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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
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

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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 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 or more negative, the 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

Something off with the RV.

-RBBB
-RVH
-LPFB (left posterior fascicular block)

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 Lead I

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.

25
Q

Causes of left atrial enlargement

A

Left Heart Failure
Cardiomyopathy
Mitral Disease

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

27
Q

Causes of right atrial enlargement

A

Pulmonary HTN
Tricuspid Disease

28
Q

Where to look on EKG for LBBB

A

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

Then look at V5 and V6. Does it have a notched R wave? If yes for both - could be LBBB

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. Is there a wide 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 both precordial and Limb Leads

A

Limb: >1mm
Precordial: > 2mm

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
A
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. Oborn/Jwaves that, when severe, can look like an acute MI

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
A

Foundations of Anesthesia 1 (24 decks)

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