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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
Q

see rapid rate of 150-250 with large widened QRS waves and nothing noticeable in between…

A

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
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26
Q

lengthened QRS that have a wave/ribbon like pattern that occur 250-350 per minute, usually in brief episodes

A

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
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27
Q

“saw tooth patterned baseline”: see many P waves at 250-350/ minute with patterned QRS complexes dispersed in between

A

Atrial Flutter
- vagal maneuver can be diagnostic aid - due to increasing AV node refractoriness, allowing fewer flutters to be conducted to ventricles

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28
Q

see random rapid series of smooth sine waves of similar amplitude

A

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
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29
Q

fibrillation

A

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

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30
Q

see many little little p waves all of diffferent sizes just on baseline with a few QRS waves sporadically inserted between

A

atrial fibrillation - see irregular pulse

31
Q

squiggles all over baseline “bag of worms”

A

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
Q

see sloped start to QRS complex with no baseline between the P and R wave: see shortened PR interval and lengthened QRS

A

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
Q

a missed beat in an otherwise normal rhythm

A

sinus block

* long pause may cause escape beat from automaticity focus before SA node can keep pacing

34
Q

AV blocks

A

retard or eliminate conduction from the atria to the ventricles

35
Q

see lengthened PR interval more than one large square that is seen consistently in every cycle, with normal looking QRST sequence

A

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
Q

progressively lengthened PR intervals, with one without a QRS response (one less QRS than P in the sequence)

A

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
Q

lengthened PR with QRS, followed by a paced series of P waves without QRS

A

“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
Q

see regular P waves, but QRS complex that seems to not be associated with any P waves- both have their own rhythm

A

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
Q

bunny ears: see widened QRS on EKG with two peaks

A

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
Q

see widened QRS in V1/V2- very distinct biphasic wave

A

right bundle branch block

41
Q

widened QRS in V5/V6 - less distinct, more just widened complex

A

left BBB

42
Q

biphasic P wave

A

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
Q

large R wave (positive) in V1, with smaller S wave

A

right ventricular hypertrophy: see large peak in V1/V2, becoming progressively decreased as go left
- will also see RAD

44
Q

really deep S wave (negative) in V1, with positive tall R waves in V5

often see asymmetrical T wave inversion in V5,6

A

left ventricular hypertrophy: deflection of S in V1 + R in V5 = greater than 35 mm

strain pattern = humped ST segments

45
Q

MI triad?

A

ischemia, injury, necrosis - need not all be present at once

46
Q

symmetrically inverted T waves

A

ischemia

47
Q

stenosis of anterior descending coronary aa?

A

see inverted T wave in leads V2, V3

48
Q

elevation of ST segment

A

acute/recent cardiac injury

49
Q

ventricular aneurysm

A

can cause persistent ST elevation in most chest leads , and does not return to baseline

50
Q

pericarditis

A

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
Q

flat ST depression

A

subendocardial infarction

52
Q

see prominent Q wave

A

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

Q wave in leads V1-V4

A

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

Q wave in leads I and AVL

A

lateral infarct = occlusion of circumflex artery from LCA

55
Q

Q wave in leads II, III, AVF

A

inferior infarct = receives branches from either LCA or RCA** depending on dominance

56
Q

Q waves in only V3 and V4

A

antero-lateral infarct

57
Q

large R wave in V1 and V2

A

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
Q

hemiblocks?

A 
LAD = anterior hemiblock
RAD = posterior hemiblock
59
Q

RBB and ST segment elevation in V1, V2, V3

A

Brugada syndrome
susceptible to deadly arrhythmias
- tx via implant of IVC

60
Q

QT interval is longer than 1/2 the cardiac cycle

A

long QT syndrome

predisposed to ventricular arrhythmias

61
Q

low voltage amplitudes in all leads with RAD

A

COPD- right ventricle works harder and is hypertrophied

62
Q

flattened/widened P waves
Widened QRS waves
Peaked T waves***

A

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
Q

flattened T waves

prominent U waves

A

hypokalemia

64
Q

shortened QT interval, widened T wave

A

Hypercalcemia (accelerated rate of ventricular depolarization and repolarization)

65
Q

prolonged QT with flattened T wave

A

Hypocalcemia (prolonged depolarization and repolarization)

66
Q

narrow vertical spike

A

pacemaker

67
Q

U wave

A

hump following T wave, indicates Purkinge repolarization

68
Q

atrial flutter vs. atrial fibrillation

A
  • 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
Q

where is EKG invalid ddx tool?

A

LBBB

70
Q

firehat sign

A

MI

71
Q

hypothermia

A

Severe sinus Bradycardia
Prolonged PR interval
Widened QRS complex
Prolonged QT interval

72
Q

Brugada syndrome

A

ECG of RBBB and persistent ST segment elevation in V1-3

  • needs to be evaluated in athletes
73
Q 
severe sinus bradycardia
prolonged PR interval
widened QRS complex
prolonged QT interval
Osborn wave
A

Hypothermia

osborn wave = extra deflection at end of QRS complex

74
Q

ST segment elevation that is flattened with T wave elevated off of baseline seen in all leads

PR segment depression

A

pericarditis

Cardio II: EKG's (1 decks)

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