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ECG > EKG basics > Flashcards

EKG basics Flashcards

1
Q

each small square

A
  1. 04 sec duration

0. 1 mV amp

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2
Q

5 small squares

A

make 1 large box

  1. 2 sec duration
  2. 5 mV amp
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3
Q

P wave meaning and duration

A

initiation of impulse in SA node, depolarization of RA and LA, impulse passing through AV junction

Duration: 0.06 to 0.10 seconds
amplitude 0.5-2.5

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4
Q

PR interval

A

from start of P wave to start of QRS complex
denotes depolarization of heart from SA node through atria, AV node and His-Purkinje system
duration: 0.12-0.2 sec

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5
Q

PR segment

A

isoelectric line bw end of P wave and start of QRS complex

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6
Q

QRS complex

A

normal duration: 0.06 - 0.11 sec

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7
Q

ST seg

A

isoelectric line following QRS to beginning to T wave

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8
Q

T wave

A

ventricular repolarization; slightly asymmetrical

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9
Q

J point

A

where QRS complex meets ST segment

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10
Q

QT interval

A

onset QRS to end of T wave
measures time of ventricular depolarization and repolarization
Normal duration 0.36-0.44 sec
varies depending on HR (slower HR, longer QT)

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11
Q

Bipolar leads (*note: all move - to +)

A

Lead I: RA to LA
Lead II: RA to LL
Lead III: LA to LL
*bipolar bc record difference bw positive and negative electrode; use 3rd electrode called ground

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12
Q

Unipolar leads

A

*use 1 + electrode and reference point (center of heart); waveforms enhanced by machine bc small
*augmented limb leads: aVR, aVL, aVF
aVR: augmented vector right
aVL: augmented vector left
aVF: augmented vector foot
*precordial leads (“chest” or V leads)
V1-6 horizontal plane, all +; V4-6 on same plane

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13
Q

specifics of augmented leads

A

aVR: RA + views base of heart -atria and great vessels
aVL: LA + views lateral wall of left ventricle
aVF: LL + views inferior wall of left ventricle

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14
Q

Precordial leads

A

provide anterior and lateral views of heart

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15
Q

Leads that view anterior surface of heart

A

V1-4

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16
Q

Leads that view lateral surface

A

Lead I, aVL, V5-6

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17
Q

Leads that view inferior surface of heart

A

Lead II, III; aVF

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18
Q

5 step process for analyzing ECG

A

Rate, regularity/rhythm, P waves, QRS complex, PR interval

19
Q

Normal sinus rhythm

A

rate: 60-100
rhythm: regular
P wave: upright and round, 1:1 ratio with QRS
QRS: narrow, 0.06-0.11 sec duration
PR interval: 0.12-0.2 sec
T wave: upright and slightly asymmetrical

20
Q

methods for calculating HR

A
  1. # QRS complexes in 6 sec interval x10 (fast and easy but not as accurate) *15 large boxes in 3 sec
  2. R to R wave 300, 150, 100, 75, 60, 50 method (quick, decent accuracy, can’t use with irregular rhythms)
  3. 1500/# small sq bw two consecutive R waves (most accurate)
  4. Rate calculator: R to R wave (easy but not always available, doesn’t work for irregular rhythms)
21
Q

Methods for determining rhythm

A
  1. Caliper
  2. Paper and Pen
  3. Counting small squares
22
Q

Types of Irregular rhythms

A
  1. occasional or very
  2. slightly: “wandering atrial pacemaker” HB initiated from different sites in atria changing appearance of P waves
  3. sudden acceleration in HR: paroxysmal tachycardia (ectopic site from above ventricles fires rapidly taking over as pacemaker)
  4. Patterned/cyclical: ex = sinus dysrhythmia, 2nd deg AV block, type I
  5. Totally: no pattern i.e. a fibrillation
  6. Variable conduction ratio: not all impulses conducted through AV node –> more P waves than QRS i.e. a flutter
23
Q

Tall peaked sinus P waves

A

may indicated increased RA pressure and RA dilation

> 2.5 amp = RAE, p pulmonale

24
Q

notched, wide, or biphasic sinus P waves

A

seen in LA presure and LA dilation

width > 0.10 sec suggests LAE, p mitrale

25
Q

Premature atrial complex

A

P wave of early beat differs in appearance from underlying rhythm; continuously change in appearance

26
Q

Peaked, notched or larger than normal T waves

A

happens in rapid rates such as atrial tachycardia, P wave likely buried in T wave due to short P-P interval

27
Q

Flutter waves

A

seen instead of normal P waves when atria fire rapidly from one site 250-350 BPM - more P than QRS
“saw toothed” pattern
“F” waves or Flutter

28
Q

Fibrillatory “f” waves

A

absence of discernable P waves and chaotic looking baseline due to atria firing >350 bpm
*only some atrial impulses conducted through AV node

29
Q

Inverted P waves

A

when P wave arises from lower RA near AV node, in LA or in AV junction –> retrograde depolarization of atria

  • may immediately precede, occur during or follow QRS complex
  • associated with dysrhythmias that originate from AV junction
30
Q

More P than QRS

A

indicates impulse initiated in SA node or atria but was blocked and didn’t reach ventricles

31
Q

QRS configurations

A
  • can be more than one R and/or S but just one Q

* second is R’ or S’.. if small it is r or s

32
Q

QRS complex should appear normal if

A
  • Rhythm initiated from site above ventricles
  • Normal conduction from Bundle of His –> r and L bundle branches –> purkinje
  • Normal depolarization of ventricles has occurred
33
Q

Production and pacemaker sites for abnormal QRS complexes

A

due to abnormal depolarization of ventricles
*pacemaker site can be: SA node, ectopic pacemaker in the atria, AV junction, bundle branches, Purkinje network, or ventricular myocardium

34
Q

Various possible causes of abnormal QRS complexes

A
  • ventricular hypertrophy
  • intraventricular conduction disturbance
  • aberrant ventricular conduction
  • ventricular pre-excitation
  • ventricular ectopic or escape pacemaker
  • ventricular pacing by cardiac pacemaker
35
Q

Tall QRS complexes

A

usually caused by:

  • hypertrophy of one or both ventricles
  • abnormal pacemaker
  • aberrantly conducted beat
36
Q

Low voltage QRS complexes

A

seen in: obese pt, hypothyroid pt, pericardial effusion

37
Q

wide bizarre QRS complexes (supraventricular origin)

A

result form intraventricular conduction defect; usually R or L bundle branch block

38
Q

Aberrant Conduction

A

when electrical impulses reach bundle branch while still in refractory after conducting previous electrical impulse –> causes impulse to travel down unaffected bundle branch first followed by stimulation of other bundle branch

39
Q

Abnormal PR interval classifications

A
  1. shorter than 0.12 sec
  2. longer than .2 sec
  3. absent
  4. vary
40
Q

when do shorter PR intervals occur

A

when impulse originates in atria close to AV junction or in AV junction
*can occur when impulse arises from supraventricular site but travels through abnormal accessory pathways (ie bundle of kent) to ventricles –> premature ventricular depolarization called pre-excitation, delta waves

41
Q

Longer PR intervals

A

occur when delay in impulse conduction through AV node (ex: 1st deg AV block)

42
Q

when do varying PR intervals occur

A

In wandering atrial pacemaker, pacemaker site moves from beat to beat causing P waves to appear different and PR intervals to vary

43
Q

common cause of varying PR intervals

A

2nd deg AV block, Type I: has PR intervals that are progressively longer until QRS complex is dropped and cycle repeats

44
Q

when do absent PR intervals occur?

A
  1. a flutter
  2. a fib
  3. ventricular dysrhythmias
  4. 3rd deg AV heart block (PR interval not measurable, atria and ventricles beating independently of each other)

ECG (3 decks)

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