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EKG Flashcards

1
Q

5 Steps for Reading EKG

A

Rate, Rhythm, Axis, Hypertrophy, Infarction

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2
Q

Rate Method:

A

300, 150, 100, 75, 60, 50

Bradycardia: cycles/6 sec. strip x 10

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3
Q

Rhythm Method:

A

identify basic rhythm, then scan tracing for: prematurity, pauses, irregularity, and abnormal waves

Check: P before each QRS, QRS after each P
Check: PR interval (for AV block), QRS interval (for BBB)
if axis deviation, rule out hemiblock

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4
Q

Axis Method:

A

QRS above or below baseline for axis quadrant (normal vs L and R axis deviation)
For axis in degrees: find isoelectric QRS in limb lead
Axis rotation in Horizontal plane

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5
Q

Hypertrophy Method:

A

Check V1: P wave for atrial hypertrophy
R wave for right ventricular hypertrophy
S wave depth in V1 + R wave height in V5 for left ventricular hypertrophy

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6
Q

Infarction Method:

A 
Scan all leads for:
Q waves
Inverted T waves
ST segment elevation or depression
(find location of pathology and then identify the occluded artery)
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7
Q

Sinus Bradycardia

A

rate less 60/ min

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8
Q

Sinus Tachycardia

A

rate more than 100/ min

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9
Q

Normal Sinus Rhythm

A

60-100/ min

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10
Q

Dissociated Rhythms

A

sinus rhythm may coexist with independent focus from lower level, determine rate of each

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11
Q

Irregular Rhythms

A

Sinus Arrhythmia, Wandering Pacemaker, Multifocal Atrial Tachycardia, Atrial Fibrillation,

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12
Q

Sinus Arrhythmia

A

irregular rhythm that varies with respiration, all P waves are identical, Considered normal

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13
Q

Wandering Pacemaker

A

Irregular rhythm, P waves change shape as pacemaker location varies, rate under 100/ min

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14
Q

Multifocal Atrial Tachycardia

A

Irregular rhythm, P waves change shape as pacemaker location varies, rate exceeds 100/ min

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15
Q

Atrial Fibrillation

A

Irregular Ventricular Rhythm, Erratic atrial spikes (no P waves) from multiple automaticity foci, atrial discharges may be difficult to see

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16
Q

Escape (def)

A

an unhealthy SA node fails to emit a pacing stimulus (Sinus Block) and an escape beat arises from another automaticity focus

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17
Q

Atrial Escape Beat

A

pause, P’ wave with QRS, Sinus Resumes Pacing

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18
Q

Junctional Escape Beat

A

(idojunctional beat) pause, *usually QRS complex without P wave, Sinus Pacing Resume
*retrograde atrial depolarization, may cause inverted P wave

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19
Q

Retrograde Atrial Depolarization

A

In junctional Escape Beat or Rhythm, junctional depolarization may depolarize the atria from below, causing inverted P wave

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20
Q

Ventricular Escape Beat

A

pause, massive QRS with no P, Sinus resumes pacing after one beat

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21
Q

Atrial Escape Rhythm

A

pause, P’ with pacing of 60-80

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22
Q

Junctional Escape Rhythm

A

pause, *usually no P wave, pacing of 40-60

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23
Q

Ventricular Escape Rhythm

A

(idioventricular) pause, no P wave, massive QRS, pacing 20-40

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24
Q

Premature Beat

A

an irritable automaticity focus suddenly discharges a single stimulus

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25
Q

Atrial and Junctional irritants

A 
epinephrine release
sympathetic stimulation
caffeine or other stimulants
excess digitalis, some toxins, ethanol
hyperthyroidism
stretch
(low 02)
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26
Q

Premature Atrial Beat (PAB)

A

P’ wave produces earlier than expected, produced by atrial focus, may hide in the T wave, resets pacing of SA node (one cycle length

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27
Q

PAB with aberrant ventricular conduction

A

one of the ventricles has not depolarized yet, creating a wide QRS,
premature P’ with widened QRS (SA pacing one cycle length)

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28
Q

non-conducted PAB

A

AV node is in refractory phase, therefore no QRS

premature P’ with no QRS (SA pacing one cycle length)

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29
Q

Atrial Bigeminy

A

PAB coupled to end of each normal cycle

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30
Q

Atrial Trigeminy

A

PAB coupled after each normal cycle of two

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31
Q

Premature Junctional Beat

A

premature beat, no P*
may have retrograde atrial depolarization
may have aberrant ventricular depolarization

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32
Q

Junctional Bigeminy

A

PJB after each normal cycle

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33
Q

Junctional Trigeminy

A

PJB after each cycle of two normal beats

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34
Q

Premature Ventricular Contraction (PVC)

A

no P’, giant ventricular complex, usually opposite of normal QRS

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35
Q

Ventricular Irritants

A

low O2

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36
Q

Ventricular Bigeminy

A

PVC attached to each normal beat

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37
Q

Ventricular Trigeminy

A

PVC attached to each set of two normal beats

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38
Q

Ventricular Quadrigeminy

A

PVC attached to each set of three normal beats

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39
Q

Pathological PVC

A

6 PVC’s per minute

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40
Q

Ventricular Parasystole

A

Ventricular focus with entrance block, dual pacing of ventricle and SA node

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41
Q

Multifocal PVC’s

A

PVC’s from multiple foci, each will have different, distinguishable QRS complex

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42
Q

Mitral Valve Prolapse

A

mitral valve billows into left atrium during ventricular systole, causes PVC’s, considered benign

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43
Q

PVC on T wave

A

“R on T phenomenon” vulnerable period, respond quickly

44
Q

Tachyarrhythmias

A

rapid rhythms originating in very irritable automaticity foci

45
Q

Paroxysmal Tachycardia

A

150-250bpm

46
Q

Flutter

A

250-350 bpm

47
Q

Fibrillation

A

350-450 bpm

48
Q

Paroxysmal Tachycardia

A

(sudden) a very irritable automaticity focus that suddenly paces rapidly

49
Q

Paroxysmal Atrial Tachycardia

A

(PAT) rapid atrial beat 150-250, P’ wave

50
Q

PAT with AV block

A

rapid rate spiked P’ waves
2:1 ratio of P’:QRS
suspect digitalis or toxicity

51
Q

Paroxysmal Junctional Tachycardia (PJT)

A

rapid junctional beat 150-250, no P’ or retrograde atrial depolarization

52
Q

Paroxysmal Ventricular Tachycardia (PVT)

A

rapid 150-250 PVC like wide ventricular complexes

53
Q

Atrial Flutter

A

continuous rapid sequence of atrial complexes from single atrial focus, many flutters per QRS

54
Q

Ventricular Flutter

A

rapid series of smooth sine waves, usually leads to V-Fib

55
Q

Atrial Fibrillation

A

jagged baseline of tiny spikes with irregular QRS 350-450

56
Q

Ventricular Fibrillation

A

Totally erratic ventricular rhythm, no identifiable waves, multiple foci, immediate treatment

57
Q

SA block

A

an unhealthy sinus misses one or more cycles

58
Q

AV Block

A

blocks that delay or prevent atrial impulses from reaching ventricles

59
Q

1st deg. AV block

A

prolonged PR interval, PR interval great than 0.2s (one large square)

60
Q

2 deg AV block

A

some P waves without QRS complex, Wenckebach, Mobitz

61
Q

Wenckeback

A

PR gradually lengthens with each cycle until the last P wave does not produce QRS

62
Q

Mobitz

A

some P waves dont produce QRS

63
Q

2:1 AV block

A

may be Wenckebach or Mobitz, PR length, QRS width or vagal maneuvers may help differentiate

64
Q

3 deg block

A

(complete AV block) no P wave produces QRS response
if QRS narrow and 40-60/min junctional focus
if QRS- PVC like and rate 20-40 then ventricular rate

65
Q

Bundle Branch Block

A

find R,R’ in right or left chest leads

is QRS within 3 small squares?

66
Q

Hemiblock

A

block of the anterior or posterior fascicle of left bundle branch
check: has axis shifted outside normal range
anterior hemiblock: axis shifts left: LAD
posterior hemiblock: axis shifts right: RAD

67
Q

anterior hemiblock

A

axis shifts left: LAD

68
Q

Posterior hemiblock

A

axis shifts right: RAD

69
Q

Axis

A

QRS lead 1: positive QRS means normal for left vs right
negative: RAD
QRS AVF: positive means normal for up vs down
Negative: LAD
determine axis quadrant, find isoelectric limb lead, 90 deg from that in determined quadrant
Axis rotation: find transitional isoelectric QRS in chest lead

70
Q

Atrial Hypertrophy

A

V1 is best indicator
enlarged atrial wall, LR
diphasic P wave

71
Q

Right atrial Hypertrophy

A

V1: large diphasic P wave with tall initial component

72
Q

Left Atrial Hypertrophy

A

V1: large diphasic P wave with wide terminal component

73
Q

Ventricular Hypertrophy

A

enlarged ventricle

74
Q

Right Ventricular Hypertrophy

A

in V1 QRS is normally negative, however with RVH, large R wave in V1
R wave large than S in V1 but R gets progressively smaller from V1-V6
S wave persists in V5 and V6
RAD with slightly widened QRS
Rightward rotation in horizontal Plane

75
Q

Left Ventricular Hypertrophy

A

S wave in V1 plus R wave in V5 is more than 35mm
LAD with slightly widened QRS
Leftward rotation in horizontal plane
Inverted T wave: slants downward gradually, but up rapidly

76
Q

Myocardial Infarction

A

complete occlusion of a coronary artery

77
Q

myocardial infarction triad

A

ischemia, injury necrosis

78
Q

ischemia

A

decreased blood supply, inverted symmetrical T wave

79
Q

injury

A

acuteness of infarct,

ST segment indicates acute injury

80
Q

Brugada Syndrome

A

hereditary condition that can cause sudden death in individuals with heart disease, right bundle branch block pattern (RR’) with ST elevation in V1 to V3, elevated ST has peculiar peaked down-sloping shape shape in V1 and V2

81
Q

Pericarditis

A

flat or concave elevated ST segment, the entire T wave is elevated off baseline (inflammation of the membrane (pericardium) surrounding the heart)

82
Q

Right bundle branch block

A

check QRS in V1 and V2 looking for RR’ Double R
Is QRS within 3 small squares?
criteria for ventricular hypertrophy unreliable

83
Q

Left Bundle Branch Block

A

Check QRS in V5 V6 for RR’

with LBBB infarction is difficult to determine

84
Q

Horizontal Axis (V2)

A

placed just anterior to AV node
QRS should be negative due to thick left ventricle
most reliable information concerning Anterior and Posterior infarction of Left ventricle
projects through anterior and posterior wall of left ventricle

85
Q

Horizontal Axis Method

A

leads normally become isoelectric in V3 and V4, “transitional zone”
check chest lead isoelectric, if V5 or V6: leftward rotation
if V1 or V2 rightward rotation

86
Q

leftward rotation

A

isoelectric point is V5 or V6

87
Q

Rightward rotation

A

isoelectric point is V1 or V2

88
Q

Ischemia

A

reduced blood supply (from the coronary arteries)
symmetrical inverted T-wave, especially in chest leads
always check for T wave inversion in all chest leads

89
Q

Wellens Syndrome

A

stenosis of the anterior descending coronary artery
(ischemia)
inverted symmetrical T wave in V2 and V3

90
Q

Injury

A

indicates the acuteness of the infarct

ST segment elevation that returns to the baseline- myocardial infarction is acute

91
Q

Ventricular Aneurism

A

“ballooning of ventricular wall”

causes an ST elevation that does not return to baseline

92
Q

during angina

A

ST segment may be temporarily depressed

93
Q

Subendocardial Infarction

A

infarct that does not extend through full thickness of left ventricular wall
may cause flat depressed ST segment
type of “non-q-wave infarction)

94
Q

Stress Test

A

will record ST segment depression if coronary arteries are narrowed

95
Q

Digitalis

A

can cause a unique ST segment depression

96
Q

significant ST depression in normally upright QRS leads

A

indicates compromised coronary flow until proven otherwise

97
Q

Necrosis

A

dead tissue

significant “Q” wave diagnosis infarction (0.04 s) (one small box)

98
Q

infarction

A

diagnosed by significant Q wave (0.04 s) (one small box)

area of necrosis in the left ventricle

99
Q

q wave (insignificant)

A

caused by initial mid-septal depolarization from terminal purkinje fibers of the left bundle branch at mid-septal location
by definition less than 0.04 s

100
Q

Significant Q wave

A

(0.04 s) (one small box)
1/3 of QRS amplitude
check all leads except aVR

101
Q

aVR Q wave

A

do not check Q wave in aVR, it will appear significant, but its not

102
Q

lateral leads

103
Q

inferior leads

104
Q

chest leads

105
Q

Anterior infarct

A

significant Q wave in V1-V4

106
Q

Lateral infarct

A

significant Q wave in LI and aVF

107
Q

Inferior infarct

A

Q on leads II, III, and aVF

CCT (3 decks)

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