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Cardio Pulm > EKG > Flashcards

EKG Flashcards

1
Q

The heard depolarizes from _____ to _____

A

bottom to top

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2
Q

EKG

A
  • recording of electrical events in heart
  • any area of heart
  • picked up by electrodes on skin
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3
Q

Depolarization of the SA Node –>

A
  1. bachman’s bundles–>R atrium–>L atrium

2. internodal tracts–> AV node –> bundle of His –> R & L bundle branches –>purkinje fibers –>R & L Ventricles

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4
Q

Leads

A

-the sensing electrodes used to monitor electrical activity

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5
Q

Standard Limb Lead

A

Lead I: - electrode R arm; + electr L arm
Lead II: - electr R arm; + electr L leg
Lead III: - electr L arm; + electr L leg
Ground: R leg

(Frontal Plane)

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6
Q

Augmented (unipolar) limb leads

A

-Fills in gaps of standard (frontal)

  • aVr= + R arm
  • aVl= + L arm
  • aVf= + leg (foot)
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7
Q

Normal EKG Speed

A

25mm/sec

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8
Q

6 Major EKG Deflections

A 
P
Q
R
S
T
U
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9
Q

PR Interval

A
  • beginning of P wave to beginning of QRS
  • Atrial contraction + A-V conduction delay
  • flat spot=isoelectric
  • 0.12-0.2 sec
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10
Q

Length of PR Interval

A
  • 0.12-0.2 sec

- 3-5 small boxes

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11
Q

R

A

First + deflection

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12
Q

Small box dimensions

A
  • height: 0.1 mV

- width: 0.04 sec

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13
Q

Precordial (chest) leads

A

Transverse Plane

V1: R of sternum; 4th intercostal space
V2: L of sternum; 4th IC space
V3. between 2 & 4
V4: midclavicular; 5th IC space
V5: ant axillary line; 5th IC space
V6: mid axillary line; 5th IC space
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14
Q

Big square dimensions

A
  • 5x5 small squares
  • height: 5mV
  • 0.2 seconds
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15
Q

P Wave

A
  • atrial depolarization

- can be positive/neg/biphasic; but must be the same each time

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16
Q

QRS Complex

A
  • Ventricular Depolarization
  • Made up of Q, R, S, R^1, S^1 (QS)

Should be <2.5 small boxes

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17
Q

Length of QRS Complex

A

<2.5 small boxes

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18
Q

S

A

neg deflection after R

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19
Q

S^1

S prime

A

neg deflection following R prime

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20
Q

Q

A

Initial negative deflection before R

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21
Q

R^1

R prime

A

2nd + Deflection

22
Q

QS

A

Total deflection

23
Q

QT Segment

A
  • beginning of Q to end of T wave
  • Should be <1/2 distance of R to R interval (in normal rhythm)
  • Prolonged QT bad (increase chance for ectopic foci & arrhythmias
24
Q

QT Segment Length

A

<1/2 distance from R to R

25
Q

U Wave

A
  • uncertain cause
  • (final phase ventricular repol)
  • same direction as T wave
  • not everyone has U wave
26
Q

PT’s use EKG to:

A
  • determine if pt in normal sinus rhythm

- monitor response to ex’s

27
Q

Methods to Calculate HR from EKG

A
  • Small box method
  • Big Box method
  • 6 Sec strip
28
Q

ST Segment

A

-end QRS to beginning of T wave
-represent beginning of ventricular repolarization
-usually isoelectric (Flat)
(-beginning called J point)

29
Q

J Point

A
  • point where ST segment begins

- where thin line becomes thick

30
Q

Small Box Method

A

bpm=1500/# small boxes between successive R waves

31
Q

6 Second Strip

A

bpm=# Cycles in 6 Sec X 10

use only fro slow HR

32
Q

How to get HR when Irregular

A

bpm=# cycles in 15 sec X 4

5 sections of 3 seconds
(75 big boxes=15 sec)

33
Q

Sinus Bradycardia

A
  • all perfect except rate
  • Atrial rate 40-50bpm (or slower)
  • Ventricular Rate: <60 bpm (same as atrial rate)

-PT assess and treat if asymptomatic

34
Q

Sinus Tachycardia

A
  • everything perfect but rate
  • Atrial Rate: >100bpm
  • Ventricular Rate: >100bpm (same as atrial rate)

PT: assess and treat if asymptomatic

35
Q

Large box Method

A

-# large boxes between successive R waves

300/150/100/75/60/50/42/35

36
Q

Normal Sinus Rhythm

A
  • Rhythm: normal
  • Atrial/Ventricular Rate: 60-100bmp
  • P Wave: all same; 1 per QRS; upright in lead II
  • PR Interval: 3-5 sm boxes
  • QRS: all same; < 2.5 sm boxes; one per P wave
  • T wave: same direction as P
37
Q

Third Degree Heart Block (CHB)

a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

A

a. rhythm: regular but ventr and atrial rates different
b. atrial rate: normal
c. ventricular rate: 20-60bpm
d. P wave: normal (not related to QRS)
e. PR: none
f. QRS: junctional pacemaker=normal QRS; ventricular focus=QRS >0.11 sec
g. T wave: not uniform
h. mechanism: complete block between SA to AV (artia & vent contractions unrelated)
i. PT: no PT, medical emergency

38
Q

Left BBB

A

Rabbit ears on V6

39
Q

Right BBB

A

Rabbit ears on V1

40
Q

Asystole

a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

A

a. rhythm: none
b. atrial rate: none
c. ventricular rate: none
d. P wave: none
e. PR: none
f. QRS: none
g. T wave: none
h. mechanism: no electrical activity in atria or ventr
i. PT: medical emergency; CPR

41
Q

PAC

a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

A

a. rhythm: irregular @ site of PAC; R-R shorter before, longer after
b. atrial rate: normal
c. ventricular rate: normal
d. P wave: all same but premature; 1 per QRS
e. PR: 3-5 small boxes
f. QRS: normal
g. T wave: same direction as P
h. mechanism: ectopic atrial focus
i. PT: usually OK; high frequency can–> a-fib

42
Q

Atrial Flutter

a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

A

a. rhythm: regular/irreg
b. atrial rate: 250-300 bpm
c. ventricular rate: depends on ratio of conduction
d. P wave: “F” waves=sawtooth
e. PR: none
f. QRS: usually normal
g. T wave: covered by F waves
h. mechanism: ectopic atrial focus takes over normal pacemaker activity
i. PT: do PT if asymptomatic (chronic fluttter)

43
Q

Atrial Fibrillation

a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

A

a. rhythm: irregularly irregular
b. atrial rate: >350 bpm; can’t count on EKG
c. ventricular rate: normal/slow/fast but irregular
d. P wave: none, jagged baseline
e. PR: none
f. QRS: usually normal
g. T wave: altered/obliterated by fib waves
h. mechanism: chaotic atrial activity–>loss atrial kick–>decr ventr filling–> decr CO by 30%
i. PT: high clot risk

44
Q

PVC

a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

A

a. rhythm: irregular due to premature beats
b. atrial rate: depends on underlying rhythm
c. ventricular rate: depends on underlying rhythm
d. P wave: none w/ PVC, others normal
e. PR: none w/ PVC, others normal
f. QRS: >0.11 sec, usually >0.16 sec
g. T wave: none after PVC, others normal
h. mechanism: ectopic focus
i. PT: some PVC normal; notify Dr if >6/min or couplets/triplets or every other

45
Q

V-Tach

a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

A

“picket fence”

a. rhythm: regular
b. atrial rate: none
c. ventricular rate: 100-250bmp
d. P wave: none
e. PR: None
f. QRS: weird/bizzare; 3+ PVC in row diagnoses V-tach
g. T wave: none
h. mechanism: single ventricular focus
i. PT: med emergency; no PT; CPR, Defibrillation

46
Q

V-Fib

a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

A

a. rhythm: irregular
b. atrial rate: none
c. ventricular rate: none
d. P wave: none
e. PR: none
f. QRS: none; fibrillation fine or coarse
g. T wave: none
h. mechanism: multifocal irritation; chaotic activity
i. PT: medical emergency; no PT; CPR; defibrillation

47
Q

First Degree Heart Block

a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

A

a. rhythm: regular
b. atrial rate: 60-100bpm (or slower)
c. ventricular rate: same as atrial rate
d. P wave: uniform/normal; 1 per QRS
e. PR: consistent but >0.25 sec (>3-5 sm boxes)
f. QRS: normal
g. T wave: normal
h. mechanism: AV node sick & slow
i. PT: do PT; unless change in EKG

48
Q

Second Degree Heart Block Type I (Wenckebach)

a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

A

a. rhythm: regularly irregular
b. atrial rate: 60-100bpm
c. ventricular rate: slower than A rate
d. P wave: normal; some don’t have QRS (droppped beats)
e. PR: progressively longer until QRS dropped, then start over
f. QRS: normal
g. T wave: normal
h. mechanism: block high in junction
i. PT: do PT with Dr. clearance

49
Q

Second Degree Heart Block Type II (Mobitz)

a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

A

a. rhythm: regularly irregular
b. atrial rate: 60-100bpm
c. ventricular rate: regular but diff than atrial rate
d. P wave: normal; not a QRS for each
e. PR: normal if QRS present
f. QRS: normal
g. T wave: normal
h. mechanism: block low in bundle of His
i. PT: no PT; CO compromised

PR consistent but too long with dropped QRS

50
Q

BBB

a. rhythm
b. atrial rate
c. ventricular rate
d. P wave
e. PR
f. QRS
g. T wave
h. mechanism
i. PT

A

a. rhythm: regular
b. atrial rate: normal
c. ventricular rate: same as atrial rate
d. P wave: normal
e. PR: normal
f. QRS: >0.11 sec
g. T wave: normal
h. mechanism: delay of action potential in one bundle branch
i. PT: do PT unless new or change

Cardio Pulm (27 decks)

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