EKG/ ACLS Flashcards
If lead I and aVF are both (+) what does this tell you about the QRS axis?
Normal
If lead I is (+) and aVF is (-) what does this tell you about the QRS axis?
LAD
next check lead II
If LAD based on I and aVF and QRS is predominately (+) in lead II, what does this tell you about the QRS axis?
Normal axis
If LAD based on I and aVF and QRS is predominately (-) in lead II, what does this tell you about the QRS axis?
LAD
If lead I is (-) and aVF is (+) what does this tell you about the QRS axis?
RAD
An m-shaped P wave in lead II indicates?
LAE
A tall P wave in lead II (≥ 3mm) indicates?
RAE
If QRS is narrow, you should skip looking for what?
BBB
Wide QRS, broad/ slurred R in V5/V6, deep S wave in V1, and ST elevations in V1-V3 indicates?
Left BBB
Wide QRS, RsR’ in V1/V2, and wide S wave in V6 indicates?
Right BBB
Q waves/ ST elevations in V1-V4 indicates an infarction where and involves what artery?
Anterior wall
Left anterior descending (LAD)
Q waves/ ST elevations in V1-V2 indicates an infarction where and involves what artery?
Anterior wall/ septal
Proximal LAD
Q waves/ ST elevations in I, aVL, V5-V6 indicates an infarction where and involves what artery?
Lateral wall
Circumflex (CFX)
Q waves/ ST elevations in I, aVL, V4-V6 indicates an infarction where and involves what artery?
Anterolateral
Mid LAD +/- CFX
Q waves/ ST elevations in II, III, aVF indicates an infarction where and involves what artery?
Inferior
Right coronary artery (RCA)
Q waves/ ST depressions in V1-V2 indicates an infarction where and involves what artery?
Posterior wall
RCA/ CFX
Vectors move towards __ and away from __?
Vectors move towards hypertrophy and away from infarction
summation of all the vectors = general direction of the impulses through the heart = (QRS) axis
If lead I is (-) and aVF is (-) what does this tell you about the QRS axis?
ERAD
extreme RAD
What are the only 2 shockable rhythms using defibrillation (unsynchronized cardioversion)?
V-fib and pulseless V-tach
A sinus arrhythmia will increase with __ and decrease with __?
A sinus arrhythmia will increase with inspiration and decrease with expiration
In a sinus rhythm, P waves are positive/ upright in leads __ and negative in __?
In a sinus rhythm, P waves are positive/ upright in leads I, II, aVF and negative in aVR
What is the tx for sinus tachycardia?
Treat underlying cause then BBs if persistent
What is the tx for sinus bradycardia if symptomatic or unstable?
Atropine
What is the tx for sinus bradycardia if asymptomatic/ physiologic?
No tx needed
What is the tx for sick sinus syndrome if stable?
alternating episodes of tachy/ brady
None- sxs transient
What is the tx for sick sinus syndrome if hemodynamically unstable?
(alternating episodes of tachy/ brady)
Atropine
+/- dopamine/ epinephrine/ transcutaneous pacing
What is the tx for long-term sick sinus syndrome?
alternating episodes of tachy/ brady
Pacemaker
Prolonged PR interval with all P waves followed by QRS complexes indicates?
1st degree AV block
Progressive PR internal lengthening followed by a dropped QRS indicates?
2nd degree type I AV block
Constant prolonged PR interval followed followed by a dropped QRS indicates?
2nd degree type II AV block
Sawtooth pattern with no discernible P waves on EKG indicates?
Atrial flutter (250-350 bpm)
Irregularly irregular rhythm with fibrillary waves (no discrete P waves) on EKG indicates?
Atrial fibrillation
What is used for anticoagulation risk stratification in nonvalvular atrial fibrillation?
≥2 = moderate to high risk = chronic oral anticoagulation
CHA2DS2-VAS congestive HF- 1 hypertension- 1 age ≥ 75- 2 dm- 1 stroke/ TIA/ thrombus- 2 vascular disease- 1 age 65-74- 1 sex (female)- 1
Regular, narrow-complex tachycardia with no discernible P waves on EKG indicates?
Paroxysmal SVT
“If you can’t tell if the bump is a P or a T, then it must be SVT”
How do you differentiate between wandering atrial pacemaker and multifocal atrial tachycardia?
Both ≥ 3 P wave morphologies but WAP HR < 100 and MAT HT > 100
Delta waves (slurred QRS upstroke) on EKG indicates?
WPW, bundle of kent
Wave (delta), PR interval (short), Wide QRS
P waves inverted or not seen with narrow QRS indicates?
AV junctional dysrhythmias
Junctional rhythm HR = __ bpm
Accelerated junctional rhythm HR = __ bpm
Junctional tachycardia HR = __ bpm
Junctional rhythm HR = 40-60 bpm
Accelerated junctional rhythm HR = 60-100 bpm
Junctional tachycardia HR > 100 bpm
Wide, bizarre QRS occurring earlier than expected with the T wave in the opposite direction of the QRS indicates?
Premature ventricular complex (PVC)
Waxing and waning QRS amplitude indicates?
Torsades de pointes- tx with IV magnesium
What is the most common etiology of ventricular tachycardia?
Underlying heart disease (ischemic most common)
Torsades de pointes is a variant of v-tach or v-fib?
V-tach
Clinical manifestations of __ include unresponsive, pulseless, or syncope
Clinical manifestations of v-fib include unresponsive, pulseless, or syncope
(erratic pattern of electrical impulses/ no P waves on EKG)
What are the classes of anti-arrhythmic agents?
I- Na channel blockers II- beta blockers III- K channel blockers IV- Ca channel blockers V- other (Digoxin) Nets play BK for the Championship
What classes of anti-arrhythmic agents are primarily used for rhythm control?
I (Na channel blockers) and III (K channel blockers)
What classes of anti-arrhythmic agents are primarily used for rate control?
II (beta blockers) and IV (Ca channel blockers)
