EKG 1 and 2- fiore (incomplete) Flashcards
Why do we obtain an EKG?
screening: aka asymptomatic
Diagnostic: Assess signs/symptoms
Prognositic/Monitoring
when are EKG screenings typically performed
generally, only for those with high cardiac risk:
over 65
screening for “silent” heart attacks, Afib, and hypertrophy
CDL license
Familial history of life-threatening dysrhythmias
when are EKGs used for diagnostic purposes
assess signs and symptoms:
chest pain
SOB
Near syncope/syncope
palpitations
confusion/AMS
weakness
exercise intolerance
MOST PTS THAT ENTER THE ER
02, IV, MONITOR
When do we use prognostic/monitoring EKGs
telemetry
cardiac risk monitor aka stress test
event vs continuous monitoring: monitor for dysrhythmias
Trauma (CNS, Cardiac)
OD pts
Medication monitoring
What are the two specialized cells within the heart
pacemaker cells and myocyte
What is Einthoven’s triangle
three leads
bipolar leads (positive and negative side) - go negative to positive
What are augmented leads
aVR, aVL, and aVF
unipolar - single positive with reference point
more information about axis and geographic ischemia
What type of lead give us more information about axis and geographic ischemia
augmented leads
aVT, aVL and aVF
What are the precordial leads
aka “V” leads
unipolar leads- positive
shows the heart in the anterior and LEFT lateral (side) view
what are positive leads
the view points
what are the locations of the 12 lead EKG
10 leads total:
4 Limb cables (leads)
6 precordial cables (leads)
12 leads (views) on paper
what is the normal QRS duration
0.06 to 0.10 seconds
what it the T wave
repolarization
slightly asymmetric
what is the PR interval
conduction through the AV node
beginning of P wave to the beginning of the QRS
normal: 0.12 to 0.20 seconds (3 to 5 small squares)
when does the PR interval shorten
as HR increases
when does the PR interval lengthen
as HR decreases
what condition has a short PR interval
Wolf Parkinsons White (WPW) syndrome
What is a Delta wave
shortened PR interval in Wolff-Parkinson-White syndrome
What is Wenkebach
2nd degree Mobitz Type 1 AV block
longer and longer PR interval
what is a complete AV block
3rd degree AV block
What is the normal QT interval
400-440 milliseconds (0.4-0.44 seconds)
what is artifact
distortion of tracing NOT cardiac
loose or missing electrodes
broken cables or machine
tremors
movement
interference
What is the 6 step method to interpreting an EKG
- Rate
- Rhythm
- Axis
- Intervals
- Hypertrophy
- Ischemia/Infarct
What is normal heart rate
60-100
what is bradycardia
< 60bpm
what is tachycardia
> 100 bpm
What is a regular rhythm
same distance between each R wave
what is a regularly irregular rhythm
repeating PATTERN of irregularity
example: 2nd degree Mobitz type 2
what is a irregularly irregular rhythm
R to R are not the same and there is NO PATTERN
Example: Afib
what is the placement of V1
Right side sternum, 4th intercostal space
What is the placement of V2
Left side sternum, 4th intercostal space
what is the placement of V3
between V2 and V4
What is the placement of V4
Left mid-clavicular, 5th intercostal space
what is the placement of V5
left anterior axillary, 5th intercostal space
what is the placement of V6
Left mid axillary , 5th intercostal space
What part of the heart is the I, AVL, V5 and V6 looking at
lateral
what part of the heart is the II, III and AVF looking at
Inferior
what part of the heart is V1, V2, V3 and V4 looking at
anterior/septal
What is Eintoven’s triangle
only using limb leads (bipolar)
I, II, III leads
what do leads 1,2 and 3 create
Eintovens triangle
What is a hexaxial reference system
eintovens triangle with augmented leads
- gives different vantage points
What is a QRS duration of 0.10-0.12 considered
incomplete bundle branch block
what is a QRS duration of > 0.12 considered
Complete bundle branch block - QRS is WIDE
What is RBBB associated with
CAD or may be associated with AV block
What is LBBB associated with
acute (MI) or chronic (CAD, HTN, Dilated Cardiomyopathy)
What lead is a RBBB seen in
V1
what lead is LBBB seen in
V6
What is seen on ECG with right atrial enlargement
Peaked P wave in leads II, III and AVF
Biphasic P wave in V1
When is right atrial enlargement seen
COPD and Pulmonary hypertension
what is seen on ECG with left atrial enlargement
2nd part of the P wave is prominent
Notched (saddle) P wave in II, III and AVF
Biphasic P wave in V1 with more prominent negative
when is left atrial enlargement seen
mitral valve pathology
Left ventricular failure (CHF)
Systemic Hypertension
how does ventricular hypertrophy usually present on an EKG
increase in amplitude (voltage)
often associated with ST depression and T wave inversion
What is the Sokolov-Lyon Criteria
S wave depth in V1 + tallest R wave height in V5-V6 > 35 mm.
if >35, considered diagnostic of LVH
What is ACS
Acute Coronary Syndrome
Transient of permanent obstruction of the coronary arteries
what can lead to ACS
unstable angina
non-ST-segment elevation Myocardial infarction (NSTEMI)
ST-segment elevation myocardial infarction (STEMI)
What presents with an anterior wall STEMI on EKG
ST elevation leads to V2 and V4
LAD - aka widowmaker
What presents with an inferior wall STEMI on EKG
ST elevation INFERIOR leads II, III and AVF
RCA and Left circumflex
need to get a right sided EKG
what presents with Lateral Wall STEMI on EKG
Leads 1, AVL, V5 and V6 elevations
left circumflex or LAD diagonal branch
What is Sgarbossa’s criteria
used to identify myocardial infarction in the presence of a LBBB or a ventricular paced rhythm.
Myocardial infarction is often difficult to detect when LBBB is present on ECG.
What is Brugada Syndrome
Sodium channelopathy M>F
most prevalent in Asian populations
sudden cardiac death about 42 yo
What is the treatment of Brugada syndrome
internalDefibrilator
What is the EKG presentation of Hyperkalemia
Mild: peaked T wave, prolonged PR segment
Moderate: Loss of P wave, prolonged QRS complex, ST segmented elevated
Severe: progressive widening of WRS complex
Ventricular fibrillation, Asystole
What is an Osborn Wave
notch between the J point and the start of ST segment
seen in hypothermia
Gently rewarm
DO NOT JOSTLE THE PTS
