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Cardiopulmonary > EKG > Flashcards

EKG Flashcards

1
Q

Normal P wave

A

atrial depolarization

no taller than 3 mm (3 small boxes)
not wider than 0.11seconds

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2
Q

Normal PR interval

A

delayed at AV node to optimize ventricular filling

no longer than one big box (0.2sec)

can be longer if atrial infarction or pericarditis

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3
Q

Normal QRS Complex

A

ventricular depolarization

less than half of a big box wide (0.07 to 0.11 sec)

Leads I-III: no smaller than 6mm tall
Leads V1-V6: no taller than 25-30mm

**if taller in V1//2 then RVH; V5/6 then LVH

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4
Q

Normal Q wave

A

septal depolarization
usually cannot see the Q wave unless pathological b/c a thin tissue
- may only see in leads I, aVL, V5-6

less than 0.04seconds (one small box)
no deeper than 1/3 of QRS complex

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5
Q

R progression in precordial leads

A

V1 –> V6
the r wave starts small and the S wave is big…
then the R wave gets bigger and the s wave gets smaller

tallest R wave in V5 or V6

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6
Q

Axis Deviation

  • what is it
  • normal
A

average direction of depolarization as the impulse travels through the ventricles
- referring to the QRS complex

Normal = -30 to +90

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7
Q

Left axis deviation

- causes

A

more negative than -30 (-30 to -90)

limb lead I is positive, aVF is negative

Causes:
left anterior hemiblock
Q waves of inferior MI
artificial cardiac pacing
emphysema
hyperkalemia
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8
Q

Right axis deviation

- causes

A

more positive than 90 (90 to 180)

limb lead I is negative, aVF is positive

Causes:
RVH
chronic lung disease
anterolateral MI
left posterior hemiblock
pulmonary embolus
atrial and/or ventricular septal defect

**may be normal in tall thin adults and children

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9
Q

Interval VS Segment

A

Interval - always includes a wave

Segment - isoelectric line from wave to wave

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10
Q

ST Segment

A

starts at the J point (junction at end of QRS complex) & ends with the t wave

represents time when ventricular cells are in a plateau phase
- absolute refractory period, will not respond to a stimulus

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11
Q

T wave

A

earliest time ventricles can respond to another stimulus usually coincides w/ apex of T wave
- time of relative repolarization

Same polarity of the QRS complex

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12
Q

Sinus arrhythmia

A

normal sinus rhythm but w/ unequal distances between R-R

- beat to beat variability

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13
Q

Sinus bradycardia

  • causes
  • symptoms
  • associated w/
A

less than 60 bpm

Causes: beta blockers, decreased function of SA node, athlete in good shape

Generally asymptomatic unless pathologic condition persists
- may c/o dizziness, syncope, angina (decreased Q)

Associated w/ development of dementia

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14
Q

Sinus tachycardia

  • causes
  • symptoms
A

> 100bpm

Generally benign

Causes:
fear, anxiety, stress, obesity, caffeine, nicotine, amphetamines or demands of O2 are increased (exercise, infection, MI, hemorrhage)

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15
Q

Sinus Exit Block

  • cause
  • symptoms
A

block in conduction of impulse from SA node causing a skipped beat

May c/o SOB if block gets longer and multiple beats are missed

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16
Q

Premature Atrial Contraction

  • what is it
  • causes
  • symptoms
A

P wave is premature (always present) w/ an abnormal configuration due to ectopic focus in either atria that initiates the impulse

Causes: stress, nicotine, caffeine, alcohol, infection, hypoxemia, MI, atrial damage

Usually asymptomatic

17
Q

Atrial Tachycardia

  • what is it
  • causes
  • symptoms
A

aka supraventricular contraction

R-R interval very close together (HR 100-200) and hard to make out a p wave

Same causes as PAC + pulmonary HTN, altered pH and COPD

IF prolonged, Q is compromised –> SOB, dizziness, fatigue

18
Q

Atrial flutter

  • what is it
  • causes
  • symptoms
A

Normal R-R intervals w/ excess “saw tooth” pattern of p waves due to rapid firing of ectopic source in atria

Causes: pathological (mitral valve disease, CAD, MI, stress, renal failure, pericarditis, RHD)

usually asymptomatic d/t normal R-R intervals

19
Q

Atrial Fibrillations

  • what is it
  • causes
  • symptoms
  • at risk for…
A

uncontrolled R-R rhythm with undiscernable p waves due to erratic quivering of the atria (multiple ectopic foci) causing no true depolarization of the atria

Causes: age, CHF, HTN, ischemia/infarction, drug, cardiomyopathy, stress, pain, renal failure

Symptoms: palipitations, fatigue, dyspnea, lightheadedness, syncope, chest pain
–> decreased Q b/c decreased blood from no atrial kick

A fib is at risk for stroke b/c blood will pool in the atria (may be prescribed baby aspirin to thin blood)

20
Q

Premature junctional contraction

- what is it

A

missing p wave for QRS complex (just one beat) and a NORMAL QRS width w/ a shortened R-R interval

impulse comes from the AV node/bundle and the SA node does not fire

21
Q

Junction Escape Rhythm

  • what is it
  • causes
  • symptoms
A

missing p wave throughout entire rhythm due to SA node not functioning properly;
typical rate = 40-60 bpm

Causes: inc vagal tone, digoxin, infarction/severe ischemia to right coronary artery

Symptoms: dizziness, fatigue, SOB, chest pain, extreme fatigue w/ ADL’s
(decreased HR –> decreased Q)

22
Q

Premature Ventricular contractions

  • what are they
  • symptoms
  • types (6)
A

p wave absent and QRS has a wide and aberrant shape due to ectopic foci in ventricle causing premature depolarization

Symptoms: SOB, dizziness, decreased tolerance to activity
–> if increased frequency of PVCs leading to decreased SV and decreased Q

Types:
- unifocal, multifocal, couplet, run, bigeminy, trigeminy

Can be life threatening and should be considered serious!

23
Q

Ventricular tachycardia

  • what is it
  • causes
  • symptoms
A

3 or more consecutive PVCs at a ventricuar rate >150

Causes: ischemia, acute infarction, HTN, digoxin

Symptoms: lightheadedness, disorientation, weak/thready pulse –> leading to syncope (w/n 10 seconds)
–> severly diminshed Q and BP

NOT shockable rhythm; leads to V-fib

24
Q

Ventricular fibrillations

  • what is it
  • causes
A

no R-R interval, ventricles are not beating, they are quivering/fibrillating asynchronously & ineffectively

Causes: heart disease, MI, cocaine

Sequel to v-tach

NO Q, patient is unconscious and needs defibrillation immediately!

25
Q

Torsades de Pointes

A

“twisting appearance of EKG”

life threatening, can go into v-tach –> v-fib

26
Q

Idioventricular rhythm

- what is it

A

no p wave, wide QRS complex
HR 20-40 bpm

Hearts last attempt at surviving

27
Q

First degree heart block

  • what is it
  • causes
  • symptoms
A

PR interval longer than 1 big box (>0.2sec) but relatively constant from beat to beat due to delayed signal at AV node

Causes: CAD, infarction, digoxin, medications that suppress AV node

generally asymptomatic (unless bradycardia)

28
Q

Second degree type I heart block

  • what is it
  • causes
  • symptoms
A

PR interval progressively becomes longer until it skips a beat (P:QRS ratio = 3:2)

Causes: right CAD or infarction, digoxin, excessive beta blocker

generally asymptomatic (sufficient Q)

29
Q

Second degree type II heart block

  • what is it
  • causes
  • symptoms
A

PR interval length does not change, but there are multiple skipped beats

Causes: MI (esp LAD), digoxin

IF HR is slow, Q is decreased (dizziness, SOB, fatigue)

30
Q

Third degree heart block

  • what is it
  • causes
  • symptoms
A

Complete heart block; atria and ventricles are being paced independently
(atria rate > ventricular rate)

Causes: acute MI, digoxin, degeneration of conduction system, heart surgery

Symptoms: dizziness, SOB, chest pain, possibly faint
(If HR is very slow and Q drops)

PACEMAKER IMMEDIATELY

31
Q

Left ventricular hypertrophy (2)

A

Height of S wave in V1 and V2
PLUS
Height of R wave in V5 and V6
= if greater than 35 mm

OR R wave in aVL is greater than 11mm

32
Q

Right ventricular hypertrophy (1)

A

R wave is BIGGER in V1 and gets progressively smaller through precordial leads

commonly due to pulmonary HTN

33
Q

Left atrial enlargement (2)

A

Broad (sometimes M shaped) p wave in lead II

AND/OR

Diphasic (sine wave) p wave in lead V1 with a larger terminal component (neg deflection)

34
Q

Right atrial enlargement (2)

A

Peaked p wave in II greater than 2.5mm

AND/OR

Diphasic p wave in lead V1 with a larger INITIAL component (pos deflection)

35
Q

Right Bundle Branch Block

A

Right ventricle signal is being blocked, therefore it is delayed

Spikey double peaked R wave that goes past isoelectric line in leads V1 or V2

36
Q

Left bundle branch block

A

left ventricle signal is being blocked, therefore it is delayed

“batmans cap” shape of double peaked R wave (or appears flattened w/ two tiny points) in leads V5 or V6

Cardiopulmonary (10 decks)

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