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PCM2 > EKG > Flashcards

EKG Flashcards

1
Q

What are the steps to reading an EKG systematically?

A
  1. Standard
  2. Rate
  3. Rhythm
  4. Axis
  5. Intervals
  6. Enlargement/Hypertrophy
  7. AVB
  8. BBB and Hemi-block
  9. Pre-excitation
  10. Ischemic changes
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2
Q

Define bradycardia.

A

<60 bpm

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3
Q

Define tachycardia.

A

> 100 bpm

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4
Q

1 small box = ?

A

0.1 cm = 0.04 s = 0.1 mV

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5
Q

1 large box = ?

A

0.5 cm = 0.2 s = 0.5 mV`

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6
Q

Heart rate = ?

A

300/large boxes

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7
Q

What is sinus rhythm?

A
  1. P wave before each QRS
  2. P wave upright in II, flipped in aVR
  3. All P waves identical in morphology
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8
Q

Normal PR interval = ?

A

0.12 - 0.2 s (3-5 small boxes)

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9
Q

Normal QRS interval = ?

A

0.07 - 0.11 s (2-3 small bocks)

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10
Q

Normal QT interval = ?

A

0.2 - 0.4 s OR < 40% of total cycle (RR interval)

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11
Q

Draw the axis. What is normal?

A

Look it up to confirm you are correct; -30 to 90 degrees

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12
Q

What changes are seen in RA enlargement?

A
  1. P wave amplitude > 2.5 mm (II, III, AVF)
  2. No change in p wave duration necessary
  3. Possible right axis deviation of P wave
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13
Q

When is RA enlargement seen?

A

Severe lung disease

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14
Q

What changes are seen in LA enlargement?

A
  1. 2nd half of P wave has an amplitude > 1 mm (V1)
  2. P wave duration > 0.04 seconds (II)
  3. No axis deviation necessary
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15
Q

When is LA enlargement seen?

A

Mitral valve disease

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16
Q

What changes are seen in RV hypertrophy?

A
  1. Right axis deviation > 100 degrees

2. R > S (V1) + S >R (V6)

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17
Q

When is RV hypertrophy seen?

A

COPD, congenital heart disease

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18
Q

What changes are seen in LV hypertrophy?

A
  1. R (V5 or V6) + S (V1 or V2) > 35 mm
  2. R (V5) > 26 mm
  3. R (V6) > 18 mm
  4. R (V6) > R (V5)
  5. R (aVL) > 13 mm (97% specific)**
  6. R (aVF) > 21 mm
  7. R (I) > 14 mm
  8. R (I) + S (III) > 25 mm
  9. LVH strain - ST depression with asymmetric inverted T waves in lateral leads
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19
Q

What indicates ischemia?

A

ST depression

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20
Q

What indicates infarction?

A

ST elevation

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21
Q

What is a standard EKG?

A

10 mm/mV voltage

25 mm/sec paper speed

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22
Q

What defines a first degree AV block?

A

PR >0.2 seconds, but P:QRS ratio still 1:1

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23
Q

What defines a second degree AV block?

A

P:QRS not 1:1

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24
Q

What are the two types of 2nd degree AV block?

A

Mobitz Type I (Wenckebach) and Mobitz type II

25
Q

How is Mobitz type I defined?

A

PR widens with each beat until a beat is skipped, P:QRS ratio constant but not 1:1

26
Q

How is Mobitz type II defined?

A

Skipped beats without constant P:QRS ratio

27
Q

What defines a 3rd degree AV block?

A

Atria and ventricles electrically dissociated

28
Q

What defines a BBB?

A

QRS > 0.12 seconds

29
Q

What defines a RBBB?

A
  1. QRS >0.12 seconds
  2. RSR’ rabbit ears (V1, V2) w/ST depression, T inversion
  3. Reciprocal changes in left lateral leads
30
Q

What defines a LBBB?

A
  1. QRS >0.12
  2. Broad notched R w/prolonged upstroke (left lateral leads), ST depression and T inversion
  3. Reciprocal change V1, V2
  4. Possible left axis deviation
31
Q

What defines an anterior hemiblock?

A
  1. Normal QRS, ST, T
  2. LAD
  3. No other cause for LAD
32
Q

What defines a posterior HB?

A
  1. Normal QRS, ST, T
  2. RAD
  3. No other cause for RAD
33
Q

What defines a bifasicular block?

A
  1. RBBB + Anterior or Posterior HB
34
Q

What defines atrial flutter?

A

Saw tooth P waves at 250-350 bpm in lead II

35
Q

What defines atrial fibrillation?

A

No pattern, no visible p waves, irregularly irregular ventricular rate

36
Q

What is a premature atrial contraction?

A

Premature beat with a preceding P wave

37
Q

What is paroxysmal supraventricular tachycardia?

A

Regular rhythm, 150-250 bpm, sudden onset

38
Q

What is ventricular tachycardia?

A

Run of 3 or more PVCs

39
Q

What is V fib?

A

Spasmodic EKG, no true QRS

40
Q

What is a PVC?

A

Wide bizarre QRS

41
Q

What is Accelerated Idioventricular Rhythm?

A

No p waves
Wide QRS
Inverted T waves
50-100 bpm

42
Q

What is Paroxysmal SVT?

A

Arrhythmia - regular rhythm, 150-250 bpm, sudden onset, possible retrograde p wave

43
Q

What is a delta wave?

A

Slurred upstroke in the QRS complex associated with a short PR interval - seen in WPW syndrome

44
Q

What do early peaked T waves indicate?

A

Ischemia without injury, hyperkalemia

45
Q

What does ST elevation indicate?

A

Benign early repolarization
Acute MI
Pericarditis
LV aneurysm

46
Q

What does ST depression indicate?

A 
Posterior MI
Subendocardial infarction or ischemia
LVH with repol abnl (STRAIN)
Digoxin
Hypokalemia
47
Q

Which EKG leads are associated with an anterior wall MI? Which artery supplies this?

A

V1, V2, V3, V4

Left anterior descending artery

48
Q

Which EKG leads are associated with a lateral wall MI? Which artery supplies this?

A

I, AVL, V5, V6

Left circumflex artery

49
Q

Which EKG leads are associated with an inferior wall MI? Which artery supplies this?

A

II, III, AVF

Right coronary artery

50
Q

What indicates a right coronary artery infarct?

A

ST depression in V1-V3 with upright T waves

51
Q

What does T-wave inversion indicate?

A

Ischemia, PE, CNS, LV strain

52
Q

What is indicative of an old infarction?

A

Q wave > 0.04 seconds + Q wave = 1/3 of R wave in same QRS complex = significant Q wave

53
Q

What changes are associated with ischemia and MI?

A

Hyper-acute T waves (preceding STEMI)
ST elevation (during STEMI; may see reciprocal T-wave inversions in opposite leads)
Inverted T waves (post-MI)
Q waves

54
Q

What EKG findings indicate hyperkalemia?

A
  1. T wave peaking (progressive to all 12 leads)
  2. PR becomes prolonged with P wave flattening until it disappears
  3. QRS widening (merges w/T wave and appears sinusoidal)
55
Q

What EKG findings indicate hypokalemia?

A
  1. ST segment depression
  2. T wave flattening
  3. U wave appearance (after T wave and more prominent)
56
Q

What EKG findings indicate hypercalcemia?

A
  1. Shortened QT interval
57
Q

What EKG findings indicate hypocalcemia?

A
  1. Prolonged QT interval
58
Q

What EKG findings indicate hypothermia?

A
  1. Bradycardia and prolongation of all segments/intervals

2. J wave/Osborne wave (ST segment elevation with abrupt ascent at J point followed by abrupt plunge back to baseline)

59
Q

What EKG findings indicate the digitalis effect?

A
  1. Changes seen at therapeutic levels
  2. ST segment depression (gradual down-slop merged with R wave)
  3. T wave flattening/inversion
  4. Most prominent in leads w/tall R waves

PCM2 (16 decks)

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