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Diagnostic Interpretation PA 545: Cardiac > EKG Exam > Flashcards

EKG Exam Flashcards

1
Q

EKG graph

A
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2
Q

EKG graph

A
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3
Q

QRS configurations

A
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4
Q

PR interval

A
  • time from start of atrial depolarization to start of ventricular depolarization
  • .12-.2sec
  • isoelectric
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5
Q

ST segment

*J point

A

end of ventricular depolarization and initiation of ventricular repolarization

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6
Q

QT interval

A

time taken for ventricular depolarization and repolarization

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7
Q

P wave

A
  • atrial depolarization
  • less than .12 sec
  • 3 small boxes
  • amp is less than 2.5 mm in limb leads
  • amp is less than 1.5 mm in precordial leads
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8
Q

Left Ventricular Hypertrophy

A
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9
Q

LVH in AVL

A
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10
Q

5 basic types of arrhythmias

A
  • Arrhythmias of sinus origin—originate in the SA node, but the rate is too fast, too slow, or irregular
  • Ectopic rhythms—originating in a focus other than the SA node
  • Re-entrant arrhythmias—an electrical impulse trapped and recirculating somewhere in the heart
  • Conduction blocks—a normally originating impulse following a normal track that encounters unexpected delays or blocks
  • Pre-excitation syndromes—an impulse following an abnormal or aberrant pathway through the heart, i.e., a shortcut
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11
Q

Arrhythmias of sinus origin

A
  • Sinus tachycardia (fast rate)—above 100 beats per minute
  • Sinus bradycardia (slow rate)—below 60 beats per minute
  • Sinus arrhythmia – slightly irregular sinus rhythm in which the variation in heart rate accompanies respiration
    • The heart rate accelerates with inspiration and slows with expiration
  • Sinus arrest, Asystole, and Escape beats
    • In Sinus Arrest, the SA node does not fire normally and so there is a pause between complexes
    • If nothing else happens, the EKG would just be a flat line without any electrical activity—prolonged electrical inactivity is called Asystole
    • Thankfully, other natural cardiac pacemakers may take over in sinus arrest and spontaneously depolarize, generating a rescue or “escape beat”
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12
Q

Sinus tachycardia

A
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13
Q

Sinus bradycardia

A
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14
Q

Respiratory Sinus Arrhythmias

A
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15
Q

Sinus pause, arrest, escape beat

A
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16
Q

Ectopic or Nonsinus Pacemakers

A

¤Atrial pacemakers (other than the SA node, i.e., the P-Wave looks different from a P-wave originating in the SA node)

  • AV Nodal or Junctional pacemakers ( usually no P Wave at all- may see a retrograde P wave-, and normal QRS complex)
  • Ventricular pacemakers (wide, bizarre QRS complexes)
  • Atrial—60-75 beats per minute
  • Junctional—40-60 beats per minute
  • Ventricular—30-45 beats per minute, generally less than 40
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17
Q

Supraventricular Arrhythmias

A
  • Paroxysmal supraventricular tachycardia (PSVT)
  • Atrial Flutter (Flutter)
  • Atrial Fibrillation (AF or A Fib)
  • Multifocal Atrial Tachycardia (MAT)
  • Paroxysmal Atrial Tachycardia (PAT)
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18
Q

Paroxysmal supraventricular tachycardia (PSVT)

A
19
Q

Atrial Fibrillation (AF or A Fib)

A
20
Q

Atrial Flutter (Flutter)

A
21
Q

Multifocal Atrial Tachycardia (MAT)

A
22
Q

Wandering Atrial Pacemaker

A
23
Q

Paroxysmal Atrial Tachycardia (PAT)

A
24
Q

Ventricular Arrhythmias

A

*rhythm disturbances arising below the AV node*

  • Premature Ventricular Contractions (PVCs)
  • Ventricular Tachycardia (VT or V tach)
  • Ventricular Fibrillation (V fib)
  • Accelerated Idioventricular Rhythm
  • Torsade de Points (a unique form of VT)
25
Q

Premature Ventricular Contractions (PVCs)

A
26
Q

Ventricular Tachycardia (VT or V tach)

A
27
Q

Ventricular Fibrillation (V fib)

A
28
Q

Accelerated Idioventricular Rhythm

A
29
Q

Torsade de Points (a unique form of VT)

A
30
Q

Supraventricular vs. Ventricular Arrhythmias

A
  • The main distinction between supraventricular and ventricular arrhythmias is simply that:
    • Supraventricular arrhythmias have a narrow QRS complex
    • Ventricular arrhythmias have a wide QRS complex
    • You can see a wide complex which is preceded by a P Wave which comes from above the ventricles but it must be conducted aberrantly (and it will usually come with a pulse) due to a block in the conduction system - this is known as “SVT with aberrancy”
31
Q

Conduction Blocks

A

¤Any obstruction or delay in the flow of the electrical current through the normal conduction pathways of the heart is considered a Conduction Block, i.e., a blockage in time.

  • A conduction block can occur anywhere in the system but typically appears in one of three areas:
    • Sinus Node Block—it appears as a delay or pause in the cardiac cycle
    • Atrio-ventricular Block—a block anywhere between the SA node and the Purkinje fibers, including the AV node and Bundle of His
    • Bundle Branch Block—a block in part or all of the ventricular bundle branches
32
Q

1st degree AV block

A
33
Q

2nd degree AV block (Mobitz 1/Wenckebach)

A
34
Q

2nd degree AV block (Mobitz 2)

A
35
Q

Mobitz 1 vs. Mobitz 2

A
36
Q

3rd degree AV block

A
37
Q

RBBB

A
38
Q

LBBB

A
39
Q

Hemiblocks

A
  • When we talk about hemiblocks, we are talking about the left bundle only and either anterior or posterior fascicle pathology
  • Hemiblocks cause axis deviation
    • A Left Anterior Hemiblock causes a left axis deviation (Lead 1 is positive and aVF is negative) and it is more common of the two types of blocks
    • A Left Posterior Hemiblock causes a right axis deviation (Lead 1 is negative and aVF is positive)
  • Hemiblocks do not prolong the QRS complex
  • Hemiblocks do not cause any ST segment or T Wave changes
  • These axis deviations are NOT due to ventricular hypertrophy
40
Q

Left Anterior Hemiblock

A
41
Q

Left Posterior Hemiblock

A
42
Q

Preexcitation Syndromes

A
  • There are two major pre-excitation syndromes:
    • Wolff-Parkinson-White (WPW) syndrome
    • Lown-Ganong-Levine (LGL) syndrome
  • These two conditions are actually the opposite of cardiac blocks, that is the electrical current is conducted to the ventricles more rapidly than usual
  • In order for pre-excitation syndromes to exist there must first be accessory pathways in the patient (i.e., congenital abnormalities)
  • Less than 1% of individuals possess accessory pathways; males predominate. The accessory pathway may be an isolated finding, or occasionally noted in patients with mitral valve prolapse, hypertrophic cardiomyopathies, and other congenital disorders
43
Q

Wolff-Parkinson-White (WPW) syndrome

A
44
Q

Lown-Ganong-Levine (LGL) syndrome

A

Diagnostic Interpretation PA 545: Cardiac (7 decks)

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