ECG Flashcards
What is a ECG?
Graphic representation of the electrical impulses of the heart
What is an ECG used to ID?
ID irregularities in heart rhythm
How are ECGs recorded?
From body surface by electrodes
Where do impulses start?
In the SA node
Conduction system pathway?
SA node AV (junctual) node Bundle of His Left and Right bundle branches Purkinje fibers
The P wave represents what?
SA node firing
Atrium contracts
After the P wave before the QRS complex is a flat line that represents?
AV node pauses
QRS complex represents:
Ventricular depolarization follow by quick contraction
The t wave is the:
Ventricle relaxing
Isoelectric line means that:
No electrical activity is occurring (at the PR interval)
What is the point of the AV node slowing down the impulse?
So that the atrium and ventricle do not contract at the same time
At the bundle of His, impulses are moving where?
Passing down to L and R ventricles
Contraction of the heart is from the ______ and goes to the ______
Bottom
Top
Where does conduction end?
Purkinje fibers
ST segment is a _________ and is the beginning of ______
Isoelectric line
Ventricular repolarization
Resets at the end of the _____ wave
T wave
If the QRS is wider than normal, this indicates
A problem!
The distance between Q and T describe what?
How the ventricles are working or responding to certain medications (QT interval)
RR interval should be very regular from R to R
True
P wave is a ____ issue
Atrial
QRS complex is a ____ issue
ventricle
This wave is normally rounded, symmetric and upright. It represents atrial depolarization, followed closely by atrial contraction
P wave
This represents the slowing of conduction through the AV node
P-R interval
This represents ventricular depolarization and normally followed closely by ventricular contraction
QRS complex
Repolarization begins when ______ ends
Ventricular contraction
This _______ pause is known at the ST segment and it is when the ventricle is initiating repolarization
Isoelectric
Repolarization is complete by the end of the _____
T wave
What is the most common type of monitoring practice in step downs, ICUs and CPPT rehab programs?
Single lead
What is the adv/disadv to single lead?
It can detect rate and rhythm disturbances
Cannot detect ISCHEMIA
What kind of lead is used to determine ischemia or infarction?
12 lead EKG
Decreased blood flow to cardiac tissues
ischemia
Interruption of blood flow that leads to death of cardiac muscle tissue
Infarct
6 limb leads and 6 chest of pericardial leads
(I, II, III, aVR, aVL, aVF)
V1-V6
V1-V6 are…
Chest leads
V1-2 are in the…
Septum (space between ventricles)
V3-4 are in the…
Anterior left ventricle
V5-6 are in the ….
Lateral left ventricle
12 lead: This is indicated by INCREASED height (R wave) and depth (S wave) in QRS complex
Ventricular hypertrophy
12 lead: This is indicated by ST segment depression or T wave inversion when present with angina
Myocardial ISCHEMIA
T12 lead: this is occurring when there is a ST segment elevation
Myocardial infarction
If ST elevation is seen on EKG in conjunction with acute onset chest pain……
THIS IS A MEDICAL EMERGENCY
On graph paper, 1 small box = 1 mm= ___ seconds
0.04
On graph paper, 1 big box= 5 mm= ___ seconds
0.20
Counting boxes can be a way to quickly determine _____ fro an EKG printout
HR
What is measured on the y-axis of the EKG?
Voltage or amplitude
What is measured on the x axis of the EKG?
Time
Ticks are found at the top of the rhythm paper, and one tick to the following tick represents ____ seconds
3
Count the # of QRS complexes between 2 ticks and multiply by 10 to determine HR
Effective only if rhythm is regular
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
PR interval is constant at _____ seconds
0.12-0.20 seconds
In normal sinus rhythm rate is _____bpm
60-100 bpm
After a previous MI, what wave might look different?
Q wave
T- wave changes, tall tented Ts mean?
Hyperkalemia
Widened QT interval can be caused by…
Inheritance
Medication use
U wave represents…
Repolarization of the perkinje fibers or papillary muscles
Arrhythmias can be classified as (5) things:
Sinus Atrial Junctional Ventricular Blocks
If you have sinus arrhythmia… the _____ is still intact
SA node
What are junctional arrhythmias?
Premature impulses that arise from AV node or junctional tissues
What is tachyarrythmia?
Rhythm with a rate >100 bpm
What is bradyarhythmia?
Rhythm with a rate < 60 bpm
What is ectopy?
Electrical activity outside of the normal pathways
Sinus tachycardia
Criteria for NSR except rate is greater than 100 bpm
What is the cause of sinus tachycardia?
Increase in sympathetic stimulation (caffeine, stress, stimulants, etc)
What do we do if someone has sinus arrhythmia?
Attempt to eliminate the cause
Initiation of BETA BLOCKER therapy
Sinus bradycardia is what?
Criteria for NSR except rate is less than 60 bpm
Causes of sinus bradycardia?
Super fit people
Beta blockers
Increased vagal stimulation
What do we do for sinus bradycardia?
Nothing unless symptoms arise
Sinus arrhythmia is what?
Criteria for NSR except R to R interval varies.
Quickening and slowing of impulse formation
What is the most common cause of sinus arrhythmia?
Respiratory circle
Expiration- slowing
Inspiration- speeding
In sinus arrythmia, expiration is ….
Slowing
In sinus arrythmia, inspiration is ….
Speeding
Respiratory sinus arrhythmia is usually seen in young and elderly and dissappears with….
ACTIVITY
Atrial flutter is what?
No true P waves seen, instead we see flutter waves
In an atrial flutter, you have more than one ____ before every _____
P wave before every QRS
In an atrial flutter, because there is no p wave regularity, we can link this to a _____-
Atrial issue
Is the ventricular rate affected in an atrial flutter?
No
What are the causes of an atrial flutter?
Rheumatic heart disease, mitral valve disease, hypoxemia
Treatment for atrial flutter
Meds
Cardio version
Flutter waves, or saw tooth waves, indicate that the impulse did not originate from the ____
SA NODE
The arterial rate is between _____ times per minute in an atrial flutter
250-350
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..
Atrial flutter can lead to…
A-Fib
What is atrial fibrillation?
No true p waves are seen
In atrial fibrillation, _____ is no longer the pacemaker
SA node
There are multiple ectopic foci in the atria in a _______
Atrial fibrillation
Ventricular rate depends on ______ responsiveness in an atrial fibrillation
AV node
What are the causes of atrial fibrillation?
Advanced age Ischemia/infarction CHF Stress Renal failure
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
when should you terminate/hold exercise when someone has AFib?
Usually if ventricular rate is >120-130 bpm at rest
What is the treatment of AFib?
Pharm control
Anticoagulation
Radio frequency ablation
What happens to CO in atrial fibrillation?
Decreased between 15-30%
Heart blocks occur when cardiac electrical impulse is either delayed or blocked within the ______, ______, or _________
AV node
Bundle of His
Purkinje system
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
A first degree heart block is actually a _____ rather than a block
Delay
What is a first degree heart block caused by?
Conduction delay at AV node or bundle of His
In a 1st degree heart block, PR interval will be ______ than normal
Longer (0.2 seconds)
In a 2nd degree heart block, type 1; it is almost always a disease of the ______ node
AV
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
In a 2nd degree heart block, type 1; treatment?
Nothing unless symptomatic
VIn a 2nd degree heart block, type 1; other names?
Mobitz I or Wenckebach
In a 2nd degree heart block, type 2; almost always a conduction disorder involving _______ or ________
Bundle of His or Purkinje system
In a 2nd degree heart block, type 2; PR interval states the same but dropped beats will be _______
Visible
In a 2nd degree heart block, type 2; intermittent, non conducted _______
P waves
In a 2nd degree heart block, type 2;
2:1 Mobitz II block would mean what?
Two P waves for every 1 QRS complex
In a 2nd degree heart block, type 2;
Definitive treatment?
Implanted pacemaker
In a 3nd degree heart block, impulse is generated in _____ but not conducted to ________
SA node
Ventricles
In a 3nd degree heart block, it is categorized by complete lack or relationship between _____ and _____
P waves and QRS complexes
In a 3nd degree heart block, where is the QRS coming from?
Somewhere in the ventricle
NOT FROM CONDUCTION SYSTEM
In a 3nd degree heart block, a new or accessory pacemaker will generate “escape rhythms” usually in the ______
Ventricles
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
In a 3nd degree heart block, causes?
Coronary ischemia
Inferior wall MI
Anterior wall MI
In a 3nd degree heart block, symptoms?
Severe bradycardia
HYPOtension
Hemodynamic instability
In a 3nd degree heart block, treatment?
Electrical pacing, temporary or permanent
Definitive treatment is dual chamber artificial pacemaker
What does PVC stand for?
Premature ventricular contraction
When an ectopic focus generates an impulse from somewhere in the ventricles - from myocardium, what is this called?
PVC
PVCs can be ____ or _____
Unifocal or multifocal
For PVCs, you should be concerned when you have ___ PVCs in a row, and ___ PVCs in one minute
3
6
PVCs can lead to ______
Ventricular tachycardia
What does bigeminy mean?
Every other beat
What does trigeminy mean?
Every third beat
Causes of PVC if isolated?
Stress Caffeine Nicotine Ischemia Cardiac disease Irritation of myocardium
Symptoms of PVC
Feeling of a skipped beat
Anxiety
SOB
Dizziness
Treatment for PVC?
Treat underlying cause
Patients with lung disease, PVC –> hypoxemia
Antiarrhythmic medication
What is ventricular tachycardia (v tach)?
Defined as 3 or more PVCs in a row
Rate 100-250 bpm
V tach can be _____ or ______
Sustained
Non-sustained
Non-sustained v tach has self termination in ____ seconds
< 30
Sustained v tach = run of v tach _____ seconds, even if it self terminates
> 30 seconds
V tach can lead to _______
Ventricular fibrillation
What are the causes of v tach?
Ischemia Acute infarction CAD Heart disease Med reactions Athletes during exercise
Symptoms of v tach
Dizziness
Syncope
Disorientation
Weak, thready pulse
Treatment for v tach?
Immediate pharm intervention
Cardio version
Defibrillation
In v tach, _____ are absent
P waves
Torsade de Pointes is what?
A unique configuration of v tach
Torsade de pointes is a twisting of the points along the _____ line
Isoelectric
Torsade de pointes is often associated with prolonged _____ interval
Q-T
Torsade de pointes occurs at a ____ rate and terminate _______
Rapid
Spontaneously
Torsade de pointes can lead to _____
V-fib
What is ventricular fibrillation?
Erratic quivering of ventricular musculature
What is v fib caused by?
Multiple ectopic foci firing at the same time.
No cardiac output
V-fib is always associated with ______
Cardiac arrest
How do you treat v fib?
Always de fib v fib
Being CPR, supplemental O2, grab AED
In V fib, a spike is seen before ______, if paced ventrically
QRS complex
If V fib, spike seen before ____ wave, if paced atrially
P wave
