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Physiology > EKG continued (B 2: W 1) > Flashcards

EKG continued (B 2: W 1) Flashcards

1
Q

What does this ECG show?

A

ST elevation MI (inferior)

  • See ST elevation in inferior leads
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2
Q

What does this ECG show?

A

Atrial fibrillation, with PVCs

  • Irregular rhythm
  • No defined P wave
  • Large, ugly QRS waves
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2
Q

What does this ECG show?

A

Regularly irregular rhythm

  • P wave: present on the first, then absent on the next because it happens so quickly
    • PAC - premature atrial complex
  • PR interval is normal
  • QRS is normal
  • QT is normal
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2
Q

What is a 3rd degree AV block?

A

Complete block in the AV node

Atrial and ventricular rhythms are completely independent

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3
Q

What is a premature atrial complex?

A
  • P wave present, looks different than sinus beats
  • Comes in early
  • QRS complex no different from baseline
  • Bigeminy, trigeminy, couplets, triplets, etc.
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3
Q

What does this ECG show?

A

Wenkebach - Second degree AV block, type 1

  • Progressive elongation of PR
  • PR after dropped beat is shorter than PR before
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4
Q

What is a normal QRS interal?

A

Less than 3 small squares

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4
Q

What is junctional rhythm?

A
  • Impulses originiate at AV node with retrograde and antegrade direction
    • P wave is often inverted, may be under or after QRS
  • HR is slow
  • Can cause bradycardia or tachycardia
  • Narrow QRS suggests “high” junction: stable
  • Wide QRS suggests “low” junction: unstable
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5
Q
A
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6
Q

What does this ECG show?

A

Complete heart block

3rd degree AV block

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7
Q

How do you determine the axis of the heart from the EKG?

A

Leads I and II:

Both positive: normal axis

-I and +II: Rightward axis

+I and -II: Leftward axis

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8
Q

What does this ECG show?

A

Paced rhythm

  • Long QRS
  • Small spike form the P wave means that there is a pacemaker
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9
Q

What does this ECG show?

A

Right bundle branch block

  • Long QRS
  • V1 and V2 have a positive deflection
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10
Q

What does this ECG show?

A

Junctional escape

  • No P wave - no SA nodal activity
  • Some sinus rhythm
  • QRS is wide
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12
Q

What is the placement of the limb leads, and what is their charge?

A

Right arm: negative

Left arm: positive/negative

Left foot: positive

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13
Q

What are some indications that a person should get an EKG?

A
  • Chest pain
  • Shortness of breath
  • Dizziness, syncope
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13
Q

What is a 1st degree AV block?

A
  • PR interval is >200 m sec
  • 1:1 conduction is maintained
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14
Q

What is indicated by ST elevation?

A

Elevation = infarction

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15
Q

Which leads are considered the vertical leads?

A

I, II, III, aVR, aVL, aVF

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16
Q

Which are considered the horizontal leads?

A

V1 - V6

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17
Q

How is a premature ventricular complex (PVC) recognized?

A
  • Wide random, “ugly” QRS
  • Usually come in “early”
  • Can be unifocal (all look the same), or multifocal
  • Can be multiple
    • Couplet
    • Triplet
    • Non-sustained ventricular tachycardia
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18
Q

What is an ectopic atrial rhythm?

A
  • P wave present
  • Focus of atrial activity is not the sinus node
  • Can occur in R or L atria
  • Negative P waves in inferior leads
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18
Q

What is a type 1, 2nd degree AV block (Wenckebach)?

A
  • Progressive prolongation of the PR interval
  • Eventually, there is a transient block of AV conduction resulting in a dropped beat
  • PR interval before the dropped beat is longer than PR interval after
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19
Q

What does this ECG show?

A

Lots of PVCs: non sustained ventricular tachycardia

  • We have P waves
  • HR is normal
  • Normal axis
  • PR interval is a little long
  • QRS is normal
  • We want to see Q in 2 inferior leads - II has it
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20
Q

What does this ECG show?

A

Prior anteroseptal infarct

  • Large Q waves in anterior and septal leads
21
Q

What does this ECG show?

A

Prior Inferior infact

  • Inferior leads have Q wave
  • Wide, large
23
Q

What would be considered a pathologic Q wave?

A

40 m sec wide

1/3 the height of the QRS

24
Q

What does this ECG show?

A

Left bundle branch block

  • Long QRS
  • Compare V1/V2 and V5/V6
    • V5 and V6 have a positive deflection
25
Q

What drugs can be used to terminate supraventricular tachycardia?

A

Drugs that affect the AV node - adenosine

26
Q

Which leads are considered to be septal? Lateral?

A

Septal: V1, V2

Lateral: V5, V6

28
Q

What is the plane of the chest leads? Are they positive or negative?

A

Horizontal plane, positive leads

28
Q

What is supraventricular tachycardia?

A
  • Regular tachycardia
  • Narrow QRS complex (assuming normal underlying conduction system)
  • Typcially at a rate of 150 bpm
  • Re-entrant tachycardia involving the AV node
30
Q

What is a normal QT interval?

A

Less than 3 large squares

31
Q

What is indicated by ST despression?

A

Depression = Ischemia

32
Q

What are the intervals of bpm for large squares?

A

1: 300 bpm
2: 150 bpm
3: 100 bpm
4: 75 bpm
5: 60 bpm
6: 50 bpm

32
Q

What does a pathological Q wave indicate?

A

Prior myocardial infarction

  • Should be in at least two sonsecutive anatomic leads
  • Should be 40 m sec wide
  • Should be about 1/4 to 1/3 of the total QRS voltage
  • Q waves are normal in III and V1
33
Q

What does this ECG show?

A

Supraventricular Tachycardia

  • Narrow QRS
  • Rate of 150 bpm
  • Hard to find p wave
34
Q

How would you explain bigeminy and trigeminy PVCs?

A

Bigeminy: every other beat is PVC

Tirgeminy: every 3rd beat is PVC

35
Q

What does this ECG show?

A

ST elevation MI (anterolateral)

  • See ST elevation in anterolateral and anteroseptal leads
36
Q

What is indicative of a normal sinus rhythm?

A
  • P waves present
    • P waves positive in the inferior leads
  • P:R should be 1:1
  • Regular rhythm
    • R to R intervals should be the same
36
Q

What does this ECG show?

A

Junctional rhythm

  • Slow HR
  • P wave after QRS
37
Q

What does this ECG show?

A

Atrial fibrillation

  • Irregular rhythm strip
    • Irregular rhythm
  • No defined P wave
38
Q

Which are considered the inferior leads?

A

II, III, aVF

39
Q

What is a type 2, 2nd degree AV block?

A

Random, intermittent block i the AV node, resulting in a dropped beat

40
Q

What does this ECG show?

A

Right bundle branch block

  • Wide QRS
  • Positive deflection in R leads V1 and V2
42
Q

What does this ECG show?

A

Atrial flutter (variable)

  • HR is variable
  • QRS is normal
  • No T wave to measure
43
Q
A
44
Q

What does this ECG show?

A

Atrial fibrillation with ischemia

  • Irregular, fast rhythm
  • No P wave
  • PVCs
  • ST depression (ischemia)
46
Q

What does this ECG show?

A

Ectopic atrial rhythm

  • P wave: yes
    • Positive in I
    • Negative in inferior leads (II, III, aVF)
  • HR: 120
    • Atrial tachycardia
  • PR is short - conduction is fast
  • QRS is fast
  • QT short
47
Q

What is atrial flutter?

A
  • Saw tooth P waves
    • Usually at a rate of 300
  • Variable conduction
    • 2:1, 3:1, etc
  • Macro-reentrant tachycardia, amenable to ablation
48
Q

What is a normal PR interval?

A

Less than one large square

49
Q

What is atrial fibrillation?

A
  • Irregularly irregular rhythm
    • R to R intervals vary without any pattern
  • No P waves
    • Atrial HR can run 400-500
  • Tends to have a rapid ventricular response
51
Q

What does this ECG show?

A

Sinus Tachycardia

  • There is a P wave, but it is fast
  • HR is high - 150
  • ST is slightly depressed
51
Q

What is pathological about a long QRS interval?

A
  • Should be less than 120 m sec (3 small squares)
  • For QRS that is greater than 120 m sec
    • L bundle branch block: terminal forces positive in V5 and V6
    • R bundle branch block: terminal forces positive in V1 and V2
    • Paced ventricular rhythms
    • Indeterminate IVCD
52
Q

What does this ECG show?

A

2nd Degree AV block, Type 2

  • Random occurance
  • Right bundle block
    • QRS long in V1
    • Also positive
54
Q

What is ventricular tachycardia?

A
  • Wide complex, fast
56
Q

How is ventricular tachycardia treated?

A

If it is stable, initial treatment is medical

If it is unstable, fatal rhythm is treated emergently with cardioversion

58
Q

What does this ECG show?

A

3rd degree (complete) heart block

  • P waves: yes, but some irregular
  • P waves don’t relate to QRS complex
  • Junctional escape
59
Q

What is the time indicated by 1 small square, 1 large square, and 5 large squares?

A

1 small square = 0.04 sec (40 m sec)

1 large square = 0.2 sec (200 m sec)

5 large squares = 1 sec (1000 m sec)

60
Q

What does this ECG show?

A

Left bundle branch bock

  • Wide QRS
  • No pacing spikes
  • Left side of leads have positive deflection
61
Q

What does this ECG show?

A

Ventricular tachycardia

  • Wide, fast QRS complexes
62
Q

What is the significance of a prolonged QT interval?

A
  • Long QT associated with ventricular dysrhythimias and sudden death
  • Can be congenital or acquired (medications)
  • Normally it is approximately 450 m sec
  • QT should be less than half of the R to R interval

Physiology (29 decks)

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