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DMS EKG > DMS EKG I > Flashcards

DMS EKG I Flashcards

1
Q

What are the anterior leads?

A

V2
V3
V4

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2
Q

What are the inferior leads?

A

II
III
aVF

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3
Q

What are the left lateral leads?

A

I
aVL
V5
V6

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4
Q

What are the right leads?

A

aVR

V1

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5
Q

What happens when the wave of depolarization meets the myocardial cell?

A

releases Ca causing it to contract

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6
Q

Which leads should you look at for atrial enlargement?

A

II & V1

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7
Q

R atrial enlargement

A

look at II & V1

inc. height of 1st portion of P wave

possible R axis deviation of P wave

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8
Q

L atrial enlargement

A

look at II & V1

sometimes have inc. height of last portion of P wave

inc. P wave duration

aka P mitrale

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9
Q

R vent. hypertrophy

A

R axis dev

ratio of R:S height >1 in V1
<1 in V6

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10
Q

L vent. hypertrophy

A
  1. R wave in V5/V6 + S wave in V1/V2 >35
  2. R wave in V5 > 26
  3. R wave in V6 > 18
  4. R wave in V6 > V5
  5. R wave in aVL > 13
  6. R wave in aVF > 21
  7. R wave in I > 14
  8. R wave in I + S wave in III > 25
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11
Q

4 questions to ask about arrhythmias

A
  1. Are normal P waves present?
  2. Are the QRS complexes narrow or wide? (0.12s normal)
  3. What is the relationship btwn the P waves & the QRS complexes?
  4. Is the rhythm regular or irregular?
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12
Q

Paroxysmal Supraventricular Tachycardia (PSVT)

A

P waves retrograde if visible in II/III

150-250 bpm

Carotid massage - slows or terminates

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13
Q

A Flutter

A

Saw-toothed
2:1, 3:1, 4:1
Best seen in II & III

atrial rate: 250-350 bpm
vent. rate slower

Carotid massage inc. block

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14
Q

A Fib

A 
irregularly irregular
undulating baseline
atrial rate 350-500 bpm
vent. rate variable
best seen in V1

Carotid massage may slow vent. rate

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15
Q

Multifocal Atrial Tachycardia (MAT)

A

at least 3 diff. P wave morphologies

100-200 bpm

WAT if <100 bpm

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16
Q

Paroxysmal Atrial Tachycardia (PAT)

A

100-200 bpm
warm-up period

Carotid massage - no effect or mild slowing

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17
Q

VT vs. PSVT

A

v - diseased heart, no effect from carotid massage, cannon A waves may be present, AV dissociation may be seen, slightly irregular, fusion beats may be seen, abnormal QRS

Everything is opposite in PSVT

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18
Q

1st degree AV block

A

PR interval >0.2 s

beats conducted through to ventricles

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19
Q

Wenckebach Type I 2nd degree AV block

A

Progressive prolongation of the PR interval until a QRS is dropped

Usually from block w/in AV node

20
Q

Mobitz Type II 2nd degree AV block

A

QRS complexes dropped w/o PR interval prolongation

Usually from block below AV node in His bundle

21
Q

3rd degree AV block

A

no beats are conducted through to the ventricles

complete heart block w/ AV dissociation

atria & vent. driven by independent pacemakers

22
Q

RBBB

A

wide QRS

RSR’ in V1&V2 w/ ST depression & T wave inversion
Bunny ears!!!

Reciprocal changes in V5, V6, I & aVL
(L lateral leads)

23
Q

LBBB

A

Wide QRS

broad or notched R wave, ST depression & T wave inversion
-bunny ears in L lateral leads

Reciprocal changes in V1&V2

L axis deviation may be present

24
Q

L anterior hemiblock

A

L axis dev >-30
w/ no other cause of dev.

more coomon

25
Q

L posterior hemiblock

A

R axis dev.
w/ no other cause of dev.

only seen in diseased hearts

26
Q

Bifascicular block

A

RBBB w/ L anterior or posterior hemiblock

27
Q

Describe the effects from carotid massage

A

PSVT - slows/terminates

A flutter - inc. block

A fib - slow vent. rate

28
Q

What is the most common cause of enlargment?

A

V overload

29
Q

What is a normal P wave?

A

btwn 0 & 70

0.12s

30
Q

Why do arrhythmias happen?

A 
H - hypoxia
I - ischemia & irritability
S - sympathetic stimulation
D - drugs
E - electrolyte disturbances
B - bradycardia
S - stretch
31
Q

Nonsinus pacemakers

A

Atrial 60-75 bpm

Junctional 40-60 bpm

Ventricular 30-45 bpm

32
Q

What is the most common cause of paroxysmal supraventricular tachycardia?

A

PSVT

reentrant circuit w/in AV node

33
Q

What is the most common cause for atrial flutter?

A

a reentrant circuit that runs around the annulus of the tricuspid valve

sawtooth in II & III

34
Q

What arrhythmia is irregularly irregular?

A

A fib

35
Q

accelerated idioventricular rhythm

A

looks like Vtach but slower

50-100 bpm

36
Q

Ashman phenomenon

A

wide aberrantly conducted supravent. beat after a QRS then long pause
usually seen in Afib

37
Q

Reciprocal changes w/ vent. hypertrophy

A
  1. ST segment depression
  2. T wave inversion
    Seen best in leads w/ tall R waves

R - V1 & V2
L - I, aVL, V5 & V6

38
Q

What is the most common nonsinus pacemaker?

A

junctional

40-60 bpm

39
Q

What is the common cause of PSVT?

A

reentrant circuit in AV node

40
Q

What is Aflutter usually caused by?

A

reentrant circuit that runs around the annulus of the tricuspid

41
Q

PVC

A

wide & abnormal QRS
compensatory pause

Bigeminy - 1 beat then 1 PVC
Trigeminy - 2 beats then 1 PVC

42
Q

What are the rules of malignancy w/ PVCs?

A
  1. Frequent
  2. Runs w/ 3 or + in a row
  3. Multiform
  4. PVC falling on T wave of previous beat = R on T phenomenon
  5. PVC w/ acute MI
43
Q

Uniform vs. polymorphic Vtach

A

U - often seen w/ healed infarcts

P - common w/ ischemia, infarcts, electrolyte disturbances & conditions w/ prolonged QT intervals

44
Q

Accelerated idioventricular rhythm

A

looks like PSVT but slower rate
50-100 bpm

idioventricular rhythm - <50 bpm

rarely req. Tx
seen during acute MI or during reperfusion

45
Q

Incomplete BBB

A

RBBB or LBBB w/ narrow QRS (0.10-0.12)

46
Q

Who should get pacemakers?

A
  1. 3rd degree AV block
  2. AV block or bradycardia if symptomatic
  3. Blocks w/ MI
  4. Recurrent tachycardias
47
Q

What is cardiac resynchonization therapy?

A

vent. pacemaker to correct timing

only helps in Pts w/ wide QRS & LV dysfunction

DMS EKG (2 decks)

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