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Cardiology > EKG > Flashcards

EKG Flashcards

1
Q

EKG Limb leads

A

Standard: I, II, III

Augmented: AVF, AVL, AVF

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2
Q

Precordial Leads

A

V1-V6

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3
Q

Bipolar limb lead charges

A

Lead I: R to L arm, L arm positive = electrical activity over top of heart

Lead II: R arm to L leg, L leg positive

Lead III: L leg to L arm, both leads positive

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4
Q

Augmented Limb Lead charges

A

aVR = right arm positive

aVL = left arm positive

aVF = left leg positive

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5
Q

Lateral leads

A

AVL

I

V5

V6

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6
Q

Inferior leads

A

II

III

AVF

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7
Q

Anteroseptal leads

A

V1-V4

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8
Q

Anterolateral leads

A

V3-V6

I

AVL

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9
Q

Anterior leads

A

V3-V4

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10
Q

Inferolateral leads

A

II

II

AVF

V5-V6

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11
Q

Precordial lead polarity

A

Each lead is positive, all pass through AV node

V1 and V2 are negative deflections

V3-V6 become more positive w/ peak positive ~ V4

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12
Q

Precordial leads and vasculature

A

RCA: II, III, AVF

LAD: I, AVL

V1-V6

CX: I, AVL, V5-V6

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13
Q

Septal leads

A

V1-V2

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14
Q

P wave time interval

A

<0.12

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15
Q

PR interval

A

0.12-0.20

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16
Q

QRS wave

A

<0.12

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17
Q

QT Interval

A

0.34-0.43

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18
Q

Q wave

A

When at least 1/3 as high as the R wave => transmural MI

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19
Q

RS line

A

Activation of posteriobasal ventricle portion

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20
Q

J point

A

Transition point from S wave to T wave

transition from horizontal to verticle axis

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21
Q

ST segment

A

Elevation or depression is a hallmark sign of ischemia, CAD, or STEMI

0.08-0.12 seconds long

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22
Q

Prolonged QT

A

Pathological slowing of electrical activity

May allow for depolarization before complete repolarization -> go into an arrhythmia

Cause by some Abx -> Macrolides, fluroquinolones, azole antifungals

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23
Q

T wave abnormalities

A

Indicate ischemia

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24
Q

U wave

A

Purkinje fiber repolarization

Prominent U waves: hypokalemia, hypercalcemia, thyrotoxicosis, or epiniphrine exposure

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25
Q

Methods to calculate rate

A
  1. Count # R waves in 6 seconds, x10
  2. 300-150-100, 75-60-50
  3. Count number of small squares between R waves, and divide into 1500
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26
Q

SVT

A

Supreventricular tachycardia

150-200 bpm

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27
Q

Prolonged PR interval

A

AV block - 1st and 2nd degree Type 2

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28
Q

Irregular PR interval

A

Sinus arrhythmia

Wandering pacemaker

AV block - 2nd degree Type 1

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29
Q

Lack of PR interval

A

A-fib

Atrial flutter

Complete heart block - 3rd degree

Ventricular rhythm

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30
Q

Second degree AV block types

A

Type 1 - Wenckebach

-PR interval gets progressively longer until QRS doesn’t occur

Type 2

-PR interval fixed, but sometimes a QRS doesn’t occur

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31
Q

Third degree AV block

A

P waves and QRS complexes are independent of each other

Impulses are not traveling past the AV node

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32
Q

Conduction delays

A

Widened QRS (anything > 0.12)

3 types:

  • Left bundle branch block
  • Right bundle branch block
  • Intraventricular conduction delay
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33
Q

Right bundle branch block

A

R ventricular depolarization occurs more slowly than L vent due to R bundle branch blockage

Get “rabbit ears” in leads over RV - V1 and V2

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34
Q

Left bundle branch block criteria

A

QRS > 0.12

Dominant S in V1

Broad R in I, AVL, V5-V6

Absent Q in I, V5-V6

T wave inversions

-Dubin’s criteria = QS or rS in V1 w/ RsR in V6

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35
Q

Dubin’s criteria

A

For LBBB

V1 => QS or rS comples

V6 => RsR

Not a definite thing

36
Q

LBBB considerations

A

Cannot Dx LVH or ischemia w/ a LBBB

MI until proven otherwise

LBBB on exercise stress test => increased mortality rate and cardiac events

37
Q

Bundle branch block causes

A

LBBB - scar tissue/dead spot

RBBB - PE

38
Q

Intraventricular conduction delay (IVCD)

A

QRS > 0.12

Doesnt meet criteria for a specific bundle branch block

39
Q

QRS Axis

A

Shows where the main vector of electrical activity is going

Axis goes toward hypertrophy, away from ischemia

40
Q

Dubin’s thumb up/thumbs down

A

To determine axis

Look at QRS in leads I (lateral = left) and aVF (inferior = right)

Whichever is up wins = axis deviation towards that side

Both up = normal

41
Q

Best leads to check for hypertrophy

A

Atrial leads

II, III, AVF, V1 (biphasic)

42
Q

P Pulmonale

A

R atrial enlargement

Lead II

-P wave is taller and overlaps more w/ LA as RA takes longer to depolarize

V1 - P wave is >1.5mm

43
Q

P Mitrale

A

LA enlargement

Lead II shows P wave >0.12 seconds, w/ a possible notch in the middle

44
Q

P wave inversion

A

Leads II, III, AVF

ectopic atrial and junctional rhythms

45
Q

Right ventricular hypertrophy

A

Large R wave in V1 that gets smaller as you move towards V6

Should accompany RAE and deviated axis (I and AVF)

46
Q

Left ventricular hypertrophy

A

V1 = deep S wave

V5 = Tall R wave

S wave (V1) voltage + R wave (V5) >35mm = LVH

Also may have inverted/asymmetrical/depressed T wave in lateral leads (I, AVL, V5-V6)

47
Q

Ventricular strain

A

Associated w/ ventricular hypertrophy

Depression of ST segment

RV strain = V1

LV strain = V5-V6

48
Q

EKG analysis

A

Rate

Rhythm

Axis (I, AVF)

P waves (V1, II)

R waves (V1-V6)

Hypertrophy (R: V1-V6, L: V1 and V5)

Strain (R:V1, L:V5-V6)

49
Q

EKG markers of ischemia

A

Pathologic Q waves

Poor R wave progression (V1-V6)

ST segment elevation/depression

T wave abnormalities

50
Q

ST elevation or depression

A

Depressed ST (also inverted T) => coronary ischemia

ST elevation => MI, hypokalemia, or digitalis toxicity

51
Q

Non-ST Elevation Infarction

A

ST depression and T wave inversion

After infaction has resolved/fibrosis occurs, ST returns to baseline but T wave remains inverted

52
Q

ST Elevation Infarction

A

Initial ischemia shows ST depression, peaked then inverted T waves

Infarction shows ST elevation and Q waves appear

Fibrosis shows normal T waves and ST segments, but Q waves may persist

53
Q

Sinus Arrhythmia

A

Only rate changes - synchronizes w/ respiratory cycle

No need for treatment

54
Q

Sinus Pause/Arrest

A

Pause between 2 seconds and 2 minutes

Tx: pacemaker, atropine

Healthy heart, myocarditis, MI, digitalis toxicity

55
Q

Sinus bradycardia

A

<60 bpm

Caused by BB, digoxin

Only Tx w/ HTN or dizziness

Tx: atropine, pacemaker (long-term)

56
Q

Sinus Tachycardia

A

>100 bpm

Caused by anemia, thyrotoxicosis, fever, pain, exercise

Tx underlying cause, CCB, BB

57
Q

Supraventricular Tachycardia

A

Originates above HIS w/ reentry into AV node

Can be caused by PVC/PAC

palpitation, dizziness, syncope, SOB, anxiety, angina

Tx: vagal maneuvers, Adenosine, Cardioversion, IV BB/CCB

Prevent: BB, CCB, digoxin, SVT ablation

58
Q

Paroxysmal supraventricular tachycardia (PSVT)

A

140-240 bpm

P buried in QRS, QRS narrow and normal

Tx: BB

59
Q

Wolff-Parkinson-White Syndrome (WPW)

A

>200 bpm

Electrical pathway shortcut

Causes A-fib, can cause V-fib

EKG: Delta wave on QRS beginning

Tx: Ablation, BB, CCB, Flecainide, Adenosine w/ acute episodes

60
Q

Paroxysmal Atrial Tachycardia (PAT)

A

150-250 bpm

P wave morphology varies from sinus rhythm

Usually transient, doesn’t need Tx

Tx: vagal maneuvers, Adenosine, cardioversion, digoxin

61
Q

Premature Atrial Contractions (PAC)

A

P waves vary, precursor to A-fib

Common w/ MI, Cardiomyopathy, Mitral valve dx

Tx: BB

62
Q

Wandering Atrial Pacemaker

A

45-100 bpm

Need 3 or more distinct P waves - multifocal A-tach

No Tx

Occurs w/ heart dx, COPD

63
Q

Multifocal Atrial Tachycardia (MAT)

A

>100 bpm

3 or more distinct P waves, no hemodynamic instability

Occurs w/ lung dx, COPD, acute MI, sepsis

Tx: BB, CCB

64
Q

Atrial Fibrillation

A

110-170 bpm, irregularly irregular

No P waves, possible ST depression

Prevent Thromboemboli ( Warfarin w/ INR between 2-3)

Control Rate/Rhythm

Rate: CCb, BB, Digoxin

Rhythm: Class 1a, 1c, and 3 - usually amiodarone

65
Q

Atrial Flutter

A

250-350 atria, 150 ventricle - regularly irregular

Precipitates CHF, A-fib

Tx: ASA, Ablation, Class 1a, BB, CCB, Digoxin

66
Q

Junctional escape/Accelerated junctional rhythm

A

40-60 bpm escape, 60-100 bpm accelerated

Inferior MI, Digoxin toxicity

Narrow QRS w/ retrograde/absent P waves

No treatment

67
Q

Junctional Tachycardia

A

150-250 bpm

Initiated by PAC, no P wave

Acute Tx: Vagal maneuvers, Adenosine

Long-term Tx: BB, CCB, Class 1a/1c/3 antiarrhythmics

68
Q

First degree AV block

A

Inferior MI, Digitalis toxicity, hyperkalemia, increased vagal tone, acute rheumatic fever, myocarditis

EKG: PR Interval > 0.20

Tx: none needed, monitor progression to 2/3 degree

69
Q

Second-degree AV Block

A

Type 1: Wenckebach

  • Transient, longer PR interval until QRS dropped
  • No Tx, monitor
  • MI, digitalis toxicity

Type 2: after acute anterior MI

  • Rate varies, QRS wide, PR normal until dropped QRS
  • Tx: permanent pacemaker
70
Q

Third Degree AV Block

A

Digitalis toxicity, acute infection, MI, Conductive tissue degeneration

Vent rate is slower than atrial rate

Tx: Pacer

71
Q

Premature Ventricular Contractions (PVC)

A

Rate varies, P obscured by QRS w/ PVC, QRS wide

Tx if: MI, continuously multifocal, > 6 PVC/min

Tx: Lidocaine, procainamide, amiodarone, replace electrolytes

R on T phenomenon - R PVC wave lands on normal T wave, causes Torsades

72
Q

Ventricular Tachycardia

A

Ischemia and electrolyte abnormalities, MI, congenital defect, dilated cardiomyopathy, hypertrophic cardiomyopathy

No P wave, Wide QRS, rate regular

>30 seconds = hemodynamic instability - life-threatening

Pulse: Cariovert, amiodarone

Pulseless: Defibrillate then amiodarone

73
Q

Torsade de Pointes

A

Lengthened QT, electrolyte imbalance, myocardial ischemia

Tx: synchronous cardioversion, replace electrolytes, overdrive pacing

74
Q

Ventricular Fibrillation

A

Sudden cardiac death - no output

Tx: Defibrillate and ACLS, treat underlying cause, ICD

75
Q

Idioventricular rhythm

A

Dying heart rhythm

No P, widened QRS

Ischemia/infarction, pacemaker failure, metabolic imbalance

Tx: Pacemaker, improve C.O. and rhythm, atropine

76
Q

Pulseless Electrical Activity (PEA)

A

electrical activity w/ no mechanical response - no pulse

Tx: epi, atropine, CPR

77
Q

Posterior MI

A

Mirror image of septal MI

Large R wave, no Q waves

ST-segment depression, not elevation

Upright T waves

78
Q

Digitalis/Digoxin

A

Therapeutic levels cause a scooped ST depression across all leads

Toxicity = increases automaticity and decreases AV conduction

-heart block, A-tach, PAC/PVC, PAT, Atrial/Junctional tachyarrhythmias

79
Q

Hyperkalemia

A

Peaked “Eiffel tower” T waves

Flat and wide P

Wide QRS

Can cause V-fib

80
Q

Hypokalemia

A

U waves

Flattened/inverted T waves

Ventricular foci irritation - Torsades, VT, VF

81
Q

Hypercalcemia

A

Short QT interval

J waves

82
Q

Hypocalcemia

A

Prolonged QT - T barely finishes before next P

83
Q

Hypomagnesemia

A

Prolonged QT

Torsades

Frequent PVC/PAV

Ventricular and Atrial tachyarrhthmias

84
Q

Hypothermia

A

Osborn (J waves) - positive deflection at J site after QRS

Slow heart and metabolic rate

J waves indicate ventricular depolarization abnormality

85
Q

Pulmonary embolus

A

Sinus tach most common

S1Q3T3 - prominent S in I, Q and T abnormal in III

Right axis deviation, RBBB, T inversions in V1-V4

Cardiology (7 decks)

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