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Cardio II: EKG's > EKG's > Flashcards

EKG's Flashcards

1
Q

irregular rhythm
P wave shape varies
rate less than 100

A

wandering pacemaker

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2
Q

irregular r.
p wave shape varies
rate exceeds 100

A

multifocal atrial tachycardia

  • rhythm in COPD
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3
Q

irregular rhythm

continuous chaotic spikes b/w QRS complexes

A

atrial fibrillation

= due to continual rapid-firing of mult. atrial automaticity foci
- all foci are parastyolic and insensitive to overdrive suppression

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4
Q

see P waves

60-80 rate

A

atrial escape rhythm

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5
Q

see no P waves
rate: 40-60 bpm
lone QRS complexes

A

junctional escape rhythm (originating from AV junction)

atrial depolarization may occur in retrograde fashion, resulting in depressed P wave before or after the QRS complex

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6
Q

rate: 20-40 bpm
random P waves
large QRS complexes

A

idioventricular rhythm = ventricular escape rhythm

  • bloodflow to brain is reduced resulting in syncope –> “Sokes-Adams Syndrome”
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7
Q

Escape beats

A

pause in electrical activity: resulting from unhealthy SA node, results in escape beat

atrial escape beat: see a P wave
AV (junctional) escape beat = no P wave

ventricular escape beat = no P wave, enormous QRS complex (due to PS innervation inhibiting the above foci)

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8
Q

premature atrial beats

A

irritable automaticity focus fires sponateously

premature atrial beat = see different p wave earlier than expected, followed by QRS (or see very large T wave) - then pacing resets to the premature beat

  • can see slightly widened QRS following premature beat due to the incomplete repolarization of bundle branch - thus more slow depolarization of one ventricle

atrial and junctional foci are irritable bc:

  • adreniline/epi
  • increased symp stimulation
  • caffeine, cocaine, B1 receptor agonists
  • toxins, ethanol
  • hyperthyroidism
  • stretch/low O2
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9
Q

non-conducted premature atrial beat

A

see P wave, but no QRS following due to the AV node still being depolarized and in refractory period

  • P wave results in reset of SA rhythm
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10
Q

see two QRS complexes preceded by P waves followed closely together in sequence

A

atrial bigeminy = pattern established by irratable PAB

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11
Q

see two close together beats, one normal one, then two close together beats all with P waves

A

atrial trigeminy

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12
Q

see normal rhythms and beats followed by a slightly widened QRS that comes out of sequence

A

premature junctional beat with aberrant conduction

premature junctional beat can also cause retrograde atrial depolarization causing inverted P wave in the EKG at or before the QRS

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13
Q

Junctional Bigeminy/ Trigeminy

A

irritated junctional automaticity focus fires a premature stimuls coupled to the end of each normal SA node cycle

may see inverted P waves with every PJB

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14
Q

what makes a ventricular focus irratible?

A

low O2, reduced CO, hypokalemia, mitral valve polapse, stretch

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15
Q

see very widened QRS looking a lot different, coming out of order with no P wave in front?

A

premature ventricular contraction (PVC)

only depolarizes the ventricle, sometimes see the P wave right after it - however ventricles are still in refractory period so they dont show QRS –> results in a gap

6 PVCs / min = pathology

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16
Q

ventricular tachycardia

A

see three or more PVC’s in rapid succession, if more than 30 seconds then it is termed as “sustained” VT

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17
Q

multifocal PVCs

A

irregular lengthened QRS spikes with no P waves, come from many foci and are dangerous in developing V fib

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18
Q

mitral valve prolapse

A

= “floppy” mitral valve that billows into left atrium during systole

results in PVC’s, runs of VT, and multifocal PVCs

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19
Q

rhythm of 150-250

A

paroxysmal tachycardia: suddenly irratible focus
(not to be confused with sinus tachycardia, seen during exercise)

paroxysmal atrial tachycardia: see P waves

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20
Q

rhythm of 250-350

A

flutter

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21
Q

rhythm of 350-450

A

fibrillation

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22
Q

see rate of 150-250 with multiple P waves before every QRS wave

A

paroxysmal atrial tachycardia with AV block

  • usually a sign of digitalis xs, or toxicity or low potassium levels
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23
Q

rate of 150-250 with no P waves, but normal QRS waves

A

paroxysmal junctional tachycardia

  • may result in inverted P wave from retrograde depolarization of atria
  • may be slightly widened QRS
  • looks similar to AV nodal circus reentry
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24
Q

supraventricular tachycardia

A

either paroxysmal atrial tachycardia or paroxysmal junctional tachycardia

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25
see rapid rate of 150-250 with large widened QRS waves and nothing noticeable in between...
paroxysmal ventricular tachycardia - SA node still paces the atria, but this is hidden - thus there is AV dissociation - signifies coronary insufficiency/ischemia - seen most in elderly - see AV disocciation captures and fusions - seen in extreme RAD
26
lengthened QRS that have a wave/ribbon like pattern that occur 250-350 per minute, usually in brief episodes
Torsades de Pointes - caused by low potassium and meds that block potassium channels, long QT syndrome: all of these lengthen QT segment - occurs in short bursts - no effective ventricular pumping
27
"saw tooth patterned baseline": see many P waves at 250-350/ minute with patterned QRS complexes dispersed in between
Atrial Flutter - vagal maneuver can be diagnostic aid - due to increasing AV node refractoriness, allowing fewer flutters to be conducted to ventricles
28
see random rapid series of smooth sine waves of similar amplitude
Ventricular flutter: 250-350 bpm - produced by single ventricular automaticity focus firing at high rate - almost always deadly - often progresses into V Fib - no effective CO --> coronary arteries don't receive blood --> V Fib
29
fibrillation
multiple foci discharging rapidly: 350-450/min erratic rhythm due to profoundly irritated atrial or ventricle foci - all are parasystolic and suffer from entrance block
30
see many little little p waves all of diffferent sizes just on baseline with a few QRS waves sporadically inserted between
atrial fibrillation - see irregular pulse
31
squiggles all over baseline "bag of worms"
ventricular fibrillation: rapid-rate discharge from many parasystolic ventricular automaticity foci --> twitching of ventricles w/ rate of 350-450/min - amplitude of waves diminishes as patients heart dies
32
see sloped start to QRS complex with no baseline between the P and R wave: see shortened PR interval and lengthened QRS
Wolff-Parkinson-White syndrome - see "delta wave": sloped transition into R wave - abnormal, accessory AV conduction pathway called "bundle of kent" can "short circuit" the usual delay of ventricular conduction in the AV node. this prematurely depolarizes a portion of the ventricles produce a delta wave, just before normal depolarization begins - WPW can lead to paroxysmal tachycardia, re-entry or atrial fibrillation
33
a missed beat in an otherwise normal rhythm
sinus block | * long pause may cause escape beat from automaticity focus before SA node can keep pacing
34
AV blocks
retard or eliminate conduction from the atria to the ventricles
35
see lengthened PR interval more than one large square that is seen consistently in every cycle, with normal looking QRST sequence
primary AV block (more than .2 seconds) - from beginning of wave to beginning of QRS complex - PR interval should normally be less than one large square (less than .2 seconds) - if it is longer on any lead, then there is an existant AV block
36
progressively lengthened PR intervals, with one without a QRS response (one less QRS than P in the sequence)
Wenkebach second degree AV block - sometimes caused by PS excess in AV node - non-pathologic * in 2:1- PR interval is lengthened but QRS is normal
37
lengthened PR with QRS, followed by a paced series of P waves without QRS
"Mobitz" second degree AV block - has regular punctual P waves, but never premature P waves - pathologic, originates often below AV node in Bundle of His * in 2:1 - PR interval is normal, but the QRS is widened
38
see regular P waves, but QRS complex that seems to not be associated with any P waves- both have their own rhythm
complete third degree AV block 1. Junctional focus = Block in upper AV node = leaves junctional foci to escape and pace ventricles (40-60), QRS appears normal 2. Ventricular focus = complete block of entire AV Node or bundle of His = leaves only ventricular focus (20-40), see wide QRS complexes Stokes Adams syndrome = patient loses consciousness due to not enough blood flow to brain
39
bunny ears: see widened QRS on EKG with two peaks
Bundle Branch block - causing either left or right ventricle to depolarize late (QRS is greater than .12 seconds - at least three small squares wide) - cannot interpret vector or ventricular hypertrophy accurately from this
40
see widened QRS in V1/V2- very distinct biphasic wave
right bundle branch block
41
widened QRS in V5/V6 - less distinct, more just widened complex
left BBB
42
biphasic P wave
atrial enlargement If initial component of diphasic P wave is larger in Lead 1 then it is right atrial enlargement If heigh of P wave is larger than 2.5 mm in any lead, suspect right atrial enlargement If terminal portion of diphasic P wave is larger in V1 then its left atrial enlargement (stenosed mitral valve)
43
large R wave (positive) in V1, with smaller S wave
right ventricular hypertrophy: see large peak in V1/V2, becoming progressively decreased as go left - will also see RAD
44
really deep S wave (negative) in V1, with positive tall R waves in V5 often see asymmetrical T wave inversion in V5,6
left ventricular hypertrophy: deflection of S in V1 + R in V5 = greater than 35 mm strain pattern = humped ST segments
45
MI triad?
ischemia, injury, necrosis - need not all be present at once
46
symmetrically inverted T waves
ischemia
47
stenosis of anterior descending coronary aa?
see inverted T wave in leads V2, V3
48
elevation of ST segment
acute/recent cardiac injury
49
ventricular aneurysm
can cause persistent ST elevation in most chest leads , and does not return to baseline
50
pericarditis
ST segment is elevated and usually flat or concave or the entire T wave may be elevated off of the baseline usually present in all leads
51
flat ST depression
subendocardial infarction
52
see prominent Q wave
Necrosis = dead tissue prominent Q = the size of one small box or 1/3 heigh of QRS scan all but AVR for presence of Q waves
53
Q wave in leads V1-V4
anterior infarct = occlusion of anterior descending branch of LCA - chest leads are mostly anterior - when Q appears in V1 and V2 = antero-septal infarction in acute anterior infarction see ST elevation in first few chest leads
54
Q wave in leads I and AVL
lateral infarct = occlusion of circumflex artery from LCA
55
Q wave in leads II, III, AVF
inferior infarct = receives branches from either LCA or RCA** depending on dominance
56
Q waves in only V3 and V4
antero-lateral infarct
57
large R wave in V1 and V2
posterior wall infarct = occlusion of right coronary artery (along with SA, AV and His bundle) = V wave turned upside down when see ST segment depression in V1 and V2 as well = acute posterior infarction
58
hemiblocks?
``` LAD = anterior hemiblock RAD = posterior hemiblock ```
59
RBB and ST segment elevation in V1, V2, V3
Brugada syndrome susceptible to deadly arrhythmias - tx via implant of IVC
60
QT interval is longer than 1/2 the cardiac cycle
long QT syndrome | predisposed to ventricular arrhythmias
61
low voltage amplitudes in all leads with RAD
COPD- right ventricle works harder and is hypertrophied
62
flattened/widened P waves Widened QRS waves Peaked T waves***
hyperkalemia - will see this in all leads - see large peaked T waves in moderate - see no P wave and super wide QRS in extreme * note: T wave is tent housing K+ ions, when hyperkalemic, the tend is large, when hypokalemic the tent is flat
63
flattened T waves | prominent U waves
hypokalemia
64
shortened QT interval, widened T wave
Hypercalcemia (accelerated rate of ventricular depolarization and repolarization)
65
prolonged QT with flattened T wave
Hypocalcemia (prolonged depolarization and repolarization)
66
narrow vertical spike
pacemaker
67
U wave
hump following T wave, indicates Purkinge repolarization
68
atrial flutter vs. atrial fibrillation
- atrial flutter, see a distinct pattern of QRS complexes amidst recurrent P waves - afib: see recurrent and random P waves with random QRS complexes
69
where is EKG invalid ddx tool?
LBBB
70
firehat sign
MI
71
hypothermia
Severe sinus Bradycardia Prolonged PR interval Widened QRS complex Prolonged QT interval
72
Brugada syndrome
ECG of RBBB and persistent ST segment elevation in V1-3 * needs to be evaluated in athletes
73
``` severe sinus bradycardia prolonged PR interval widened QRS complex prolonged QT interval Osborn wave ```
Hypothermia osborn wave = extra deflection at end of QRS complex
74
ST segment elevation that is flattened with T wave elevated off of baseline seen in all leads PR segment depression
pericarditis

Cardio II: EKG's (1 decks)

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