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Adult Health 1 - (Josh) > ECG Interpretation Part 1 (Josh) > Flashcards

ECG Interpretation Part 1 (Josh) Flashcards

1
Q

What is Ejection Fraction (EF)?

A

ratio of the SV ejected from the left ventricle with each beat to the volume of blood at the end of diastole (LVEDV)

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2
Q

What is a normal Ejection Fraction?

A

greater than 50%

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3
Q

What does an Ejection Fraction less than 35% indicate?

A

Poor Ventricular Function

Poor Ventricular Filling

Obstruction to Outflow

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4
Q

Which heart node fires off first?

A

SA node fires before AV node

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5
Q

What is LVEDV?

A

Left Ventricular End Diastolic Volume

What SV is compared with to get the Ejection Fraction

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6
Q

Ejection Fraction is a good indicator of — —

A

heart function

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7
Q

Which node is the Pacemaker?

A

SA node

**starts the spontaneous conduction of the heart

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8
Q

Cardiac Conduction:

What is the P-wave indicative of?

A

Atrial Contraction

  • Depolarization of Atrium
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9
Q

Cardiac Conduction:

What does the PR Interval show us?

A

If there is any difficulty between conduction between the SA Node and the AV Node

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10
Q

If there is a problem with the AV node, where would we see it on ECG?

A

PR Interval

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11
Q

What does the QRS Complex represent?

A

Ventricular Depolarization

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12
Q

What QRS Complex is considered normal?

Abnormal?

A

Normal = Narrow

Abnormal = Wide

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13
Q

What does the ST Segment represent?

A

Beginning of repolarization

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14
Q

What does the T Wave represent?

A

Repolarization of Ventricle

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15
Q

What is a normal SA Node rate?

A

60 -100 bpm

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16
Q

What is a normal AV Node rate?

A

40- 60 bpm

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17
Q

What is contraction of AV Node called?

A

Atrial Kick

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18
Q

AV Node contraction is signified by — —

A

PR Segment

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19
Q

SA Node contraction is signified by — —

A

P Wave

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20
Q

What is normal rate of Bundle of His contraction?

A

20 - 40 bpm

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21
Q

What is the normal rate of contraction in the Perkunjie Fibers?

A

less than 15 bpm

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22
Q

Reading an ECG:

How much time does each 1 mm square count?

A

0.04 seconds

***5 mm square is 0.2 seconds

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23
Q

Reading an ECG:

How is amplitude measured?

A

milimeters

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24
Q

Reading an ECG:

How is duration measured?

A

seconds

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25
Q

Reading an ECG:

What is baseline?

A

isoelectric line

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26
Q

Reading an ECG:

What is the length of a typical measurement strip?

A

6 seconds

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27
Q

How do you estimate HR with ECG Waveform strip?

A

count number of QRS complexes in each 6 six second interval and multiply by 10

ex: if there are 9 QRS in 6 secs, then the HR is 90 bpm

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28
Q

Reading an ECG:

What is PR Segment?

A

the time required for impulse to travel through AV node, where it is delayed, and through the bundle of His, perkunjie fibers, just before Ventricular depolarization

end of P wave to beginning of QRS

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29
Q

Reading an ECG:

What is PR Interval?

A

Beginning of P-Wave to beginning of QRS (end of PR segment)

***represents time required for Atrial depolarization as well as impulse travel through BoH and Perkunjie.

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30
Q

Reading an ECG:

What does QRS Complex represent?

A

ventricular depolarization

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31
Q

Reading an ECG:

What is the J Point?

A

the junction where the QRS ends and the ST segment begins

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32
Q

Reading an ECG:

What is the ST Segment?

A

early part of ventricular repolarization

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33
Q

Reading an ECG:

What is the T Wave?

A

ventricular repolarization

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34
Q

Reading an ECG:

What is the U Wave?

A

late part of ventricular repolarization

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35
Q

Reading an ECG:

What is the QT Interval?

A

represents total time required for ventricular depolarization and repolarization

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36
Q

Reading an ECG:

How is QT Interval measured?

A

beginning of QRS to the end of T-Wave

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37
Q

P-Wave:

What is normal duration?

A

0.12-0.2 secs

**3-5 blocks (each block is 0.04 secs)

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38
Q

What should shape of P-Wave look like?

A

upright

rounded

***should all look the same because there is only one SA Node

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39
Q

Abnormal P Waves:

What is a tall, peaked P Wave?

A

P Pulmonale

***indicates right atrial hypertrophy

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40
Q

Abnormal P Waves:

What is an M-shaped P Wave?

A

P Mitrale

  • **indicates left atrial hypertrophy
  • **Mitral valve goes with left side of heart
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41
Q

QRS:

What is normal QRS duration?

A

0.06 - 0.1 seconds or less than 0.12

42
Q

Which part of ECG shows ventricular excitation, contraction, and recovery?

A

QT Interval

43
Q

What does length of QT Interval depend on?

A

HR

  • **faster HR = short QT
  • **slower HR - long QT
44
Q

What are normal upper limits on QT Interval?

A

0.39 - 0.43 secs

***dependent upon HR

45
Q

How long should QT Interval be in relation to the R to R Interval?

A

QT should be half of R-R Interval

***if more than that it is PROLONGED

46
Q

A normal QT Interval should be — of the RR Interval.

47
Q

What is a Corrected QT Interval (QTc)?

A

adjusts QT Interval to account for HR

***Normal QTc = less than 0.44 secs

48
Q

What is a normal QTc?

A

less than 0.44 secs

49
Q

Why are we worried about QT Interval?

A

prolonged can lead to V-tach (lethal)

50
Q

Reading an ECG:

Which part of ECG is the time of no electrical activity?

A

ST Segment

***don’t measure LENGTH

***MEASURE HEIGHT ONLY

51
Q

How is an ST Segment described?

A

by height

  • isoelectric (flat)
  • elevated
  • depressed
52
Q

Reading an ECG:

Which part indicates Ventricular Repolarization?

A

T-wave

**do NOT measure duration

53
Q

How is a T-wave described?

A

upright, round and smooth, inverted, peaked or depressed

54
Q

Reading an ECG:

What is the U Wave?

A

repolarization of His-Perkunjie

  • **normal in kids
  • **not normal in adults
55
Q

What does U Wave signify in adults?

A

Hyperthyroidism or Hypokalemia

56
Q

When doing ECG Rhythm analysis, what are we assessing?

A

Regularity

Rate

P-wave

PR Interval

QRS duration

Interpret Rhythm

57
Q

ECG Rate Determination:

How do we determine rate if it is regular?

How do we determine rate if it is irregular?

A

Regular: count number of small boxes between 2 R waves and divide into 1500

Irregular: count number of R waves in a 6 second strip

58
Q

What is Normal Sinus Rhythm?

A

Regular

Rate = 60-100

P Wave = normal and upright with 1:1 with QRS

PR Interval = 0.12 - 0.2 secs and constant

QRS = 0.04 - 0.1 and constant

59
Q

What rate is Sinus Tachycardia?

A

101-150

***treat by correcting underlying cause not to decrease the rate

60
Q

What is Sinus Bradycardia?

A

less than 60 bpm

61
Q

What are causes of Sinus Bradycardia?

A

Increased Parasympathetic Tone in Athletes (Lance Armstrong)

SA Nodal disease (Sick Sinus Syndrome)

Medications

VAGAL STIMULATION

62
Q

What is the hemodynamic effect of Sinus Bradycardia?

A

Decreased CO

Hypotension

  • orthostatic
  • syncope
63
Q

What is the management for Symptomatic Bradycardia?

A

Atropine (DOC)

Pacemaker

***only treat sinus bradycardia if it is symptomatic

64
Q

Sinus Bradycardia:

What is PR Interval?

QRS?

A

PRI = 0.12 to 0.20

QRS = less than 0.12

65
Q

Which is a Sinus Arrhythmia?

A

normal rate with irregular rhythm

***not normal for adults

66
Q

What is cause of Sinus Arrhythmia?

A

HR varies with respiration due to fluctuations in parasympathetic outflow

67
Q

What is a PAC?

A

Premature Atrial Contraction: single beat originates in atria and comes early in cardiac cycle

***Cyclic

***Bigeminy (every other beat)

***Trigeminy (every other beat)

68
Q

What is difference between Atrial Tachycardia and Sinus Tachycardia?

A

the rate is more in Atrial Tach (150-250) than in Sinus Tach (101-150)

69
Q

What would the rate of an Atrial Flutter be and what would P Wave look like?

A

250-350 bpm

P-Wave has a ‘sawtooth’ appearance

70
Q

What is the hemodynamic effect of Atrial Fibrillation?

A

lose Atrial Kick

decreased SV

***CO can decrease by 20-30%

71
Q

What is the most common dysrhythmia?

A

A-fib

***Can be compensated for if Ventricular Response is high enough (80 bpm or something like that)

72
Q

What is the main problem with A.Fib?

A

atria is quivering and not pumping blood good so….

STASIS of BLOOD in atria that can lead to PE, VTE, etc

73
Q

Management for A.Fib?

A

Get them out of the rhythm

Control Ventricular Response

Prevent complications from stasis of blood

74
Q

What is a Junctional Rhythm?

A

AV node takes over when a higher pacemaker fails to initiate AV node

75
Q

How do you tell difference between Junctional Rhythm and Sinus Bradycardia?

A

inverted P Wave in Junctional Rhythm

***both have slow rate of 40-60

76
Q

If they have a Symptomatic Junctional Rhythm, what med do we give?

77
Q

Why does the Junctional Rhythm have an inverted P Wave?

A

electrical rhythm is going back up the heart

78
Q

What can Dig Toxicity cause?

A

Premature Junctional Contractions

79
Q

What is Supraventricular Tachycardia?

A

a broad term for a group of rhythms originating ABOVE the ventricle

***any fast rhythm not coming form ventricle

80
Q

What does the QRS look like in a Premature Ventricular Contraction (PVC)?

A

wide and bizarre

***can be positive (going up) or negative (going down)

81
Q

What is an R on T?

A

a Preventricular Contraction that happens on top of T wave

***QRS will be on top of T Wave

82
Q

What is danger with an R on T?

A

Can cause V-tach

83
Q

If V-tach is with a pulse, treat with —-

If V-tach is without a pulse, treat with —-

A

meds

defibrillation

***always check for a pulse with V-tach

84
Q

V-tach caused by prolonged QT Interval?

A

Torsades do Pointe

**correct cause and give IV Mag

85
Q

What is an Idioventricular Rhythm?

A

QRS is wide and bizarre (greater than 0.12) with a slow rate (20-40 bpm)

86
Q

What meds with Idioventricular Rhythm?

A

Atropine

PPM

***not Amiodarone or Lidocaine because it’s the only rhythm we have

87
Q

Nursing mgmt for Vfiv or Pulseless Vtach?

A

Check for pulse (if none, then)

Shock

CPR for 5 cycles (about 2 mins)

Check for Pulse

88
Q

What are shockable rhythms?

A

Pulseless Vtach

Vfib

89
Q

What is Ventricular Asystole?

A

no electrical activity and a flat line on ECG monitor

90
Q

Mgmt for Ventricular Asystole?

A

Check diff. lead

CPR (NOT SHOCKABLE)

Epi every 3-5 mins

91
Q

Can you shock

Ventricular Systole?

A

NO

give CPR and Epi q 3-5 mins

92
Q

What is PEA?

A

Pulseless Electical Activity

***electical activity with no corresponding contraction, which means no PULSE

93
Q

What are the 5 H’s of PEA?

A

Hypovolemia

Hypoxia

Hydrogen ions (acidosis)

Hyper or Hypokalemia

Hypothermia

94
Q

What are teh 5 T’s of PEA?

A

Tables (drug overdose)

Tamponade

Tension Pneumothorax

Thrombosis (coronary or pulmonary)

95
Q

What is the Compression/Ventilation ratio for CPR?

96
Q

Which AV Block?

All sinus impulses eventually reach ventricles.

A

First Degree

97
Q

Which AV Block?

Some sinus impulses reach ventricles but some do not

A

Second Degree

98
Q

Which AV Block?

No sinus impulses reach ventricles.

A

Third Degree

99
Q

What does P Wave look like with Wenckebach (Type 1) Second Degree AV Block?

A

progressively lengthens until one P Wave is blocked

***blocked means you have a P Wave with no corresponding QRS

100
Q

What are the two types of Second Degree AV Blocks?

A

Type 1 (Weckebach)

Type 2 (Mobitz)
*** no warning with this one
101
Q

Which type of Second Degree block is worse?

A

Type 1 is usually benign

Type 2 is MORE OMINOUS

102
Q

What do P Waves and QRS look like in Complete (Third Degree) AV Block?

A

not connected

P Waves regular to themselves

QRS regular to themselves

Adult Health 1 - (Josh) (26 decks)

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