EKG Flashcards
what heart rate is considered tachycardia?
100 BPM
what heart rate is considered bradycardia
< 60 bpm
what is the intervals between each dark line on an ECG
.2 seconds
what is the interval between each of the tiny boxes on an ECG
.04 seconds
What are the BPM intervals between .2 second lines on an ECG
300
150
100
75
60
What are the corresponding lead angles for lead I
0, 180
What are the corresponding lead angles for lead II
+60, -120
What are the corresponding lead angles for lead III
+120, -60
what are the lead angles for lead AVL
-30, +150
What are the lead angles for lead AVF
-90, +90
What are the lead angles for lead AVR
-150, +30
What should the basis of treatment be for sinus tachycardia?
Look for cause and treat that!
Caffiene, stress, anxiety, Dr. hillard
What features of the sinus node makes it the dominant cardiac pacemaker?
Highest intrinsic discharge rate
You have a young athetic person who likes BDSM. They are a sub and wear a really tight collar. What physiologic heart rhythm are they most likely to have
bradycardia
caused by anything that massages carotid, obstructive jaundice, sliding hiatial hernia, valsalva maneuver
What prevelent drugs can cause bradycardia?
Digitalis
drugs that inhibit sympathetic tone
Beta blockers
If bradycarida becomes severe enough needing treatment, what is the first line treatment
Atropine .3 -> .5 | 1 mg -> 2mg IV
What three types of premature contraction can a person experience
Premature Atrial Contraction
Premature Junctional Beat
Premature Ventricular Contraction
What type of arythmia is seen in people without significant heart disease but can be associated with stress, alchohol, tobacco, coffee, COPD, and CAD?
Premature Atrial Contraction
What is the key ECG feautre of Premature Atrial Contaction
a second P wave before the QRS
What are the 2 types of PAC you can see on ECG
Normally conducted
Blocked PAC
What is the treatment of symptomatic PAC
reverse causes
Beta Blockers - metoprolol
What is paroxysmal atrial tachycardia
Suddent HR above 100 (150-200)
What are the key ECG findings of PAT with AV block
Rapid rate, spiked P’ waves
2:1 ratio of P’:QRS
Cause: digitalis toxicity
What are the key findings on ECG for Multifocal Atrial Tachycardia
- 3 or mor different P waves
- P-R interval variable
- Associated with lung disease (Right sided deviation)
What is the treatment for multifocal atrial tachycardia?
- Calcium channel blocker
Describe ECG of Atrial Flutter and the best leads to check
Saw tooth appearance
Leads II, III, AVF, V
Describe the ECG of paroxysmal junctional (nodal) rhythms
- 150 - 200 BPM tachy
- Pwave lost or inverted before or after each QRS
What are the characteristics of an ECG with Preventricular Contractions?
- Premature, bizarre, wide QRS
- No preceding P wave
- ST-T wave moves opposite direction of QRS
- Full compensatory pause
What is it called when some one throws more than 6 preventricular contractions?
V-Tach (ventricular tachycardia)
What situation in a PVC can predispose someone to vtach?
if th PVC lands on a T wave
Someone just has an ischemic attack on their ol ticker. However, they got to the hospital and got that good clotbuster and his heart is being reperfused. what arrythmia must we be concerned about?
Accelerated idioventricular rhythm
(i think this is still V-Tach)
What is hallmark of a Torsades de Pointes
QRS swings from positive to negative direction
inherited: prolonged QT
aquired: Class I II antiarrhythmetics, Alcohol, TCA
What is the treatment for torsades de pointes
MgSO4, 1-2 g IV bolus
Override pacing
Isoproternol
What is VFib
Disorganized contractility. This is what Coding is.
NOT ASYSTOLE
What is an AV block?
a block in the cardiac conduction system that causes a disruption of atrial to ventricular conduction
What is hallmarck of a first degree AV block?
PR interval >.2 seconds (normal .12 - .2 sec)
What disease processes can precipatate 1 degree AV block
Athersclerosis
HTN
Dibeetus
Fibrosis - Ischemia
What are the 2 types of second degree A-V block
Mobitz I (Wencke Bach)
Mobitz II
What is hallmark of Mobitz I type 2 degree AV block?
Progressive PR-interval prologation prior to droped QRS
Grouped beats
can be seen in INFERIOR MI
What causes Mobitz type II AV block
Ischemic heart disease, ANTERIOR MI
Describe Mobitz II 2 AV block
uniform PR interval
Dropped QRS
Describe a third degree (complete) heartblock
P waves dont relate to QRS
if occurs above AV node - narrow QRS (40-55)
If occurs below AV node - wide QRS (20-40)
What are the common features of BBB
- Wide QRS Complex (.12 sec or greater)
- ST segments - T wave slope opposite QRS
What is characteristic of a right bundle branch block?
QRS segment with R’ present in V1 and V2
What is characteristic of Left bundle branch block?
R’ locsted in leads I, AVL, V5, V6
What disease process is associated with LBBB
HTN
Ischemia
Aortic Stenosis
Cardiomyopathy
What is a hemiblock or fascicular block?
Block of a division of a bundle branch
Left - anterior(more common)/posterior
What are the characteristics of a LAH
Left axis deviation
small Q in I;AVL
Small R in II, III, AVF
What is the criteria of LPH
- Right axis deviation
- Small R leads I and AVL
- Small Q in II, III, AVF
S1Q3
what changes occur in Right Atrial Enlargement?
looks like a ski slope in II and VI
What disease processes are associated with RAE
Pulmonary diseases - PH. COPD, Mitral stenosis, Mitral regurgitation
Describe the characteristics of a Left Atrial Enlargement
P mitral M shaped wave or has P wave with immediate inversion.
As a consequence of increasing force needed to eject blood from enlarged ventricles, what changes do you expect to be observed in Left Ventricular Hypertrophy
-QRS complex increases
– deeper S waves over RV
– Taller R waves over LV
What are the Romhilt-Estes Scoring System Criteria
R or S in limb lead 20 MM or more
S in V1 V2 V3 25 mm or more
R in V5 V6 30 mm or more
and ST shift
What are the Sokolow Lyon Criteria
R in I + S in III > 25 mm
R in AVL > 11
R in V6 > 26 mm
What are the clues suggesting RVH
RAD 90 degrees or more
R in V1 7 mm or more
R in V1 + S in V6 10 MM or more
R/S ratio V1 >1
S/R ratio in V6 > 1
What effect will low potassium have on ECG
Smaller QRS
What effect will high potassium have on ECG
wider QRS
What does low calcium do to ECG
prolong QT interval
What is the hallmark finding of hyperkalemia on ECG
peaked T wave, wide QRS, increased PR interval
What is the hall mark of hypothermia
Bradycardia and J wave (osborne wave)
What are the ECG findings associated with PE
S1 Q3 T3
T wave inversion in V1-4
Transient RBBB
What are the ECG findings associated with Wolff-Parkinson -White syndrome
Short P-R interval
Slurred upstroked - (delta wave)
In which populations is Brugada’s disease most prominent
Asian Men
Sloped ST segments V1-3
What do dual pace maker EKG look like?
Twin Towers in lead III
