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EMRG 1230- CARDIAC UNIT > ECG interpretation > Flashcards

ECG interpretation Flashcards

1
Q

How many little boxes does one big box contains?

A

5 little boxes

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2
Q

Each little box represents ____ seconds

A

0.04s

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3
Q

Multiply 0.04 by ___ small boxes to make up __ large box

A

5 small boxes to make up 1 large box

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4
Q

How many seconds does each large box make up?

A

0.20 seconds

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5
Q

What does P wave mean?

A

atrial depolarization

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6
Q

What does a good P wave look like?

A

smooth, round and upright

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7
Q

What to look for with the P wave…..

A
  • if there are no P waves
  • if a P wave is present, but not followed by a QRS complex
  • can give clues to pacemaker site
  • P waves that vary in size and configuration
  • Upright or inverse
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8
Q

What is the PR interval? How is it measured?

A
  • amount of time it tasks atria to DEPOLARIZE and for impulse to travel through the AV node
  • measured from the start of the P wave to the point at which the QRS complex begins
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9
Q

How long is the PR interval supposed to be?

A

<0.20s (one bigger box, 5 little ones)

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10
Q

What does the QRS complex supposed to look like?

A

Narrow, with sharply pointed waves and has a duration of less than 0.12s (3 small boxes or less)

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11
Q

What does the QRS complex represent?

A

Ventricular depolarization

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12
Q

What does a wide QRS mean?

A

a BLOCK somewhere

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13
Q

Do T waves really matter in reading a lead II ECG?

A

NOPE

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14
Q

What is the 1st step in reading an ECG rhythm?

A

Measure the heart rate
- 6 sec strip
- 300 rule

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15
Q

What is the 2nd step in reading an ECG rhythm?

A

Identify the P waves.
- upright? contoured? retrogade? inverted?
- do they all look the same?

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16
Q

What is the 3rd step in reading an ECG rhythm?

A

Measure the PI interval.
- should be less than 0.20s (one bigger box, 5 little ones)

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17
Q

What is the 4th step in reading an ECG rhythm?

A

Determine the relationship of the P waves with QRS.
- should be 1:1 ratio

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18
Q

What is the 5th step in reading an ECG rhythm?

A

Determine if the QRS complex is wide or narrow.
- wide means there is a block
- narrow=normal, <0.12s, 3 little boxes

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19
Q

What is the 6th step in reading an ECG rhythm?

A

Determine rhythm regularity.
- are the QRS’s equally distance from each other?
- is it regularly irregular? irregularly irregular?

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20
Q

What is the number sequence for the 300 rule?

A

300, 150, 100, 75, 60, 50, 43, 38, 33, 30

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21
Q

What are the 3 different categories of dysrhythmias?

A
  1. disorder of impulse formation
    - SA node failure, other pacemakers and ectopic focuses
  2. Disorders of impulse conduction
    - Delayed or blocked in the heart
  3. Artifact
    - 60 cycle inference, poor contact, damaged cable
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22
Q

Rate: 60-100 bpm
P waves: present/ upright
PRI: <0.20s
QRS: <0.12s
Ratio: 1:1
Rhythm: regular

A

Normal Sinus Rhythm

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23
Q

Rate: 60-100 bpm, but sometimes below rates of 60bpm, the rate slightly increases and decreases with expiration and inspiration
P waves: present/ upright
PRI: <0.20s
QRS: <0.12s
Ratio: 1:1
Rhythm: regular irregular, it coincides w breathing patterns

Heart rate varies slightly with respiratory pattern

A

Sinus Arrhythmia

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24
Q

Rate: <60bpm
P waves: present/ upright
PRI: <0.20s
QRS: <0.12s
Ratio: 1:1
Rhythm: regular

A

Sinus Bradycardia

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25
Q

Rate: >100bpm
P waves: present/ upright
PRI: <0.20s
QRS: <0.12s
Ratio: 1:1
Rhythm: regular

A

Sinus Tachycardia

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26
Q

Rate: 140-250bpm
P waves: buried under the preceding T wave
PRI: N/A
QRS: narrow <0.12s
Ratio: N/A
Rhythm: regular

A

Supra ventricular Tachycardia

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27
Q

Rate: rate change is sudden and unexpected (120-230bpm)
P waves: may be seen during slower phase
PRI: N/A during fast rate
QRS: narrow
Ratio:1:1(during slower rhythm)
Rhythm: each section has regular rhythm

A

Paroxysmal Supraventricular Tachycardia (PSVT)

28
Q

What is RE ENTRY syndrome?

A

when conduction is abnormally slow in some area (ex. heart damage) the myocardial cells are unable to activate the fast sodium channel

part of impulse will arrive late and potentially be treated as a new impulse

series of beats, sudden onset

29
Q

What is pre excitation syndrome?

A

occurs because there exists muscle fibre that penetrates the AV ring that normally isolates the 2

30
Q

What are types of pre excitation syndromes?

A

WPW- (kent bundle): pathway through the AV ring that bypasses the Av node

MANHEIM FIBERS: from the AV node, bundle of His or branches

LGL- bypass the AV node and goes directly to the bundle of His

31
Q

Rate: generally slow-normal
P waves: present and upright, the FOLLOWING beat will have a different morphology from the other P waves
PRI: interval normal
QRS: narrow
Ratio: 1:1
Rhythm: regular, expect where disrupted by the pause

A

sinus arrest

32
Q

Rate: slow-normal
P waves: present except when dropped (after dropped, returns to normal)
PRI: normal
QRS: narrow
Ratio: 1:1
Rhythm: regular except where disrupted by dropped beats

A

Sinus exit block / SA block

33
Q
  • Ectopic beat from somewhere in the atria
  • Contraction ahead of the regular P wave
  • similar OR diff morphology
  • PRI can be normal or long
  • SA node is firing normally and the atrium decided to shoot a single off
A

Premature Atrial Complex (PAC)

34
Q

When the P wave must be upright during a PAC, if it is inverted/ retrograde, what is it called?
- coming from the AV node

A

Premature Junctional Complex (PJC)

35
Q

Rate: 40-60bpm
P waves: absent, inverted or retrograde (after T)
PRI: is normal or short or N/A
QRS: usually narrow
Ratio: 1:1
Rhythm: regular

A

Junctional

36
Q

Rate: >100bpm
P waves: retrograde
PRI: short
QRS: narrow
Ratio: 1:1
Rhythm: regular

A

Junctional tachycardia

37
Q
  • waves with NO organization or regularity
  • indication of random electrical activity
  • can be atrial or ventricular
  • wavy line
A

Fibrillation

38
Q

Rate: will vary
P waves: not discernible
PRI: N/A
QRS: usually narrow
Ratio: N/A
Rhythm: irregularly irregular= the HALLMARK…

A

A-Fib (Atrial fibrillation)

39
Q

What should we give to pt’s who are in A FIB?

A

blood thinners

40
Q

Rate: 200-350bpm
P waves: saw tooth appearances
PRI: n/a
QRS: usually narrow
Ratio: 2:1, 3:1, 4:1
Rhythm: usually regular

A

Atrial Flutter

41
Q

Ventricular Rhythms: What are the different types of AV blocks?

A

1st degree (long PRI)
2nd degree: type I & II
3rd degree

42
Q

Rate: depends on the underlying rhythm
P waves: normal
PRI: >0.20s
QRS: narrow
Ratio: 1:1
Rhythm: regualr

A

1st degree AV block

43
Q

Rate: generally slow-normal
P waves: present, stand alone
PRI: becomes increasingly longer until a beat is dropped (hint: the PRI before dropped beat will be longer the one after) LONG before—> SHORT after
QRS: narrow
Ratio: 1:1
Rhythm: regularly irregular

A

2nd degree- type I

44
Q

Rate: generally slow
P waves: present, stand alone
PRI: when there are P waves associated with QRS the PRI will be CONSTANT
QRS: narrow
Ratio: FIXED ratio
Rhythm: usually regular

A

2nd degree, type II

45
Q

Rate: slow 45 or below, atrial rate is normal
P waves: present, stand alone
PRI: N/A
QRS: wide
Ratio: N/A
Rhythm: regular
- No connection between the atrium and ventricles
- Pt will obviously be SICK

A

3rd degree (complete block)

46
Q

Rate: 20-40bpm
P waves: absent
PRI: N/A
QRS: >0.12 and BIZARRE looking
Ratio: N/A
Rhythm: regular

A

Idioventricular

47
Q

Rate: >40 less than 100bpm
P waves: absent
PRI: N/A
QRS: wide >0.12 and BIZARRE
Ratio: N/A
Rhythm: regular

A

Accelerated Idioventricular- AIVR

48
Q

Rate: 120-250bpm
P waves: N/A
PRI: N/A
QRS: always wide >0.12s (usually >0.14s)
Ratio: N/A
Rhythm: usually regular unless polymorphic

A

Ventricular Tachycardia

49
Q

What is monomorphic V Tach?

A

All QRS complexes have the same morphology

50
Q

What is polymorphic V Tach?

A

When the QRS complexes vary in size/shape!

51
Q

What is torsades de pointes?

A

axis of the QRS complex changes from positive to negative in a haphazard fashion

“twisting of points”

can convert to NSR or V FIB

52
Q
  • caused by premature firing of the ventricular cell
  • ventricular pacer fires before the SA node
  • underlying pacing rhythm schedule is not altered, so the beat after the PVC on arrive on time
  • ectopic complexes
  • occurs EARLY than expected
A

Premature Ventricular Complex

53
Q

What does multifocal mean?

A

arising from 2 or more ectopic foci
- results in multiple QRS morphologies

54
Q

What does unifocal mean?

A

arising from a single ectopic foci
- results in each PVC looking identical

55
Q

Two consecutive PVCs?

A

couplet

56
Q

Every other beat is a PVC?

A

Bigeminy

57
Q

Every third beat is a PVC?

A

Trigeminy

58
Q

Every fourth beat is a PVC?

A

Quadrigeminy

59
Q
  • Rhythm most commonly seen in cardiac arrests
  • Responds well to defibrillation
  • CPR compressions help make heart more susceptible to defibrillation
  • can be coarse or fine
A

Ventricular Fibrillation (V FiB)

60
Q

V fib pts are clinically _______ !!

A

DEAD

61
Q

2 types of V FIB:

A

coarse and fine

62
Q
  • Flatline
  • Entire heart is no longer contracting
  • Generally confirmation of death
A

ASYSTOLE

63
Q
  • clinically dead or VSA (no pulse)
  • presence of some form of electrical activity and a rhythm but the pt is apenic and pulseless
  • CPR is indicated
  • can be any heart rhythm
A

Pulseless Electrical Activity (PEA)

64
Q

What are the 6 H’s of causes of PEA:

A

Hyperkalemia
Hypoxia
Hydrogen Ion Access
Hypoglycemia
Hypothermia
Hypovolemic

65
Q

What are the 6 T’s of causes of PEA:

A

Tamponade
Toxins
Thrombosis (MI)
Thrombosis (PE)
Trauma
Tension pneumothorax

66
Q

What is artifact?

A
  • somatic tremors from skeletal muscle contraction
  • alternating current
  • disrupt the baseline as well as the clarity of the tracing

EMRG 1230- CARDIAC UNIT (11 decks)

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