromboembolism w warfarin/coumadin
Atrial flutter
Sawtooth
Rapid identical back-to-back atrial depolarization waves- do have distinct P waves, just a lot of them!
220-300bpm (once it’s >300 it’s A-fib)
Rx for atrial flutter
Try to convert to sinus rhythm
Use Class 1a, 1c, or III anti-arrhythmics
1st degree AV block
Prolonged PR interval
PR should be <200 msec, so this is more than that- aka greater than one big box.
Asymptomatic, benign- but more likely to go into 2nd degree block.
What organism can cause 1st degree AV block?
Borrelia burgdorferi
2nd degree heart block: what are the types?
Mobius Type 1 = Wenckebach
Mobius Type 2
Mobius Type 1 (2nd degree heart block)
Wenkebach.
Progressive lengthening of the PR interval until a beat is dropped- there is a P wave which is NOT followed by a QRS.
Usu asymptomatic, benign
Mobius Type 2 (2nd degree heart block)
Dropped beats that are NOT preceded by a change in length of PR interval (so no warning, just have a missed QRS all of the sudden)
The abrupt non-conducted P waves result in a pathologic condition.
Often found as 2:1 block, where there are 2 P waves for every 1 QRS response.
Can progress to 3rd degree AV block, so treat w pacemaker to prevent this.
3rd Degree heart block
Atria and ventricle beat completely independently of each other- so have both P waves and QRS, but no connection between the two.
SA node is not communicating w AV node
Atrial rate (P waves) is faster than the ventricular rate (QRS).
Usu treated w pacemaker
What disease can cause 3rd degree heart block?
Lyme dz