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Health Assessment Oral > EKG Assessment > Flashcards

EKG Assessment Flashcards

1
Q

What are the vessels that supply blood to the heart? Describe where they specifically supply to.

A

LCA → LAD and LCX

  • LAD: anterior ⅔, septum, LV, RV
  • LCX: Lateral and posterior LV

RCA: RV, posterior interventricular septum, SA and AV node branch

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2
Q

Describe the vector of depolarization.

A
  • Vector of depolarization –> QRS complex on EKG
    • Shows the heart being depolarized from in to out
      • Base to apex
      • Endocardium to epicardium
  • Myocytes go from internally negative to internally positive → produces a positive electrical current
    • Positive deflection → VoD travels TOWARD positive electrode
      • Ex: Upright waves (best Lead II for P wave)
  • Negative deflection → VoD travels AWAY positive electrode
    • Inverted waves (ex: aVR or junctional rhythms)
      • Junctional rhythms/WPW: retrograde depolarization starting from AV node (away from SA node) → see inverted P waves
  • Biphasic deflection → VoD travels perpendicular (90 deg) to positive electrode
    • Ex: V3 directly perpendicular to SA node → most biphasic lead
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3
Q

Describe the vector of repolarization and some abnormalities seen on the EKG related to that.

A
  • Heart repolarizes from apex to base (epicardium → endocardium)
  • Myocytes go from internally positive to negative → produces NEGATIVE current
    • POSITIVE deflection → wave travels AWAY from a positive electrode
    • Repolarization: Positive electrode → negative electrode = positive deflection
      • T wave should have a POSITIVE deflection (internally positive→ negative)
    • Inverted T wave: (not on aVR) (T wave should always match P wave)
      • WPW syndrome
      • Ischemia- certain area of heart not repolarizing as quickly as others or not at all
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4
Q

Describe the standard limb leads and views of the heart.

A

Standard limb leads:

  • BIPOLAR
  • Positive pole
  • Negative pole
    • Lead I: LATERAL view → LCx
      • negative electrode (R arm) → positive electrode (L arm)
      • LCx= lateral and posterior LV
    • Lead II: INFERIOR view → RCA
      • negative electrode (R arm) → positive electrode (L lower limb)
      • RCA= RV, posterior interventricular septum, SA/AV node branch
    • Lead III: INFERIOR view → RCA
      • negative electrode (L arm) → positive electrode (L lower limb)
      • RCA= RV, posterior interventricular septum, SA/AV node
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5
Q

Describe the augmented limb leads and the views associated to the heart.

A

Augmented limb leads → UNIPOLAR

  • One positive pole and a reference point in the opposite side of the heart but use same electrode placement as the standard limb leads.
  • The “negative pole” is the average distance between the two other points to create negative placement
  • Referred to as augmented bc voltage must be amplified by the EKG machine
  • a= augmented
  • V= vector
  • R/L/F= right, left, foot
    • aVR: looks upside down on EKG (AWAY from depolarization)
      • R arm electrode = positive pole
      • L arm & L leg → channeled together to form common reference point with negative charge
    • aVL: LATERAL wall
      • L arm= positive
      • R arm & L leg = common reference w/ negative charge
      • LATERAL wall → LCA: posterior and lateral view LV
    • aVF: INFERIOR view
      • L leg = positive
      • R arm & L arm = common reference w/ negative charge
      • INFERIOR= RCA: RV, posterior interventricular septum, SA/AV node branch
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6
Q

Describe the precordial leads and the heart views associated with it.

A

Precordial leads are the last six leads of the EKG that look at events in the heart on a horizontal plane. It views the heart on an anterior and lateral surface.

  • Positive poles: anterior and lateral chest
  • Negative poles: opposite side of positive pole
    • V1: positive pole placed directly on RA
      • View: SEPTAL Wall→ LAD (LV, RV)
    • V2: positive pole placed anterior to AV node
      • View: SEPTAL Wall→ LAD (LV and RV)
    • V3: “ “ over ventricular septum
      • View: ANTERIOR wall of heart → LAD (LV and RV)
    • V4: “ “ ventricular septum
      • View: ANTERIOR wall of heart → LAD (LV and RV)
    • V5 & V6: “ “ lateral surface of LV
      • View: LATERAL view of heart → LCx(posterior/lateral view of LV)
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7
Q

List the leads associated with views of the Left circumflex (LCx), LAD, and RCA

A
  • RCA: II, III, aVF
  • LCx (left cirumflex): I, aVL, V5, V6
  • LAD: V1, V2, V3, V4

Another way to say it…

  • Anterior wall: V3, V4 (LAD)
  • Septum: V1, V2 (LAD)
  • Anterior-septal: V1-V4 (LAD)
  • Inferior: II, III, aVF (RCA)
  • Lateral: I, aVL, V5, V6 (LCx)
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8
Q

Describe the 5-lead EKG system and the views associated

A
  • Most common system used in the OR
  • Takes the standard 3 lead system (R arm, L arm, L leg electrode) and adds a R leg and chest lead.
  • By adding the R leg lead→ can view any of the six limb leads
    • aVR, aVF, aVL, I, II, III
  • Chest electrode can be moved to any of the precordial V positions to obtain all six precordial views
    • Placed ANYWHERE in V1-V6 position
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9
Q

Provide steps on how to conduct an EKG Analysis: (5 steps)

A
  1. Rate
    1. (6 sec; rule 1500s; rule of 300s)
  2. Analyze rhythm
    1. (regular/irregular, P waves/QRS, ectopy, pauses, PR interval, QRS interval, QT interval)
  3. Axis deviation (*look at R wave → leads I, aVF)
    1. Left axis deviation: LEAVING each other (^ v)
      1. Lead I: positive R wave deflection
      2. aVF: negative R wave deflection
    2. Right axis deviation: REACHING each other (v ^)
      1. I: negative R wave deflection (v)
      2. aVF: positive (^)
    3. Extreme right axis deviation: both DOWNWARD (v v)
      1. I: negative R wave deflection (v)
      2. aVF: negative (v)
    4. Normal: both positive
      1. (I, aVF)
  4. Hypertrophy
    1. RVH= large R wave in V1, progressively smaller in V2-V4)
    2. (LVH= height/depth of S wave in V1 + height of R wave in V5 >35mm)
  5. Ischemia/Infarction
    1. T wave inversions, ST segments, abnormal Q waves)
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10
Q

What are some causes of Left and right axis deviation? And describe what you would see on the EKG.

A

Normal VoD from base to apex (endocardium to epicardium) when vector not directed in usual direction → axis deviation.

→ vectors tend to point toward areas of hypertrophy and away from areas of injury

Can deviate as consequence of ventricular hypertrophy, conduction block, or physical change in position of heart

  • Left axis deviation → conditions that make the left side of the heart work harder or hypertrophy
      1. Chronic HTN
      1. LBBB
      1. Aortic Stenosis
      1. Aortic Insufficiency
      1. Mitral Regurgitation
      1. LVH
      1. R sided ischemia
  • Right axis deviation → conditions that make the right side of the heart work harder or hypertrophy
      1. COPD
      1. Acute bronchospasm (acute)
      1. Cor pulmonale
      1. Pulm HTN
      1. PE (acute)

Assessing on EKG:

  • Left axis deviation: LEAVING each other (^ v)
    • Lead I: positive R wave deflection
    • aVF: negative R wave deflection
  • Right axis deviation: REACHING each other (v ^)
    • I: negative R wave deflection (v)
    • aVF: positive (^)
  • Extreme right axis deviation: both DOWNWARD (v v)
    • I: negative R wave deflection (v)
    • aVF: negative (v)
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11
Q

What are the indicators of myocardial ischemia/infarction on the EKG???

A

(peaked P waves include??)

  1. T wave inversion
  2. T wave pseudonormalization
  3. ST segment elevation > 1mm
  4. ST segment depression, flattening, downward slope > 1 mm
  5. Q wave development (old MI)
    1. Ischemia: T wave

Orrrrr … ??? (from CV assessment lecture)

  • ST segment elevation , ≥1mm
  • T wave inversion
  • Development of Q waves → myocardial necrosis
  • ST segment depression, flat or downslope of ≥1mm
  • T wave “pseudonormalization”
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12
Q

How do you assess for a RBBB or a LBBB?

A
  • RBBB:
    • Broad QRS: > 0.12 sec
    • V1- V3: RSR’ pattern
      • Rabbit ears for RBBB
    • Lateral Leads: Wide, slurred S wave (circumflex leads)
      • I, aVL, V5-V6
        • ( Doesn’t come to baseline quickly)
  • LBBB:
    • ST segments and T waves → directed opposite to main vector of QRS complex
      • Inverted (negative) QRS:
        • ST elevation
        • Upright T waves
      • Upright (positive) QRS:
        • ST depression
        • T wave inversion
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13
Q

How do you assess the heart rate in a regular 12 lead EKG?

A
  • Rule of 1500s
    • More accurate than 6 second method, can only be used on regular rhythms
    • Count the number of small blocks between the tallest point of two consecutive P waves (QRS →QRS)
      • ex: 1500/# boxes= atrial rate
      • Repeat to find the ventricular rate
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14
Q

How do you analyze a rhythm on an EKG?

A

Are R-R intervals regular?

Is the origin of rhythm sinus?

  • P waves upright before each QRS?
  • QRS after each P wave?

Ectopy?

Abnormal waves? (U wave) (Q wave?)

Pauses?

PR interval measurement (nml 0.12-0.2)

QRS interval measurement (nml < 0.12)

QT interval measurement (nml < 0.45 men, < 0.47 women)

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15
Q

What are the components of a normal EKG waveform, segments, and intervals?

A
  • P wave: represents SA node firing and atrial depolarization
    • Normal: 0.08-0.12 sec (best seen in lead II)
  • PR interval: beginning of P wave to beginning of QRS. Represents delay of electrical impulse at AV node to allow atrial contraction
    • Normal: 0.12-0.2 sec
  • QRS complex: ventricular depolarization
    • Normal: < 0.12 sec w/ progressive amplitude in V1-V6
  • Q wave: present/not present
    • Normal: < 0.04 sec
  • ST segment: follows QRS complex & connects to T wave. Represents ventricular repolarization
    • Normal: isoelectric
  • T wave: follows QRS. represents ventricular repolarization
    • Normal: follow QRS, match QRS deflection, smaller amplitude in limb leads compared to precordial
  • J point: point where QRS seg meets ST seg. Used for reference for ST elevation or depression
    • Normal: isoelectric
  • QT interval: beginning of QRS to end of T wave. Measures time it takes for ventricular depolarization → repolarization
    • Normal: men < 0.45, women < 0.47 sec
  • U wave: may follow T and usually same deflection as T wave
    • Normal: not present
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16
Q

How do you evaluate LVH on the EKG?

A
  • V1 → S wave
  • V5 → R wave
    • Depth of S + height of R = > 35 mm → LVH
17
Q

How do you evaluate RVH on the EKG?

A

V1- Large R wave

V1 → V4 progressively get smaller R waves

Health Assessment Oral (12 decks)

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