- recorder placed in middle 1st) depolar toward recorder = (+) deflection 2nd) depolar away recorder = (-) deflectoin

EKG Flashcards by rich Pitts

EKG paper?

small box:
time = 0.04sec
distance = 1.0mm
voltage(y-axis) = 0.1mV

Big box:
time = 0.20sec
distance = 5mm
voltage (y-axis) = 0.5mV

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EKG

record of the electrical potentials generated during the cardiac cycle plotted against time

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Unipolar leads?

aVR
aVL
aVF

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Bipolar leads?

DI
DII
DIII

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Precordial leads?

V1 —> V6

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Anterior leads

V2, V3, V4

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Left Lateral leads

I
aVL
V5
V6

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Inferior leads

II, III, aVF

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A quick estimate of the axis can be made by looking at which two leads?

aVF

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Normal axis vs. the three types of deviations?

Normal axis = I(+) & aVF(+)
Left axis deviation = I(+) & aVF(-)
Right axis deviation = I(-) & aVF(+)
Extreme right axis deviation = (-) & aVF(-)

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Where are the 6 Precordial leads placed?

V1: R. 4th space, R. of sternum
V2: L. 4th space, L. to sternum
V3: bw V2 & V4
V4: L. 5th space, Midclavicular line
V5: L. 5th space, Ant. Axillary line
V6: L. 5th space, Mid. Axillary line

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Normal precordial leads show?

R-wave progressively gets larger

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(-) Deflection

depolar. away from recorder

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(+) Deflection

depolar. towards recorder

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Biphasic deflection

recorder placed in middle
1st) depolar toward recorder = (+) deflection
2nd) depolar away recorder = (-) deflectoin

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*Order of ventricle depolar. vectors?

1st = septal vector
2nd = free wall LV
3rd = basal vector

Mean Electric Axis?

summation of ventricular depolar. vectors

Normal MEA?

Left Inf. Quadrant: 0-90 degrees
I (0)
II (60)
aVF(90)

Determine MEA with which leads in QRS?

I(+)

aVF(+)

*Sinus Tachycardia?

*Increased HR = HR>100beats/min
-due to Increased AP of SAN
normal P-wave, PR-I,
QRS = narrow
Rhythm = Regular

*Atrial fibrilation?

No P-wave
Different beats (R-R)

*Ventricular fibrilation?

Random rhythm/completely chaotic
No HR
No clear p-waves, QRS, t-wave
Ventricular muscle: AP run into each other and cancel out

*First degree AV Block

*PR-I = (>0.20sec) = constantly prolonged the same duration

Wenchkebach (Mobitz I) AV Block?

HR = normal
p-wave: in Wenckebach (type I) their is dropped beats
p-waves that stand alone

*PR-I: progressively prolonged until a dropped beat
**the PR-I before dropped beat will be longer then the
one after
Rhythm: irregular

ID = p-wave w/out QRS following
- prior p-wave = Most prolonged PR-I
- after p-wave = Least prolonged PR-I

Type II AV Block

HR = slow *PR-I: constant w/ no changes QRS: narrow (<0.12sec) and No R-wave after some p-waves Rhythm: regular **ID = p-wave w/ no QRS following Prior PR-I: constant w/ no change After PR-I: constant w/ no change

Third Degree AV Block

HR = slow (less than 100) * p-wave: present & completely dissociated from QRS - equal distance bw each p-wave - one p-wave superimposed into QRS and alters S-wave **ID: constant p-wave durations one p-wave superimposed into QRS = altered S-wave

Techniques to measure or determine Right Ventricular Hypertrophy?

V1->V4 = decreased (amplitude) R-wave & progressively get smaller ``` *V1 = R-wave(>7mm) >> S-wave V5,V6,V7 = S-wave > 7mm RAD = RA depolar. ```

Techniques used to measure or determine Left Ventricular Hypertrophy?

*2 (-)leads, 2(biphasic)leads, 2(+)leads ``` *V1(R-wave) + V5(R-wave) >> 35mm V5(R-wave) > 25mm aVF (R-wave) > 20mm aVL (R-wave) > 11mm DI(R-wave) + DIII(R-wave) > 25mm ```

*3-Features about Acute Myocardial Infraction?

``` Ischemia = ST-Seg. DEPRESSION Acute MI -> ST-Seg. = ELEVATION T-wave = INVERSION Anoxic injury = depolar. myocytes Necrosis-> Q-wave = DEEP ```

**Ischemia on EKG?

``` ST-Seg = DEPRESSION T-wave = INVERSION ``` *ischemia is reversible if BF is restored

*Acute MI on EKG?

ST-Seg = ELEVATION Anoxic injury = depolar. by myocytes close to epicardium

*Necrosis on EKG?

Q-wave = DEEP tiss. is electrically silent

*Hypokalemia on EKG?

``` ST-seg = Depression *T-wave = decreased Amplitude (flattened out) U-wave = increased H+ ``` Cardiac arrhythmias ``` QRS = prolongation of time/duration P-wave = increased Amplitude & increased duration ```

*Hyperkalemia on EKG?

Increased [K+]e = 6-7mEq/L -> earliest change: Peaking T-wave (High (A)) Greater Increase [K+] = 7-8mEq/L -> Taller, Peaked (Greater (A)) T-wave w/ narrow base

*Hypercalcemia on EKG?

``` *QT-In = DECREASED T-wave = normal ST-Seg = Decreased duration ``` Increased sensitivity to Digitalis -may prevent arrhythemias

*Hypocalcemia on EKG?

``` *QT-In = Increased duration/Prolongation ST-Seg = Increased duration/Prolongation T-wave = normal ```