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Cardiology > EKG > Flashcards

EKG Flashcards

1
Q

LVH

A

Lead I >14boxes OR Lead avL >13 boxes, OR highest R in V5 and V6 + deepest S in V1 and V2 >/= 35

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2
Q

MI

A

St segment depression or prominent T wave inversion and/or elevation of cardiac enzymes in absence of ST seg elevation
Q waves-> dead tissue
Significant Q waves either greater than 1 box or 1/2 ht of QRS complex

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3
Q

RVH

A

RAD (F+, I-)

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4
Q

Sinus rhythm

A 
60-100bpm
nml upright P wave
PR interval 0.12-0.20 (3-5 boxes)
QRS interval </= 0.12 seconds
P:QRS ratio 1:1
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5
Q

V1-V6

A

V1-V5 will see R wave sizes progress, V6 R wave smaller than V5

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6
Q

V6-V1

A

V6-V2 S waves progress in size, V1 S wave usually smaller than V2

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7
Q

If suspicious of LVH what should you order?

A

ECHO, only 50% of LVH show up on EKG.

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8
Q

1st degree block

A

PR interval longer than normal
causes:nml heart, increased vagal tone, digitalis toxicity, inferior MI, myocarditis
Tx. underlying problem

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9
Q

2nd degree block Type 1

A

PR interval longer, longer, drop

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10
Q

2nd degree block Type 2

A

PR interval consistent (either nml or long), randomly dropped
causes: cardiomyopathy, MI

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11
Q

3rd degree block

A

No communication between P and QRS; nml QRS complex; RR interval same, PP interval same
causes: MI, drugs (digoxin, BB)

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12
Q

Sinus Arrhythmia

A

P with every QRS

Irregular rate

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13
Q

Pre-cordial leads

A

V1-V6 (located around the heart)

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14
Q

Limb leads

A

I,II,III, aVL, aVF, aVR

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15
Q

SA node rate

A

60-100bpm

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16
Q

AV node rate

A

40-60bpm

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17
Q

Muscle cells/ventricles

A

20-40bpm

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18
Q

What 3 components do you need in an EKG diagnosis?

A

Rhythm, axis, other EKG changes

eg. A. Fib w. normal axis and no other EKG changes
eg. 3rd degree block w. normal axis and R wave in V6 greater than R wave in V5

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19
Q

How do you indicate an Irregular rhythm

A

eg 90 I , 90 irregular

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20
Q

Reading an EKG

A

1) regular or irregular
2) Fast/slow/nml
3) Rate
4) PQRS present
5) P w/ every QRS
6) PR interval 0.12-0.20seconds
7) Width of QRS </= 0.12 seconds

21
Q

LAD indicates

A

Hyperkalemia, Cardiac pacing

22
Q

RAD indicates

A

Lung disease, Rt. Ventrical Hypertrophy

23
Q

ERAD indicates

A

Hyperkalemia, Cardiac pacing

24
Q

Artery in Inferior infarct

A

R coronary artery

25
Q

Artery in Lateral infarct

A

Left Cirumflex

26
Q

Artery in anterior infarct

A

anterior intraventricular

27
Q

A. fib

A

shimmering baseline (atrial depolarization >400bpm)
normal QRS width
Causes: HTN, rheumatic heart dz, ischemic heart dz, PE, COPD, ETOH, pericarditis
Beware of forming Thrombus!
Symptoms: palpitations, lightheaded, fatigue, angina, dyspnea, syncope
Unstable: electrical cardioversion
stable: control rate with IV CCB (diltiazem) or BB or Digoxin
Stable: can electrical cardiovert if A. fib less than 48 hrs,
*must anticoagulate for 3 weeks prior to cardioversion

28
Q

Ventricular Tachycardia

A

Rate >100 usually 150-200
Wide, bizarre QRS waves
Flipped T-waves–> Ventricles do not depolarize normally therefore will not repolarize normally
(supraventricular tachycardia will see narrow or reg QRS, normal T wave because the problem is above the AV node)

29
Q

Sinus Tachycardia causes

A

caffeine, cocaine, nicotine, anxiety, fever, anemia, PE

30
Q

Atrial flutter

A 
Sawtooth flutter waves
Atrial rate 250-350 bpm
Ventricular rate 150
AV block 2:1 rate
Almost always due to underlying heart disease (MI, ischemia), also PE, digoxin toxicity
Tx: ventricular rate control: CCB, BB, Digoxin
Chemical conversion: antiarrhythmics
electrical cardioversion >90% successful
31
Q

V. fibrillation

A

Irregular zigzag pattern with no P or QRS waves

immediate cardioversion

32
Q

Criteria for RBBB

A

QRS complex greater than 0.12 seconds

RSR’ in V1 and V2 with ST seg depression and T wave inversion

33
Q

Criteria for LBBB

A

QRS complex greater than 0.12 seconds

Broad or notched R wave in I, aVL, V5, V6 with ST seg depression and T wave inversion

34
Q

Sinus arrhythmia tx

A

none

35
Q

Sinus bradycardia tx

A

none, unless <50bpm then atropine 0.5mg IV q 3-5min

36
Q

Sinus tachycardia tx

A

None, unless in setting of acute MI then BB

37
Q

Atrial flutter tx

A

Electrical cardioversion
Ventricular rate with dig, CCB, BB
Chemical cardioversion w antiarrhthmics

38
Q

Atrial fibrillation tx

A

Unstable: electrical cardioversion
Stable: rate control with CCB, BB, dig
Chemical cardioversion

39
Q

Supraventricular tachycardia tx

A

Vagal maneuvers: valsalbva, carotid sinus massage
Adenosine: stops heart, hurts
Verapamil: CCB, blocks the AV node
Unstable: electrical cardioversion

40
Q

Premature atrial contraction tx

A

stop any precipitating durgs
tx underlying disorder
PAC that trigger flutter/fib may be suppressed with quinidine, procainamide, BB

41
Q

Premature ventricular contraction tx

A

Otherwise healthy: O2 first
In setting of MI: tx underlying cause first
Chronic PVC: antiarrhythmics may increase chance of sudden arrhythmic death, consider defibrillator if underlying heart disease

42
Q

Ventricular tachycardia tx

A

Unstable: immediate electrocardioversion
Stable: IV antiarrhythmics: amiodarone, lidocaine, bretylium, procainamide

43
Q

Ventricular Fibrillation tx

A

IMMEDIATE ELECTRICAL DEFIBRILLATION
CPR
IV amiodarone, lidocaine, bretylium

44
Q

Ventricular Asystole tx

A

CPR

Epinephrine, atropine

45
Q

1st degree heart block tx

A

Underlying problem

46
Q

Second degree heart block type 1 tx

A

Stable: no treatment

If hypoperfusion, atropine and/or cardiac pacing

47
Q

Second degree heart block type 2 tx

A

If hypoperfusion, atropine and/or cardiac pacing

Permanent pacemaker

48
Q

3rd degree heart block tx

A

O2, IV, atropine, pacing

49
Q

BBB

A

May result in 1st, 2nd, or 3rd degree block

Cardiology (2 decks)

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