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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
Q

What am I?

A

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!

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26
Q

what am I?

A

Monomorphic VT

Wide complex

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27
Q

What am I?

A

Artifact

It looks like Toursades but if you look…There are QRS that are marching through

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28
Q

What am I?

A

Torsades de Pointes

No QRS

same in all leads

ventricular fibrillation

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29
Q

what am I?

A

SVT

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30
Q

How are you going to treat?

A

Toursades de Pointes

Chest Compressions

Defibrilation

You can give magnesium but the mainstay here is chest compressions and early defibrillation

31
Q

what am I?

A

Atrial Flutter

32
Q

what am I?

How do we treat?

A

Atrial Fibrillation

33
Q

What am I?

A

Toursades de Pointes

34
Q

what am I

A

Ventricular vibrillation

35
Q

Calculating rate on ECG by boxes

1 box=

2 box =

3

4

5

6

A

300

150

100

75

60

50

36
Q

formula for calculating HR on ECG

A

300 divided by Number of Large boxes between QRS = HR

37
Q

what am I

What is the rate

How do you treat

A

Sinus Bradycardia

48 bpm

Common, benign finding - because of high vagal tone

38
Q

what am I

Rate?

How do you treat?

A

Sinus Rhythm

170

Normal finding ….can be up to 230 when irritable…should be transient

39
Q

what am I?

A

NSR

40
Q

What am I?

A
41
Q

What am I?

A

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
Q

what am I?

How do you treat?

A

low right atrial rhythm

The p wave is upright in Lead I and inverted in aVF

Normal, benign variant at normal heart rates

43
Q

what am I?

A

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
Q

ECG with Short PR interval

Delta Wave

Wide QRS

what am I

A

Wolff-Parkinson-White (WPW)

45
Q

ECG with Long PR intervall

All P waves conduct to a QRS

What am I?

A

1st degree AV block

46
Q

what am I?

A

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
Q

What am I?

How do I treat?

A

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
Q

In Bundle branch block the QRS is > ___ms

A

120

49
Q

What am I?

How to Treat?

A

Right ventricular conduction Delay

AKA: Incomplete R bundle branch block

common benign finding in childhood - possible association with ASD

50
Q

what am I?

how do we treat?

A

RBBB

QRS >120 ms

Bunny ears

History of CHD - almost all have this

If no cardiac history - further workup…could be from myocarditis

51
Q

What is this?

Treat?

A

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
Q

measurment for prolonged QTc

A

Borderline - 450-460 ms

>460 is prolonged

53
Q

The QT interval represents the time required for

A

Ventricular depolarization and repolarization

54
Q

Bazett formula is used for what?

What is it?

A

QTc

= QT (sec) divided by square root of R-R (sec)

55
Q

what am I?

A

Long QT syndrome

QTc = 540 ms

56
Q

R atrial enlargement the P wave height is over ____ boxes

A

2.5

57
Q

In pediatrics, the T wave abnormalities are more commonly associated with

A

Caridomyopathy

In adults - ischemic changes

58
Q

What does the T wave do in V1 in a newborn

A

Upright as a newborn then inverted after one week of age.

59
Q

T wave in V1 is inverted in adolescence….

A

Normal to invert after one week of age. if it remains inverted this is a normal variant

60
Q

T wave in V5 and V6 should look how in all ages

A

Upright

61
Q

After age 13, T-wave inversions (>1 mm depth) in >=2 leads (V2-V6) is normal or abnormal

A

may be abnormal

62
Q

In Hypertrophic Cardiomyopathy, What is often seen on ECG with T waves

A

T wave inversions

63
Q

what am I?

What are some pathologies to consider in pediatrics with other signs and symptoms?

A

1st Degree AV block

common in healthy asymptomatic adolescent due to high vagal tone

other pathologies: Lyme disease, myocarditis, neuromuscular disease

64
Q

what am I

A

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
Q

Intermittent non-conducted P waves without preceding PR prolongation

A

2nd degree AV block, mobitz type 2

rare in pediatrics

66
Q

what am I?

A

3rd degree (complete) AV block

P to QRS ratio >1

Steady R-R interval

67
Q

When is 3rd degree (complete) AV block seen

A

Congenital heart disease

Heterotaxy syndrome

Myocarditis

neuromuscular disease

68
Q

What am I?

Treat?

A

SVT

Adenosine via rapid IV push which halts conduction at AV node to terminate reentrant SVT

69
Q

what am I

A

Ventricular Tachycardia

70
Q

what am I

Treatment?

A

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
Q

T-wave inversion in the inferior and/or lateral leads may warrant evaluation for

A

Cardiomyopathy

72
Q

wide complex tachycardia should be considered what until proven otherwise

A

VT

73
Q

what am I

A

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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