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
2
Q
Ventricle conduction
A
20-30 bpm
3
Q
Q wave
A
First negative wave BEFORE a positive wave
4
Q
R wave
A
Any positive wave within the QRS complex
5
Q
S wave
A
First negative wave AFTER a positive wave
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
7
Q
1 small square
A
40 ms
1 mm
8
Q
1 big box
A
200 ms
5 mm
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
10
Q
Short PR interval
A
Pre-excitation syndrome: WPW
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
12
Q
Prolonged QRS interval Ddx
A
Bundle branch blocks, IVCD, WPW, LVH, RVS
Ventricular tach, PVCs, idioventricular rhythm
13
Q
QT interval
A
Complete ventricular cycle
Defined based on heart rate
HR 60 = 400 ms
HR 100 = 320 ms
14
Q
Calculating rate
A
Boxes between each R wave/300
15
Q
Limb lead 1 view
A
Between right (negative) and left (positive) shoulders
16
Q
Limb lead 2 view
A
Between right (netagive) shoulder and left (positive) foot
17
Q
Limb lead 3 view
A
Between left foot (positive) and left shoulder (negative)
18
Q
V1 placement
A
4th intercostal space, RSB
19
Q
V2 placement
A
4th intercostal space, LSB
20
Q
V3 placement
A
Between V3 and V4
21
Q
V4 placement
A
Mid clavicular line, 5th intercostal space
22
Q
V5 placement
A
Anterior axillary line, 5th intercostal space
23
Q
V6 placement
A
Mid axillary line, 5th intercostal space
24
Q
Energy going away results in a…
A
Negative wave
25
Septum depolarizes from...
Left to right (left bundle branch innervates the septum)
26
Left axis deviation ddx
Left bundle branch block
LVH
Inferior wall MI
Left anterior fascicular block
27
Right axis deviation ddx
Right bundle branch block
RVH
High lateral wall MI
Left posterior fascicular block
28
Right bundle branch block
```
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
```
29
Left bundle branch block
```
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
```
30
Intraventricular conduction delay
wide QRS but doesn't fit any other explanation
31
WPW
Short PR interval <120 ms
Wide QRS complex 110 or greater
Delta waves
Secondary STT changes
32
Left anterior fascicular block
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
33
Left posterior fascicular block
Right axis deviation
Long but not abnormally long QRS
Small R in lead 1, small Q in lead 3
No other cause for RAD
34
Bifascicular block
RBB and LAFB is very common and stable- RBB with a left axis deviation
35
Right atrial abnormality
Lead 2, taller than 2.5 boxes
Lead V1, more positive than negative
36
Left atrial abnormality
3 boxes long P wave in lead II (I and III often)
| More negative P wave in lead V1
37
LVH simplified criteria
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
38
Ddx for large R waves in V1
Right ventricular hypertrophy
Dextrocardia
Posterior MI
Completely backwards lead placement
39
RVH findings
Right atrial abnormality
RAD
Persistent precordial S waves
Incomplete RBBB
Low voltage
Strain
Tall R wave in lead V1 aka poor R wave progression
40
Ischemia on an EKG
ST segment depression 2 mm or greater
T wave inversion
**Can't differentiate from NSTEMI
41
Injury on an EKG
ST segment elevation 1 mm or greater
| Peaky tall T waves
42
Infarction on EKG
Significant Q waves:
Q wave that is 1/4 the height of QRS
OR
Wider than 40 ms
43
Where are insignificant Q waves generally found?
I, aVL, and V4-V6 (septal Q waves)
44
What are leads that give technically significant and large, but are actually not significant, Q waves?
V1 and lead III
45
Acute vs. age indeterminate
Acute- ST elevation
Age indeterminate- no ST elevation
46
High lateral MI direct and reciprocal changes
Direct- I, aVL
| Reciprocal- II, III, aVF
47
Inferior MI direct and reciprocal changes
Direct- II, III, aVF
| Reciprocal- all other leads
48
Anteroseptal MI direct and reciprocal changes
Direct- V1 and V2
| Reciprocal- II, III, aVF
49
Anterior MI direct and reciprocal changes
Direct- V3 and V4
| Reciprocal- II, III, aVF
50
Anterolateral MI direct and reciprocal changes
Direct- V5 and V6, I and aVL
| Reciprocal- II, III, aVF
51
Complete anterior MI direct and reciprocal changes
Direct- 5/6 of the chest leads
| Reciprocal- II, III, aVF
52
Reciprocal changes
1. Occur during hyperacute phase
2. Short lived
3. Display opposite changes that are seen in direct leads
53
Posterior wall MI direct and reciprocal changes
Direct- V8 and V9
| Reciprocal- V1 and V2
54
Printzmetal's angina
Vasospastic disease of coronary vessels
Can't differentiate from an acute infarction
55
Ventricular aneurysm
Occurs generally in the anterior wall
ST elevation that is persistent after a known MI
56
Pericarditis
PR depression
ST elevation
Can lose p wave altogether
57
Hyperkalemia
Tall rocket ship T waves
Fins at the bottom of the T wave
58
Hypokalemia
U waves
Become larger and larger, envelop the T wave
59
Hypercalcemia
Shortens the QT interval
60
Hypocalcemia
Lengthens QT interval
61
Digoxin
Scooping of ST segment (has a strain look to it)
ST segment depression
Flattening/inversion of the T wave
62
Digoxin toxicity
Can develop any arrhythmia EXCEPT a fib and a flutter
63
Lead that is used for rhythm?
Limb lead II unless otherwise stated
64
Sinus bradycardia
40-60 bpm
65
Sinus tachycardia
100-160+ bpm
66
Sinus arrrhythmia
Irregular rhythm that is generally subtle
60-100 bpm or slower
67
Sinus block
Basic rhythm resumes on time after the pause
Impulse continues to be produced, but does not get transported outside the atria
68
Sinus arrest
Basic rhythm does NOT resume after the pause
69
Wandering atrial pacemaker
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
Premature atrial contractions
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
Compensatory rhythm
Rhythm maintains its integrity
72
Noncompensatory pause
Rhythm does not map out to be the rhythm before the PAC
73
Nonconducted PACs
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
Paroxysmal supraventricular tachycardia
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
PSVT/PAT treatment
1. Carotid massage
2. Valsalva maneuvers
3. DOC- adenosine
76
Atrial fibrillation
Rhy: irregular
Rate: variable, usually fast >100
P: not consistently present or reproducible
PR: not measurable
QRS: normal but can be wide
*quivering
77
Atrial fibrillation traetment
Rate control is first priority
2. Convert to normal sinus
3. Electric therapy
4. Anticoagulation
78
Atrial flutter
Rhy: regular or irregular
Rate: atrial- 250-400, ventricular varies
P: saw tooth deflections
Need to note the conduction
79
Atrial flutter treatment
Treat more aggresively
1. Rate control
2. Normal sinus
3. Electric therapy
80
Junctional rhythm
Rate: 40-60 bpm
Inverted P wave in lead II, before after or hidden in QRS complex
Short PR interval
81
Premature junctional contractions
Rhy: underlying usually regular
P: premature for the PJC, inverted in lead II, occurs before, after or hidden within QRS
PR: short!! <100
82
Accelerated junctional rhythm
P: inverted in lead II, occurs before, after or hidden within QRS
PR: short !!
Rate: 60-100
83
junctional tachycardia
Rate: greater than 100 bpm
P: inverted in lead II, before after or hidden within QRS
PR: short!!
84
First degree AV block
Rate: that of underlying rhythm
PR: prolonged, remains constant and fixed **this is the only feature
85
Second degree AV block, type 1
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
Second degree AV block, type 2
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
Third degree AV block
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
High 3rd degree block
40-60 bpm, AV node is pacing the ventricle
89
Low third degree AV block
Ventricle pacing its contractions, 30-40 bpm
90
Treatment for MOBITZ 2 and third degree AV block
Pacemakers!
91
Idioventricular rhythm
Rate: 30-40 bpm
No P
Wide QRS complex
92
Premature ventricular contraction
QRS always opposite of the T wave
QRS: premature QRS complex, abnormal shape, wide
Compensatory pause
6 PVCs in a minute is threatening
93
PVC- R on T phenomenon
Ventricle is depolarizing in the semi refractory period of the T wave, raises risk level of the PVC
94
PVC treatment
Lidocaine
95
Ventricular tachycardia
Rate: 150-250
QRS: wide** only distinction between this and PAT
Greater than 3 PVCs in a row is vtach
96
Torsades de pointe
Ventricular tachycardia with changing voltage throughout
97
Vtach treatment
Magnesium
98
Ventricular fibrillation
Vtach deteriorates into v fib, quivering of the ventricle
99
Vfib traetment
ACLS protocol
100
Asystole
Treatment
Flat line
ACLS protocol
