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Critical Care I > ECG > Flashcards

ECG Flashcards

1
Q

what does the P wave represent

A

atrial depolarization that make the atria contract

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2
Q

What does QRS represent

A

Ventricular depolarization that make the ventricles contract

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3
Q

long PR interval means what?

A

longer means that the AV node interval is delayed…its holding on a little longer to fire off

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4
Q

Wide QRS means what

A

it is taking longer for the Ventricular depolarization - Bundle branch block

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5
Q

QT interval is what

A

ventricular repolarization time

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6
Q

Time is shown on what axis on the ECG

A

X axis

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7
Q

Big square on ECG is how many seconds

A

.2 seconds

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8
Q

Little square on ECG is how many seconds

A

.04 seconds

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9
Q

Lateral leads are represented on ECG where

A

Lead I and AVL, V5, V6

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10
Q

Inferior lead are represented on where on the ECG

A

Lead II, III, AVF

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11
Q

Anterior leads are represented on the ECG

A

V3, V4

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12
Q

Septal leads are represented where on ECG

A

V1, V2

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13
Q

V3r and V4r are for what

A

if they have electrical activity on R side

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14
Q

What am I

A

Sinus Rhythm

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15
Q

what am I

A

Sinus Bradycardia

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16
Q

What is the Rate

A

about 30

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17
Q

what am I

A

Artifact

QRS is regular…this is artifact

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18
Q

What am I

A

WPW

Wide QRS

short PR

problem with AV conduction - faster

What syndrome has fast AV conduction bc it extra wire that connects the atria and ventricles that bipasses the atrioventricular node -

Delta Waves (widening of QRS during the PR interval)

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19
Q

what am I ?

Up on the auto read…it may say consider acute STEMI

A

Early Repolarization

J point elevation

ST segment elevation

In adults this is concerning for heart ischemia

In healthy children this is a normal variant

Their heart is repolarizing before depolarization is over

Nike Swoosh instead of Tombstone - classic for early repolarization and it is normal

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20
Q

what am I

A

Sinus Rhythm with PAC

so you have to have a P wave

This P wave comes prematurely

P wave is a little different

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21
Q

What am I?

A

Sinus Pause

about 3.5 sec

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22
Q

What am I

A

SVT

side note- you can have p waves in SVT

this is narrow complex without p waves

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23
Q

what am I

A

Sinus Rhythm with PVC

Look at QRS

PVC can have a P wave

look at morphology

Different QRS morphology

It came in early

came from Ventricle

Broader and funny looking

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24
Q

what am I

A

Atrial Bigeminy

Find a sinus beat first

1st QRS of each couple has a P and QRS

They each have a twin

PAC - has a p wave…look in between QRS….it has a shoulder…its a p wave hiding in the T wave

so its coming from the Atria

Look at the morphology of QRS

PACs in the pattern of Bigeminy

1 sinus beat followed by a PAC

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25
What am I?
2:1 Pseudo AV Block due to QT prolongation There are more Ps then QRS - so some sort of AV nodal block For every 2 P waves you have 1 QRS 2:1 Block There is Long QT its so long that it is preventing ventricular repolarization The 2:1 AV block is a symptoms of QT prolongation Their heart rate is super slow here **You give a B Blocker which will bring their heart rate up like magic!**
26
what am I?
Monomorphic VT Wide complex
27
What am I?
Artifact It looks like Toursades but if you look...There are QRS that are marching through
28
What am I?
Torsades de Pointes No QRS same in all leads ventricular fibrillation
29
what am I?
SVT
30
How are you going to treat?
Toursades de Pointes Chest Compressions Defibrilation You can give magnesium but the mainstay here is chest compressions and early defibrillation
31
what am I?
Atrial Flutter
32
what am I? How do we treat?
Atrial Fibrillation
33
What am I?
Toursades de Pointes
34
what am I
Ventricular vibrillation
35
Calculating rate on ECG by boxes 1 box= 2 box = 3 4 5 6
300 150 100 75 60 50
36
formula for calculating HR on ECG
300 divided by Number of Large boxes between QRS = HR
37
what am I What is the rate How do you treat
Sinus Bradycardia 48 bpm Common, benign finding - because of high vagal tone
38
what am I Rate? How do you treat?
Sinus Rhythm 170 Normal finding ....can be up to 230 when irritable...should be transient
39
what am I?
NSR
40
What am I?
41
What am I?
Limb Lead Reversal Abnormal P wave Axis - inverted in Lead I but normal in aVF look in V6 - it looks right Lead I and V6 should always be identical even if abnormal What happened? R and L arm leads are placed incorrectly.
42
what am I? How do you treat?
low right atrial rhythm The p wave is upright in Lead I and inverted in aVF Normal, benign variant at normal heart rates
43
what am I?
Bursts of Ectopic atrial tachycardia (from irritable non-sinus focus in atrium) If frequent, it can lead to tachycardia-induced cardiomyopathy look at p waves in AvF ...chaotic
44
ECG with Short PR interval Delta Wave Wide QRS what am I
Wolff-Parkinson-White (WPW)
45
ECG with Long PR intervall All P waves conduct to a QRS What am I?
1st degree AV block
46
what am I?
Wolff-Parkinson-White (WPW) Short PR interval Slurred upstroke of QRS (Delta wave) May be at risk for SVT- common and Preexcited atrial fibrillation -rare
47
What am I? How do I treat?
1st degree AV block Common benign finding (esp in teen athletes) May progress to higher grade AV block if assoicated with myocarditis, neuromuscular disease
48
In Bundle branch block the QRS is \> \_\_\_ms
120
49
What am I? How to Treat?
Right ventricular conduction Delay AKA: Incomplete R bundle branch block common benign finding in childhood - possible association with ASD
50
what am I? how do we treat?
RBBB QRS \>120 ms Bunny ears History of CHD - almost all have this If no cardiac history - further workup...could be from myocarditis
51
What is this? Treat?
LBBB Rare in pedatrics QRS \>120ms Dominant S wave in V1 Wide R wave in V6 we watch these ...at risk for further cardiac later
52
measurment for prolonged QTc
Borderline - 450-460 ms \>460 is prolonged
53
The QT interval represents the time required for
Ventricular depolarization and repolarization
54
Bazett formula is used for what? What is it?
QTc = QT (sec) divided by square root of R-R (sec)
55
what am I?
Long QT syndrome QTc = 540 ms
56
R atrial enlargement the P wave height is over ____ boxes
2.5
57
In pediatrics, the T wave abnormalities are more commonly associated with
Caridomyopathy In adults - ischemic changes
58
What does the T wave do in V1 in a newborn
Upright as a newborn then inverted after one week of age.
59
T wave in V1 is inverted in adolescence....
Normal to invert after one week of age. if it remains inverted this is a normal variant
60
T wave in V5 and V6 should look how in all ages
Upright
61
After age 13, T-wave inversions (\>1 mm depth) in \>=2 leads (V2-V6) is normal or abnormal
may be abnormal
62
In Hypertrophic Cardiomyopathy, What is often seen on ECG with T waves
T wave inversions
63
what am I? What are some pathologies to consider in pediatrics with other signs and symptoms?
1st Degree AV block common in healthy asymptomatic adolescent due to high vagal tone other pathologies: Lyme disease, myocarditis, neuromuscular disease
64
what am I
2nd degree AV block, Mobitz type 1 Wenckebach Progressive PR prolongation, followed by a non-conducted P-wave common during sleep and in athletic adolescens due to high vagal tone
65
Intermittent non-conducted P waves without preceding PR prolongation
2nd degree AV block, mobitz type 2 rare in pediatrics
66
what am I?
3rd degree (complete) AV block P to QRS ratio \>1 Steady R-R interval
67
When is 3rd degree (complete) AV block seen
Congenital heart disease Heterotaxy syndrome Myocarditis neuromuscular disease
68
What am I? Treat?
SVT Adenosine via rapid IV push which halts conduction at AV node to terminate reentrant SVT
69
what am I
Ventricular Tachycardia
70
what am I Treatment?
Left Posterior Fascicular VT (Belhassen VT) Monomorphic tachycardia, wide complex, Left Superior Axis (QRS upright in I and down in aVF) with RBBB morphology Highly responsive to Calcium channel blockers (Verapamil)
71
T-wave inversion in the inferior and/or lateral leads may warrant evaluation for
Cardiomyopathy
72
wide complex tachycardia should be considered what until proven otherwise
VT
73
what am I
Brugada syndrome Coved ST segment elevation (\>2 mm) in V1 and or V2 with T wave inversion INherited disorer associated with risk of V-Fib and sudden cardiac death May be associated with a sodium channelopathy (loss-of-function mutation in SCN5A gene)

Critical Care I (27 decks)

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