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Cardiology and Respiratory SA Med > ECG > Flashcards

ECG Flashcards

1
Q

Which node initiates a current of depolarization?

A
  • SA node
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2
Q

What occurs during P wave?

A
  • Atrial muscle depolarization
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3
Q

What occurs during PR interval?

A
  • Conduction from SA through AV node
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4
Q

What happens during QRS wave?

A
  • Ventricular muscle depolarization
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5
Q

What happens during QT interval?

A
  • Time it takes for ventricular muscle to depolarize and repolarize
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6
Q

What happens during T wave?

A
  • Ventricular muscle repolarization
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7
Q

What is a lead?

A
  • Evaluation of the electrical field from different aspects of the body
  • Different from a lead wire or electrode on the body
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8
Q

How many leads are there?

A
  • 6!

- All 6 leads calculate your mean axis

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9
Q

Which lead is most commonly used for measurements?

A
  • Lead II

- Moving from base to apex, right to left

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10
Q

Positive deflection vs negative deflection on an ECG

A
  • Toward the positive electrode, a positive deflection is observed in that lead
  • Away from the positive electrode, a negative deflection occurs
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11
Q

Polarity of QRS

A
  • Normally a large positive on lead II, due to large muscle mass of the left heart
  • If QRS is negative and leads are in correct position, means that there is right ventricular enlargement
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12
Q

Mean electrical axis

A
  • QRS in all six leads is used to calculate actual # degree of axis
  • Also gives information about ventricular enlargement
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13
Q

Is lead II QRS normally positive or negative in dogs and cats?

A
  • POSITIVE
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14
Q

What is ECG BEST for evaluating (2 main things)

A
  1. Heart rate

2. Heart RHYTHM and conduction

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15
Q

What can ECG tell you about cardiac chamber enlargement?

A
  • It can tell you about cardiac enlargement
  • Specific but NOT VERY SENSITIVE
  • If you see a change, it exists; if you don’t see changes, doesn’t mean that they don’t exist
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16
Q

ECG and CHF or quality of cardiac muscle contraction

A
  • CAN NOT tell you about presence of CHF or quality of cardiac muscle contraction
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17
Q

What are two primary reasons to obtain an ECG in practice?

A
  • Diagnose an arrhythmia detected on physical examination

- Search for an arrhythmic cause of syncope/collapse

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18
Q

Other reasons to obtain an ECG?

A
  • Assess cardiac size (knowing that a normal ECG does not exclude cardiac enlargement)
  • Assess/monitor a critical patient post-HBC or GDV
  • Individualize therapy for heart failure patients (monitor HR, rhythm)
  • Monitor effectiveness of anti-arrhythmic therapy
  • Evaluate patients with suspected drug toxicity (digoxin, etc.)
  • Screen for electrolyte abnormalities (hyperkalemia, etc.)
  • Look for supportive evidence of other disease processes
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19
Q

What might you see with pericardial effusion on ECG?

A
  • Low-voltage complexes, electrical alternans
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20
Q

What might you see with hypothyroidism on ECG?

A
  • Low-voltage complexes
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21
Q

What might you see with hypoadrenocorticism on ECG?

A
  • Bradycardia, spiked T wave, flat P wave
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22
Q

Types of ECG equipment

A
  • Standard vs rhythm monitoring
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23
Q

Which type of ECG can you measure complexes with?

A
  • Standard/in hospital/diagnostic
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24
Q

Rhythm monitoring (surgical) ECG use

A
  • Not diagnostic
  • Rhythm and heart rate machine
  • SHOULD NOT USE FOR CARDIAC CHAMBER ENLARGEMENT
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25
Q

Ambulatory monitor definition

A
  • Portable device that records ECG while the animal is in home surroundings (AKA Holter monitor)
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26
Q

Ambulatory monitor indication

A
  • Evaluating collapsing patients for intermittent arrhythmia or monitor response to anti-arrhythmic therapy
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27
Q

What are the four steps of ECG interpretation?

A
  1. Evaluate ECG for artifacts, quality and calibrations
  2. Determine heart rate
  3. Name the cardiac rhythm
  4. Evaluate the P-QRS-T complex configurations and morphologies
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28
Q

Standard calibration for ECG complex height

A
  • 1 cm (10mm) = 1 mV
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29
Q

ECG complex width

A
  • Duration can indicate cardiac chamber enlargement

- Complex duration - horizontal axis or paper speed

30
Q

What speed are P-QRS-T measurements typically made at?

A
  • 50mm/sec

- 1 small box = 0.02 sec

31
Q

Why quality and calibrations?

A
  • Values are measured for duration and amplitude of P wave and R wave
  • Measurements indicate heart enlargement or electrical conduction abnormalities
32
Q

Dogs normal HR on ECG

A
  • 60-160 BPM

- Can be as low as 120 in the home environment

33
Q

Cats normal HR on ECG

A
  • 140-220 BPM

- Can be as low as mid 20s to 30s for sleeping dogs

34
Q

Other reference ranges for ECG

A
  • P wave (max)
  • PQ interval
  • QRS (width)
  • R wave (max)
  • ST segment
  • T wave (max)
  • QT interval

SEE SLIDES and also ask if this is important?

35
Q

What can happen with artifacts?

A
  • Affect ability to interpret the electrocardiogram by basking the real ECG or appearing similar to an arrhythmia
  • Common examples: Purring, respiration movement, motion, muscle twitches
36
Q

How many boxes to count for HR at 50 mm/sec?

A
  • 30 boxes for 3 sec, then multiply by 20

- Bic pen is exactly 3 seconds on 50 mm/sec speed

37
Q

How many boxes to count for HR at 25 mm/sec?

A
  • 15 boxes is 3 seconds
38
Q

Normal horse heart rate

A
  • 28-40 BPM
39
Q

Normal cow heart rate

A
  • 70-90 BPM
40
Q

2 normal rhythms in dogs

A
  • Sinus rhythm

- Sinus arrhythmia

41
Q

Sinus rhythm characteristics

A
  • Normal P wave
  • Normal heart rate
  • Normal, similar shaped P wave for every QRS
  • Normal, similar shaped QRS for every P wave
  • Regular, very little variation in P-P interval (<10%)
42
Q

Sinus arrhythmia characteristics

A
  • Irregular rhythm originating from the SA node, but normal in many species
  • Defined by normal heart rate
  • Normal shaped P wave (some variation in height okay; “wandering” pacemaker of vagal tone)
  • Normal QRS for every P wave
  • Pattern of increasing and decreasing heart rate that is regularly irregular
43
Q

What is the cause of a sinus arrhythmia?

A
  • Pronounced vagal tone

- SOMETIMES associated with respiration

44
Q

What are the normal rhythms in cats?

A
  • JUST ONE

- Sinus rhythm or sinus tachycardia

45
Q

Normal rhythms in bovines

A
  • Sinus rhythm

- Sinus bradycardia may be associated with a lack of food intake

46
Q

Normal rhythms in equines

A
  • Normal sinus rhythm
  • Sinus arrhythmia
  • Second degree atrioventricular block (vagal tone species)
47
Q

Morphology of complex assessment

A
  • Are complex measures within normal range for amplitude and duration?
  • Do P waves look different?
  • Do QRS waves look different?
48
Q

Normal variations in ECG

A
  • In some animals, Q wave may not be present or S wave may not be visible
  • T wave can be small, positive, negative, or biphasic
49
Q

Normal P wave, deep S wave rule out

A
  • Right ventricular enlargement

- HIS bundle branch block

50
Q

Big T wave meaning

A
  • Hyperkalemia

- Maybe if you have ventricular depolarization abnormalities and expect to see repolarization abnormalities

51
Q

Meaning of Tall P wave

A
  • Right atrial enlargement in dogs
  • Right or left atrial enlargement in cats
  • Sinus tachycardia in dogs
52
Q

Meaning of Tall R wave***

A
  • Left ventricular enlargement
53
Q

Meaning of Wide P wave

A
  • Left atrial enlargement in dogs and cats

- Pseudo abnormality

54
Q

Absent p wave meaning

A
  • Hyperkalemia
  • Atrial standstill
  • SIlent atrium or atrial fibrillation
55
Q

P height variation

A
  • Wandering pacemaker (normal finding with sinus arrhythmia), atrial or junctional premature beats
56
Q

Meaning of shortened PR interval

A
  • High sympathetic tone
57
Q

Meaning of prolonged PR interval

A
  • First degree AV block
58
Q

Meaning of deep Q wave

A
  • normal variation in deep-chested dogs; biventricular enlargement potentially
59
Q

Meaning of wide QRS

A
  • Ventricular enlargement; intraventricular conduction disturbance
60
Q

Meaning of small QRS

A
  • Normal variation; pericardial or pleural effusion; pneumothorax, hypothyroidism, obesity
61
Q

Meaning of large T wave

A
  • Myocardial hypoxia, interventricular conduction disturbance, bradycardia, ventricular enlargement, hyperkalemia
62
Q

Meaning of small T wave

A
  • Same as for small QRS, normal for cats
63
Q

Meaning of dep S wave

A
  • Normal variation; right ventricular enlargement; left ventricular hypertrophy (in leads II, III, and aVE? ONLY)
64
Q

Ectopic beat definition

A
  • Complex with abnormal shape may come from a different location of the heart (not from sinus node)
65
Q

Where can ectopic beats come from?

A
  • Atria or ventricle
66
Q

Premature vs escape beats

A
  • Premature is earlier than expected

- Escape is later than expected

67
Q

Supraventricular complex appearance

A
  • QRS looks similar, but P wave looks different (or in junctional, are absent)
  • Timing will usually be early
  • QRS is the same!
68
Q

Ventricular complex appearance

A
  • Wide and bizarre
  • Nothing like a sinus rhythm
  • Look to sinus beats to see if there is chamber enlargement
69
Q

How do you differentiate escape beats and premature beats?

A
  • Escape and premature beats can look morphologically the same
  • Differentiated by timing (early or late) compared to preceding complexes
70
Q

What four things to assess with morphology of complexes that appear different from the rest?

A
  • Which beat is it?
  • Is it ventricular or supraventricular?
  • Is it premature or delayed?
  • What would you call it?

Cardiology and Respiratory SA Med (15 decks)

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