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Foundations of Anesthesia 1 > EKG Fundamentals > Flashcards

EKG Fundamentals Flashcards

1
Q

Electrical alternans is an electrocardiographic phenomenon in which the ______ varies between heart beats.

A

QRS amplitude

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2
Q

Normal PR interval

A

less than 0.2s (200ms)

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3
Q

Normal QRS

A

Less than 0.12s (120ms)
3 small boxes

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4
Q

Normal QT interval for men and women

A

men: less than 0.43s (430ms)
women: less than 0.46 (460ms)

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5
Q

1 large box is how many mm

A

5mm

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6
Q

1 small box is how many mm and seconds

A

1mm, 0.04seconds

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7
Q

1 small box is how tall, how many mV

A

1mm, 0.1mV

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8
Q

Prolonged QT increased risk of?

A

polymorphic tachycardia

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9
Q

Upward deflection occurs when the flow does what?

A
  1. Depolarization - the flow of positive charges Approaches the positive electrode
  2. Repolarization - the flow of negative charge Approaches the negative electrode
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10
Q

Downward deflection occurs when the flow does what?

A

the flow of positive charge Moves Away from the positive electrode

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11
Q

Which electrode is considered the eye? Moving away or towards the eye produces what deflection?

A

Positive Electrode
Moving towards the eye, positive deflection
Moving away from the eye, negative deflection

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12
Q

Describe the position of Lead II and flow movement

A

RA –> LL
RA: Negative Electrode
LL: Positive Electrode

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13
Q

Describe the position of Lead I and flow movement.

A

RA –> LA
RA: Negative Electrode
LA: Positive Electrode

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14
Q

Describe the position of Lead III and flow movement.

A

LA –> LL
LA: Negative Electrode
LL: Positive Electrode

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15
Q

What is the most common lead used in a rhythm strip of the 12-lead EKG

A

Lead II

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16
Q

Atrial depolarization is what waveform

A

P wave

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17
Q

AV node depolarization is what waveform

A

PR segment. No net movement of charge.

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18
Q

What are the two roles of the AV node

A
  1. Slow conduction of SA node impulses - holds charge 0.1s (100ms)
  2. Intrinsic rate of 40-60 beats for second
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19
Q

Q wave is indicative of?

A

Septal depolarization

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20
Q

What portion of the electrical conduction system depolarizes the interventricular septum

A

Left Bundle

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21
Q

Depolarization of the apex of the ventricles is what waveform?

A

R wave

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22
Q

Depolarization of the base of the ventricles is what waveform?

A

S wave

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23
Q

What occurs during the ST segment in the conduction system?

A

Ventricles are “stuck” in a depolarized state - no movement of electrical charge.

24
Q

What waveform is the repolarization of the ventricles?

A

T wave

25
Q

Lead I “looks” at what portion of the heart?

A

High Lateral Wall of LV

26
Q

Lead II and Lead III “look” at what portion of the heart?

A

Inferior Wall

27
Q

The inferior portion of the heart is supplied by?

A

RCA

28
Q

Leads V1 and V2 “look” at what portion of the heart? What artery supplies that portion?

A

Superior Septum
LAD

29
Q

Leads I, aVL, V5, and V6 “look” at what portion of the heart? What artery supplies that portion?

A

Lateral Wall
(I and aVL = high lateral. V5 and V6 = low lateral)
Circumflex Artery

30
Q

When assessing a three-lead ECG, you know that lead III is characterized by?

A

A neutral lead on the right arm

31
Q

At standard recording speed, how many millimeters of ECG paper represents one second of time?

A

25mm (25 small boxes)
5 big boxes

32
Q

Name two ECG changes associated with hyperkalemia.

A

peaked T waves
widened QRS

33
Q

Name two ECG changes associated with hypokalemia.

A

Flattened T waves
Prominent U waves

34
Q

During your patient interview in the preoperative area, you noticed that the patient’s chart indicates a diagnosis of right atrial hypertrophy. In lead II of the ECG, which characteristic is consistent with right atrial hypertrophy?

A

Enlarged P wave

35
Q

Sinoatrial node depolarization is transmitted from the right atrium to the left atrium via

A

Bachmann’s bundle

36
Q

The ST segment is measured from the ___ of the QRS complex to the ___ of the T wave.

A

end, beginning

37
Q

Which of the following electrocardiographic leads would be best for monitoring for the transmural injury that could occur during angioplasty procedures?

A. Lead I
B. aVF
C. V3
D. V1

A

C. V3

38
Q

Select two common standard leads to analyze or monitor the ST segment.

A. Lead I
B. Lead II
C. V1
D. V5
A

B and D

39
Q

Which of the following 12-lead electrocardiographic changes would be most consistent with subendocardial injury?

A. ST depression in lead II
B. ST elevation in lead II
C. Shortened PR interval in lead I
D. ST elevation in lead I

A

A

40
Q

What are the two types of cells within the myocardium?

A

Nodal Cells (electrical conduction)
Contractile Cells (heart muscle)

41
Q

Intrinsic heart rates from SA node, AV node, and Bundle of His

A

SA: 60-100
AV: 40-60
BoH: 20-40

42
Q

In which precordial lead is the R wave usually smallest?

A

V1

43
Q

In which precordial lead is it normal to have a narrow QS or rSR’ ekg pattern?

A

V1

44
Q

In normal healthy people, the transition zone, where R and S waves have the same voltage, occurs in which precordial leads?

A

Commonly V3 and V4,
A normal variant is to have an early transition in V2 or delayed in V5

45
Q

In which precordial lead is the R wave usually tallest?

A

V5
V6 is usually blocked a little by the left lung

46
Q

q wave reflects depolarization of?

A

Septum - may not always show up on ECG tracing.

47
Q

Poor R wave progression can indicate?

A
  • Normal Variant
    -Cardiac Rotation in the chest, possibly due to lung disease or cardiac enlargement
48
Q

Which 2 leads do you want to examine when look at the P wave, specifically

A

Lead II (atrial axis)
V1 - across the atria

49
Q

A prolonged or broadened P wave longer than 0.11s could indicate?

A

interatrial conduction delay
Sick Sinus Syndrome
Dual Chamber PM

50
Q

What is a Sinoatrial Block? How many kinds are there?

A

The sinus node continues to fire at regular intervals, but some impulses cannot exit from the sinus node or are considerably delayed.

4 types

51
Q

What is the classic ekg sign of a wandering pacemaker

A

Three different morphologically different P-waves
usually less than 100bpm and exclude PAC

52
Q

Should you be alarmed if you identify a Wandering Pacemaker ekg tracing?

A

No - usually benign, often occurs in young people of athletes because of augmented vagal tone

53
Q

When assessing for a junctional rhythm, which leads should you look at?

A

Leads II, III, and aVF because p waves should be upright. (Only negative if the impulse is coming below atria)

54
Q

How do you determine if primary pacemaker has shifted to the AV node/junction?

A

Inverted retrograde p waves in the inferior leads and narrow QRS. (p-wave could be absent if no retrograde conduction is occurring)

Rate - 40-60

55
Q

What is the only difference between VTach and Accelerated Idioventricular Rhythm (AIVR)

A

The rate. AIVR is a rate around or greater than 40.

VT is a rate greater than 100.

Both are originating in the ventricles

Foundations of Anesthesia 1 (29 decks)

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