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CV II > EKG Interpretation Unrein Lecture > Flashcards

EKG Interpretation Unrein Lecture Flashcards

1
Q

The Basics •Every time

A

–Rate –Rhythm –Axis –Hypertrophy –Infarction –Wave interval and segment abnormalities

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2
Q

Tracings •Waves -Summation Vectors

A

–P, Q, R, S, T, U

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3
Q

Tracings •Segments

A

–ST

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4
Q

Tracings •Intervals

A
  • PR - QRS - QT
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5
Q

PR interval

A

less than 0.2 seconds (one big –five little boxes)

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6
Q

QRS interval

A

less than 0.12 seconds (three little boxes)

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7
Q

QT interval

A

0.44 seconds Bazett’s formula

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8
Q

Rate

A

–300, 150, 100, 75, 60, 50 –Six second strip -Multiply by 10 –Normal, Bradycardia, Tachycardia

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9
Q

QRS Sequence of Ventricular Depolarization

A

Depolarization starts at the ventricular septum (Q wave) and the endocardial surfaces. Average current flows from the base of the heart to the apex (R wave). At the end of depolarization, the current reverses, flows toward the outer walls of the ventricles near the base (S wave).

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10
Q

Atrial Rhythm simplified

A

•Up right P waves, narrow QRS

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11
Q

Junctional Rhythm simplified

A

•Absent or inverted P waves, narrow QRS

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12
Q

Ventricular Rhythm simplified

A

•No p waves •Wide QRS complexes

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13
Q

Repetitive Sequence Rhythm simplified

A

•Bigeminal, Trigeminal, Quadrigeminal –A series-pattern of ectopic depolarizations, either atrial or ventricular in origin

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14
Q

Physiology that affects Rhythm

A

–Sympathetic •adrenergic –Parasympathetic •Cholinergic –Depolarization/repolarization •Automaticity –Escape beats »Refractory periods –Premature »Irritable focus »Reentry –Injury/scaring

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15
Q

Supraventricular Rhythms

A

–Sinus/Atrial –Junctional –Wolf-Parkinson-White (WPW)

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16
Q

–Sinus/Atrial Rhythm Overview

A

•Sinus arrhythmia •Wandering pacemaker, multifocal atrial tachycardia (MAT) •Paroxysmal atrial tachycardia (PAT) •Artial flutter –Singular atrial focus–reentry mechanism •Artial fib –Lack of any organized atrial activity

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17
Q

Junctional Rhythm Overview

A

•Paroxysmal junctional tachycardia (PJT) •AV nodal reentry

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18
Q

Wolf-Parkinson-White (WPW) Rhythm overview

A

•Accessory conduction pathway (bundle of Kent) •Delta waves •Often has the appearance of an IWMI, this determination must be interpreted carefully •Shortened PR interval

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19
Q

Wandering Pacemaker

A

Irregular Rhythm P’ wave shape varies atrial rate less than 100 irregular ventricular rhythm

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20
Q

Atrial Bigeminy

A

normal sinus beat followed by an abnormal beat

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21
Q

atrial flutter

A

sawtooth

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22
Q

atrial fibrillation

A

no p waves, qrs coming in at no pattern

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23
Q

Junctional Rhythm notes

A

no p waves, so not atrial origin

if qrs is truly widended and not from a supraventricular origin, the upper limit is 3 boxes

inverted p waves, conduction is retrograde from junctino up to atria

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24
Q

Wolf-Parkinson-White (WPW) notes

A

p wave runs into qrs to make delta wave

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25
First Degree AV Blocks
•Prolonged PR interval -\> 0.2 seconds
26
Second Degree AV block overview
Variable penetration of AV conductions –lone P waves without a QRS conduction following
27
Type I second degree AV block
(conduction abnormality in the AV node and heavy parasympathetic influence) –Wenckebach –Progressively prolonged PR intervals with a subsequent dropped beat and lone P wave –usually a fixed ratio/pattern –Vagal maneuvers
28
type II second degree AV block
–Mobitz –Failure of AV conduction in a fixed ratio/pattern, the PR interval is not gradually increasing in length –Widened QRS multiple p waves to each qrs?
29
Third Degree AV block
–Complete Atrial and Ventricular dissociation –both are being independently paced
30
wenckeback is a...
Regularly Irregular pattern
31
Ventricular Dysrhytmias
Wide QRS complex tachycardia greater than .12 usually less than 40 Ventricular tachycardia Torsades De Pointes Vetricullar Fibrillation
32
Ventricular Dysrhythmias Wide QRS complex tachycardia
–Supraventricular vs. ventricular
33
Ventricular Dysrhythmias Ventricular Tachycardia
–Irritable focus of a ventricular origin –usually reentry mechanism
34
Ventricular Dysrhythmias Torsades de Pointes
twisted ribbon
35
Ventricular Dysrhythmias Ventricular fibrillation
–Multiple irritable automatic foci depolarizing
36
Prolonged QT syndrome leads to?
Torsades de pointes
37
Prlonged QT syndrome can be caused by hypo-
magnesemia
38
Right Bundle Branch Block
»Left bundle conducts first »Best viewed inV1 V2
39
Left Bundle Branch Block
»Right bundle conducts first »Best viewed in V5 V6
40
Axis Vector direction and mass summation
–Limb leads –frontal plane (Determine axis) –Chest Leads –horizontal plane (Determine rotation) –0-90 degrees is normal (actually -30 to 110) –Isoelectric point •Right angle from the axis plane
41
Atrial Hypertrophy Lead V1
–Used to assess atrial enlargement –Positioned over the atria right side of the chest •Biphasic P wave – the predominate vector deflection determines the hypertrophy –positive right atrial hypertrophy –negative left atrial hypertrophy
42
Atrial Hypertrophy Leads II, III, aVF (heart lays on its side)
–amplitude is increased to greater than 2.5 mm in leads II, III, aVF is also indicative of right atrial hypertrophy (also referred to as p-pulmonale)
43
Ventricular Hypertrophy Overview
•Can be determined electrically with caution in the presence of a Bundle Branch Block •Electrical size –Chamber size increase – dilation –Increased muscle mass
44
Ventricular Hypetrophy V1
–positioned over the atria right side of the chest –Used to assess atrial enlargement •Biphasic P wave –Used to assess right ventricular hypertrophy - abnormally large R wave –Used to assess left ventricular hypertrophy - abnormally large S wave
45
Ventricular Hypertrophy V5
–Used to assess left ventricular hypertrophy - abnormally large R wave
46
Left ventricular hypertrophy
–Millimeters on EKG of S wave in V1 plus the R wave in V5 \> 35mm –Inverted/asymmetric T waves (repolarization abnormality) –Strain pattern depressed and humped ST segment
47
Infarction - Ischemia
–Symmetrically inverted T waves –ST segment depression subendocardial infarction, angina, stress tests
48
Infaction - injury
–Acute •ST segment elevation transmural infarction
49
Infarction - Necrosis
–Q waves •Old injury
50
Myocardial Infarction - inferior
II,III,AVF
51
Myocardial Infarction - anterior
V1-4
52
Myocardial Infarction - lateral
I,AVL,V5-6
53
Myocardial Infarction - Posterior
V1,V2 - tall R wave and ST depression
54
Myocardial Infarction - LBBB
EKG is invalid diagnostic tool for Acute MI
55
Firemans hat sign shows what?
MI
56
Posterior-lateral Wall MI Artery?
Circumflex Artery (with anterior reciprocal changes)
57
Hyperkalemia
* Flattened/widened P waves * Widened ORS complexes * Peaked T waves
58
Hypokalemia
* Flattened T waves * Prominent U waves
59
Hypercalcemia
* Shortened QT interval * Widened T wave
60
Hypocalcemia
* Prolonged QT interval * Flattened T waves
61
Hypothermia
•Severe sinus Bradycardia •Prolonged PR interval •Widened QRS complex •Prolonged QT interval •Osborn wave –Extra deflection at the end of the QRS complex
62
Pericarditis
* ST segment elevation that is flattened with T wave elevated off the baseline * Usually present in all leads * Convincing evidence of PR segment depression
63
Paced Rhythm
* Sharp depolarizations - spikes * Unable to interpret anything beyond that it is a paced rhythm * Can be atrial, ventricular or AV sequential pacers
64
Atrial Flutter
65
Atrial Bigeminy
66
Atrial fibrillation
67
Rhythm
Junctional
68
Rhythm
Junctional
69
Wolf-Parkinson-White (WPW)
70
Wolf-Parkinson-White (WPW)
71
First degree AV block
72
Wenckebach
73
Wenckebach
74
Second Degree AV Block Mobitz type II
75
Second Degree AV Block Mobitz type II
76
Third Degree AV Block
77
Ventricular Bigeminy
78
Ventricular Tachycardia
79
Ventricular Tachycardia
80
Torsades de Pointes
81
Prolonged QT Syndrome
82
Prolonged QT Syndrome (Hypomagnesemia)
83
Vetricular Fibrillation
84
RBBB
85
RBBB
86
LBBB
87
Axis
+30
88
Axis
- 90
89
Axis
- 60
90
Axis
0
91
Axis
+100
92
Left Atrial Hypertrophy
93
Left Atrial Hypertrophy
94
Right Atrial Hypertrophy
95
Left Ventricular Hypertrophy
96
Left Ventricular Hypertrophy - with Strain Pattern
97
Left Ventricular Hypertrophy - with Strain Pattern
98
Anterior Ischemia
99
Inferior Wall MI
100
Inferior Wall MI
101
Anterolateral Wall MI
102
Posterior MI
103
Posterior-lateral Wall MI - ircumflex Artery (with anterior reciprocal changes)
104
Hyperkalemia
105
hypercalcemia
106
Hypocalcemia
107
Hypothermia
108
Hypothermia
109
Hypothermia
110
Hypothermia
111
Hypothermia
112
Hypothermia
113
Pericarditis
114
Reciprocal changes in V1, I and aVL
115
Pericardial effusion?
116
Paced Rhythm
117
Paced Rhythm
118
Paced Rhythm
119
Dextrocardia

CV II (2 decks)

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