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COMLEX Level 2CE > EKG review lecture (F) > Flashcards

EKG review lecture (F) Flashcards

High yield review: murmurs, arrhythmias, & cardiac dz Deck is full

1
Q

how does WPW present on EKG?

A

delta wave

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2
Q

what are the 3 holosystolic murmurs?

A
  1. MR
  2. VSD
  3. TR
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3
Q

MR + S3 sound = ?

A

worsening CHF

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4
Q

what is the best indicator of prognosis in HF?

A

S3 on p/e

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5
Q

what are the systolic murmurs?

A
  1. AS
  2. PS
  3. MVP
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6
Q

what will you hear in MVP?

A

mid-systolic click

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7
Q

what are the diastolic murmurs?

A

-AR / PR
-MS / TS
(ARMS = PRTS)

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8
Q

when do w/u systolic murmur?

A

grade 3-4 only

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9
Q

when do you w/u diastolic murmurs?

A

ALWAYS

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10
Q

which murmurs are assoc w/ widened pulse pressure?

A
  • AR

- PDA

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11
Q

what is a widened pulse pressure?

A
  • large diff btwn SBP and DBP

- HIGH SBP / LOW DPB

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12
Q

which murmurs are accentuated (made worse) by inspiration?

A

TR and PS

R sided murmurs

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13
Q

which murmurs are accentuated (made worse) by exhalation?

A

AR (L sided murmurs)

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14
Q

what murmurs will be seen in pts w/ bicuspid aortic valves?

A

early dz –> AR

late dz –> AS

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15
Q

which valve is most likely the culprit if Q stem doesn’t mention any hx ?

A

mitral

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16
Q

what murmur is assoc w/ widened fixed S2?

A

ASD

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17
Q

which murmur radiates to the axilla?

A

MR

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18
Q

which murmur radiates to the neck?

A

AS

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19
Q

which murmur localizes to the 1st R intercostal space and presents w/ thrill @ suprasternal notch?

A

supravalvular AS

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20
Q

which 2 murmurs get softer w/ squating and louder w/ standing and valsalva?

A
  1. HOKUM

2. MVP

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21
Q

what are the most important features of afib?

A
  • irreg irreg

- no pwaves

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22
Q

pt presents to the ER w/ new onset afib. you have no pmHx. what must you suspect as the cause of the afib?

A

hyperthyroid

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23
Q

what do you do always check w/ new onset afib and an unknown pmHx?

A

check TSH

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24
Q

besides afib, what is another irreg irreg arrhythmia?

A

multifocal atrial tachycardia (MAT)

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25
Q

what is MAT assoc w/?

A

COPD

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26
Q

what does MAT look like on EKG?

A
  • irreg irreg

- variable pwave morphologies >=3

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27
Q

pt presents w/ afib. what is the first Q you ask?

A

are they stable or unstable?

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28
Q

in a stable pt, how to you tx afib?

A
  1. CCB
  2. BB
  3. If onset afib >=48hrs ago –> + anticoag (warfarin)
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29
Q

how will an unstable pt w/ afib present?

A

AMS, low BP, tachy

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30
Q

in an unstable pt, how do you tx afib?

A
  1. synced cardioversion (100-200J)
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31
Q

in new onset afib (<48hrs) unstable pts should receive a TTE prior to synced cardioversion (time permitting). if a clot is found, how do you proceed?

A
  1. anti-coagulate

2. synched cardiovert

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32
Q

what should you do for an unstable pt presenting w/ new onset afib (<48hrs) when you are unable to do a TTE prior to cardioverting?

A

start anti-coag prior to synced cardioversion just in case

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33
Q

when do you give adeNosiNe?

A

-NARROW complex tachy = afib, aflutter, SVT

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34
Q

what causes aflutter?

A

a re-entrant pathway

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35
Q

how does aflutter present on EKG?

A
  • HR 250-350
  • “sawtooth” pattern
  • 2:1 AV block
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36
Q

how do you tx aflutter?

A

same as afib

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37
Q

what is synced cardioversion?

A

sync to the rhythm –> shock the heart

38
Q

what is unsynced cardioversion (i.e. defibrillation)?

A

shocks the heart at random

39
Q

when do you defibrillate?

A

only when there is no discernable heart rhythm (vfib and pulseless vtach)

40
Q

which fast rhythms have wide QRS complexes?

A

vtach and torsades

41
Q

which fast rhythms have narrow QRS complexes?

A

afib, aflutter, SVT

42
Q

pt is stable but EKG shows vtach. how do you tx the pt?

A

amiodarone (vtach = Wide. Wide gets aMiodarone)

43
Q

pt presents in vtach and QRS complex on EKG is short (low amplitude). what should you suspect as the underlying etiology of the arrhythmia?

A

amyloid dz

44
Q

what lab do you use to dx amyloid?

A

congo red stain

45
Q

what does amyloid look like on congo red stain?

A

+ apple green birefringence

46
Q

how do you tx SVT?

A
  1. carotid massage/ vagal maneuver

2. adeNosiNe (SVT = Narrow complex)

47
Q

when is carotid massage C/I?

A

CAS

48
Q

what does SVT look like on EKG?

A
  • Narrow QRS complex

- no pwaves

49
Q

what are the 5Hs of PEA?

A
  1. hypovolemia
  2. hypothermia
  3. hypoxia
  4. H+ (acidosis)
  5. hypo/hyperkalemia
50
Q

what are the 5Ts of PEA?

A
  1. tamponade
  2. tension pneumo
  3. tablets/toxins (drugs)
  4. thrombus (coronary)
  5. thrombus (PE)
51
Q

how do you tx PEA?

A
  1. CPR
  2. EPI/vasopressin
  3. correct underlying cause (5Hs and 5Ts)
52
Q

what do you never do to tx PEA?

A

cardiovert

53
Q

how do you tx vfib and pulseless vtach?

A

CPR + defibrillation

54
Q

how much time does one small box = on EKG?

A

0.04 sec

55
Q

how much time does one big box = on EKG?

A

0.2 sec

56
Q

how do you tell 1st degree heart block from 2nd and 3rd degree?

A

1st degree = no dropped beats

57
Q

what does 1st degree block look like on EKG?

A
  • prolonged PR int > 0.2 sec (i.e. >1 big box)
  • PR = stable length
  • NO dropped beats
58
Q

what are the 2 types of 2nd degree heart block?

A

type 1 = mobitz 1 = wenkebach

type 2 = mobitz 2

59
Q

what does mobitz type 1 look like on EKG?

A

“longer longer longer drop. then you have a wenkebach”

60
Q

what does mobitz type 2 look like on EKG?

A
  • fixed prolonged PR int

- randomly dropped beats

61
Q

what is 3rd degree heart block?

A

complete dissociation of atria and ventricles

62
Q

what does 3rd degree heart block look like on EKG?

A
  • if Ps and Qs don’t agree, then you’ve got a 3rd degree”

- will not have a pwave for every QRS complex

63
Q

what is the def of sinus rhythm?

A

every QRS complex is preceded by a pwave

64
Q

how do you tx 1st degree heart block

A

1st degree - generally asymp and won’t tx

65
Q

how do you tx mobitz 1 heart block?

A

Generally won’t need to tx. If you do,

  1. atropine
  2. synced cardioversion (unstable)
66
Q

how do you tx mobitz 2 and 3rd degree heart block?

A 
acute presentation: 
   1. atropine
   2. synced cardioversion
chronic mobitz 2 and 3rd degree:
   permanent pacemaker
67
Q

what class of drugs do you avoid in heart block?

A

BB

68
Q

what does R vent hypertrophy look like on EKG?

A

+R axis deviation (lead 1: QRS -, avF: QRS +)
+R wave in V1 >7mm (>1.4 big boxes)
+/- wide S wave lead 1, V5, V6

69
Q

what 2 things cause axis deviation?

A
  1. BBB

2. vent. hypertrophy

70
Q

what are 5 causes of R axis deviation?

A
  1. cor pulmonale
  2. dextrocardia
  3. RBBB
  4. COPD
  5. PE
71
Q

what does L vent hypertrophy look like on EKG?

A

-R wave in avL >=12mm (>= 2.4 big boxes)

^very specific finding

72
Q

what is LBBB associated w/?

A
  1. MI

2. L axis deviation (lead 1: QRS +, avF: QRS -)

73
Q

what is seen on EKG in NSTEMI?

A
  • non-specific changes

- might see ST depression

74
Q

how do you dx NSTEMI?

A

-labs = troponin and CK-MB

75
Q

what is seen on EKG in STEMI?

A

> =1-2mm ST elevation in 2+ contig leads

76
Q

how long will the ST elevations last after a STEMI?

A

up to 4 weeks

77
Q

what is the dx if ST elevation >4wks after a STEMI?

A

ventricular aneurysm

78
Q

which leads show ST elevations in lateral STEMIs?

A

lead 1, avL, v5, v6

79
Q

which leads show ST elevations in inferior STEMIs?

A

leads 2, 3, avF

80
Q

which leads show ST elevations in septal STEMIs?

A

v1, v2

81
Q

which leads show ST elevations in anterior (apical) STEMIs?

A

v3, v4

82
Q

which leads show ST elevations in posterior STEMIs?

A

+ leads 7-9

+/- lead 2, 3, avF

83
Q

what will nL vs R vs L axis deviation look like?

A

nL –> 1 up, avF up
R –> 1 down, avF up
L –> 1 up, avF down

84
Q

what does pericarditis look like on EKG?

A

+diffuse ST elevations (all leads elevated except avF)
+/- PR depression (pathognomonic when present)
+/- electrical alternans (if effusion present)

85
Q

if untreated, pericarditis can develop into what?

A

pericarditis –> pericardial effusion –> cardiac tamponade

86
Q

what is Beck’s triad?

A
  • the triad of s/s seen in cardiac tamponade

1. hypotension, 2. JVD, 3. muffled/distant heart sounds

87
Q

electrical alternans is seen in what two conditions?

A
  1. cardiac tamponade

2. pericarditis w/ large pericardial effusion

88
Q

what do peaked twaves mean?

A

high K

89
Q

what does low K look like on EKG?

A
  • flattened/inverted T waves

- u waves

90
Q

what does torsades de pointes look like on EKG?

A

twisted ribbon

91
Q

how do you tx torsades?

A

Mg

COMLEX Level 2CE (23 decks)

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