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Physiology Block 6 > ECG Basics And Interpretation > Flashcards

ECG Basics And Interpretation Flashcards

1
Q

Reference electrode is always

A

Positive

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2
Q

What do electrodes measure

A

Change in polarity

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3
Q

Waves are recorded as

A

Depolarization moves toward or away from electrode

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4
Q

Depolarizations moving towards an electrode

A

Positive

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5
Q

Depolarizations moving away from electrode are

A

Negative

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6
Q

Depolarizations moving towards an electrode

A

Negative

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7
Q

Repolarizations moving away from electrode

A

Positive

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8
Q

Moving at a right angle to electrode

A

Generates no wave

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9
Q

What do the electrodes ultimately measure

A

Sum and vector of everything

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10
Q

Most EKGs are what kind

A

12 leads

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11
Q

Limb leads

A

6

  • 3 standard leads
  • 3augmented leads

Requires a lead on each limb

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12
Q

Precordial leads

A

6

-arranged along chest wall

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13
Q

What do multiple leads allow

A

Entire heart to be viewed in (basically) 3D

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14
Q

Lead I

A

Left arm (+). Right arm (-)

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15
Q

Lead II

A

Right arm (-), legs (+)

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16
Q

Lead III

A

Left arm (-), legs (+)

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17
Q

Augmented leads

A

One +, other 2 are -

Up in atria

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18
Q

Precordial leads

A 
Around heart at mid chest 
Gives horizontal view
Used to localize infarcts 
Always have V in front of it 
Number gets bigger as you move towards the left
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19
Q

P waves in leads

A

Small and positive in the left and inferior leads

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20
Q

QRS in leads

A
  • Large and positive R eaves are seen in left and inferior leads
  • R wave progresses from negative to more positive through V1-V5

V1-V5, R wave gets taller (more +), breaks down during MI

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21
Q

T waves in leads

A

Variable, but positive in large R wave leads

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22
Q

How many beats on each lead?

A

2-3

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23
Q

What is a quick dirty diagnosis of morphology of heart

A

Mean electrical axis

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24
Q

Vector that shows where most depolarization occurs

A

Mean electrical axis

Shows most muscle mass is

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25
Q

Sum of all QRS vectors is usually

A

60 degrees

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26
Q

Why does the mean electrical axis go to 60 degrees normally?

A

Goes down and to the left because left ventricle is largest chamber

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27
Q

What happens if mean electrical axis changes?

A

The heart has changed shape

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28
Q

What changes in the heart would causes MEA to change

A

Hypertrophy/dilation in response to cardiac disease. Causes change in MEA because more muscle in heart needs to be treated

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29
Q

What are the two leads you need to look at when calculating MEA?

A

lead I and aVF

-covers all the ventricles

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30
Q

Where will aVF be positive?

A

Towards base

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31
Q

Where will Lead I be positive

A

Towards the left

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32
Q

Where will aVF be negative

A

Towards apex

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33
Q

Where will lead I be negative

A

Towards the right

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34
Q

Where is there normally overlap?

A

Bottom left, both leads are positive

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35
Q

Deviations of MEA are indicative of what

A

Structural changes

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36
Q

What are two functional changes of hte heart that will affect MEA?

A

Hypertrophy

Dilation

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37
Q

Heart cells get bigger

A

Hypertrophy

Response to hypertension
Heart will get thicker

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38
Q

Chamber gets bigger of heart

A

Dilation

Response to volume overload

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39
Q

What do both dilation and hypertrophy result in?

A

Shift towards THE AFFECTED area, usually the ventricles.

40
Q

Why do atrial problems not normally showing in MEA changes?

A

Ventricles will hide the atrial dysfunction because the atria are smaller. Also, the left side can obscure right side changes

41
Q

You receive an ECG with a positive R wave in lead I and a negative R wave in aVF. What is this persons MEA?

A

Left axis

42
Q

You receive an ECG with a positive R wave in lead I and a negative R wave in AVF. Which of the following could result in such an ECG change?

A

Left ventricular hypertrophy, and maybe left atrial hypertrophy

43
Q

Any alteration to normal rhythm, regularity, origin or condition of the heart beat

A

Arrhythmias

44
Q

Are all arrhythmias bad?

A

Not all are dangerous, but some are fatal

45
Q

Symptoms of arrhythmias

A

Palpitations and or sudden light-headedness

46
Q

What can arrhythmias excacerbate?

A

Underlying conditions like heart failure

47
Q

What do you do to diagnose arrhythmias?

A

Use rhythm strip. Gives a longer recording like 10s of lead II

48
Q

How do you determine arrhythmia?

A

Rate and rhythm

49
Q

How to determine rate

A

300/# of large squares between successive R waves.

50
Q

What do you check when looking at rhythm?

A

Does it look normal

  • P waves?
  • QRS narrow or wide?
  • 1:1 ratio between P and QRS?
  • is it regular?
51
Q

HR under 60BPM?

A

Bradycardia

52
Q

Where does sunis bradycardia and tachycardia originate?

A

SA node

53
Q

What kind of drug could cause sinus bradycardia?

A

M2 agonist

54
Q

What changes on the EKG in bradycardia?

A

Lengthened PR interval

55
Q

What does the lengthened PR interval on the EKG during bradycardia tell us?

A

Lengthened nodal delay

56
Q

Which is worse, bradycardia or tachycardia?

A

Tachycardia

57
Q

HR over 100 bpm

A

Sinus tachycardia

58
Q

Is there a greater change in diastole or systole when the HR is increased?

A

Diastole, heart doesn’t stay relaxed long enough, decreased output because it didnt have proper time to fill

59
Q

Rapid, irregular atrial depolarizations with a sawtooth pattern on EKG. Normal QRS

A

Atrial flutter

60
Q

Why is the QRS complex normal in atrial flutter?

A

AV node refractory for most atrial depolarizations

61
Q

What node is affected in atrial flutter

A

SA

62
Q

No coordination of atrial depolarization. Irregular QRS

A

Atrial fibrillation

63
Q

Why is the QRS irregular in A fib?

A

AV node will fire as soon as it is no longer in refractory. There is uncoordinated contraction between the atria and the ventricles

64
Q

What kind of meds do you want to make sure someone with A fib is on?

A

Anticoagulants

65
Q

Occur when depolarization is not conducted properly from atria to ventricle (AV node or bundle branches)

A

Conduction block

66
Q

What is 1st degree conduction block?

A
  • normal HR, but prolonged PR interval (>.2s)
  • due to increased AV node delay
  • can be seen in highly trained athletes. Each P wave has QRS, not a big deal. Prolonged pause between atrial and ventricular depolarization
67
Q

What is 2nd degree conduction block?

A
  • not all P waves are conducted via AV node
  • P waves to QRS ratio is >1:1
  • dropped beats (more P than QRS)
68
Q

What are the types of 2nd degree conduction block?

A
  • mobitz type I (Wenckebach)

- Mobitz type II

69
Q

PR interval gets progressively longer until a beat is dropped

A

2nd degree conduction block: Mobitz type I (wenckebach)

70
Q

PR interval is set, but still drop beats

A

Second degree conduction block: Mobitz type II

71
Q

What is a 3rd degree conduction block?

A

No conduction via AV node between atria and ventricles

  • both P waves and QRS have a regular rhythm but are not in sync.
  • QRS can be wide
72
Q

What does a wide QRS mean?

A

Ventricular origin of depolarization

73
Q

What kind of conduction block kills every P wave as it tries to cross AV node?

A

3rd degree

74
Q

What can ventricular arrhythmia lead to?

A

Ischemia

75
Q

Disturbances arise from below the AV node and produce wide QRS and are life threatening

A

Ventricular arrhythmias

76
Q

Ventricular tachycardia

A
  • fast depolarization
  • ischemic event
  • no P waves
  • can lead to fibrillation (still ejected a little blood but screwed up the filling of blood)
77
Q

Ventricular fibrillation

A
  • uncoordinated depolarization
  • rapid death
  • no ejection of blood
78
Q

What kind of heart disturbance do you shock for

A

Ventricular arrhythmias

79
Q

Disruption of oxygen delivery affects the EKG. What is this called?

A

Ischemia

80
Q

What is something that can cause ischemia?

A

Atherosclerosis

81
Q

Why does disruption of O2 delivery affect the heart?

A

Can’t make energy, cant pump ions for contraction

82
Q

What is the first thing you will see if an ischemic attack is just happening

A

Peaked T waves, transitioning into inverted waves T waves.

  • early sign
  • reversible damage
83
Q

What is a sign of hyperkalemia on an EKG?

A

Peaked T waves, transitioning into inverted T waves

84
Q

What is the second thing you will see as ischemia progresses on the EKG?

A

ST-segment elevation

-approaching permanent damage

85
Q

What is the third thing you see on EKG with old ischemic attacks or ones that are far along?

A

Q waves

  • permanent damage
  • also present with healed infarct
86
Q

What does hyperkalemia resemble on EKG?

A

Early ischemia

87
Q

Hyperkalemia affects on EKG

A

Progressive changes in QRS

  • peaked T waves
  • prolonged PR interval
  • widens QRS, merges with T wave
88
Q

Hypokalemia affects on EKG

A
  • ST depression
  • flattened T wave and long QT
  • U wave
89
Q

Why is EKG good for detecting ionic imbalances?

A

It is much quicker to do an EKG than it is to draw blood and wait for the results to return from the lab

90
Q

What do you need to be able to do every time you read an EKG?

A

Check for:

  • rate
  • rhythm
  • axis
  • infarction
91
Q

When you check rate on the EKG, what are you looking for?

A

Normal
Tachycardia
Bradycardia

92
Q

When you check rhythm on EKG, what are you looking for?

A

Sinus or ventricular (1st-3rd degree blocks, fibrillation or flutter)

93
Q

When you check axis on EKG, what are you looking for?

A

Determine the mean electrical axis (normal, left shift, right shift, intermediate shift) and predict pathology associated with that shift

94
Q

When you are looking for infarction on EKG, what are you looking for

A

Is there active ischemia (peaked/inverted T waves), active infarction (ST-segment elevation), old/resolved infarct (Q waves)

95
Q

What could result in widened QRS complex?

A

Sodium channel (Nav) blocker

Physiology Block 6 (7 decks)

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