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RRCCPA Clinical Medicine I > EKG stuff- Exam 2 > Flashcards

EKG stuff- Exam 2 Flashcards

1
Q

The __________ node is the primary pacemaker of the heart and is located in the upper right atrium.

A

Sinoatrial (SA) node

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2
Q

The ________ node slows impulses and backs up the pacemaker. It is located in the lower right atrium.

A

Atrioventricular (AV) node

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3
Q

The ________ ___ ____ goes from the AV node through the ventricular septum.

A

Bundle of His

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4
Q

The “baseline” of an EKG, from which all defections take off from is called the ______________.

A

Isoelectric line

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5
Q

The P wave represents what?

A

atrial depolarization, contraction of both atria

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6
Q

True or False? Sinus means “normal”.

A

FALSE. Sinus means that the SA node is properly initiating the beat

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7
Q

What should normal P waves look like?

Normal Amplitude? Normal Length?

A

Smooth, round, and usually upright EXCEPT- may be inverted on aVR or V1
Up to 2.5mm amplitude
< .12 secs / 3 small boxes

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8
Q

The presence of broad, notched (bifid) P waves in

lead II or V1 is a sign of ____ ______ ___________.

A

Left atrial enlargement

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9
Q

The presence of peaked P waves (high amplitude)

in leads II and V1 is indicative of ______ ______ ___________.

A

Right atrial enlargement

caused by pulmonary HTN or chronic lung disease

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10
Q

If a pt’s EKG shows different/ asymmetrical P waves, it usually indicates what?

A

That the SA node is not firing correctly and is likely firing from different spots

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11
Q

P waves that do not originate from the SA node are called _________ P Waves and can be positive or negative.

A

Ectopic

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12
Q

Site of origin high in atria = ________ P wave
Site of origin lower or from AV junction =________ P
wave

A

upright

inverted

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13
Q

The __ interval represents atrial depolarization through the onset of ventricular depolarization or REST.

A

PR interval

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14
Q

The PR interval is measured from beginning of ________ to onset of ____________.

A

P Wave

QRS complex

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15
Q

What is the normal duration of a PR interval?

A

< 0.20 secs

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16
Q

The _____ _________ Represents ventricular

depolarization – time from the AV node through the Purkinjie fibers.

A

QRS Complex

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17
Q

TRUE OR FALSE
The QRS Complex may or may not be composed of
three individual waves (Q, R, S)

A

TRUE

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18
Q

Where does the QRS Complex begin and end?

A 
Begins where first wave complex
deviates from baseline
Ends where last wave of complex
flattens at, above, or below the
baseline
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19
Q

What should a normal QRS complex look like? Normal amplitude? Normal duration?

A 
• Should be narrow and
sharply pointed
• Amplitude varies from
<5 mm to >15 mm
• Less than 0.12 sec
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20
Q

The __ Wave is the first NEGATIVE deflection of the QRS Complex

A 
Q wave
(If theres no negative deflection then theres no Q wave)
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21
Q

What is the normal amplitude and normal duration of a Q wave?

A

Should be less than 2 boxes in amplitude and 1 box in duration

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22
Q

A Q wave is considered pathological if it is what?

A

Deeper than 2 small squares (0.2mV) and/or

Wider than 1 small square (0.04s)

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23
Q

What might a pathological Q wave indicate for a patient?

A

Past or current MI

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24
Q

The __ Wave is the first POSITIVE deflection in the QRS complex and arises from ___________.

A

R wave

ventricular activation

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25
Q

The ___ Wave is the negative deflection following the R wave, which represents _________.

A

S wave

Represents ventricular depolarization

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26
Q

The __ ______ is from the end of the QRS

complex to the beginning of the T wave and represents ___________________.

A

ST interval
the time between ventricular depolarization to
repolarization

27
Q

The point where the QRS complex ends and the ST

segment begins is the ____________. This point represents the end of ventricular depolarization.

A 
J point
(May not be evident or May indicate early repolarization, ischemia/infarction, or pericarditis)
28
Q

ELEVATION of the ST segment (greater than 2 small boxes) can mean several things including ___________.

A

Infarction
Pericarditis – diffuse elevation in all/most leads
Early repolarization

29
Q

DEPRESSION of the ST segment (greater than 2 small boxes) can mean several things including ___________.

A
  • Ischemia

* After Digitalis administration (ionotropic med given to some CHF pts)

30
Q

The __ Wave represents ventricular repolarization.

A

T wave

31
Q

TRUE OR FALSE? The T wave should only be above the isoelectric line.

A

FALSE. The T wave can be above or below the isoelectric line.

32
Q

What do we look for in a normal T wave? What about duration/amplitude?

A

Normal T waves should be Slightly rounded and slightly asymmetrical.
We do not measure T waves, we are only concerned if they are “inverted” or “peaked”.

33
Q

Why would you be concerned about an inverted T wave?

A

Inverted T waves may suggest cardiac ischemia,
left ventricular hypertrophy, CNS injury, Digitalis
administration, and hypokalemia

34
Q

TRUE OR FALSE.
T wave amplitude more than half the height of QRS
complex (peaked T wave) may indicate
myocardial ischemia or hyperkalemia.

A

TRUE.

However, this is not common.

35
Q

The QT interval begins at the onset of ______ and ends at the end of ________.

A

QRS

T wave

36
Q

The QT interval represents ___________ and _____________.

A

Ventricular depolarization and repolarization

37
Q

How long does a normal QT interval last?

A

Normal 0.33 sec - 0.47 sec

38
Q

A QT interval greater than ____ is always abnormal!!

A

500

39
Q

In the QT interval, Prolonged and shortened both increase risk of _________ __________.

A

ventricular tachycardia - Torsades

40
Q

Prolonged QT can be genetic or caused by
___________________________.
Shortening of QT can by due to _____________.

A

prolonged- medications, hypothyroidism, hypocalcemia

shortened- hypercalcemia

41
Q

The __ Wave is not always present, but is most often seen in young athletes or bradycardia.

A

U Wave

42
Q

If the U wave is large, may represent _________, __________ or _____________.

A

hypokalemia, thyroid disease, medication effect

43
Q

The U wave is thought to represent repolarization of the ______ ______.

A

papillary muscles/ Purkenje Fibers

44
Q

The R-R interval is used to measure ____________.

A

the regularity of the rhythm

same throughout= regular rhythm

45
Q

How would you calculate an approximate heartrate on an EKG using the 6-second methond?

A

Count number of QRS complexes in a 6-second

interval and multiply number by 10

46
Q

To calculate a heartrate on an EKG using the Triplicate method, you would do what?

A

Start at a QRS (preferably on dark line, to help you see it, but if no R hits dark line you can start on any line) and count over 5 boxes, beginning at 300 on first line, then 150, then 100, then 75, 60, 50, stopping at next QRS. Where this QRS falls gives you the heartrate.

47
Q

When determining the AXIS of an EKG, Imagine that your left thumb is ______ and right thumb is ____, then look at the QRS complexes in those leads, if majority are positive, thumb is ___, if majority are negative, thumb is _____.

If both thumbs are up, the axis is ________. If right thumb up, but left thumb is down, the EKG has __________. If left thumb is up, but right thumb is down, the EKG has _________. If both thumbs are down, this is an ____________ axis.

A 
Lead I (left)
aVF (right)

up
down

normal
right axis deviation (RAD)
left axis deviation (LAD)
indeterminate

48
Q

If you have an indeterminate axis, you would then refer to which lead?
If lead II is positive, you would have a ______ axis.
If lead II is negative, you would have a ______ axis deviation.

A

Lead II
Normal
Left

49
Q

What might an indeterminate axis indicate?

A

emphysema, hyperkalemia, improper lead placement

50
Q

What types of disorders could a LAD be indicative of?

What about a RAD?

A

LAD: left ventricular hypertrophy (LVH), emphysema,
hyperkalemia, ASD (atrial septal defect), obesity

RAD: RVH (right ventricular hypertrophy), chronic lung dz, PE

(**left usu cardiac issues, right usu lung issues)

51
Q

A _____ axis deviation can be normal in kids and tall thin adults

A

right

52
Q

What would you call a heart RHYTHM that has patterned irregularity or “group beating“?

A

Regularly Irregular

53
Q

What would you call a heart RHYTHM that has only one or two R-R intervals are unequal to the others?

A

Occasionally irregular

common in PAC’s or PVC’s

54
Q

What would you call a heart RHYTHM that has totally irregularity; no relationship between R-R intervals? What condition is this rhythm usually indicative of?

A

Irregularly irregular

AFIB

55
Q

What would you evaluate the P wave for when interpreting an EKG ?

A

peaked, absent, inverted, biphasic

Is there one P wave before every QRS? One QRS for
every P?
Normal duration? <0.12sec
Are P waves present and uniform in appearance?

56
Q

What would you evaluate the PR interval for when interpreting an EKG ?

A

shortened or prolonged

Is the PR interval within normal limits?
Is the PR interval normal? 0.12 - 0.20sec
Is the PR interval constant or does is vary?
(Dont measure just one-measure multiple in running lead!)

57
Q

What would you evaluate the Q wave for when interpreting an EKG ?

A

Abnormally deep? Should be less than 2 boxes in

amplitude and 1 box in duration

58
Q

What would you evaluate the QT interval for when interpreting an EKG ?

A

short or prolonged?

Duration? (Also varies by source) 0.33-0.47 sec

59
Q

What would you evaluate the R wave for when interpreting an EKG ?

A

tall? look at QRS complex- wide?

Do they all look the same and normal?

60
Q

What would you evaluate the ST segment for when interpreting an EKG ?

A

elevation or depression

61
Q

What would you evaluate the T wave for when interpreting an EKG ?

A

Upright or inverted?
Peaked or flat?
U wave?

62
Q

What would you evaluate the QRS Complex for when interpreting an EKG ?

A

Is the QRS duration normal?
• Duration tends to vary by source, < 0.12sec
• >0.12 second (wide), something is slowing the electrical current through the ventricles (Purkinje fibers)
• Do the QRS’s look alike?

63
Q

How could you tell someone has LEFT VENTRICULAR HYPERTROPHY by looking at their EKG?

A

S in V1 or V2 (whichever is bigger) ≥ 30 mm (6 large boxes)
-OR
R in V5 or V6 ≥ 35 mm (7 large boxes)

RRCCPA Clinical Medicine I (49 decks)

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