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632 Advanced Anesthesia Health Assessment > EKG monitoring > Flashcards

EKG monitoring Flashcards

1
Q

What cells generate the electrical potential recorded in the EKG monitor

A

Myocardial cells

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2
Q

Best lead placement to read dysrhythmias

A

Lead II

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3
Q

What occurs during systole?

A

Mitral and tricuspid valve close

Aortic & pulmonic valve open

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4
Q

What occurs during diastole?

A

Aortic & pulmonic valves close

Tricuspid & mitral valve open

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5
Q

What does the P wave represent

A

Atrial depolarization

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6
Q

What is a normal PR interval?

A

0.08 - 0.20

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7
Q

What happens during the QRS on an EKG?

A

Ventricular depolarization

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8
Q

What is a normal QRS interval?
What can cause an abnormal interval?

A

0.08 - 0.12
Prolonged in HF & Cardiomyopathy

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9
Q

What does the T wave represent on an ECG? And what is a normal measurement?

A

Ventricular repolarization
- 0.4 sec

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10
Q

What can cause EKG artifact in the OR

A
  • Patient movement
  • Electrocautery use
  • Nearby currents
  • Surgeon manipulation
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11
Q

What EKG interpretation represents Ischemia?

A

Flat or down sloping ST depression exceeding 1 mm
- especially w/ T wave inversion

ST elevation w/ peaked T waves

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12
Q

What conditions can you not accurately read ST interpretations?

A
  • Wolf Parkinson White (WPW)
  • Pacemakers
  • Digoxin therapy
  • Bundle Branch Block
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13
Q

True or False:
ECGs can be normal when something awful is happening.

A

True.
ECGs aren’t fool proof.
If you think the patient is experiencing angina from the history, but the ECG is normal, put in a consult.

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14
Q

How many leads must show ST depression to confirm angina

A

2 or more consecutive leads to confidently say it is a case of angina.

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15
Q

If you manually have to set up your ECG monitor, what do you always want to check? And what is the setting?

A
  • ST Segment
  • ECG must be set that a 1 mV signal results in a deflection of 10 mm on a strip monitor.
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16
Q

Purpose of analyzing the ST Segment

A
  • Allows for early detection of ischemia
  • Increases sensitivity of ischemia detection
  • Doesn’t require additional practitioner skill/vigilance
  • May help diagnose intraoperative myocardial ischemia
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17
Q

ST depression = ?

A

Ischemia
- The ST segment (flat area between the QRS & the T wave) sinks lower than the baseline

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18
Q

ST elevation = ?

A

Injury

  • in the inferior leads = greater than 1 small square
  • in the limb leads (V1-6) = greater than 2 small squares
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19
Q

Where does ST elevation most commonly occur?

A

Can occur anywhere in the heart.

  • More commonly in the antero-septal or the inferior regions of the ECG
  • Need to see in 2 or more consecutive leads
20
Q

What is more important in your assessment than an EKG by itself?

A

The patient’s history & a change on the ECG is more important than an EKG by itself.

  • Serial EKGs are better than one. They interpret what the heart is doing in that exact moment.
21
Q

What do Q waves represent?

A

Scarring/ infarction
Ischemic tissue is negatively charged = an inversion on the ECG
Q waves = > 1mm in width & > 1/3 total height of the QRS

22
Q

If a STEMI w/ ST elevation is seen in leads II, III, and aVF what reciprocal changes would you see?

A

ST depression in Lead I and aVL
- Reciprocal changes are mirror image changes that occur when 2 electrodes view the same MI from the opposite angle

23
Q

What are hemodynamic changes of a Right-sided MI? And why?

A

Lower Blood Pressures (systolic < 140 mmHg)
- decreased RV contractility = decreased LV preload

24
Q

What should you withhold during a Right-sided MI?

A

Nitroglycerin
- Patient is already experiencing peripheral edema, JVD, hypoxemia, and hypotension from the RV not contracting, decreasing blood flow from the venous system to the lungs.

25
Q

What should you look for in a Posterior MI

A

Look for ST-depression & larger than normal R waves in Leads V1 and V2

26
Q

How do you distinguish Pericarditis on an EKG?

A

Global ST-elevation in every lead of the 12-lead

27
Q

Left Coronary Artery Main supplies ?

A
  • Circumflex artery
  • Left Circumflex artery
  • Left Anterior Descending artery
  • Left Anterior interventricular artery
28
Q

What Leads represent the Lateral Circumflex?

A

Lead I & aVL

29
Q

What leads will represent Inferior RCA

A

Lead II, III, & aVF

30
Q

What Lead will represent Septal LAD

A

V1 & V2

31
Q

What leads will represent an Anterior & Distal LAD?

A

V3 & V4

32
Q

What leads represent the Lateral side?

A

V5 & V6

33
Q

What is a Normal QRS axis on an EKG?

A

Normal axis = 0 to + 90 (or -20 to + 100)

  • Right axis = overly positive
  • Left axis = overly negative
34
Q

What leads do you look at for QRS deflection & axis deviation?

A

Look at the QRS in Lead I & aVF

35
Q

If the QRS in Lead 1 is negative/downward and the QRS in aVF is positive/upward what would you interpret this as?

A

Right axis deviation

36
Q

If the QRS in Lead 1 is positive/upward and the aVF is negative/downward what would you interpret this as?

A

Left axis deviation

37
Q

If your patient has a left axis deviation what might be some clinical diagnoses to expect?

A
  • Left Bundle Branch Block
  • Left ventricular hypertrophy
  • Pregnancy
  • Ascites
  • Abdominal tumors

Anything pushing up against the heart

38
Q

Why do you care about an axis deviation?

A

It could mean a lot of things:

  • Infarct
  • Hypertrophy
  • Conduction delay
  • Abnormal anatomy
39
Q

What might a Right axis deviation depict clinically?

A
  • Right bundle branch block
  • Right ventricular hypertrophic
  • Emphysema
40
Q

What lead is the only one to deflect negatively in normal tissue?

A
  • aVR
    Do not use this lead to diagnose
41
Q

How does the R wave progress in leads V1 - V6

A

Progressively get more positive.

V1 & V2 are downward deflections

V3 & V4 are half & half “transitional” or “biphasic”

V5 & V6 are upward deflections (primarily positive)

42
Q

Reasons for poor R wave progression ? (V leads)

A
  • Anterior myocardial infarction
  • Left bundle branch block
  • Wolf parkinson white
  • Right ventricular hypertrophy
  • Left ventricular hypertrophy
43
Q

How to calculate the rate on an ECG strip?

A

2 Methods:

  1. Count QRS in a 6 sec strip and multiply by 10
  2. Count the number of small boxes between QRS peaks & divide this number INTO 1500
44
Q

Reasons for a prolonged QT (9):

A
  1. Drugs (Na Ch blockers)
  2. Antipsychotics
  3. Hypomagnesemia
  4. Hypocalcemia
  5. Hypokalemia
  6. Hypothermia
  7. AMI
  8. Congenital
  9. Increased ICP
  • Can lead to Torsades de Pointes = Fatal
45
Q

What are 7 steps to reading an EKG?

A
  1. Regular or irregular
  2. Rate
  3. P wave presence and regularity
  4. P to QRS ratio
  5. QRS width
  6. PR interval
  7. QT interval

632 Advanced Anesthesia Health Assessment (12 decks)

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