ECG Flashcards
1
Q
What is a ECG?
A
Graphic representation of the electrical impulses of the heart
2
Q
What is an ECG used to ID?
A
ID irregularities in heart rhythm
3
Q
How are ECGs recorded?
A
From body surface by electrodes
4
Q
Where do impulses start?
A
In the SA node
5
Q
Conduction system pathway?
A
SA node AV (junctual) node Bundle of His Left and Right bundle branches Purkinje fibers
6
Q
The P wave represents what?
A
SA node firing
Atrium contracts
7
Q
After the P wave before the QRS complex is a flat line that represents?
A
AV node pauses
8
Q
QRS complex represents:
A
Ventricular depolarization follow by quick contraction
9
Q
The t wave is the:
A
Ventricle relaxing
10
Q
Isoelectric line means that:
A
No electrical activity is occurring (at the PR interval)
11
Q
What is the point of the AV node slowing down the impulse?
A
So that the atrium and ventricle do not contract at the same time
12
Q
At the bundle of His, impulses are moving where?
A
Passing down to L and R ventricles
13
Q
Contraction of the heart is from the ______ and goes to the ______
A
Bottom
Top
14
Q
Where does conduction end?
A
Purkinje fibers
15
Q
ST segment is a _________ and is the beginning of ______
A
Isoelectric line
Ventricular repolarization
16
Q
Resets at the end of the _____ wave
A
T wave
17
Q
If the QRS is wider than normal, this indicates
A
A problem!
18
Q
The distance between Q and T describe what?
A
How the ventricles are working or responding to certain medications (QT interval)
19
Q
RR interval should be very regular from R to R
A
True
20
Q
P wave is a ____ issue
A
Atrial
21
Q
QRS complex is a ____ issue
A
ventricle
22
Q
This wave is normally rounded, symmetric and upright. It represents atrial depolarization, followed closely by atrial contraction
A
P wave
23
Q
This represents the slowing of conduction through the AV node
A
P-R interval
24
Q
This represents ventricular depolarization and normally followed closely by ventricular contraction
A
QRS complex
25
Repolarization begins when ______ ends
Ventricular contraction
26
This _______ pause is known at the ST segment and it is when the ventricle is initiating repolarization
Isoelectric
27
Repolarization is complete by the end of the _____
T wave
28
What is the most common type of monitoring practice in step downs, ICUs and CPPT rehab programs?
Single lead
29
What is the adv/disadv to single lead?
It can detect rate and rhythm disturbances
| Cannot detect ISCHEMIA
30
What kind of lead is used to determine ischemia or infarction?
12 lead EKG
31
Decreased blood flow to cardiac tissues
ischemia
32
Interruption of blood flow that leads to death of cardiac muscle tissue
Infarct
33
6 limb leads and 6 chest of pericardial leads
(I, II, III, aVR, aVL, aVF)
| V1-V6
34
V1-V6 are...
Chest leads
35
V1-2 are in the...
Septum (space between ventricles)
36
V3-4 are in the...
Anterior left ventricle
37
V5-6 are in the ....
Lateral left ventricle
38
12 lead: This is indicated by INCREASED height (R wave) and depth (S wave) in QRS complex
Ventricular hypertrophy
39
12 lead: This is indicated by ST segment depression or T wave inversion when present with angina
Myocardial ISCHEMIA
40
T12 lead: this is occurring when there is a ST segment elevation
Myocardial infarction
41
If ST elevation is seen on EKG in conjunction with acute onset chest pain......
THIS IS A MEDICAL EMERGENCY
42
On graph paper, 1 small box = 1 mm= ___ seconds
0.04
43
On graph paper, 1 big box= 5 mm= ___ seconds
0.20
44
Counting boxes can be a way to quickly determine _____ fro an EKG printout
HR
45
What is measured on the y-axis of the EKG?
Voltage or amplitude
46
What is measured on the x axis of the EKG?
Time
47
Ticks are found at the top of the rhythm paper, and one tick to the following tick represents ____ seconds
3
48
Count the # of QRS complexes between 2 ticks and multiply by 10 to determine HR
Effective only if rhythm is regular
49
What is the sequence given for the square counting method starting at 300?
300, 150, 100, 75, 60, 50
The first thick line after QRS complex is 300
Stop at next QRS complex
This number is approximate HR
50
PR interval is constant at _____ seconds
0.12-0.20 seconds
51
In normal sinus rhythm rate is _____bpm
60-100 bpm
52
After a previous MI, what wave might look different?
Q wave
53
T- wave changes, tall tented Ts mean?
Hyperkalemia
54
Widened QT interval can be caused by...
Inheritance
| Medication use
55
U wave represents...
Repolarization of the perkinje fibers or papillary muscles
56
Arrhythmias can be classified as (5) things:
```
Sinus
Atrial
Junctional
Ventricular
Blocks
```
57
If you have sinus arrhythmia... the _____ is still intact
SA node
58
What are junctional arrhythmias?
Premature impulses that arise from AV node or junctional tissues
59
What is tachyarrythmia?
Rhythm with a rate >100 bpm
60
What is bradyarhythmia?
Rhythm with a rate < 60 bpm
61
What is ectopy?
Electrical activity outside of the normal pathways
62
Sinus tachycardia
Criteria for NSR except rate is greater than 100 bpm
63
What is the cause of sinus tachycardia?
Increase in sympathetic stimulation (caffeine, stress, stimulants, etc)
64
What do we do if someone has sinus arrhythmia?
Attempt to eliminate the cause
| Initiation of BETA BLOCKER therapy
65
Sinus bradycardia is what?
Criteria for NSR except rate is less than 60 bpm
66
Causes of sinus bradycardia?
Super fit people
Beta blockers
Increased vagal stimulation
67
What do we do for sinus bradycardia?
Nothing unless symptoms arise
68
Sinus arrhythmia is what?
Criteria for NSR except R to R interval varies.
| Quickening and slowing of impulse formation
69
What is the most common cause of sinus arrhythmia?
Respiratory circle
Expiration- slowing
Inspiration- speeding
70
In sinus arrythmia, expiration is ....
Slowing
71
In sinus arrythmia, inspiration is ....
Speeding
72
Respiratory sinus arrhythmia is usually seen in young and elderly and dissappears with....
ACTIVITY
73
Atrial flutter is what?
No true P waves seen, instead we see flutter waves
74
In an atrial flutter, you have more than one ____ before every _____
P wave before every QRS
75
In an atrial flutter, because there is no p wave regularity, we can link this to a _____-
Atrial issue
76
Is the ventricular rate affected in an atrial flutter?
No
77
What are the causes of an atrial flutter?
Rheumatic heart disease, mitral valve disease, hypoxemia
78
Treatment for atrial flutter
Meds
| Cardio version
79
Flutter waves, or saw tooth waves, indicate that the impulse did not originate from the ____
SA NODE
80
The arterial rate is between _____ times per minute in an atrial flutter
250-350
81
In an atrial flutter, how is it documented?
By # of flutter waves to every QRS
So 2:1 or 3:1 or 8:1 etc..
82
Atrial flutter can lead to...
A-Fib
83
What is atrial fibrillation?
No true p waves are seen
84
In atrial fibrillation, _____ is no longer the pacemaker
SA node
85
There are multiple ectopic foci in the atria in a _______
Atrial fibrillation
86
Ventricular rate depends on ______ responsiveness in an atrial fibrillation
AV node
87
What are the causes of atrial fibrillation?
```
Advanced age
Ischemia/infarction
CHF
Stress
Renal failure
```
88
In atrial fibrillation you have, ______ cardiac output, becomes very dangerous in the presence of _________, and stagnant blood can lead to a ______
Decreased
Tachycardia
Clot formation
89
when should you terminate/hold exercise when someone has AFib?
Usually if ventricular rate is >120-130 bpm at rest
90
What is the treatment of AFib?
Pharm control
Anticoagulation
Radio frequency ablation
91
What happens to CO in atrial fibrillation?
Decreased between 15-30%
92
Heart blocks occur when cardiac electrical impulse is either delayed or blocked within the ______, ______, or _________
AV node
Bundle of His
Purkinje system
93
heart blocks are classified into the following types: (4)
Bundle branch block (right or left)
1st degree heart block
2nd degree heart block (type 1 or type 2)
3rd degree heart block or complete heart block
94
A first degree heart block is actually a _____ rather than a block
Delay
95
What is a first degree heart block caused by?
Conduction delay at AV node or bundle of His
96
In a 1st degree heart block, PR interval will be ______ than normal
Longer (0.2 seconds)
97
In a 2nd degree heart block, type 1; it is almost always a disease of the ______ node
AV
98
In a 2nd degree heart block, type 1; on ECG you will see progressive elongation of PR interval followed by a ______
Dropped or missing QRS complex
99
In a 2nd degree heart block, type 1; treatment?
Nothing unless symptomatic
100
VIn a 2nd degree heart block, type 1; other names?
Mobitz I or Wenckebach
101
In a 2nd degree heart block, type 2; almost always a conduction disorder involving _______ or ________
Bundle of His or Purkinje system
102
In a 2nd degree heart block, type 2; PR interval states the same but dropped beats will be _______
Visible
103
In a 2nd degree heart block, type 2; intermittent, non conducted _______
P waves
104
In a 2nd degree heart block, type 2;
2:1 Mobitz II block would mean what?
Two P waves for every 1 QRS complex
105
In a 2nd degree heart block, type 2;
| Definitive treatment?
Implanted pacemaker
106
In a 3nd degree heart block, impulse is generated in _____ but not conducted to ________
SA node
Ventricles
107
In a 3nd degree heart block, it is categorized by complete lack or relationship between _____ and _____
P waves and QRS complexes
108
In a 3nd degree heart block, where is the QRS coming from?
Somewhere in the ventricle
NOT FROM CONDUCTION SYSTEM
109
In a 3nd degree heart block, a new or accessory pacemaker will generate "escape rhythms" usually in the ______
Ventricles
110
In a 3nd degree heart block, this causes 2 independent rhythms on the ECG.... what are they?
P waves with regular P to P interval
The QRS complexes with regular R to R interval
PR interval is variable
111
In a 3nd degree heart block, causes?
Coronary ischemia
Inferior wall MI
Anterior wall MI
112
In a 3nd degree heart block, symptoms?
Severe bradycardia
HYPOtension
Hemodynamic instability
113
In a 3nd degree heart block, treatment?
Electrical pacing, temporary or permanent
| Definitive treatment is dual chamber artificial pacemaker
114
What does PVC stand for?
Premature ventricular contraction
115
When an ectopic focus generates an impulse from somewhere in the ventricles - from myocardium, what is this called?
PVC
116
PVCs can be ____ or _____
Unifocal or multifocal
117
For PVCs, you should be concerned when you have ___ PVCs in a row, and ___ PVCs in one minute
3
| 6
118
PVCs can lead to ______
Ventricular tachycardia
119
What does bigeminy mean?
Every other beat
120
What does trigeminy mean?
Every third beat
121
Causes of PVC if isolated?
```
Stress
Caffeine
Nicotine
Ischemia
Cardiac disease
Irritation of myocardium
```
122
Symptoms of PVC
Feeling of a skipped beat
Anxiety
SOB
Dizziness
123
Treatment for PVC?
Treat underlying cause
Patients with lung disease, PVC --> hypoxemia
Antiarrhythmic medication
124
What is ventricular tachycardia (v tach)?
Defined as 3 or more PVCs in a row
| Rate 100-250 bpm
125
V tach can be _____ or ______
Sustained
| Non-sustained
126
Non-sustained v tach has self termination in ____ seconds
< 30
127
Sustained v tach = run of v tach _____ seconds, even if it self terminates
> 30 seconds
128
V tach can lead to _______
Ventricular fibrillation
129
What are the causes of v tach?
```
Ischemia
Acute infarction
CAD
Heart disease
Med reactions
Athletes during exercise
```
130
Symptoms of v tach
Dizziness
Syncope
Disorientation
Weak, thready pulse
131
Treatment for v tach?
Immediate pharm intervention
Cardio version
Defibrillation
132
In v tach, _____ are absent
P waves
133
Torsade de Pointes is what?
A unique configuration of v tach
134
Torsade de pointes is a twisting of the points along the _____ line
Isoelectric
135
Torsade de pointes is often associated with prolonged _____ interval
Q-T
136
Torsade de pointes occurs at a ____ rate and terminate _______
Rapid
| Spontaneously
137
Torsade de pointes can lead to _____
V-fib
138
What is ventricular fibrillation?
Erratic quivering of ventricular musculature
139
What is v fib caused by?
Multiple ectopic foci firing at the same time.
No cardiac output
140
V-fib is always associated with ______
Cardiac arrest
141
How do you treat v fib?
Always de fib v fib
Being CPR, supplemental O2, grab AED
142
In V fib, a spike is seen before ______, if paced ventrically
QRS complex
143
If V fib, spike seen before ____ wave, if paced atrially
P wave
