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Foundations of Anesthesia 1 > EKG Rhythms > Flashcards

EKG Rhythms Flashcards

1
Q

What are the 4 major narrow complex tachycardias?

A
  1. Sinus Tachycardia
  2. Paroxysmal Supraventricular Tachycardia
  3. Atrial Flutter
  4. Atrial Fibrilation
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2
Q

What are three types of Paroxysmal Supraventricular Tachycardia

A
  1. AV nodal reentrant Tachycardia (AVNRT): Dual AV nodal pathways like
    Wolff Parkinson White
  2. Atrioventricular reentrant tachycardia (AVRT) - “typical” SVT
  3. Multifocal Atrial Tachycardia
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3
Q

Of the narrow supraventricular tachycardias, which are regular (5)?

A

Sinus tachycardia,
Atrial tachycardia, or
Atrial flutter with pure 2:1 (or rarely 1:1) conduction,
Atrioventricular nodal reentrant tachycardia (AVNRT) - SVT, and Atrioventricular reentrant tachycardia (AVRT) - WPW
are very regular.

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4
Q

Of the narrow supraventricular tachycardias, which are irregular (3)?

A

Atrial fibrillation,
Multifocal atrial tachycardia and Atrial flutter or Atrial tachycardia with variable degrees of atrioventricular (AV) block are irregular.

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5
Q

How do we determine the rate of EKG via big boxes?

A

300 / number of big boxes between R-R. only works for regular rhythms

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6
Q

What is a hallmark of SVT (AVRT) on EKG?

A

No p waves or retrograde p waves after the QRS

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7
Q

Hallmark of Multifocal Atrial Tachycardia on EKG?

A

3 or more morphologically different P waves and Irregular

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8
Q

What is the wide regular tachycardia?

A

Monomophric Ventricular Tachycardia

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9
Q

What are the wide irregular tachycardias?

A

Polymorphic Ventricular Tachycardia (Tdp)
Ventricular Fibrillation

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10
Q

EKG for sinus bradycardia
PR interval and QRS

A

Normal PR Interval and no dropped QRS.

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11
Q

EKG for 1st Degree AV Block
PR interval and QRS

A

PR interval - Prolonged greater than 0.2s
No drop in QRS

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12
Q

EKG for 2nd Degree AV Block Type 1
PR interval and QRS

A

Progressively longer PR
Dropped QRS

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13
Q

EKG for 2nd Degree AV Block Type II
PR interval and QRS

A

PR Constant
Drops QRS

Visible QRS usually widened

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14
Q

EKG for 3rd Degree AV Block
PR interval and QRS

A

AV Dissociation - no communication

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15
Q

What should a normal axis look like? What leads do you look at?

A

Look at Lead I and aVF.
Are P and QRS both upright?
If aVF is equiphasic, count as up.

if yes, Normal Axis

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16
Q

What would left axis deviation look like? What leads do you look at? Where do you look to confirm?

A

Look at Lead I and aVF.

If Lead I is positive and aVF is more negative - it is likely Left Axis Deviation.

Look at Lead II to confirm. If it is equal phasic, it is indeterminate.

If Lead II is more negative, then Left Axis Is Deviated.
If Lead II is positive, it is a normal axis.

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17
Q

Causes of Left Axis Deviation

A

Things that alter LV depolarization
-LBBB
-LVH
-LAFB (left anterior fascicular block)

Normal Variant in Obese People

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18
Q

What would right axis deviation look like? What leads do you look at? Where do you look to confirm?

A

Look at Lead I and aVF

If Lead I is negative and aVF is positive you have right axis deviation.

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19
Q

Causes of Right Axis Deviation

A

-RBBB
-RVH
-LPFB (left posterior fascicular block)
-COPD, PE
-WPW
-Previous Lateral/Ant MI (LV atrophy, can’t conduct)

Can be a normal variation in tall/slender people

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20
Q

EKG changes for extreme right axis deviation

A

Both Lead I and aVF downward reflected

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21
Q

Characteristic EKG changes of Wolf Parkinson White

A
  1. Delta wave
  2. Short PR interval
  3. QRS greater than 120ms
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22
Q

Some causes of prolonged QT interval (>500ms)

A

Anti-Arrthymics
Anti-Biotics
Anti-psyChotics
Anti-Depressants
Anti-Emetics

-Hypo K, Mg, Ca

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23
Q

Some causes of short QT interval (<460ms)

A

Hyperkalemia, Hypercalcemia

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24
Q

Where to look for EKG changes for left atrial enlargement

A

Lead II and V1

Is lead II p wave biphasic with a sort of dicrotic-looking notch? Then look at V1.

Is V1 a biphasic but mostly negative deflection at the terminal end?

If both yes, it is indicative of left atrial enlargement.

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25
Q

Causes of left atrial enlargement

A

Left Heart Failure
Cardiomyopathy
Mitral Disease

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26
Q

Where to look for EKG changes for right atrial enlargement?

A

Lead II and V1

Lead II p-wave tal, greater than or equal to 2.5mm. Then look at V1, if initial component is larger than second of p-wave - indicative of RA enlargement

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27
Q

Causes of right atrial enlargement

A

Pulmonary HTN
Tricuspid Disease

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28
Q

Where to look on EKG for LBBB

A

Look at V5 and V6. Does it have a notched R wave? If yes, could be LBBB

Look at V1 and V2. Does it have a rS morphology? Deep (negative) S wave.

29
Q

Where to look on EKG for RBBB?

A

First look at V1 and V2 - does it have a rSR’ morphology? (bunny ears)

Next look at V5 and V6. qRs, Is there a wider, slurred s wave?

  • if yes to both, RBBB indicated
30
Q

Where to look for EKG changes indicating LVH

A

Lead V1 and V2 - Deep S Waves

Then V5 and V6 - Tall R Waves

31
Q

2 causes of LVH

A

Aortic Stenosis
Hypertension

32
Q

Where to look for EKG indicating RVH

A

V1 and V2 - Tall R wave

V5 and V6 - Deep S wave

33
Q

Name a cause of RVH

A

Pulmonary HTN

34
Q

When assessing for ST depression, where should you first look and what are you looking for?

A

V2 and V3 - ST Depression 0.5mm or more
All other leads >1mm

Horizontal and/or Down-Sloping ST Depression in two contiguous leads

35
Q

What morphology of ST depression is less indicative of ischemia?

A

An upsloping ST depression

36
Q

ST depression and T wave inversion can be indicative of?

A

If trops positive - NSTEMI
If trops negative - Unstable Angina

Digoxin Toxicity, Hypokalemia

37
Q

Which is more concerning: ST Elevation with a concave or Convex morphology

A

Convex

38
Q

What amount of elevation is concerning for ST Elevation in all leads? Is there an exception?

A

New ST elevation at the J point in two contiguous leads of 0.1mV in all leads EXCEPT V2 and V3.

V2 and V3: greater than or equal to 0.2mV in men 40 years old or more

greater than or equal to 0.25mV in men less than 40

greater than or equal to 0.15mV in women

39
Q

Causes of ST elevations

A

STEMI
Pericarditis
Hyperkalemia

40
Q

How can you differentiate between Pericarditits and STEMI

A

Pericarditis usually has a concave ST elevation shape and more diffuse across almost all leads

41
Q

What is the difference between Atrial Tachycardia and Multifocal Atrial Tachycardia?

A

AT: 3 or more consecutive PACs coming from a single atrial focus, having identical, NON-SINUS, P-wave morphology

MAT: 3 or more consecutive different morphologies P waves

42
Q

MAT most commonly occurs in patients with?

A

chronic lung disease

43
Q

Longer runs, or chronic, atrial tachycardias are usually treated with?

A

Antiarrhythmics or Ablations

44
Q

An isolated posterior MI is treated as a STEMI. What would you see on a regular 12 lead EKG that would make you want to investigate and consider a posterior 12 lead?

A

ST depression in Anterior leads (V1-V2) may indicate the presence of a posterior MI

45
Q

When assessing for R wave progression, what direction of the chest leads do you expect the R wave to go from smaller to larger?

A

V1 smallest -> V5-6 biggest

46
Q

What leads do you review for R wave progression?

A

Precordial / Chest Leads

46
Q

As the R wave gets bigger, what happens to the S wave?

A

As R wave gets bigger, S wave gets smaller

47
Q

What are the characteristics of an Accelerated Idioventricular Rhythm?

A

3+ consecutive ventricular beats that are faster than regular intrinsic ventricular beats >40bpm, but slower the vTach which is >100

48
Q

1st degree AV Block has a PR interval greater than?

A

0.2s or 200ms

49
Q

What is the difference in PR interval between 2nd-degree type II and 3rd-degree AV block?

A

2nd degree type II has a consistent PR interval

The atrial rate is always faster than the ventricular rate in 3rd degree

50
Q

Your potassium is ~5.5 or greater; what EKG findings could you see?

A

QRS > 0.20, no visible p waves, Peaked T wave in MORE THAN ONE LEAD.

51
Q

Your potassium is less than ~2.7; what ekg changes could you see?

A

Prominent U wave due to delayed ventricular repolarization. Small or inverted T-wave may or may not be visible.

52
Q

What are some ECG changes that could occur with hypermagnesemia - Mag > 10

A

Delayed intraventricular conduction, prolonged QT interval, first-degree heart block, Can progress to worsening blocks

53
Q

ECG findings with hypomagnesemia Mg<1.0

A

Prolongation of QT and PR intervals

54
Q

With what electrolyte disturbance would you see an Osborn or J wave? What condition can also produce J waves?

A

Hypercalcemia - send troponins AND a calcium level.
Hypothermia

55
Q

What ECG changes can you see with hypercalcemia?

A

Shortening the ST segment corresponds to shortening or QT.

Osborn Wave / J wave

56
Q

T waves usually have a gradual ascending limb and a steeper descending limb. What electrolyte disturbance may cause a reverse of this, steep ascending and gradual descending?

A

Hypercalcemia

57
Q

Atrial Flutter is commonly a macro-reentrant tachycardia, what does that mean?

A

Develops a circuit within the RA where the impulses keep firing at the AV node.

58
Q

What is Sick Sinus Syndrome? How does it manifest? How is it treated?

A

Irreversible dysfunction of SA node. Idiopathic, “normal” wear of the heart.

Manifests as SB, sinus arrest, SA block, tachybrady syndrome

Tx: Permanent Pacemaker

59
Q

Normal T wave morphology. How should the ascending and descending parts of the wave look?

A

Upstroke should be slower and downstroke should drop / be steeper.

Think rollercoaster

60
Q

In a normal EKG, the T wave is always upright in what leads?

A

Leads I, II, V3-V6

And inverted in aVR (if it’s not, we have some sort of pathology going on)

61
Q

T waves may be flipped in what leads as a normal variant

A

V1 and V2 (maybe V3)

62
Q

What is the normal degree range for the QRS axis

A

-30 to 90 degrees

63
Q

If you’re having extreme right axis deviation, that means electrical activation is originating from?

A

The ventricles. Bad news, bears.

63
Q

Causes of extreme right axis deviation

A

VT
Accelerated Idioventricular Rhythm (death of primary pacer cells)
Massive MIs
Severe RVH
Hyperkalemia

64
Q

What is an incomplete Right BBB or LBBB?

A

It meets the morphology criteria, but it is within normal QRS duration. Less than 0.12s.

65
Q

In a LBBB, which ventricle depolarizes first?

A

Right Ventricle, then Left Ventricle

66
Q

What is the most common intraventricular conduction defect?

A

Left Anterior Fascicular Block (LAFB)

67
Q

What do you expect to see on an EKG with a patient with a Left Anterior Fascicular Block?

A

Left Axis Deviation

rS complexes in II, III, aVF
qR complexes in I and/or aVL

Foundations of Anesthesia 1 (29 decks)

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