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cardipulmonary > EKG pathologies > Flashcards

EKG pathologies Flashcards

1
Q

Multifocal Atrial Tachycardia

A

irregular rhythm

  • P wave shape varies (some DP way more than others, its multiple, ectopic, irritable foci)
  • 3 or more different P waves
  • atrial rate exceeds 100
  • irregular ventricular rhythm
  • PR interval varies
  • associated with lungers/ COPD!! and low electrolytes, lower K lower Mg
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2
Q

MAT is arrythmia often seen in patients very ill with.. / could be this toxicity

A

COPD!!

digitalis toxicity

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3
Q

Atrial fibrillation

A
  • atrial rate > 350 -600/ min
  • undulating baseline!!!
  • no discernible P waves!!
  • irregular RR interval (QRS complex)
  • continuous chaotic atrial spikes
  • “irregularly irregular” ventricular rhythm
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4
Q

1st degree AV block

A

PR interval greater than 0.2 seconds [one large square; 5mm]
- PR remains consistently lengthened cycle-to-cycle
- in leads 1/2/3 see low voltage/ amplitude of QRS complexes (squished almost)
-if PR interval > 0.2 sec ANYWHERE in tracing, some kind of block is present
PR interval should be constantly prolonged in every cycle for first degree
P-QRS-T sequence normal in every cycle

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5
Q

hyperkalemia

A

tall, pointed T waves

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6
Q

tachy and brady

A

tachy > 100 HR

brady

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7
Q

P wave follow QRS in

A

SVT

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8
Q

No P waves in

A

Afib
A flutter
VT

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9
Q

Premature Atrial Contractions

A

irritable focus spontaneously firing a single stimulus, leads to irregular rate

  • P wave bigger, comes prematurely
  • PAC resets SA node pacing (after premature QRS, SA node picks up and resumes regular intervals)
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10
Q

atrial arrythmias

A
  • seen in absence of significant heart disease; assoicated with stress, alcohol, tobacco, coffee, COPD and CAD
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11
Q

Premature Ventricular Contractions

A
  • many times don’t see P, gets lost in QRS complexes; sometimes a retrograde P wav ein ST segment
  • QRS complexes, are early, bizarre and W I D E
  • QRS complexes and ST segments go in opposite direction
  • usually full, compensatory PAUSE!!
  • depresed T wave
  • RR intervals shorter, QRS coming early
  • potential for deadly R on T phenomenon
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12
Q

PVCs >6
PVCs > 3 consecutively
PVCs for > 30 seconds

A

> 6 pathological
3, Vtach!!!
30 seconds its sustained VT
multifocal PVC –> Vfib (deadly)

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13
Q

V tach

A

150-250/ min
- very irritable ventricular focus appears SUDDENLY and paces RAPIDLY
- has usually regular, W I D E QRS complexes (remember VT is just multiple PVCs)
- 3 or more consecutive bizarre QRS complexes
- ventricular rate 120-200 (100-250)
- P wave often lost; if seen no relationship to QRS (AV dissociation)
lasts > 30 seconds (sustained)

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14
Q

Supraventricular Tachy (SVT) [includes PAT and PTJ] / AV nodal re-entry tachy (AVNRT)

A

supra -> all atrial and junctional foci are above the ventricles
- QRS here are NARROW, normal looking ( .14 sec)
- dont see P wave morphology
Remember for AVNRT: N = No P waves!!

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15
Q

atrial flutter

A

250-350/ min
rapid succesion of back to back atrial depolarization waves “flutter” waves
-SAW TOOTH appearance
flutter waves: QRS response is 2:1
- leads II, III, aVF, V1 often best leads

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16
Q

V fib

A
  • totally erratic, rapid “twitching” of the ventricles [disorganized depolarization]
  • lack of ANY identifiable waves
  • if you recognize regularity, its NOT V fib!!!
  • from low or high K+
17
Q

Torsades De Pointes

A

“Twisting of the points”

  • twisted ribbon morphology: QRS swings from positive to negative direction
  • twisting of the QRS complex
  • very unstable rhythm
  • may be inherited (prolonged QT)
  • lower Mg levels, hypokalemic, anti-dep can set you up for this
18
Q

Hypokalemia

A
  • “U” waves [ come after where you would expect T to be on x axis]
  • increased QT interval
  • flat or inverted T wave
    usually in patients who took diuretics, metabolic alkolosis, diarrhea, renal loss..
  • the lower the K+ the flatter/ more inverted the T wave, and more prominent the U wave
19
Q

hyperkalemia

A
  • PEAKED T wave (Tombstone Ts)
  • W I D E QRS
  • wide, flat P
  • increased PR interval
  • the whole pattern is wide and bizarre
  • more the K+, wider the QRS and likelier P is to be absent
    ST segment going way up sometimes; T waves almost 13 mm in height
20
Q

ECG for ST segment elevation AMI

A

“transmural” form endo to epicardial - whole portion of heart that artery is feeding is plugged up by thrombus
- complete interruption of blood flow
usually thrombus involved

21
Q

flow occlusion in MIs

A

coronary flow completely occluded - STEMI
partial occlusion - UA (unstable angina) or NSTEMI
most MIs caused by atherosclerosis

22
Q

where is the J point?

A

Right before ST segment

23
Q

STEMI criteria - men/ women

A
  • ST elevation of 2 mm or > at J point in V2-V3 in men

- or 1.5 mm or > in woman in absence of LVH or > 1mm in 2 or more CONTIGUOUS chest of limb leads

24
Q

NSTEMI features

A

ST segment DEPRESSION
T wave inversion
chest pain, elevated cardiac enzymes

25
Q

zones of infarction

A

ischemia – deficienct blood supply/ impaired repolarization – T wave changes!!
injury - deficienct blood supply/ inability to fully polarize – ST segment shifts!!
infarction – dead tissue/ lacks depolarization – Q waves!!

26
Q

artery and leads for Anterior wall infarcation

A

LAD (left anterior descending)

V1 - V7

27
Q

artery and leads for Inferior wall infarction

A

RCA (right coronary artery)
II, III
aVF {F for inFerior]
V3-V6

28
Q

artery and leads for lateral wall infarction

A

Circumflex artery
I [1 looks like small L]
AvL [ L for lateral]
V5-V6

29
Q

strongest biomarker for Necrosis and its features

A 
Troponin I (cTnI) or T (cTnT)
1-4 hours detectable after onset AMI
10-24 hours peak
persist 5-14 days
renal failure can cause false positive cTnT

cardipulmonary (12 decks)

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