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Cardiopulm Test 1 > ECG Lecture 4 > Flashcards

ECG Lecture 4 Flashcards

1
Q

What are the 4 questions to ask when interpreting an ECG

A

Speed?

QRS Width?

P Wave?

Regular or Irregular?

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2
Q

How long is a normal ECG strip?

A

6 seconds

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3
Q

What is atrial kick?

A

Normal contraction of atria to increase pressure gradient and send blood to ventricals through mitral valve

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4
Q

What does the P wave represent?

A

Depolarization of atria

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5
Q

What does the PR interval represent?

A

Duration of time for electricity to go from SA to AV node (Atria to ventricals)

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6
Q

What does the QRS complex represent

A

R and L ventricular depolarization

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7
Q

What does the T wave represent?

A

Ventricular repolarization

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8
Q

What does the QT interval represent

A

Time between ventricular start of depolarization and end of repolarization

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9
Q

If an ECG is reading with an abnormally low voltage, does this mean a problem is likely?

A

Yes

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10
Q

What is the isoelectric line?

A

The x=(0) in an ECG

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11
Q

Monitoring a Q wave is important because it can tell you….

A

If there was a recent MI

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12
Q

The normal rythmicity of the SA node is…

A

60-100bpm

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13
Q

The normal rythmicity of the AV node, the AV junction, and the Bundle of His is…

A

40-60bpm

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14
Q

What is the normal rhythmicity of the purkinje networks?

A

20-40

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15
Q

The rate of an arythmia can tell you what?

A

Where its coming from based on the autorythmicity of the different heart cells

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16
Q

An inverted T wave could potentially indicate what 2 problems?

A

Myocardial ischemia or infarction

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17
Q

An ST segment depressed by 2 boxes could mean what

A

Myocardial ischemia

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18
Q

An ST segment elevated by 2 boxes could mean what

A

Myocardial infarction

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19
Q

What is the risk associated with an ST segment being too long?

A

RIsk of serious ventricular arrythmias due to slow repolarization time

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20
Q

How many leads does a typical ECG have?

A

12

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21
Q

Limb Lead 1 goes from where to where?

A

From R to L

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22
Q

Limb Lead 2 goes from where to where?

A

From upper right to lower left

Note: this is why it is the most important in capturing the electrical impulse path inside the heart

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23
Q

Limb Lead 3 goes from where to where?

A

Upper left to lower left

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24
Q

Lead aVF goes to and from where?

A

From top to bottom

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25
Q

Lead aVR goes to and from where?

A

From Middle to left

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26
Q

Lead aVL goes to and from where?

A

From middle to left

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27
Q

What are the “artificial leads”

A

These leads are calculated by combining the signals from two limb electrodes and the Wilson’s Central Terminal (an imaginary point formed by averaging the voltage of the three limb electrodes)

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28
Q

How many precordial leads are there?

A

6

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29
Q

V1 and V2 leads look at what?

A

The right side of the heart

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30
Q

V3 and V4 leads look at what?

A

The septum of the heart

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31
Q

V5 and V6 leads look at what?

A

The left side of the heart

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32
Q

A wide QRS complex indicates that there could be an arrtyhmia coming from ________

A

The myocardium of the ventricals

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33
Q

If you suspect something is wrong on an ECG what is the first thing you should do?

A

Check the patient

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34
Q

What heart rate is considered too fast?

Too slow?

A

above 100 or below 60

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35
Q

What should you do if you see something wrong on an ECG but the patient is presenting fine?

A

Sit the patient down and check the leads

36
Q

If the ECG reads the patients heart is too fast or too slow, they will likely show symptoms of _______

A

Poor cardiac output

37
Q

What produces the S4 heart sound?

A

Atrial kick against a stiff ventricular wall/hypertension

38
Q

What produces the S3 heart sound?

A

Turbulence when filling the ventricals (particularly the left ventrical) during early diastole. Ventricular walls are too compliant (sign of stretch/insufficinecy of the ventricular wall)

39
Q

The S3 heart sound is potentially indicative of ______ cardioMyopathy

A

Dilated

40
Q

When does the S3 heart sound take place?

A

Early diastole, Right after the closing of the aortic and pulmonary valves

41
Q

When does the S4 heart sound take place?

A

Late diastole, just before the closing of the atrioventricular valves.

42
Q

What kind of cardiomyopathies are associated with the S4 heart sound?

A

Restrictive Cardiomyopathy and Hypertrophic cardiomyopathy

43
Q

How will an ECG look coming from the right side of the heart (V1 and V2)

A

ECG will be inverted because current is moving away from it

44
Q

If an impulse is traveling perpendicular to an electrode it may create a _______ waveform

A

Biphasic

45
Q

If a patient’s ECG is reading with a wide T wave with a long pause afterwards, what is likely happening?

A

PVC (premature ventricular contraction)

46
Q

If you have a PVC every 2nd beat what is this called?

A

Ventricular Bigeminy

47
Q

If you have a PVC every 3rd beat, what is this this called?

A

Ventricular Trigeminy

48
Q

For every 1 litre of blood tranfused a patient needs ______ of rest

A

30 mins

49
Q

How wide is a normal QRS wave?

A

1.5-3 spaces

50
Q

Junctional rythm usually presents as ____(fast/slow) and with a missing _ Wave

A

Slow with a missing P wave

51
Q

Why could P wave inversion be normal?

A

You’re looking at Lead 3, AVR, or lead v1 v2

(anything looking at right side)

52
Q

What could be a pathological cause of P wave inversion

A

Heart block/junctional rhythm

53
Q

What causes this dip (characterized by rounded edges)

A

Digoxin medication

54
Q

A Q wave is normally _______ after a heart attack and 2 days later it is _______

A

Deep after a heart attack and 2 days later it’s deeper

55
Q

Why does the Q wave change when you’ve had a heart attack?

A

Scar tissue from the MI blocks impulses which leads to lower current in that region

56
Q

What can cause a peaked T wave?

A

Hyperkalemia or cardiac ischemia

57
Q

How can hypokalemia effect a T wave?

A

Flattened T wave

(wack repolarization bc no potassum)

58
Q

Inverted T waves are associated with

A

Cardiac ischemia

59
Q

In what populations is T wave inversion normal?

A

Normal in children due to heart being smaller

60
Q
A
61
Q

Hypertrophic cardiac myopathy is associated with ________ Inversion

A

T wave Inversion

Note: T wave inversion also associated with raised intracranial pressure, ischemia, infarction, PE, and Bundle Branch BLock

62
Q

What is an ectopic beat?

A

Heart beat coming from area of the heart that has lost the rhythm with the rest of the heart

63
Q

Identify this rhythm

A

Premature ventricular contraction

64
Q

If 2 PVC’s do not look the same, what can you conclude?

A

They’re coming from 2 different sources

65
Q

What is the difference between atrial flutter and atrial fibrillation?

A

Atrial fibrillation is irregularly irregular whereas atrial flutter is regularly irregular

66
Q

What is torsade de pointe rhythm?

A

Ventricular tachycardia due to prolonged QT interval

67
Q

If you see a bundle branch block on an ECG what should you think?

A

Not lifethreatening on it’s own but it is a warning sign of future issues

68
Q

A major criteria of a bundle branch block is that the QRS wave takes longer than __s

A

0.12 seconds

69
Q

What is the best lead to see a left bundle branch block from?

A

V6

70
Q

If you see an M shape on an ECG, what could this mean?

A

R or L bundlebranch block

71
Q

What is the best lead to see a R bundle branch block (RSR pattern) from?

A

V1

72
Q

During a right bundle branch block, you will see a deep S wave in what 2 leads?

A

Lead 1 and V6

(both are looking left so it is inverted)

73
Q

What kind of AV block is normal and may occur in athletes?

A

First degree AV block

(essentially just the heart rate slowing down normally)

74
Q

The qualification for a first degree AV block is if the P-R interval is over __ squares on the ECG

A

5

75
Q

In a first degree AV block, there is a delay through the AV node, and ____ signals eventually reach the ventricals

A

all of the signal (Not an actual problem!)

76
Q

What is the name for a type 1 second degree AV block?

A

Mobitz (Wenckebach)

77
Q

What will you normally see in a type 1 Second degree AV block?

A

Longer PR intervals which leads to eventually skipping a QRS complex

78
Q

What is more dangerous? A type 1 or type 2 second degree AV block?

A

Type 2

79
Q

What is normally seen in a second degree type 2 AV block?

A

Randomly dropped QRS complex with no increasing PR interval

80
Q

What is the difference between a type 1 and type 2 second degree block?

A

Type 1- Lengthened PR interval

Type 2- Consisted PR interval (Shortened QRS complex)

81
Q

If a patient has a Second degree type 2 or type 3 heart block what to they need in order to work with PT?

A

A pace maker!!!!

82
Q

With a third degree AV block (AKA COMPLETE) there is a risk of __________

A

A-systole (no systole)

83
Q

What is typically seen in a patient with a 3rd degree AV block?

A

No synchronization between atria and ventricals

84
Q

Patient’s with long term atrial fibrillation are more likely to have a ______

A

Stroke

85
Q

If a patient has long term atrial fibrillation what medication should they be on?

A

Blood thinner to prevent stroke

86
Q

Patients with mitral valve disease may develop _____ -fib

A

Atrial fibrillation

Because the mitral valve is not closing and it regurgitates blood to the atrium and dilates the atrium

Cardiopulm Test 1 (11 decks)

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