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Cardiology > EKG Quiz > Flashcards

EKG Quiz Flashcards

1
Q

ST segment represents what?

A

first phase of ventricular repolarization

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2
Q

T wave represents what?

A

Final phase of ventricular repolarization

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3
Q

Small squares are how much time?

A

0.04 seconds

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4
Q

bold squares are how much time?

A

0.2 seconds

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5
Q

Rate range of atrial foci?

A

60-80bpm

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6
Q

Rate range of junctional foci?

A

40-60bpm

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7
Q

Rate range of ventricular foci?

A

20-40bpm

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8
Q

Cause of sinus arrhythmia?

A

Parasympathetic and sympathetic activation in response to respiration.

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9
Q

Name of the conduction branch of the left atrium?

A

Bachmann’s Bundle

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10
Q

What do we call “entrance block”?

A

Parasystole

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11
Q

Wandering Pacemaker

A
  • pacemaker activity wanders to nearby atrial focus
  • cycle length variation
  • P’ wave variation
  • <100bpm
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12
Q

Multifocal Atrial Tachycardia

A
  • pacemaker activity wanders to nearby atrial foci
  • cycle length variation
  • P’ wave variation
  • > 100bpm
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13
Q

Atrial Fibrillation

A
  • firing of multiple irritable, parasystolic atrial foci at once
  • no real P waves (kind of a wavy baseline)
  • irregular QRS complexes
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14
Q

Atrial Escape Rhythm

A
  • due to sinus arrest
  • P’ waves at a regular rate
  • slower rate than sinus pacing (60-80bpm)
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15
Q

Junctional Escape Rhythm

A
  • due to sinus arrest and atrial foci failure or conduction block at the proximal portion of the AV node
  • either no P waves or inverted P’ waves (retrograde depolarization)
  • lone QRS complexes
  • 40-60bpm
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16
Q

Ventricular Escape Rhythm

A
  • due to complete conduction block high in the ventricular conduction system or to downward displacement of the pacemaker (if all foci above fail)
  • If the former, there will be P waves regularly, but they’re “overlaid” on top of regularly paced (but slow) QRS complexes at a different rate
  • if the latter cause, then there will only be QRS complexes at 20-40bpm
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17
Q

Atrial Escape Beat

A
  • due to transient sinus block
  • pause followed by single P’ wave + cycle
  • normal pacing resumes
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18
Q

Junctional Escape Beat

A
  • due to sinus block and no atrial response

- pause, followed by QRS w/o P wave

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19
Q

Ventricular Escape Beat

A
  • due to burst of parasympathetic activity, depressing the SA node, atrial foci and junctional foci
  • pause, followed by enormous QRS w/o P wave
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20
Q

Premature Atrial Beat (PAB)

A
  • due to an irritable atrial focus
  • P’ wave earlier than expected
  • P’ is up if in superior portion of atrium or inverted if in lower portion of atrium
  • SA node is reset and normal pacing resumes
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21
Q

PAB with Aberrant Ventricular Conduction

A
  • due to premature atrial beat conducted to ventricles when one bundle branch isn’t done repolarizing yet
  • P’ wave with slightly wide QRS
  • SA node is reset and normal pacing resumes
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22
Q

Non-Conducted PAB

A
  • due to a premature atrial beat that hits the ventricles in a refractory periord
  • P’ wave earlier than expected followed by no QRS complex
  • SA node is reset and normal pacing resumes
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23
Q

Atrial Bigeminy

A
  • due to an irritable atrial focus that fires after every normal cycle
  • SA node is reset producing a span of clear baseline after every couplet
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24
Q

Atrial Trigeminy

A
  • due to an irritable atrial focus that fires at the end of every second normal cycle
  • SA node is reset, producing a span of clear baseline after every couplet
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25
Q

Premature Junctional Beat

A
  • due to an irritable junctional focus
  • depolarizes ventricles and sometimes atria in retrograde fashion
  • widened QRS complex without P wave if no retrograde atrial depolarization
  • if atrial depolarization, there can be an inverted P’ wave before, during, or after the QRS complex
  • SA node will be reset if atria depolarize
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26
Q

Premature Ventricular Contraction

A
  • irritable ventricular focus
  • very wide and often inverted QRS complexes because one part of the ventricles depolarizes before the rest
  • there may be many PVCs because a focus is very irritable
  • there may be a long series of PVCs because a focus is parasystolic
  • a run of three or more is ventricular tachycardia
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27
Q

Multifocal Premature Ventricular Contractions

A
  • PVCs that are due to several different irritable focuses

- each PVC produces a unique QRS complex

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28
Q

Mitral Valve Prolapse

A

Can cause PVC because it causes localized stretch

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29
Q

Paroxysmal Atrial Tachycardia

A
  • due to sudden, rapid firing of an atrial focus at 150-250bpm
  • P’ wave before every QRS-T
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30
Q

Paroxysmal Atrial Tachycardia with block

A
  • two P’ waves for every QRS-T

- often caused by digitalis overdose/toxicity

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31
Q

Paroxysmal Junctional Tachycardia

A
  • due to a sudden, rapid firing of a junctional focus at 150-250bpm
  • may be no P wave if atria are not depolarized
  • if they are, there will be an inverted P’ wave either before, during, or after the QRS complex
  • possible widened QRS complex due to aberrant ventricular conduction
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32
Q

AV Nodal Re-entry Tachycardia

A

-Looks like paroxysmal junctional tachy, but is really due to a reentry circuit

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33
Q

Paroxysmal Ventricular Tachycardia

A
  • due to a sudden, rapid firing of a ventricular focus at 150-250bpm
  • often due to poor oxygenation of the heart
  • really just a run of PVCs
  • widened QRS complexes
  • SA node is still pacing atria, so we have normally-timed P waves
  • sometimes the SA node depolarization reaches the AV node and produces a normal or fusion QRS complex
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34
Q

Torsades de Pointes

A
  • due to low K+, drugs that block K+ channels, or congenital defect
  • rapid ventricular rhythm with lengthened QT segment
  • 150-250bpm
  • QRS point up, then down and get smaller, then bigger
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35
Q

Atrial Flutter

A
  • due to rapid atrial depolarization at 250-350/min

- produces rapid, identical P’ waves with QRS complex every 2-3 P’ waves

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36
Q

Ventricular Flutter

A
  • due to rapid firing of a single ventricular focus at 250-350/min
  • produces rapid sine-like waves
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37
Q

Ventricular Fibrillation

A
  • due to many irritable, parasystolic ventricular foci firing at once
  • rapid twitching of the ventricles (very bad)
  • erratic, unidentifiable waves on EKG
38
Q

Wolff-Parkinson-White Syndrome

A
  • due to the Bundle of Kent “short-circuiting” the atrial conduction, prematurely depolarizing a portion of the ventricles
  • produces a delta wave on EKG
  • can lead to paroxysmal tachycardia
39
Q

Lown-Ganong-Levine Syndrome

A
  • due to the AV node being bypassed by the James Bundle, which depolarizes the ventricles without conduction-delay via the AV node
  • P waves are right next to the QRS complex with no PR interval
40
Q

Sick Sinus Syndrome

A
  • collection of arrhythmias due to dysfunctional SA node and unresponsive atrial/junctional foci
  • marked by sinus bradycardia with no escape rhythm
  • PSEUDO-sick sinus syndrome may be experienced in young, healthy ppl due to parasympathetic excess at rest
41
Q

Bradycardia-Tachycardia Syndrome

A

-Patients with sick sinus syndrome may experience SVT mingled with their sinus bradycardia

42
Q

1 degree AV Block

A
  • prolongs AV nodal conduction

- PR interval that is lengthened ( >0.02 seconds) the same amount in every cycle

43
Q

Wenckebach 2 degree AV Block

A
  • some conduction gets through the AV node, some doesn’t
  • occurs in the AV node itself, which is blocked more and more until it’s blocked completely for one cycle
  • PR interval gets longer and longer until one QRS complex is dropped
  • should have one less QRS than P wave
44
Q

Mobitz 2nd Degree AV Block

A
  • some conduction gets through the AV node, and some doesn’t
  • occurs below the AV node
  • series of normal P waves with no following QRS complexes for a few beats
  • Should have P:QRS ratios of 3:1, 4:1, 5:1, etc.
45
Q

3rd Degree (Complete) AV Block

A
  • due to a complete blockade between atria and ventricles
  • If block is in proximal AV node, then junctional foci can pace
  • if block is below that (in the node or lower), then ventricular foci can pace
  • AV dissociation: normal P wave pacing with a slower, completely separate QRS pacing
  • If junctional foci pace, then QRS complexes with be normally-shaped and 40-60/min
  • if ventricular foci pace, then QRS will be wide and 20-40/min
46
Q

Right Bundle Branch Block

A
  • block of the right bundle branch, delaying depolarization to the right ventricle
  • joined QRS with two peaks, larger than 0.12 seconds (3 or more small squares), on the RIGHT chest leads (V1 and V2)
47
Q

Left Bundle Branch Block

A
  • due to complete block of the left bundle branch, delaying left ventricular depolarization
  • joined QRS with two peaks, larger than 0.12seconds (3 or more small squares), on the LEFT chest leads (V5 and V6)
48
Q

Intermittent Mobitz

A
  • an occasional dropped QRS due to permanent BBB on one side and intermittent BBB on the other side
  • remember, a mobitz block is an intermittent complete block, which you would have when one bundle branch is permanently blocked, and the other is intermittently (but completely) blocked
49
Q

(-) QRS in lead I

(-) QRS in lead AVF

A

Extreme right axis deviation (re: proof on EKG)

50
Q

(-) QRS in lead I
(+) QRS in lead AVF
(re: deviation)

A

right axis deviation (re: proof on EKG)

51
Q

(+) QRS in lead I
(-) QRS in lead AVF
(re: deviation)

A

left axis deviation (re: proof on EKG)

52
Q

(+) QRS in lead I
(+) QRS in lead AVF
(re: deviation)

A

“normal” axis (no deviation) (re: proof on EKG)

53
Q

Isoelectric QRS in leads V3 and V4 (re: rotation)

A

normal (no rotation) (re: proof on EKG)

54
Q

Isoelectric QRS in leads V1 and V2 (re: rotation)

A

rightward rotation (re: proof on EKG)

55
Q

Isoelectric QRS in leads V5 and V6 (re: rotation)

A

leftward rotation (re: proof on EKG)

56
Q

Wave that we look at for atrial hypertrophy

A

P wave (what do we look at this wave for?)

57
Q

Lead that gives us the best information regarding atrial hypertrophy

A

Lead V1 (lead that gives us the best information for what?)

58
Q

Specific type of P wave that’s present with atrial hypertrophy

A

diphasic P wave (present with what?)

59
Q

Right Atrial Hypertrophy evidence on EKG

A

the initial portion of a diphasic P wave is larger

60
Q

Left Atrial Hypertrophy evidence on EKG

A

terminal portion of a diphasic P wave is larger

61
Q

Right Ventricular Hypertrophy evidence on EKG, including axis deviation and rotation

A
  • large R wave in V1 (normally the R wave is small in this lead)
  • right axis deviation
  • rightward axis rotation
62
Q

Left Ventricular Hypertrophy evidence on EKG, including axis deviation and rotation

A
  • extra deep S wave in V1
  • extra tall R wave in V5
  • if depth of V1’s S wave and height of V5’s R wave add to be greater than 35mm, diagnose LVH
  • T wave inversion and asymmetry (slow and gradual downslope with a rapid return to baseline)
63
Q

Triad of a myocardial infarction

A

injury, ischemia, necrosis

64
Q

Evidence of ischemia on EKG

A
  • T wave inversion on leads V2-V6

- the T wave inversion is symmetrical

65
Q

Evidence of injury on EKG

A
  • ST segment elevation that will eventually return to baseline
  • indicates ACUTE injury (check for this when there’s evidence of an infarct, too)
66
Q

Evidence of a Subendocardial Infarction on EKG

A

depressed ST segment that’s either flat or down-sloping

67
Q

Leads in which small “q” waves are normal

A
  • lateral leads (I and AVL)
  • inferior leads (II, III, AVF)
  • chest leads V5 and V6
68
Q

size parameters defining small “q” waves

A

< 1mm/one small square/0.04 seconds in duration

69
Q

size parameters defining a significant Q wave

A
  • at least 1mm wide, or

- amplitude 1/3 that of the total QRS complex

70
Q

Anterior Infarction

A
  • infarction on the anterior wall of the left ventricle

- Q waves in leads V1-V4

71
Q

Antero-septal Infarction

A
  • infarct that includes the septal portion of the left ventricle’s anterior wall
  • Isolated Q waves in leads V1 and V2
72
Q

Antero-Lateral Infarction

A
  • infarction of the more lateral portion of the left ventricle’s anterior wall
  • isolated Q waves in leads V3 and V4
73
Q

Lateral Infarct

A
  • infarction that involves the lateral portion of the left ventricle
  • Q waves in the lateral leads (I and AVL)
74
Q

Inferior Infarct

A
  • AKA “diaphragmatic infarct”
  • infarction that includes the inferior wall of the left ventricle
  • Q waves in the inferior leads (II, III, and AVF)
75
Q

Acute Posterior Infarct

A

-infarction of the left ventricle’s posterior wall
-very large R wave in leads V1 and V2
-ST depression in V1 and V2
(remember, this is exactly opposite from the evidence of an anterior infarct)

76
Q

“tests” performed on an EKG strip when acute posterior infarct is suspected

A
  • reversed transillumination test

- mirror test

77
Q

coronary artery occluded in a lateral infarction

A

circumflex branch of the left coronary (occlusion causes what infarction?)

78
Q

coronary occluded in an anterior infarction

A

anterior descending branch of the left coronary artery (occlusion causes what infarction?)

79
Q

coronary artery occluded in a posterior infarction

A

right coronary artery (occlusion causes what infarction?)

80
Q

coronary artery occluded in an inferior infarction

A
  • either left or right coronary, depending on which is dominant
  • right is more commonly dominant
  • (occlusion causes what infarction?)
81
Q

Ventricular conduction system components whose blood is delivered by the right coronary artery

A
  • (delivery of blood by what coronary artery?)
  • AV node
  • Bundle of His
  • variable twig sent to the posterior division of the left bundle branch
82
Q

Ventricular conduction system components whose blood is delivered by the anterior descending branch of the left coronary artery

A
  • (blood supply delivered by what coronary artery?)
  • right bundle branch
  • anterior division of the left bundle branch
  • variable twig sent to the posterior division of the left bundle branch
83
Q

True or False: If you have more P waves than QRS complexes then there is an AV block present.

A

True

84
Q

In regards to AV Blocks, if the PR interval is constant then what type of Block is present?

A

2deg Mobitz

85
Q

With AV Blocks, if the PR interval is not constant but the R-R intervals are constant then the block present is:

A

3deg AV Block

86
Q

This type of AV Block has inconsistent PR intervals as well as inconstant R-R intervals.

A

2deg Wenckenbach

87
Q

The QT interval should be what percentage of the cardiac cycle?

A

less than or equal to 40%

88
Q

How can you calculate the exact HR on EKG?

A

1500 divided by the number of small boxes between R waves

89
Q

What are causes of atrial and junctional foci irritability?

A

Adrenergic substances

90
Q

What are causes of ventricular foci irritability?

A

Hypoxia, Hypokalemia, Pathologic process

Cardiology (8 decks)

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