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ECG > ECG > Flashcards

ECG Flashcards

1
Q

What won’t an ECG tell you?

A

CO, hemodynamic status, pulse

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2
Q

What is a positive deflection?

A

impulse is heading toward the recording electrode

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3
Q

How do you place 3-lead electrodes?

A

white on right, smoke over fire (black over red on left)

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4
Q

What does each tiny box represent?

A

0.04 seconds

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5
Q

What does each larger box represent?

A

0.2 seconds

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6
Q

What is P wave representing?

A

atrial depolarization

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7
Q

What is QRS complex representing?

A

ventricular depolarization

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8
Q

What is T wave representing?

A

ventricular repolarization

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9
Q

What are the steps to reach ECG?

A
  1. rhythm
  2. rate
  3. waves
  4. intervals
  5. axis
  6. hypertrophy
  7. ST changers
  8. blocks
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10
Q

What is normal intrinsic rate from SA node?

A

60-100 bpm

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11
Q

What is normal intrinsic rate from AV node?

A

40-60 bpm

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12
Q

What is normal intrinsic rate from ventricular?

A

20-40 bpm

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13
Q

What is a normal P wave length and amplitude?

A

less than 0.12 sec and less than 2 mm

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14
Q

What is a normal QRS interval?

A

<0.12 seconds

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15
Q

What is a normal PR interval?

A

0.12 to 0.2 s

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16
Q

What does a short QT interval indicate?

A

increased Ca and Mg

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17
Q

What does a long QT interval indicate?

A

dec Ca, Mg or MI

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18
Q

What does a longer QRS interval indicate?

A

BBB, V fib or hyperkalemia

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19
Q

Positive Deflection

A

Impulse headed toward recording electrode

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20
Q

Negative Deflection

A

Impulse headed away from recording electrode

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21
Q

Small box length

A

0.04 seconds, 1mm

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22
Q

Large box length

A

0.2 seconds

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23
Q

P wave represents

A

Atrial depolarization

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24
Q

QRS represents

A

Ventricular depolarization

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25
Q

T wave

A

Ventricular repolarization

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26
Q

Normal Sinus Rhythm

A 
Rate: 60-99
Rhythm: regular
P waves: present
P-R interval: 0.12-0.20 seconds
QRS complex: <0.12 seconds
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27
Q

Sinus Tachycardia

A 
Rate: >100
Rhythm: regular
P waves: present
P-R interval: 0.12-0.20 seconds
QRS complex: <0.12 seconds
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28
Q

Sinus Bradycardia

A 
Rate: <60
Rhythm: regular
P waves: present
P-R interval: 0.12-0.20 seconds
QRS complex: <0.12 seconds
Why: meds, athletes
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29
Q

Sinus Arrhythmia

A 
Rate: 60-100
Rhythm: regularly irregular
P waves: present
P-R interval: 0.12-0.20 seconds
QRS complex: <0.12 seconds
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30
Q

Junctional Escape Rhythm

A 
Rate: 40-60
Rhythm: regular
P waves: none
P-R interval: N/A
QRS complex: <0.12 seconds
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31
Q

Ventricular Escape Rhythm

A 
Rate: 20-40
Rhythm: regular
P waves: none
P-R interval: N/A
QRS complex: >0.12 seconds
Ventricles beat at own pace (not paced by SA or AV)
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32
Q

Premature Atrial Contractions (PACs)

A 
Rate: 60-100
Rhythm: irregularly irregular 
P waves: present (can’t always be seen)
P-R interval: 0.12-0.2 seconds
QRS complex: <0.12 seconds
Why: increased epinephrine, caffeine, cocaine, hyperthyroidism
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33
Q

Premature Ventricular Contraction

A

Rate: any
Rhythm: irregular
P waves: none
P-R interval: N/A
QRS complex: <0.12 seconds in normal QRS but PVC is wider
Why: Low O2 levels, hypokalemia, injury to heart muscle, MI
3+ in a row is ventricular tachycardia

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34
Q

Supraventricular Tachycardia (SVT)

A 
Rate: >150-180
Rhythm: regular
P waves: present (may not be visible)
P-R interval: normal if visible
QRS complex: <0.12 seconds
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35
Q

Ventricular Tachycardia

A 
Rate: >100
Rhythm: regular
P waves: none visible
P-R interval: N/A
QRS complex: >0.12 seconds
Why: heart disease, MI scar
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36
Q

Torsades de Pointes

A 
Rate: >100 (usually 250-350)
Rhythm: regular
P waves: none
P-R interval: N/A
QRS complex: >0.12 seconds
Causes: hypokalemia, hypomagnesemia, hypocalcemia, meds
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37
Q

Atrial Flutter

A 
Rate: 250-360
Rhythm: regular
P waves: sawtooth waves
P-R interval: N/A
QRS complex: <0.12 seconds
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38
Q

Atrial Fibrillation

A 
Rate: varies
Rhythm: irregularly irregular
P waves: ABSENT
P-R interval: N/A
QRS complex: <0.12 seconds
39
Q

Ventricular Fibrillation

A 
Rate: none
Rhythm: chaotic
P waves: none
P-R interval: N/A
QRS complex: none
Cardiac arrest
Defibrillation needed
40
Q

Pulseless Electrical Activity (PEA)

A 
Rate: chaotic to normal
Rhythm: chaotic to normal
P waves: normal or absent
P-R interval: normal or absent
QRS complex: normal or absent
Dying heart still generates electrical impulse
41
Q

Asystole

A 
Rate: none
Rhythm: none
P waves: none
P-R interval: N/A
QRS complex:  none
42
Q

1st Degree heart block

A 
Rate: typically benign
Rhythm: regular
P waves: present
P-R interval: >0.2
QRS complex: <0.12 seconds
Why: increased vagal tone (athletes), meds, MI
43
Q

2nd Degree Heart Block Type I

A 
Rate: typically benign
Rhythm: irregularly irregular
P waves: present
P-R interval: >0.2
QRS complex: <0.12 seconds
Why: athletes, electrolyte disturbance
44
Q

2nd Degree Heart Block Type II

A 
Rate: bradycardic
Rhythm: regular with irregularity
P waves: present
P-R interval: >0.2, unchanged with intermittent non-conducting P waves
QRS complex: <0.12 seconds
45
Q

3rd degree/Complete Heart Block

A 
Rate: typically bradycardic
Rhythm: regular
P waves: present
P-R interval: 
QRS complex: <0.12 seconds
Why: complete dissociation btwn atria and ventricles (pacemaker)
46
Q

Lead I

A

RA-, LA+

47
Q

Lead II

A

RA-, leg+

48
Q

Lead III

A

LA-, leg+

49
Q

AVR

A

RA+, LA and LF-

50
Q

AVL

A

LA+ RA and RF-

51
Q

AVF

A

LF+, RA and LA-

52
Q

Axis is affected by

A

Hypertrophy
Infarction
Average general direction of ventricular depolarization

53
Q

Physiological Left Axis deviation

A

Normal variant in adults

Common in obesity & athletes

54
Q

Pathological Left Axis deviation

A

suggests L anterior hemiblock

55
Q

R axis deviation

A

Rare and almost always pathological

R ventricular ypertrophy

56
Q

Extreme R axis Deviation

A

could be lead problem

usually ventricular in origin

57
Q

Atrial Hypertrophy causes

A

Pulmonary HTN
Congenital heart disease
Tricuspid or pulmonary valve disease
Pulmonary embolism

58
Q

Left atrial hypertrophy on ECG

A

Second component of diphasic P is larger in V1

59
Q

Where do you see Lateral wall infarction

A

I, AVL, v5, v6

60
Q

Where do you see Inferior wall infarction

A

II, III, AVF

61
Q

Where do you see Septal wall infarction

A

V1, v2

62
Q

Where do you see Anterior wall infarction

A

V3, v4

63
Q

What do you see for Posterior infarct

A

ST depression and tall R waves in V1, V2 and V3

64
Q

RBBB on EKG

A

QRS duration >0.12

Broad S wave in lead I, v5 and v6

65
Q

LBBB on EKG

A

wide QRS, deep S in V1 and V2

66
Q

Anterior hemiblock on EKG

A

positive lead I, negative lead II and III

67
Q

posterior hemi block on EKG

A

Negative lead I, positive or npositive lead III

68
Q

What does the absence of p waves suggest?

A

A fib
Ventricular rhythms
Sinus arrest
Escape rhythms

69
Q

what does wide QRS represent?

A

bundle branch block, WPW, v fib or hyperkalemia

70
Q

What does QRS >1mm or 1/3 amplitude of R mean?

A

necrosis (MI)

71
Q

What does QRS >1mm or 1/3 amplitude of R plus ST elevation mean?

A

acute MI

72
Q

What does peaked T wave mean?

A

K+ increased hyperkalemia (need dialysis)

73
Q

What does flat T wave mean?

A

K+ decreased hypokalemia

74
Q

What do U waves indicate?

A

K+ decreased , Mg decreased

75
Q

What does short QT interval indicate?

A

Hypercalcemia lead II

76
Q

What does long QT interval indicate?

A

Hypocalcemia lead II (drugs)

77
Q

What does varying P-P interval indicate?

A

arrhythmia

78
Q

Right Atrial Hypertrophy on ECG

A

If first component of p diphasic p is larger in V1

79
Q

R ventricular hypertrophy on ECG

A

Large R in V1

80
Q

Left Ventricular Hypertrophy on ECG

A

Deepest S in V1 or V2 + tallest R in V5 or V6 >35

81
Q

ST depression (V1-V6) or inverted T wave

A

ischemia

82
Q

ST elevation (>1mm in 2 contiguous leads)

A

Injury (acute)

83
Q

Prolonged ST

A

hypocalcemia (drugs)

84
Q

What is loss of capture?

A

spike and no response

85
Q

What is failure to sense

A

doesn’t sense normal beat and fires

86
Q

What is over sensing

A

misinterprets normal beat and doesn’t fire when needed

87
Q

Wandering atrial pacemaker

A

Rate: 60-100
Rhythm: irregular
P waves: present but all different
PR

88
Q

Digitalis on ECG

A

Prolonged PR interval >0.20 (1 big box)
ST depressed (scooped out)
Flattened T wave or biphasic
Short QT

89
Q

Sinus arrest on ECG

A

pause >3 seconds produces escape rhythm & R-R interval changes

90
Q

Sinus block on ECG

A

R-R preserved because sinus node produces impulse w/o response

91
Q

PE findings on ECG

A

Large S in leaf I
Large Q in III
T wave inversion in III

MC finding is sinus tachy

92
Q

Brugada Syndrome (sudden death) on ECG

A

RBBB with ST elevation in V1, V2, V3

will cause syncope or sudden death

93
Q

Wellens Syndrome on ECG

A

T wave inversion in V2 and V3 1/ little to no ST elevation

caused by unstable angina or stenosis of LAD

94
Q

Long QT Syndrome on ECG

A

> 0.44 caused by a lot of meds

ECG (1 decks)

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