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NURA 606 Adv Health Assessment > EKG Analysis > Flashcards

EKG Analysis Flashcards

1
Q

Main vector of depolarization is from?

A

base to apex

in to out

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2
Q

What does the AV node do?

A

delays conduction for ventricular filling; initiates impulse 40-60 bpm

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3
Q

Purpose of bundle of His

A

directs impulse to left/right bundle branches

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4
Q

What do the purkinje fibers do?

A

reaches into myocardium to stimulate ventricular depolarization
initiates impulse 20-40 bpm

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5
Q

When the heart depolarizes from, the myocytes go from internally ________ to internally _________.

A

internally negative to internally positive –> produces a positive electrical current

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6
Q

Standard limb leads and characteristics

A

Lead I, II, III
bipolar; fixed positive and negative electrodes
Limb leasd record electrical activity from right to left and top to bottom

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7
Q

Placement and view of Lead I

A

Standard limb lead

goes from neg electrode on RIGHT UPPER limb to the positive electrode on LEFT UPPER limb

corresponds to a view of the lateral wall and area supplied by the CIRCUMFLEX ARTERY

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8
Q

Placement and view of Lead II

A

standard limb lead

goes from negative electrode on RIGHT UPPER limb to positive electrode on LEFT LOWER limb

corresponds to a view of the inferior wall and the areas supplied by the RIGHT CORONARY ARTERY

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9
Q

Placement and view of Lead III

A

standard limb lead

goes from negative electrode on LEFT UPPER limb to positive electrode on LEFT LOWER limb

corresponds to a view of the inferior wall and areas supplied by the RIGHT CORONARY ARTERY

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10
Q

Placement and view of aVR

A

augmented limb lead

RIGHT ARM electrode is positive; EKG will average the distance between the LEFT ARM and the LEFT LEG and that is now the new negative pole

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11
Q

placement and view of aVL

A

augmented limb lead

LEFT ARM is positive; EKG will average the distance between RIGHT ARM and LEFT LEG and that is now the new negative pole

corresponds to a view of the lateral wall and areas supplied by the CIRCUMFLEX ARTERY

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12
Q

placement and view of aVF

A

augmented limb lead

LEFT FOOT is positive; EKG will average the distance between RIGHT ARM and LEFT ARM and that is now the new negative pole

corresponds to a view of the inferior wall and areas supplied by the RIGHT CORONARY ARTERY

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13
Q

Precordial leads and characteristics

A

V1-V6

look at events in the heart on a horizontal plane

view the anterior and lateral surfaces of the heart

positive poles are on the anterior and lateral chest and the negative poles are on the opposite side of the positive pole

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14
Q

V1 placement and view

A

4th intercostal space, right sternal border

positive electrode placed directly over RA

corresponds to the SEPTAL WALL and areas supplied by LAD

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15
Q

V2 placement and view

A

4th intercostal space, left sternal border

positive electrode placed just anterior to the AV node

corresponds to the SEPTAL WALL and areas supplied by the LAD

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16
Q

V3 and V4 placement and view

A

positive electrode placed over ventricular septum

corresponds to the ANTERIOR WALL and areas supplied by LAD

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17
Q

V5 and V6 placement and view

A

positive electrode placed over LATERAL SURFACE of LEFT VENTRICLE

corresponds to the LATERAL WALL and areas supplied by the CIRCUMFLEX ARTERY

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18
Q

5 lead EKG: by adding the right leg lead, what can we view?

A

the six limb leads (standard + augmented)

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19
Q

Positive deflection on EKG occurs when vector of depolarization travels ________ positive electrode.

A

TOWARDS A

20
Q

Negative deflection on EKG occurs when vector of depolarization travels _________ a positive electrode.

A

AWAY FROM

21
Q

Biphasic deflection on the EKG occurs when vector of depolarization travels _________ a positive electrode.

A

PERPENDICULAR TO

22
Q

Main vector of repolarization is from?

A

apex to base; out to in

23
Q

What does t wave inversion tell you?

A

Myocytes are repolarizing AROUND an area of ISCHEMIA

also during reperfusion

24
Q

Criteria for RBBB

A

broad QRS: >120 ms/>.12 sec
RSR’ pattern in V1-V3 (rabbit ears)
Wide, slurred S wave in lateral leads (I, aVL, V5, V6)

25
Q

Criteria for LBBB

A

ST segments and T waves

  • -directed opposite to the main vector of the QRS complex
  • -ST elevation and upright T waves with negative QRS complex
  • -ST depression and T wave inversion with positive QRS complex
  • -QRS - top hat presentation
26
Q

To evaluate for axis deviation, examine which leads?

A

Lead I and aVF, specifically the direction of the R wave deflection

27
Q

Axis deviation: vectors tend to point ______ areas that are working hard (hypertrophy) and _______ areas of injury (ischemia).

A

vectors point TOWARDS areas of hypertrophy

vectors point AWAY FROM from areas of ischemia.

28
Q

Normal axis has a ______ R wave in both lead I and aVF.

A

positive R wave deflections in both lead I and aVF.

29
Q

Left axis deviation: ________ R wave deflection in lead I and _______ R wave deflection in aVF.

A

POSITIVE R wave deflection in lead I; NEGATIVE R wave deflection in aVF.

LEAVING each other = LEFT axis deviation

30
Q

Right axis deviation: ________ R wave deflection in lead I and _______ R wave deflection in aVF

A

NEGATIVE R wave deflection in lead I; POSITIVE R wave deflection in aVF.

REACHING for each other = RIGHT axis deviation

31
Q

EXTREME right axis deviation: ________ R wave deflections in both lead I and aVF.

A

NEGATIVE R wave deflections in both lead I and aVF.

“thumbs down all the way around.

32
Q

Causes of right axis deviation

A

CONDITIONS THAT MAKE THE RIGHT SIDE OF THE HEART WORK HARDER OR HYPERTROPHY

  • COPD
  • acute bronchospasm
  • cor pulmonale
  • pulmonary HTN
  • pulmonary embolism
33
Q

Causes of right axis deviation

A

CONDITIONS THAT MAKE THE RIGHT SIDE OF THE HEART WORK HARDER OR HYPERTROPHY

  • COPD
  • acute bronchospasm
  • cor pulmonale
  • pulmonary HTN
  • pulmonary embolism
  • mitral stenois
34
Q

Normal R wave progression

A

looking at precordial leads: V1 - V6

“R wave progression”
smallest R wave in V1 and gets progressively larger until V4/V5

35
Q

Evaluating RIGHT ventricular hypertrophy

A

large R wave in V1 and gets progressively smaller in V2, V3, V4

36
Q

Evaluating LEFT ventricular hypertrophy

A

LARGE S wave in V1 and LARGER R wave in V5

–depth (in mm) of S in V1, plus the height of R in V5 if > 35 mm = LVH

37
Q

LEFT axis deviation, but NO left ventricular hypertrophy = ?

A

ACUTE PROCESS!

38
Q

LEFT axis deviation, but NO left ventricular hypertrophy = ??

A

ACUTE PROCESS!

39
Q

T wave inversion or ST segment depression: EKG presentation + tx

A

ischemia

inc supply, dec demand – inc DBP, dec HR

40
Q

ST segment elevation ( >1 mm): EKG presentation + tx

A

injury

inc supply, dec demand – inc DBP, dec HR

41
Q

Infarction (old MI): EKG presentation

A

cellular death

Q waves are > 1 small box or 1/3 size of QRS

42
Q

septal ischemia seen in which leads + associated coronary artery

A

V1 - V2, anterior descending artery

43
Q

anterior ischemia seen in which leads + associated coronary artery

A

V3 - V4, anterior descending artery

44
Q

anterior - septal ischemia seen in which leads + associated coronary artery

A

V1 - V4, anterior descending artery

45
Q

inferior ischemia seen in which leads + associated coronary artery

A

II, III, aVF, right coronary artery/posterior interventricular branch

46
Q

lateral ischemia seen in which leads + associated coronary artery

A

I, aVL, V5, V6, circumflex artery

NURA 606 Adv Health Assessment (9 decks)

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