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Adult/Ped Medicine 4 > ECG Interpertation - Brown > Flashcards

ECG Interpertation - Brown Flashcards

1
Q

Identify this condition based on symptoms and the rhythm strip presented:

pt complains of palpitations, shortness of breath with exertion, fatigue, and edema

exam reveals irregular pulse, variable BP, crackles on ascultation

A

Atrial Fibrillation

Rate: Variable, usually fast > 100 bpm
Rhy: Irregularly irregular (chaotic)
P-wave: Not consistently present or reproducible
PR: Not measurable
QRS: Normal (narrow,

Differentiate between atrial fibrillation, atrial tachycardia, and atrial flutter.

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2
Q

Identify this condition based on symptoms and the rhythm strip presented:

pt reports feeling light-headed and having fainted

signs: rapid HR

A

Paroxysmal Supraventricular Tachycardia

Rate: 140 - 250 bpm*
Rhy: Very Regular
P-wave: Lost in the T-wave, not typically observed on rhythm strip
PR: Not measurable
QRS: Normal (narrow,

Differentiate between atrial fibrillation, atrial tachycardia, and atrial flutter.

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3
Q

What pathology is present?

Rate: Variable, usually fast > 100 bpm

Rhy: Irregularly irregular (chaotic)

P-wave: Not consistently present or reproducible

PR: Not measurable

QRS: Normal (narrow,

A

Atrial Fibrillation

Differentiate between atrial fibrillation, atrial tachycardia, and atrial flutter.

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4
Q

Differential Diagnosis for a Wide-QRS Complex

A

in order of descending mortality

  • hyperkalemia
  • ventricular tachycardia
  • idioventricular rhythm, including heart block
  • drug effects and overdose (tricyclics)
  • Wolff-Parkinson-White
  • Bundle Branch Blocks & IVCD
  • PVCs
  • Aberrantly conducted complexes
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4
Q

What pathology is present?

Rate: Atrial rate 250 – 400 Ventricular rate Varies

Rhythm: Regular or Irregular

P-waves: Saw tooth deflection (F waves)

PR: Not measurable

QRS: Typically normal

A

Atrial Flutter

Differentiate between atrial fibrillation, atrial tachycardia, and atrial flutter.

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6
Q

Analyze the basic ECG components required to assess pathology to include, heart rate, rhythm, axis, and intervals

Rhythm Determination on an ECG

A

Is the distance between one QRS complex the same as the others?

If yes - the rhythm is regular

If no - the rhythm is irregular

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6
Q

Insignificant Q Waves

A
  • do not meet the criteria for significance
  • typically found in leads: I, aVL, V4-V6
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7
Q

Criteria for Diagnosis of MI: Injury Pattern

A
  • ST segment elevation (1 mm or greater)
  • T wave peaks initially then inverts later
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7
Q

Criteria for Diagnosis of MI: Infarction Pattern

A

Presence of SIGNIFICANT Q WAVES

  • Q wave that is 1/3 total height of QRS
  • wider than 40 ms
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8
Q

What pathology is described and shown on the ECG below:

QRS > 120 ms

rSR’ pattern V1-V2

slurred S-wave in I and V6

A

Right Bundle Branch Block

  • QRS > 120 ms
  • Axis is RAD or normal
  • rsR’ pattern V1-V2
  • slurred S-wave in I and V6
  • NSSTT changes in V1 and V2

Describe the specific diagnostic criteria for Bundle branch blocks.

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9
Q

Analyze the basic ECG components required to assess pathology to include, heart rate, rhythm, axis, and intervals

Axis Determination

A
  • on the ECG look at Limb Lead 1 and determine if the net deflection of the QRS complex is positive, negative or equal
  • on the ECG look at Limb Lead aVF and determine if the net deflection of the QRS complex is positive, negative or equal
  • determine where the lines cross
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9
Q

Analyze the basic ECG components required to assess pathology to include, heart rate, rhythm, axis, and intervals

ECG: Right Axis Deviation

A
  • right bundle branch block
  • right ventricular hypertrophy
  • high lateral wall MI
  • right anterior fascicular block
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10
Q

ECG Waveforms

(PQRST)

A

P wave: atrial depolarization

QRS wave: ventricular depolarization, also atrial repolarization occurs

J Point: end of the QRS wave and start of the ST segment

T Wave: ventricular repolarization

U Wave: late repolarization variant, can be a normal variant or assoicated with hypokalemia or hypomagnesiumemia

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11
Q

R-Wave Progression

A
  • uses the precordial chest leads V1-V6
  • r-wave (myocardial rotation) progresses from V1 through V6
  • start small V1
  • transition occurs V3,V4
  • get big V6
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13
Q

Identify the common variances within normal ECGs.
Describe the specific diagnostic criteria for normal ECGs .

“Normal” ECG

A
  • P waves upright in: I, II, V2-V6
  • Small Q waves in: I, aVL, V4-V6
  • Deep Q waves in: aVR occassionally III and V1
  • T waves upright in: I, II, V3-V6
  • T waves inverted in: aVR
  • T waves variable in: III, aVL, aVF, V4-V6
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14
Q

Identify the pathology described below and shown on the ECG:

PR interval < 120 ms, normal P waves

Wide QRS complex

Presence of “delta-wave”

A

Wolff Parkinson White

“delta-wave” intial slurring of QRS

can also have secondary ST-T changes

15
Q

What pathology is present?

Rate: 140-250 bpm

Rhythm: regular

P-Wave: not typically observed

PR: not measurable

QRS - normal (narrow < 0.12 sec)

A

Paroxysmal Supraventricular Tachycardia

Differentiate between atrial fibrillation, atrial tachycardia, and atrial flutter.

16
Q

Analyze the basic ECG components required to assess pathology to include, heart rate, rhythm, axis, and intervals

QT Interval

A

QT

  • measures a complete ventricular cycle (depolarization and repolarization)
  • start of QRS to end of T wave
  • normal is heart rate dependent
    • HR of 60 - 400 ms
    • HR of 100 - 320 ms
  • as HR increases, QT interval decreases
  • QT is probably prolonged if it exceeds more than HALF of the R-R interval
18
Q

Analyze the basic ECG components required to assess pathology to include, heart rate, rhythm, axis, and intervals

QRS Interval

A

QRS

  • normal < 3 boxes)
  • beginning of QRS to end (J-Point)
  • length of time for ventricular contraction
  • prolonged interval
    • bundle branch blocks
    • IVCD
    • WPW
    • LVH
    • RVH
    • ventricular tachycardia
    • PVCs
    • idoventricular rhythm
19
Q
  • Develop a simple method that will allow you to consistently assess unknown ECGs for common pathologies.*
  • *
A
  • Gestalt - general impression (i.e. this is bad)
  • Determine the Heart Rate
  • Determine the Rhythm
  • Measure the Longest Interval (PR, QRS, QT) in the limb leads
  • Determine the Axis
  • Asses the R-Wave Progression
20
Q

Evaluate this rhythm strip:

A

Differentiate between atrial fibrillation, atrial tachycardia, and atrial flutter.

Paroxysmal Supraventricular Tachycardia

Rate: 140 - 250 bpm*
Rhy: Very Regular
P-wave: Lost in the T-wave, not typically observed on rhythm strip
PR: Not measurable
QRS: Normal (narrow,

Reentry process, presents abruptly for numerous reasons

Symptoms: light-headedness, syncope, racing heart; worsen angina and heart failure

22
Q

Analyze the basic ECG components required to assess pathology to include, heart rate, rhythm, axis, and intervals

ECG: Left Axis Deviation

A
  • left bundle branch block
  • left ventricular hypertrophy
  • inferior wall MI
  • left anterior fascicular block
23
Q

How to differentiate between atrial fibrillation, atrial tachycardia, and atrial flutter.

A

Is the rhythm regular?

  • yes: PVST or atrial flutter
  • no: atrial fibrillation or atrial flutter

Are P-waves (F-waves) present?

  • yes: atrial flutter
  • no: PVST or atrial fibrillation
24
Q

Criteria for Diagnosis of MI: Ischemia

A
  • ST segment depression (2 mm or greater)
  • T wave inversion (symmetrical)
25
Q

What pathology is described and shown on the ECG below?

QRS > 120 ms

Wide S waves V1-V4

Wide R waves in I and V6

A

Left Bundle Branch Block

  • QRS > 120
  • Axis is normal or LAD
  • wide monomorphic S waves V1-V4
  • wide monomorphic R waves in I and V6
  • NSSTT changes in most leads

Describe the specific diagnostic criteria for Bundle branch blocks.

26
Q

Identify the common variances within normal ECGs.
Describe the specific diagnostic criteria for normal ECGs.

what to note/evaluate on each ECG lead

A
  • location and morphology of P waves
  • QRS pattern (presence of Q-waves)
  • ST segment (elevation or depression)
  • T wave changes

**Review all leads except aVR

27
Q

Differential Diagnosis of ST-Elevation

A
  • Acute STEMI
  • Printzmetal’s Angina
  • Ventricular Aneurysm
  • Pericarditis
  • Normal Variant - early repolarization
27
Q

Evaluate this rhythm strip:

A

Atrial Flutter

Rate: Atrial rate 250 – 400 Ventricular rate Varies
Rhythm: Regular or Irregular
P-waves: Saw tooth deflection (F waves)
PR: Not measurable
QRS: Typically normal

Differentiate between atrial fibrillation, atrial tachycardia, and atrial flutter.

29
Q

Evaluate this Rhythm Strip:

A

Atrial Fibrillation

Rate: Variable, usually fast > 100 bpm
Rhy: Irregularly irregular (chaotic)
P-wave: Not consistently present or reproducible
PR: Not measurable
QRS: Normal (narrow,

Symptoms: palpitations, SOB, fatigue, DOE, CP, edema

Signs: irregular pulse, variable BP, crackles edema

Causes: organic heart disease, valvular disease, thyroid, HTN

Differentiate between atrial fibrillation, atrial tachycardia, and atrial flutter.

30
Q

System to Evaluate Rhythm Strips

A
  • Determine Heart Rate
  • Determine Rhythm
  • Presence of P-wave (location and morphology)
    • a single P-wave should proceed each QRS complex
    • should bear a family resemblance to all other P-waves
  • Measure PR and QRS intervals
31
Q

Analyze the basic ECG components required to assess pathology to include, heart rate, rhythm, axis, and intervals

Heart Rate Determination on an ECG

A

Paper speed is 25 mm/sec or 300 big boxes per second

take 300 divided by the number of big boxes from 1 QRS to the next

i.e. in this example: 300/3.8 = ~80

32
Q

Analyze the basic ECG components required to assess pathology to include, heart rate, rhythm, axis, and intervals

PR Interval

A

PR:

  • normal: 120-200 ms (3-5 boxes)
  • beginning of P wave to the beginning of the QRS complex
  • best measured in limb lead 2
  • conduction through the AV node
  • short PR interval:
    • pre-excitation syndrome (WPW, LGL)
    • PACs
  • long PR interval - lots of causes
  • refered to as “First Degree AV Block”

Adult/Ped Medicine 4 (17 decks)

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