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Cardiology > ECG Rules, Rhythms Definers > Flashcards

ECG Rules, Rhythms Definers Flashcards

1
Q

Systematic approach

A
  1. rate, 2. rhythm, 3. P waves, 4. PRI, 5. QRS
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2
Q

Normal Sinus

A

All WNL

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3
Q

Sinus Tachycardia

A

All WNL but HR >100

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4
Q

Sinus Brady

A

All WNL but HR <60

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5
Q

Sinus arrhythmia

A

All WNL but is not in cadence

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6
Q

P wave:
Wandering atrial pacemaker:
Double hump morphology:
Sharp P morph/:

A

= Atrial depolarization
= dif/ pacemaker spots in atrium
= atrium ballooning or>1 firing
= pulmonale from R-atrium lungs

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7
Q

QRS complex:
T wave:
U wave:
QT segment:

A

= ventricular depolarization
= ventricular depolarization
= “late bloomer
= all ventricle’s action

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8
Q

RVR:
SVR:

A

= Rapid ventricular response
= Slow ventricular response

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9
Q

PRI:
ST segment:
P-T is:
RR:

A

= AV holding impulse for sync
= ventricular contraction
= 1 full cardiac cycle
= gives rate & rhythm

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10
Q

Rs 6sec strip method:
big box method:
Small box method:
Triplicate method:

A

= # of Rs x 10
= 1R to R BB#s then 300/BB#
= 1R-R SB#s then 1500/ SB#
= descend W/ SB 300, 150, 100, 75, 50, 43, 38

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11
Q

PAC:
PJC:
PVC:

A

= Premature Atrial Contraction
= Premature Junction Contraction (AV)
= Premature Ventricular Contraction

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12
Q

Re-entry loops

A

= stuck in nascar loop in a chambers pathway causing SVT / no P waves

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13
Q

Atrial fibrillation:

A

= no P waves & irregularly irregular rhythm

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14
Q

Atrial Flutter:

A

= “saw tooth flutter P-waves”count bottom of points after S of flutters “3 to 1 block”, regular rhythm

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15
Q

Preexcitation Syndromes Arrhythmias Resulting from Most Common:

A

= Extra/s conduction pathways impulses used in assessory
= (WPW) bundle of Kent
= 2nd Lown-GanongLevine
= 3rd Mahaim Fiber

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16
Q

WPW definer:
Name of assessory pathway:

A

= has delta wave “wave leaning into R wave”
= Bundle of Kent

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17
Q

Lown-Ganong) definer:
Pathway name & path:

A

= has short PRI interval
= Bundle of James connects posterior internodal pathway to bundle of his

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18
Q

WPW) Orthodromic loop;
Antidromic loop:
Treatmeats:

A

= Clockwise reentry w/ narrow QRS “O NASCAR clock”
= Counterclockwise reentry w/ wide QRS “A>QRS, Anti>clock”
= procainamide 1a Na blocker, (if no procain) sedate & cardiovert) cardioversion

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19
Q

Paroxysmal Supraventricular Tachycardia (PSVT);

A

= SVT rules w/ stop or start; no P waves in SVT can be any rhythm before/after SVT

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20
Q

SA Pacemaker P wave shapes

A

Upright P waves & QRS WNL

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21
Q

AV Pace making site

A

inverted P waves (before,W/in,after QRS WNL

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22
Q

Sinus Pause

A

“Gandolf messes up flow by pausing it” 1 dropped beat OUT OF CADENCE, SA node, regular rhythms

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23
Q

Sinus Block

A

“Block be in cadence” 1 or more dropped beats, SA node, regular rhythhm “Gandolf Blocks a beat/s”

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24
Q

Sinus Arrest

A

more than 1 dropped beat & out of cadence

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25
Q

Sick Sinus Syndrome

A

Not arrhythmia per se; combination of arrhythmias; sinus node diseased or ischemic. Wild swings in HR, Ischemia of SA node,

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26
Q

Heart blocks are

A

blocks in AV node partial or complete
“Putting a rock or pebble on a cable”

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27
Q
  1. (Cardiac Pharmacology)
  2. NA Channel Blockers:
  3. Beta-Blockers:
  4. Potassium Channel Blockers:
  5. Calcium Channel Blockers:
  6. Miscellaneous:
A

1= (Vaugh-Will) Classes: 1]Na, 2]Beta, 3]K, 4]Ca, Misc] Adenosine
2= (Procainamide & Lidocaine) both Widened QRS & Prolongs QT
3= (Propranolol) Prolonged PRI & Bradycardias
4= (Amiodarone) Prolonged QT
5= (Diltiazem & Verapamil) Prolonged QT & Bradycardias
6= (Adenosine & Digoxin) Prolonged QT & Bradycardias

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28
Q

Propranolol, Labetalol, Metoprolol) class
Labetalol
Metoprolol

A

= class 2 Beta Blockers
= 2nd line med for SVT after Adenosine, A-fib/flutter w/RVR, Reduce myocardical ischemia in AMI PT’s w/elevated HR, Antihypertensive
= Hypertension, 2nd line med for A-Fib/A-Flutter w/ RVR, & SVT

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29
Q

(Procainamide & Lidocaine) class

A

= class 1A&B Na Channel Blockers
= Alterative to Amiodarone in cardiac arrest V-Fib/pVT, Stable monomorphic Ventricular TachyC w/ presserved LVF
= V-Tach with a pulse, pre-excitation rhythms (WPW) >50% QRS width

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30
Q

Amiodarone class & indication

A

Class 3 K channel blocker> VF/Pulseless VT unresponsive to shock, CPR & Epi, BradyCs to include AV blocks, Recurrent, hemodynamically unstable VT w/ pulse

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31
Q

Adenosine & Digoxin class & indication

A

class misc> Adenosine 1st line med for stable narrow complex SVT,
Regular & monomorphic wide-complex tachyC thought to be from a reentry SVT (SVT w/ BBB) Does not convert A-fib/flutter

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31
Q

Before shocking someone:
since unstable, contraindicated meds:
since unstable, Indicated meds:

A

= Sedate em! sedate to keep pain away
= Sodium Thiopental, Propofol (Diprivan), Diazepam (Valium), Midazolam (Versed)
= Etomidate (Amidate (0.2-0.4 mg/kg), Ketamine (Ketalar(1-2mg/kg)

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31
Q

(Diltiazem & Verapamil) class
Diltiazem
Verapamil

A

= class 4 Ca channel blocker
= 1st line med for A-Fib/Flutter w/ RVR >150 bpm, 2nd line med for SVT
refractory to adenosine
= 2nd line med for A-Fib/Flutter w/ RVR. May use as alterative after adenosine, narrow QRS complex tachycardia w/ preserved LV fn.

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32
Q

Cardiac Output:
Cardiac Output Formula:
Blood Pressure formula:

A

= amount of blood pumped by the heart in 1 min (70mL)
= SV x HR
= (SV x HR) x SVR

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33
Q

(Refractory periods) Absolute:
Relative:

A

= end of P to apex of T wave- cells absolute Beginning of repolarization
= “some really could happen” lot of cells repolar but not all so can throw out of rhythm Commodo cordis

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34
Q

When obtaining a 12 lead ECG, where do you place V2?
When obtaining a 12 lead ECG, where do you place V5?
When obtaining a 12 lead ECG, where do you place V6?
When obtaining a 12 lead ECG, where do you place V3?
When obtaining a 12 lead ECG, where do you place V1?
When obtaining a 12 lead ECG, where do you place V4?
When obtaining a 15 lead ECG, where do you place V4R?

A

= 4th ICS just left of Sternum
= Left 5th ICS anterior of auxiliary
= 5th ICS midaxillary
= ½ in between V2 & V4
= Right of Sternum 4th ICS
= 5th ICS left Midclavicular
= Right ICS midclavicular

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35
Q

Natural pacemaker of the heart is:
If SA Node failed to initiate a impulse, what is 1st back-up firing site?
If both SA & AV fails what is last firing site:

A

= SA node
= AV node
= Purjunkie

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36
Q

Leads V3 & V4 view
Leads V1 & V2 view
Leads 2,3, & aVF view
Leads 1, aVL, V5, V6 view

A

= Anterior
= Septal
= Inferior
= Lateral

37
Q

DIgoxin for

A

heart failure usually fools refractory Na K pumps

38
Q

Multifocal Atrial Tachycardia (MAT):
Definer:

A

1= multiple firing/pacemaker sites (is a rhythm) “WAP w/ RVR”
2= >100BPM, irregular, at least 3 dif/ P wave shapes

39
Q

1Supraventricular Tachycardia (SVT)
2 Definer

A

1= AV going NASCAR
2= No P waves, 150-250 BPM, regular cadence “Ts for Ps”

40
Q

Leads V1 and V2 look at what part of the heart?

A

Septal (blockages from LAD commonly)

41
Q

Leads 1, aVL, V5, V6 look at what part of heart:

A

L-Lateral (low view : views LCX & LAD)

42
Q

Leads V3 and V4 look at what part of the heart?

A

L-Anteriorwall (LAD & LMCA blocks)

43
Q

Leads II, III and aVF look at what part of the heart?

A

Inferior wall (most common blockacke(RCA)

44
Q

Orthodromic Re-entry loop:
Antidromic Re-entry loop

A

= Clockwise rentry conduction loop >narrow QRS
= counterclockwise reentry conduction loop > wide QRS

45
Q
  1. (A-Fib) know:
  2. Definer:
A

1= most common, only treated when >150BPM, more Js b/c more sites
2= No definite P waves, Totally Irregular

46
Q

Digoxin) Typically for:
Dynamics
works bc

A

= CHF
= allows more Ca for better contraction
= confuses K/Na pumps

47
Q

w/ (PJC) Premature Junctional Contraction) 1Rules:

2CANNOT HAVE B/C:
3Compensatory pause
4Non-compensatory pause

A

1= rate by rhythm, usually slightly irregular, P waves are either inverted before, +after, or hidden w/in QRS
2=have upright P wave (up P= PAC)
3= keeps cadence
4= doesn’t keep cadence

48
Q
  1. (Junctional rhythms) aka know by:
  2. Definer:
A

1= junctional escape: “pick up workload b/c something failed”
2= AV P waves & AV node rate 40-60BPM, Regular rhythm

49
Q

(Junctional Bradycardia) 1. Remember:
2. Rules:
3. Etiology:
4. S/S
5. Treatment of Symptom Stable:
6. Treat of Symptom Unstable:

A

1= AV inherit firing rate 40-60 so <40BPM AV Brady
2= <40BPM, REG/ rhythm, AV P waves, QRS WNL but can be wide
3= +Vagal nerve tone, Patho/ slowing of SA node rate
4= Decreased HR: decreased CO, hypotension, angina, CNS S/S
5= “table” treat w/ Med admin/ of pos/ underlying cause (SBP >90)
6= (SBP<90 or AMS) “go straight 8 Cables!” PPM 60-80, Pace ASAP to increase pacing’s efficiency

50
Q

(Heart Blocks Raps) If the R is far from the P, then you have a:
Longer, longer, longer, drop, then you have a:
If some Ps don’t get through, then you have a:
If Ps and Qs don’t agree, then you have a:

A

= FIRST DEGREE!
= WENCKEBACH!
= MOBITZ II!
= THIRD DEGREE!

51
Q

(Heart Blocks Raps) If the R is far from the P, then you have a:

A

FIRST DEGREE!

52
Q

(Heart Blocks Raps) Longer, longer, longer, drop, then you have a

A

= WENCKEBACH!

53
Q

(Heart Blocks Raps) If some Ps don’t get through, then you have a:

A

= MOBITZ II!

54
Q

(Heart Blocks Raps) If Ps and Qs don’t agree, then you have a:

A

= THIRD DEGREE!

55
Q

Re-entry loops

A

= stuck in nascar loop in a chambers pathway causing SVT / no P waves

56
Q

WPW) Orthodromic loop;
Antidromic loop:
Treatmeats:

A

= Clockwise reentry w/ narrow complex
= Counterclockwise reentry w/ wide QRS
= procainamide 1a Na blocker, (if no procain) sedate & cardiovert) cardioversion

57
Q
  1. (Accelerated Junctional) Know by:
  2. Definer:
A

1= “Baby Tachy” faster than 60 not faster than 100
2= 61-100BPM, (from SNS & AV firing), Regular rhythm, AV P waves

58
Q
  1. (Junctional Tachycardia) Know by:
  2. Definer:
A

1= “Tachy is Tachy”
2= >100BPM, AV P waves

59
Q

Atrioventricular (AV) block:

A

Electrical impulse is slowed or blocked as it passes through AV node

60
Q

2nd-Degree Type I AV block) names

A

Mobitz 1 or Wenckebach

61
Q

Wenckebach) Sir name

A

2nd-Degree Type I AV block

62
Q

2nd-Degree Type 2 AV block) names:

A

Mobitz 2 or intranodal AKA “2:1 block” rhythm

63
Q

Intranodal/Mobitz 2) Sir name

A

2nd-Degree Type 2 AV block

64
Q
  1. (1st Degree AV Block) know:
  2. Definer:
A

1= “add to any rhythm” “gandolf slowly opening door(PRI)”
2= PRI: >than 0.20 seconds for every PRI & P-P cadence

65
Q
  1. (2nd Degree Type I) AKA & Know:
  2. Definer:
A

1= “Morbitz 1”/“Wenckebach” rhythm & “AV turning off to fully down”
2= progressive longing PRI till drops beat then resets/starts over

66
Q
  1. (2nd Degree Type II) AKA & know:
  2. Definer:
A

1= “Mobitz 2/Intranodal” & “random extra Ps”
2= some P’s w/o QRS & same PRI/No longing before drop beat

67
Q
  1. (3rd Degree AV Block) AKA & know
  2. Definer:
A

1= “Complete AV-Block/dissociation” (always TCPP on) “gandalf died”
2= No relations w/ Ps & QRSs & no same PRI (top & bottom dif)

68
Q

only condition A-Fib has cadence:

A

Afib w/ 3rd degree In rhythm “Gandalf dead so Atriums & Ventricles doing own thing

69
Q

!!Poiseuille’s law:

Example:

A

= vessel w/ relative radius of 1 would transport 1mL per min at BP difference of 100mmHg. Keep pressure constant
= Less blood = vaso-press

70
Q

Which coronary artery feeds the inferior wall of the heart?

A

Right Coronary Artery (RCA)

71
Q

Which coronary artery feeds the left lateral wall of the heart?

A

Left Circumflex (LCX)

72
Q

A blockage of which of the following would result in the entire left ventricle not receiving blood supply?

A

Left Main Coronary Artery (LMCA)

73
Q

(T wave) Limb leads Amplitude:
Precordial “chest” leads amplitude:

A

= <5mm in LL
= <10mm in precordial

74
Q

1Lateral Wall high view:
2Left Lateral low view:
3Inferior wall view:
4Septal wall view:
5L-Anterior view:

A

1= Lead I & aVL= LA
2= Lead 1, aVL, V5 & V6: views LCX & LAD
3= 2,3,aVF: LL most common block(RCA) Lots of blockages/infarcs
4= V1 & V2: Along sternal borders blockages from LAD commonly
5= V3 & V4: left anterior wall : LAD & LMCA blocks

75
Q

Widowmaker :

A

clot in left coronary artery wiping out L side

76
Q

The upward slurring of the isoelectric line after the P wave up into the QRS complex that is associated with Wolff Parkinson White Syndrome (WPW) is known as the:
The accessory pathway associated with Wolff Parkinson White Syndrome (WPW) is known as the:

A

= Delta wave
= Bundle of Kent

77
Q

Typically, we don’t attempt to control the rate of Atrial Fibrillation unless it is

A

above 150 per minute and the patient is presenting with signs and symptoms related to the rhythm.

78
Q

Electrodes 2 jobs:

A

= stick & conduct (Electrodes sealed, skin prep_

79
Q

!!!Einthoven’s triangle: green electrode:
Blue electrode:
Red electrode:

A

= neutral/ground
= Negative
= Positive

80
Q

!!!Einthoven’s triangle: Lead 1 & view:
Lead 2 & view:
Lead 3 & view:

A

= negative RA → positive LA (Left lateral camera view)
= negative RA→ positive LL (Inferior camera view)
= negative LA→ positive LL (slight lateral Inferior camera view)

81
Q

!!!Einthoven’s triangle) Negitive & Positive lead 1 sites:
Negitive & Positive lead 2 sites:
Negitive & Positive lead 3 sites:

A

=negative @ RA & positive @ LA
= negative @ RA & positive @ LL
= negative @ LA & positive @ LL

82
Q

Unipolar Limb Leads:
aVR:
aVL:
aVF:

A

= Augmented by the cardiac monitor
= Right Arm positive (inferior)
= Left Arm positive (lateral )
= Left Leg positive (inferior)

83
Q

Horizontal Boxes: Each small box ?secs:
5 small boxes equal:
Each large box is ?secs:

A

= 0.04 sec
= 1 large box
= 0.20 sec

84
Q

Vertical Boxes Each small box is:
Each small box also equals:
5 small boxes equal:
Each large box is:
2 large boxes equal: 1 mV

A

= 0.1mV
= 1 mm
= 1 large box
= 0.5 mV
= 1 mV

85
Q

ECG Heart waves – P wave:
QRS complex:
T wave:

A

= Atrial depolarization
= Ventricular depolarization
= Repolarization of ventricles

86
Q

V1 V2 leads view:

A

Septum

87
Q

V3 V4 leads look at

A

Left lateral wall

88
Q

V5 V6 leads look at

A

Inferior

89
Q

V1 & V2

A
90
Q

V3 & V4

A
91
Q

V5 & V6

A
92
Q

SA node rate:
AV node rate:
Purjunkie rate:

A

=100-60BPM
=60-40BPM
=40-15BPM

Cardiology (9 decks)

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