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CardioPulm2 > EKG > Flashcards

EKG Flashcards

1
Q

Describe Lead I, how it looks at an EKG

A 
Right arm (-) to left arm (+)
If the AP is going toward the left arm, upward deflection. 
If the AP is going toward the right arm, downward deflection
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2
Q

Describe Lead II and Lead III

A

II: Right arm (-) to left leg (+)
III: Left arm (-) to left leg (+)

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3
Q

the general charges of Right arm, left leg, and left arm

A

Right arm - always negative
Left Leg Always Positive
Left Arm - what’s left.

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4
Q

What does an augmented unipolar lead mean?

A

3 connections; one being the active lead, others brought to ground.
aVR - active lead is Right arm
aVL - active lead is Left Arm
aVF - active lead is left leg (“foot”)

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5
Q

What are precordial leads?

A

the individual leads that give coronal view of heart. V1 -V6

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6
Q

What is the P wave?
QRS complex?
T wave?
What phase does each wave correspond to?

A

Atrial depolarization – Phase 0
Ventricle Depolarization – Phase 0
Ventricle Repolarization – Phase 3

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7
Q

Why is the T wave positively deflected if it’s repolarized?

A 
Depolarization makes the ECM  (-) from interventricular septum to lateral walls of heart. 
The Repolarization (which turns the ECM back to (+)) starts at the lateral walls of the heart and goes toward the interventricular septum. 
So bc of the opposite charge, and the opposite direction, the deflection will still be upward. 
(2 opposites make the same)
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8
Q 
Describe PR interval. 
Where does it begin and end?
Normal time?
What is happening electrically?
What does it indicate clinically?
A

Begins at beginning of P, ends at beginning of QRS.
0.12-0.21 seconds
depolarization traveling from atria to ventricles. (SA –> AV)
Health of AV node

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9
Q

Describe PR Segment.
Where does it begin and end?
What is happening electrically?
What does it indicate clinically?

A

Begins at END of P. ends at Beginning of QRS.
The signal is going through the AV nodes to depolarize the Ventricles.
health of AV node

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10
Q 
QT interval
Where does it begin and end?
Normal time?
What is happening electrically?
What does it indicate clinically?
A

Beginning of QRS –> end of T wave
0.43 seconds
Depolarization of every cell (Remember top of R is when HALF the cells are depolarized)
to repolarization of every cell.
Prolonged QT indicates Ca++ or K+ channel issues

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11
Q 
ST Segment
Where does it begin and end?
Normal time?
What is happening electrically?
What does it indicate clinically?
A

End of QRS, beginning of T wave
?
Phase 2/Plateau phase: Absolute refractory period
Prolonged ST indicates Ca++ or K+ channel issues

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12
Q 
RR Segment
Where does it begin and end?
Normal time?
What is happening electrically?
What does it indicate clinically?
A

Begins at R segment. Ends at next R segment
0.6- 1 sec
ventricular contraction.
Used to calculate heart rate

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13
Q

How do you calculate segments/intervals?

A

The boxes on the EKG
Small box: .04
Big box: 0.2

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14
Q

Which lead flips everything? Why?

A

aVR
The heart action potentials, in general, go from right atria –> left ventricle
This lead measures for the right arm, which is always negative. So it’s measuring the opposite direction that the action potential is going in.

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15
Q

When EKG lines are on baseline, what does this mean? Give an example

A

That the voltages are the same.

Such as: after the p wave, all the atrial walls are depolarized.

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16
Q

What does EKG measure?

A

The extracellular voltage of cells.

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17
Q

When is there a negative deflection?

Positive?

A

Negative deflections: AP is traveling away from + electrode.
Positive: Traveling toward +

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18
Q

Be able to calculate HR on an EKG

A

Use your own style. There’s many.

1) 300. 150. 100. 75. 60. 50.
2) .02 is a big box. .04 is a little box

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19
Q

What leads describe the electrical axis?
What will the EKG look like with a left deviation?
Right deviation?
Right extreme deviation?

How else can you do this?

A 
Lead I and aVF
I + aVF - 
I - aVF +
I - aVF - 
NORMAL: I + aVF +

Look for the isoelectric one, or at least the one with the least average. This is your action potential dude.
Now look at the leads perpendicular.
Which one is the biggest amplitude?
The one going positively is the way you go.

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20
Q

What leads show you what part of the heart? Which arteries do these correspond to?

A

Inferior: II, III, aVF [RCA MI]
Septal: V1, V2 [LAD MI]
Anterior: V2, V3, V4 [LAD MI]
Lateral: I, V4, V5, V6, aVR, aVL, [CFX MI]

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21
Q

The P wave is inverted in which leads?
The QRS wave is inverted in which leads?
The T wave is inverted in which leads?

A

They are all inverted in aVR for sure - maybe others?

QRS is inverted in V1 and V2

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22
Q

What does an inverted, symmetrical T wave indicate?

A

ischemia

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23
Q 
What are the normal numbers for 
Rate
Rhythm
Axis
PR Duration
QRS duration
QT
A 
Rate: 60-100
Rhythm: Uniform rhythm throughout
Axis: I an VR are +
PR Duration: 0.12 - 0.20
QRS duration: <0.12 seconds
QT: 0.43 (or half the time of the RR)
24
Q

What is the advantage of the long plateau of cardiac action potential and long refracotry period?

A

Preventrs multiple depolarizations and arrhythmias

- Longer sustained contractions for maximum ejection fraction

25
Q

Identify Bundle Blocks
Right Bundle Branch Block
Left Bundle Branch Block

A

RBBB:
V1 - Anterior: rSR’ (There’s 2 positive deflections “2 Rs”)
V6 - Lateral: qRs (elevated negative S wave- round and slow)
LBBB
V1 - Anterior: rS (just one huge S)
V6 - Lateral: R (double R sorta- M Shaped)

So if it’s Left, there’s going to be Less deflections in the QRS.
If Right, there will be too many.

26
Q 
Identify AV blocks
First degree
Second degree type 1
Second degree type 2
Third degree:
A

First degree: PR interval is prolonged.
Second degree 1: progressive lengthening of PR until QRS drops out
2nd degree T2: dropped QRS, but P wave remains normal. Pacemaker.
3rd: Unmarried P waves. Treated with Pacemaker. Can be caused by lyme disease

27
Q

What does atrial fibrillation look like?
Atrial flutter?
Ventricular fibrillation?

A

Atrial fibrillation: Chaotic P waves
Atrial flutter: regular messed up p waves “Sawtooth”
VF: completely eratic. no identifable waves

28
Q 
What are clinical implications of weird: 
QRS height
ST segment
T wave
U wave
QT interval
A

QRS height: if Q is super long, previous MI
ST segment: elevated - MI. depressed - endocardial MI
T wave: Inverted and symmetrical - ischemia
U wave: if seen, hypokalemia
QT interval: bad. Dk what tho

29
Q

WHat are the normal heart sounds?

A

S1 - Closing of AV valves during systole
S2 - Closing of semilunar valves
S3 - babies - Rapid ventricular filling vibrates ventricle wall
S4 - Atrial systole vibrates AV valve leaflets

30
Q

What can cause a systolic murmur between S1 and S2?

A
  • Mitral or tricuspid regurigtation
  • semilunar stenosis

(ventricles are contracting so blood is flowing to outflow tracts - the Semilunars are open and the AV valves are shut)

31
Q

What can cause a diastolic murmur between S2 and S1?

A

Mitral or tricuspid stenosis
- Semilunar regurg

(Ventricles are relaxing - blood flows from atria to ventricles. Semilunars should be shut, AV valves should be open)

32
Q

A patient presents with chest pain. The pain is predictable and gets better with sublingual nitro and rest. The EKG shows a an ST depression (or a T wave inversion).
Diagnosis?

A

Stable angina

33
Q

A patient presents with chest pain. The chest pain is new, occasionally gets better at rest, but has increased in frequency and duration in the past several months. Diagnosis?

A

Unstable angina

34
Q

What is the J point on an EKG?

A

Where the S ends and T begins.

35
Q

A patient’s EKG shows an elevated ST segment in Leads II, III, and aVF. There is a reciprocal ST depression in lead I and aVL. What artery is affected and what is the diagnosis?

A

RCA.

STEMI

36
Q

What is the mechanism of angina?

What pathology can it be caused by?

A

Not enough O2 for the tissue demand
Atherosclerosis, Vasospasm (drugs)
Aneurysm, ectasia, radiation.

37
Q

A 32 year old male patient presents with chest pain. He admits to cocaine use and smoking. Diagnosis?

A

Vasospastic angina

38
Q

An EKG shows an elevated ST segment, what could this be?

A

Acute MI

39
Q

An EKG shows a symmetrical inverted T wave, what could this be?

A

Ischemia

40
Q

An EKG shows a large Q wave, what could this mean?

A

Necrosis caused by a previous MI

41
Q

An EKG shows an elevated ST segment in leads II, III, and aVF. What is the diagnosis? Where would the reciprocal ST Depression be? What artery is occluded?

A

Inferior wall STEMI

Lead I, and aVL

RCA

42
Q

An EKG shows an elevated ST segment in leads I and aVL. What is the diagnosis? Where would the reciprocal ST depression be?

A

Lateral Wall STEMI.

II, III, aVF

CFX

43
Q

An EKG shows an elevated ST segment in leads V1, V2, V3, V4. What is the diagnosis? Where would the reciprocal ST depression be?

A

Anterior wall STEMI

No reciprocal depression

LAD

44
Q

An EKG shows a depressed ST wave in leads V1 - V4. What is the diagnosis? Where would the reciprocal ST depression be?

A

Posterior Wall STEMI

Posterior interventricular (?)

None

45
Q

A patient at cardiac risks has an EKG and it shows an elevated Q wave. What’s your next step?
If this test is positive, what is the diagnosis?

A

Grab blood enzymes

If positive for blood enzymes, that dude has NSTEMI

46
Q

An EKG shows QRS complexes with missing p waves. What could this mean?

A

Atrial fibrillation

47
Q

A patient presents with chest pain that lasts only a few minutes. She is a smoker and has hypertension. The EKG shows missing p waves and a narrow QRS. What’s the preemptive diagnosis, Student Doctor?

A

A Fib

48
Q

What part of the EKG shows whether the heart is in sinus rhythm?

A

P waves

49
Q

An EKG shows no p waves, what is the next thing you should notice?

A

The width of the QRS.

50
Q

An EKG shows irregular rhythm with a lack of p waves, what is the diagnosis?

A

Atrial fibrillation

51
Q

An EKG shows sawtooth formations between QRS complexes. what is the diagnosis?

A

Atrial flutter

52
Q

A patient presents for an athletic physical . in Leads V2-V4, the ST is elevated. What is the diagnosis?

A

Healthy. This is normal.

53
Q

An EKG shows regular sinus rhythm but the QRS complex is over 3 blocks wide. What does this indicate?
You then look at V1 and V6 and see a depressed ST segment. Diagnosis?

A

BUndle Block

right bundle block

54
Q

An EKG shows slow rhythm with no p waves. The QRS complex is normal. Diagnosis?

A

Junctional conduction

(The initial conduction is coming from the AV junction rather than the SA (sinus) node. If the QRS complex was wacky, then it would have been atria conduction)

55
Q

The Heart rate is above 100, so you’ve decided it is tachycardia. The QRS complex is narrow - what does this indicate?
What if hte QRS complex was wide?

A

Supraventricular tachycardia

Ventricular tachycardia

56
Q

An EKG shows a wide QRS, depressed and wide ST segment with a depressed J point. Diagnoiss?

A

PVC

57
Q

An EKG shows normal QRS, and a hooked p wave (funky looking). Diagnosis?

A

PAC

CardioPulm2 (3 decks)

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