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EKG > EKG > Flashcards

EKG Flashcards

1
Q

Side of small boxes

A

0.04 s

1 mm

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2
Q

Large box size

A

0.20s

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3
Q

What is the best method for checking rate on an irregular rhythm?

A

6 second rule

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4
Q

What are the 4 ways to determine rate?

A

1500/small boxes
300/large boxes
300, 150, 100, 75, 60, 50
6 second rule

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5
Q

When you are looking at P waves, which two leads are best?

A

V1 and Lead 2

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6
Q

If all the P waves don’t match what should you be thinking about?

A

Wandering pacemaker or multifocal atrial tachycardia

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7
Q

What is the normal amplitude of P waves?

A

<2.5 mm (lecture 1 says <2mm)

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8
Q

What are you thinking about if the P wave is greater than 2mm?

A

Atrial hypertrophy

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9
Q

What are you thinking about if there is not a P for every QRS and vice versa?

A

Irregular rhythm, escape or premature beats

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10
Q

If there are no P waves what should you be thinking about?

A

Escape rhythms, A. Fib, ventricular rhythms, or sinus arrest

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11
Q

What does it mean if the T wave is peaked?

A

Hyperkalemia

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12
Q

What does it mean if the P wave is flat?

A

Hypokalemia

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13
Q

What do U waves indicate?

A

Hypokalemia + decrease in Mg

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14
Q

If the PR interval is not normal, what should you be thinking about?

A

Blocks or WPW

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15
Q

If the QRS interval is wider than 0.12s what should you be thinking of?

A

BBB, V. Fib, or hyperkalemia

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16
Q

QT interval should be….?

A

Less than half the R-R interval

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17
Q

What is the J point?

A

Where the QRS complex ends and the TS segment begins

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18
Q

Hypercalcemia will show up how on an EKG?

A

Shortened QT interval

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19
Q

Hypocalcemia will show up how on an EKG?

A

Prolonged QT/ST

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20
Q

What is the infarction triad?

A

Ischemia (reversible)
Injury
Necrosis (irreversible)

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21
Q

What is a strain pattern?

A

A pressure overload that leads to sustained delayed repolarization of the St segment (down-sloping)
Best seen in V5 and V6

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22
Q

What is the Rule of 35?

A

Determining hypertrophy (left ventricular hypertrophy)
Measure the DEEPEST S wave in V1 or V2
+
Measure the TALLEST R wave in V5 or V6

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23
Q

What determines an ST elevation?

A

An increase of 1 mm in two are more CONTINUOUS leads

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24
Q

What are some causes of RAH?

A 
Pulmonary HTN 
Congenital heart disease 
Tricuspid or pulmonary valve disease 
Pulmonary Embolism 
Seen with RVH
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25
Q

How do the P waves differ between RAH and LAH?

A

The different between left and right atrial hypertrophy is that the RAH if initial component of diphasic P wave is larger in lead V1
LAH if terminal component of diphasic P wave is larger in lead V1

Basically where is in the P wave in lead V1 is it larger, beginning or end?

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26
Q

Why is Left ventricular Hyptertrophy most common?

A

Systemic HTN

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27
Q

What continuous leads are you looking in for anterior infarction?

A

Anterior = V3, V4

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28
Q

What leads are you looking at for septal infarction?

A

Septal = V1 + V2

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29
Q

What leads are you looking in for inferior infarction?

A

2, 3, +aVF

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30
Q

What leads are you looking at for lateral infraction?

A

1 + aVL + V5 + V6

31
Q

Which lead is not used to determine infarction?

A

aVR

32
Q

Where are you most likely going to see a RBBB?

A

Wide QRS
+
Broad S wave in 1, V5, V6

33
Q

What are you likely to see on the EKG with LBBB?

A 
Wide QRS 
\+ 
Broad R wave in lead 1, aVL, and V5 or V6 
\+
Deep S wave in V1 and V2
34
Q

What causes the “scooped out” ST segments?

A

Digitalis

35
Q

What is the difference on the EKG between sinus arrest and sinus block?

A

Both are bradycardic due to the pause
The arrest has a change in RR interval in attempts to compensate

The block has preserved RR interval, as if there was no pause

36
Q

What are you looking for in order to dx Wolff-Parkinson-White?

A

Delta wave in the QRS complex

37
Q

What are you looking for on the EKG with PE?

A

SINUS TACH IS THE MC FINDING

S1Q3T3

Large S in Lead 1
Large Q in Lead 3 (with inverted T wave)

38
Q

What is Brugada Syndrome?

A

Syncope with sudden death
Frequently inherited
Looking for RBBB with ST elevation in V1-V3
Treated with cardioverter-defibrillator

39
Q

Wellens Syndrome

A

Unstable angina, stenosis of the proximal left anterior descending (LAD) —> anterior wall infarction

V2, V3 T wave inversion
Little to no ST elevation

40
Q

Long QT syndrome

A

May be genetic, medication induced, or related to medical conditions, asymptomatic to syncope, seizure or sudden death

Longer than 0.44s typically considered abnormal

41
Q

What will you see with RBBB?

A

Wide QRS
Broad S wave in Lead 1, V5, V6
RR’ commonly seen

42
Q

What will you see with LBBB?

A

Wide QRS
Broad R wave in 1, aVL, and V5 or V6
Deep S in V1 and V2

43
Q

What is your method?

A

1) Rhythm
2) Rate
3) Waves
4) Intervals
5) Axis
6) Hypertrophy
7) ST elevation/depression (+—> location)
8) Blocks (left or right)
9) Electrolytes
10) Pacemakers
11) Zebras

44
Q

What can an EKG tell you?

A 
Rate 
Rhythm 
Where impulse originates 
Conduction pathways 
how much electricity is being conducted to the ECG leads (high or low voltage)
45
Q

What does an EKG NOT tell you?

A

cardiac output
hemodynamic status
pulse

(only confirmatory for STEMI or NSTEMI)

46
Q

What does parasympathetic activity do to the heart?

A

increase HR

47
Q

What does a vagal maneuver do to HR?

A

decrease HR

48
Q

What rhythms are irregular?

A 
sinus arrhythmia 
wandering pacemaker 
multifocal atrial tachycardia
A. fib 
V. fib
49
Q

How long should the AT interval be?

A

half the distance to R-R interval (or else it might be prolonged)

50
Q

Why are there PVCs?

A

the ventricular automaticity can be irritated by low oxygen levels, hypokalemia, and injury/inflammation/infarction

51
Q

At what point do PVCs become V. Tach?

A

if there are 3+ in a row or 6+ in a minute

52
Q

What causes multifocal PVCs?

A

severe cardiac hypoxia because several locations in the ventricles are irritated
WARNING
(this PVCs will all look different)

53
Q

How does the treatment differ between organized rhythm from unorganized rhythm?

A

organized? cardiovert

unorganized? defibrillation

54
Q

Why is there V. tach?

A

ischemic heart disease
myocardial scar from previous MI can cause an ectopic electrical focus
hemodynamic compromise

55
Q

What causes Tarsades de Pointes?

A

two competitive, irritable foci in the ventricular myocardium
d/t:
-hypokalemia
-hypomagnesemia
-hypocalcemia
-medications that block potassium channels including anti-HTN, antibiotics, and anticonvulsants
-congenital long QT syndrome

56
Q

Why does V. fib happen?

A

cardiac arrest
there is no coordinated electrical activity in the heart
no squeezing of the ventricles

57
Q

Why do first degree heart blocks occur?

A

increased vagal tone (athletes)
medications (antiarrhythmics)
MI
electrolyte disturbance

58
Q

Which second degree heart block is more dangerous?

A 
type 2 (mobitz type 2) 
regular with irregularity
59
Q

Mobitz type 1 has which type of rhythm?

A

irregularly regular

60
Q

Why do we care about axis deviation?

A

physical movement of the heart
hypertrophy (toward)
infarction (away)

61
Q

What is the difference between physiological left axis and pathologic?

A

Physiological left axis: 0- -45 (common in athletes and obese pts)
Pathological left axis: -45 - -90 (disease process, suggests left anterior hemiblock, pts are 4 times more likely to arrest with a hemiblock and chest pain”

62
Q

What causes RAH?

A

right atrial hypertrophy

  • pulmonary HTN
  • congenital heart disease
  • tricuspid or pulmonary valve disease
  • PE
  • seen with RVH
63
Q

What causes left atrial dilation?

A

volume overload or pressure

64
Q

What causes LAH?

A

HTN
AMI
mitral or aortic valve stenosis
LVH

65
Q

What causes LVH?

A

more common due to systemic HTN
increased pressure or volume
found in mitral and aortic stenosis, cardiomyopathy, HTN

66
Q

Can an EKG every rule out an MI?

A

NO

67
Q

What are the EKG signs of ischemia? (stable angina)

A

inverted T wave or ST depression

68
Q

Q wave

A

necrosis
usually dx of MI
significant if 1 mm wide or 1/3 amp of the QRS complex

69
Q

Which leads would confirm a lateral MI?

A

lead 1 + AVL + V5 + V6

70
Q

Which leads would confirm an inferior MI?

A

lead 2, lead 3, and AVF

71
Q

Which leads would confirm a septal MI?

A

V1 + V2

72
Q

Which leads would confirm an anterior MI?

A

v3 + v5

73
Q

Posterior infarct

A

opposite side of anterior
Tall R waves in V1 - V3
ST depression

EKG (1 decks)

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