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St John/ Uni > ECG > Flashcards

ECG Flashcards

1
Q

What does the P wave and PR segment and QRS represent on a ECG?

A

P wave = Depolarization of Artia and AV Node

PR segment = Delay at AV node & depolarization of the bundle of HIS, bundle branches and Purkinje fibers

QRS - depolarization of cardiac myocytes (ventricles)

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2
Q

What is the difference in Segments & intervals

A

Intervals: The time between 2 waves and included an isoelectric segment

Segment: The time from the end of a wave and the start of the next

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3
Q

What is Einthovens Triangle

A

This is the make up of the views of the 3 lead ECG

Lead 1 = Right and left arm
Lead 2 = Right arm and left leg
Lead 3 = Left arm and left leg

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4
Q

What does Bi polar leads mean?

A

This is the leads reading the opposite side.

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5
Q

What are the 4 rules of current

A

A impulse travelling towards the positive lead will show a Positive (upright) deflection.

An impulse that travels towards the Negative lead will cause a negative (downward) deflection

An impulse that travels parallel to the lead will produce the greatest deflection.

impulses perpendicular to the lead will be small

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6
Q

Why is lead 2 used for general monitoring in the ECG

A

The bulk of the direction of depolarization in the heart is towards the +ve end of lead 2

We should see
Upright p wave
Upright QRS
Large complexes

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7
Q

What does the ECG paper represent

A

The vertical axis represents voltage in mV 10mm = 1 mV (10 tiny squares)

The Horizontal axis represents time in seconds

The TINY squares are 1mm by 1 mm and represent 0.04 seconds

A medium square is 5mm by 5mm and this represents 0.20 seconds

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8
Q

What leads are correlate where

A

Inferior leads receive blood by right coronary artery
Leads 2
Leads 3
Leads AVF

Lateral leads receive blood from left circumflex artery
Leads 1
Lead AVL
Leads V5 & V6

Both anterior and septal areas are supplied by left anterior descending artery

V1 & V2 are septal leads.

V3 & V4 are anterior leads

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9
Q

What is the 5 step systematic approach for analyzing a rythum

A
  1. Regularity
  2. Rate
  3. P waves
  4. PR intervals
  5. QRS complexes
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10
Q

What are the 3 types of irregularity in rhythms

A

Basically regular - A regular rhythm interrupted by a beat or two
Regularly irregular - has a pattern of irregularity (grouped beats)
Totally irregular - there is no pattern to the RRI’s

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11
Q

What is the easiest way of getting an irregular rhythm rate

A

The 6-second method

Print off a 6-second piece of paper and count the amount of QRS complexes in it and x that num by 10 e.g. 7x10=70

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12
Q

How long is a PR interval meant to be

A

0.12 & 0.20 seconds (3-5 small squares)

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13
Q

What are the normal for QRS complex

A
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14
Q

What is a normal PR Interval and a normal QRS

A

Nomral PR interval is 0.12 0.20 seconds

Nomral QRS is between 0.06 - 0.11 seconds

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15
Q

What are the 5 steps for normal sinus rhythm

A
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16
Q

What is the difference with sinus arrhythmia

A

The only different between sinus rhythm and sinus arrhythmia is that the R-R internal is irregular.

Most commonly caused by a change in vagal tone associated with breathing.

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17
Q

What are the 4 rhythms that originate from the atria

A

Wandering Pace maker
Atrial Tachycardia
Atrial Fibrillation
Atrial Flutter

(PAC , pre mature artial contraction)

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18
Q

What causes a wandering pacemaker

A

This is where is impluses fire from other areas other than the SA node.

The shape of the P wave can change as the site of origin changes

Causes could be from.
Increased vagal tone
Digoxin toxcitity
Heart disease

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19
Q

What are the rules for identifying wandering pacemaker

A

Irregular RRI’s may be slightly different
Rate: 60-100 per min
P wave: changes as pace maker site changes
PR interval: <0.20 secs (may vary)
QRS: <0.12 secs (uniform and constant)

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20
Q

What is artial tachycardia

A

This is one of the supraventricular tachycardias

Pacemaker site is not the SA node so the P waves are not smooth. the ventricles are able to keep up

HR: 150-250

This causes decreased cardiac output

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21
Q

What is Paroxysmal Atrial Tachycardia (PAT)

A

PAT is when there are brief periods of atrial tachycardia followed by periods of sinus rhythm

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22
Q

What are the 5 steps for Atrial tachycardia

A

Regular

Rate: 150-250 atrial and ventricular rates are equal

P wave: may be difficult to see if hidden in the T wave

PR interval: between 0.12-0.20 PRI is constant

QRS: less that 0.12 secs with uniform shape

23
Q

What causes AF (Atrial Fibrillation)

A

This is where there is multiple pacemaker sites and is defined as chaotic electrical activity of the atrial tissue.

The impulses fire at such speeds that they cannot contract but quiver instead.

This causes decreased cardiac output
MI
and possibly formation of emboli

24
Q

When does AF be considered controlled or uncontrolled

A

This is determined to the ventricular rate

<100/min = controlled A fib
>100/min = uncontrolled A fib

Uncontrolled A fib is associated with
heart failure
cardiac chest pain
Syncope
Cardiogenic shock

25
Q

What are the 5 steps for AF

A

Irregularly irregular

Rate: artial rate is chaotic >350 per/min the ventricular rate is variable

P wave: no P wave

PR interval: Not measurable

QRS: <0.12 secs, constant, uniform QRS shape

26
Q

What is Artial Flutter

A

This is another supraventricular tachycardia

It has characteristic flutter waves

Rate is between 250-350

AV node blocks all the flutter waves and allows time for ventricles to fill

Ratio of conduction is usually even - 2:1, 4:1, 8:1

27
Q

What are the 5 steos for artial flutter

A

Atrial rhythm is regular, the ventricular rhythm will be regular is conduction is consistent

Rate: atrial rate 250-350, Ventricular rate depends on the ratio of impulses

P wave: Sawtooth Flutter waves

PRI: Not measurable

QRS: >0.12 secs

28
Q

PAC is a ectopic beat

A

This is where there is a premature contraction of the P wave

29
Q

What are the 3 rythums that originate at the AV junction

A

Junctional escape
Accelerated junctional
Junctional Tachycardia

30
Q

What is a Junctional rythm

A

This happens when the SA node or pacemaker cells in the atria fail. The AV node then serves as the pacemaker sending the impulse upwards and downwards

31
Q

What happens to the P wave in a junctional rythum

A

Since it is starting in the AV node it travels up and towards the negative electrode in lead 2 showing a inverted P wave

the impulse is travelling parallel and therefore shows a large P wave (<3mm)

32
Q

What is Junctional escape

A

This is the fail safe rythum when the SA node and atria fail to fire

The rate can be 40-60 BPM
The P waves can be inverted in lead 2 occuring after before or be lost in the QRS

33
Q

What is accelerated junctional rythum

A

This is where the pacemaker in the AV node becomes irritable and fire more rapidly

Rate can be 60-100 BPM

P waves will be inverted

34
Q

What is junctional tachycardia

A

This is a type of supra ventricular tachycardia where the AV junction has over ridden the SA node

The rate can be 100-200 BPM

The P waves again are inverted

35
Q

What is a PJC

A

A Premature Junctional Contraction occurs before a normal beat and are followed by a pause

The P wave will be inverted and may occur before after or hidden in the QRS

36
Q

What is SVT

A

Supraventricular tachycardia is used to describe fast rhythms that have a pacemaker site above the ventricles

The QRS is narrow and the P wave is not identifiable due to the fast rate

These are regular rythms

37
Q
A
38
Q

How many different types of heart block are there

A

4
First degree is a delay od the impluse at the AV node rather than a block

second degree 1 & 2 allow some impulses to go through the AV node

Third degree is the most serious and has a complete block at the AV node

39
Q

What does the ECG show in a first degree heart block

A

There is a prolonged PRI >0.20 (5 small squares) secs but is consistent
All P waves are eventually conducted to the ventricles

40
Q

How do you identify a 1st degree heart block

A
41
Q

how do you identify a 2nd degree type 1 hear block

A
42
Q

how do you identify a 2nd degree type II hart block

A
43
Q
A
44
Q

Why is 3rd degree heart block so serious

A

This is because there is no impulses making it from the SA node down into the ventricles.

This causes the ventricular pacemakers to fire independently usually at a much slower rate dropping cardiac output

45
Q

How do you Identify a 3rd degree heart block

A
46
Q

What are the 3 ventricular rhythms

A

VT - Ventricular tachycardia
VF - Ventricular Fibrillation
Idioventricular Rhythm

47
Q

What is a PVC

A

These are premature ventricular contractions and present with a wide QRS complex (3 small squares wide)

48
Q

What is Bigeminy

A

This is a grouped beating of PVC’s (every other beat is a ectopic beat)

49
Q

Can PVC’s cause VT

A

Yes when a PVC falls on a T wave it can cause the rthhm to go into a VT

50
Q

What are the rules for VT

A
51
Q

what are the rules for VF

A
52
Q

What is a Idioventricular Rhythm

A

this is a last ditch escape effort when all the other pacemaker sites fail the pacemakers in the ventricles are take over.

The rate of this is usually 20-40 BPM

The QRS complexes are wide and bizzare with no P waves

53
Q

what are the rules for Idoiventricular rhythm

A

St John/ Uni (23 decks)

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