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EKG > EKG Stuff > Flashcards

EKG Stuff Flashcards

1
Q

AV node

A

40-60 Bpm

AV delay- slows the SA node impulse to let the atrium contract and fill the ventricle

**has a back door

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2
Q

Ventricle conduction

A

20-30 bpm

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3
Q

Q wave

A

First negative wave BEFORE a positive wave

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4
Q

R wave

A

Any positive wave within the QRS complex

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5
Q

S wave

A

First negative wave AFTER a positive wave

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6
Q

U wave

A

Occurs on the back side of a T wave

Should be consistent throughout a lead

Late repolarization of the ventricle

Could be pathologic for: hypokalemia and hypomagnesemia

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7
Q

1 small square

A

40 ms

1 mm

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8
Q

1 big box

A

200 ms

5 mm

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9
Q

PR interval

A

Start of P wave to beginning of QRS complex

Normal is 3-5 boxes, 120-200 ms

Best seen in II

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10
Q

Short PR interval

A

Pre-excitation syndrome: WPW

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11
Q

QRS interval

A

Beginning of QRS to J point

Normal is less than 120 ms, less than 3 boxes

Limb lead with longest QRS to measure

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12
Q

Prolonged QRS interval Ddx

A

Bundle branch blocks, IVCD, WPW, LVH, RVS

Ventricular tach, PVCs, idioventricular rhythm

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13
Q

QT interval

A

Complete ventricular cycle

Defined based on heart rate
HR 60 = 400 ms
HR 100 = 320 ms

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14
Q

Calculating rate

A

Boxes between each R wave/300

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15
Q

Limb lead 1 view

A

Between right (negative) and left (positive) shoulders

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16
Q

Limb lead 2 view

A

Between right (netagive) shoulder and left (positive) foot

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17
Q

Limb lead 3 view

A

Between left foot (positive) and left shoulder (negative)

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18
Q

V1 placement

A

4th intercostal space, RSB

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19
Q

V2 placement

A

4th intercostal space, LSB

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20
Q

V3 placement

A

Between V3 and V4

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21
Q

V4 placement

A

Mid clavicular line, 5th intercostal space

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22
Q

V5 placement

A

Anterior axillary line, 5th intercostal space

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23
Q

V6 placement

A

Mid axillary line, 5th intercostal space

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24
Q

Energy going away results in a…

A

Negative wave

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25
Q

Septum depolarizes from…

A

Left to right (left bundle branch innervates the septum)

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26
Q

Left axis deviation ddx

A

Left bundle branch block
LVH
Inferior wall MI
Left anterior fascicular block

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27
Q

Right axis deviation ddx

A

Right bundle branch block
RVH
High lateral wall MI
Left posterior fascicular block

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28
Q

Right bundle branch block

A 
Wide QRS
Axis is RAD or normal (LAD with LAFB)
RSR(p) in v1-v2
Terminal S wave in I and v6
NSSTT changes in V1 and V2
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29
Q

Left bundle branch block

A 
Wide QRS
Axis or normal or LAD
Wide monomorphic S waves in V1-V4
Wide monomorphic R wave in I and V6
V6 purely positive
NSSTT changes in most leads
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30
Q

Intraventricular conduction delay

A

wide QRS but doesn’t fit any other explanation

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31
Q

WPW

A

Short PR interval <120 ms
Wide QRS complex 110 or greater
Delta waves
Secondary STT changes

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32
Q

Left anterior fascicular block

A

Left axis deviation
Small Q lead 1, small R lead 3
Longer than normal QRS, but not abnormally long
No other cause for axis deviation

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33
Q

Left posterior fascicular block

A

Right axis deviation
Long but not abnormally long QRS
Small R in lead 1, small Q in lead 3
No other cause for RAD

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34
Q

Bifascicular block

A

RBB and LAFB is very common and stable- RBB with a left axis deviation

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35
Q

Right atrial abnormality

A

Lead 2, taller than 2.5 boxes

Lead V1, more positive than negative

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36
Q

Left atrial abnormality

A

3 boxes long P wave in lead II (I and III often)

More negative P wave in lead V1

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37
Q

LVH simplified criteria

A

Deepest S wave in V1 or V2 plus tallest R wave in lead V5 or V6 is >35

R wave in lead aVL >12

Patient >35 years old

Strain pattern

LAD

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38
Q

Ddx for large R waves in V1

A

Right ventricular hypertrophy
Dextrocardia
Posterior MI
Completely backwards lead placement

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39
Q

RVH findings

A

Right atrial abnormality

RAD

Persistent precordial S waves

Incomplete RBBB

Low voltage

Strain

Tall R wave in lead V1 aka poor R wave progression

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40
Q

Ischemia on an EKG

A

ST segment depression 2 mm or greater

T wave inversion

**Can’t differentiate from NSTEMI

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41
Q

Injury on an EKG

A

ST segment elevation 1 mm or greater

Peaky tall T waves

42
Q

Infarction on EKG

A

Significant Q waves:
Q wave that is 1/4 the height of QRS
OR
Wider than 40 ms

43
Q

Where are insignificant Q waves generally found?

A

I, aVL, and V4-V6 (septal Q waves)

44
Q

What are leads that give technically significant and large, but are actually not significant, Q waves?

A

V1 and lead III

45
Q

Acute vs. age indeterminate

A

Acute- ST elevation

Age indeterminate- no ST elevation

46
Q

High lateral MI direct and reciprocal changes

A

Direct- I, aVL

Reciprocal- II, III, aVF

47
Q

Inferior MI direct and reciprocal changes

A

Direct- II, III, aVF

Reciprocal- all other leads

48
Q

Anteroseptal MI direct and reciprocal changes

A

Direct- V1 and V2

Reciprocal- II, III, aVF

49
Q

Anterior MI direct and reciprocal changes

A

Direct- V3 and V4

Reciprocal- II, III, aVF

50
Q

Anterolateral MI direct and reciprocal changes

A

Direct- V5 and V6, I and aVL

Reciprocal- II, III, aVF

51
Q

Complete anterior MI direct and reciprocal changes

A

Direct- 5/6 of the chest leads

Reciprocal- II, III, aVF

52
Q

Reciprocal changes

A
  1. Occur during hyperacute phase
  2. Short lived
  3. Display opposite changes that are seen in direct leads
53
Q

Posterior wall MI direct and reciprocal changes

A

Direct- V8 and V9

Reciprocal- V1 and V2

54
Q

Printzmetal’s angina

A

Vasospastic disease of coronary vessels

Can’t differentiate from an acute infarction

55
Q

Ventricular aneurysm

A

Occurs generally in the anterior wall

ST elevation that is persistent after a known MI

56
Q

Pericarditis

A

PR depression

ST elevation

Can lose p wave altogether

57
Q

Hyperkalemia

A

Tall rocket ship T waves

Fins at the bottom of the T wave

58
Q

Hypokalemia

A

U waves

Become larger and larger, envelop the T wave

59
Q

Hypercalcemia

A

Shortens the QT interval

60
Q

Hypocalcemia

A

Lengthens QT interval

61
Q

Digoxin

A

Scooping of ST segment (has a strain look to it)

ST segment depression

Flattening/inversion of the T wave

62
Q

Digoxin toxicity

A

Can develop any arrhythmia EXCEPT a fib and a flutter

63
Q

Lead that is used for rhythm?

A

Limb lead II unless otherwise stated

64
Q

Sinus bradycardia

A

40-60 bpm

65
Q

Sinus tachycardia

A

100-160+ bpm

66
Q

Sinus arrrhythmia

A

Irregular rhythm that is generally subtle

60-100 bpm or slower

67
Q

Sinus block

A

Basic rhythm resumes on time after the pause

Impulse continues to be produced, but does not get transported outside the atria

68
Q

Sinus arrest

A

Basic rhythm does NOT resume after the pause

69
Q

Wandering atrial pacemaker

A

Rhy: regular or irregular

P: vary in size ad shape; one P precedes each QRS

Diagnosed almost exclusively by the changing morphology of the P wave

70
Q

Premature atrial contractions

A

Rhy: underlying rhythm regular, irregular with PACs
P: P wave of PAC is premature and abnormal in size/shape; may be hidden by preceding T wave

Non compensatory pause

71
Q

Compensatory rhythm

A

Rhythm maintains its integrity

72
Q

Noncompensatory pause

A

Rhythm does not map out to be the rhythm before the PAC

73
Q

Nonconducted PACs

A

Rhy: underlying rhythm usually regular, irregular with nonconducted PACs

P: P wave of nonconducted PAC is premature and abnormal in size and shape; may be hidden in preceding T wave

PR and QRS: nonconducted PAC

P wave occurs prematurealy but the ventricles don’t contract

74
Q

Paroxysmal supraventricular tachycardia

A

Rhy: VERY regular

Rate: 140-250

P: lost in T wave

PR: not measurable

QRS: normal- only thing that differentiates it from ventricular tachycardia**

75
Q

PSVT/PAT treatment

A
  1. Carotid massage
  2. Valsalva maneuvers
  3. DOC- adenosine
76
Q

Atrial fibrillation

A

Rhy: irregular

Rate: variable, usually fast >100

P: not consistently present or reproducible

PR: not measurable

QRS: normal but can be wide

*quivering

77
Q

Atrial fibrillation traetment

A

Rate control is first priority

  1. Convert to normal sinus
  2. Electric therapy
  3. Anticoagulation
78
Q

Atrial flutter

A

Rhy: regular or irregular

Rate: atrial- 250-400, ventricular varies

P: saw tooth deflections

Need to note the conduction

79
Q

Atrial flutter treatment

A

Treat more aggresively

  1. Rate control
  2. Normal sinus
  3. Electric therapy
80
Q

Junctional rhythm

A

Rate: 40-60 bpm

Inverted P wave in lead II, before after or hidden in QRS complex

Short PR interval

81
Q

Premature junctional contractions

A

Rhy: underlying usually regular

P: premature for the PJC, inverted in lead II, occurs before, after or hidden within QRS

PR: short!! <100

82
Q

Accelerated junctional rhythm

A

P: inverted in lead II, occurs before, after or hidden within QRS

PR: short !!

Rate: 60-100

83
Q

junctional tachycardia

A

Rate: greater than 100 bpm

P: inverted in lead II, before after or hidden within QRS

PR: short!!

84
Q

First degree AV block

A

Rate: that of underlying rhythm

PR: prolonged, remains constant and fixed **this is the only feature

85
Q

Second degree AV block, type 1

A

Rhy: regular atrial, irregular ventricular

Rate: atrial- sinus rhythm
Ventricular- depending on number of impulses conducted through AV node

PR: progressively lengthens until a P wave isn’t conducted!!!!

86
Q

Second degree AV block, type 2

A

P: two or three P waves before each QRS, may be more P waves

PR: remains constant but is prolonged or normal

Need to give two rates, ventricular and atrial

Need to note conduction

Manifests as bradycardia

87
Q

Third degree AV block

A

Rate: atrial- sinus
Ventricular- 40-60 if paced junctional, 30-40 if paced by ventricle

P: no constant relationship to QRS complex, could be hidden in QRS and T waves

88
Q

High 3rd degree block

A

40-60 bpm, AV node is pacing the ventricle

89
Q

Low third degree AV block

A

Ventricle pacing its contractions, 30-40 bpm

90
Q

Treatment for MOBITZ 2 and third degree AV block

A

Pacemakers!

91
Q

Idioventricular rhythm

A

Rate: 30-40 bpm

No P

Wide QRS complex

92
Q

Premature ventricular contraction

A

QRS always opposite of the T wave

QRS: premature QRS complex, abnormal shape, wide

Compensatory pause

6 PVCs in a minute is threatening

93
Q

PVC- R on T phenomenon

A

Ventricle is depolarizing in the semi refractory period of the T wave, raises risk level of the PVC

94
Q

PVC treatment

A

Lidocaine

95
Q

Ventricular tachycardia

A

Rate: 150-250

QRS: wide** only distinction between this and PAT

Greater than 3 PVCs in a row is vtach

96
Q

Torsades de pointe

A

Ventricular tachycardia with changing voltage throughout

97
Q

Vtach treatment

A

Magnesium

98
Q

Ventricular fibrillation

A

Vtach deteriorates into v fib, quivering of the ventricle

99
Q

Vfib traetment

A

ACLS protocol

100
Q

Asystole

Treatment

A

Flat line

ACLS protocol

EKG (1 decks)

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