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Cardiology (Fall 2023) > EKG test 2 > Flashcards

EKG test 2 Flashcards

1
Q
A
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1
Q

How do you estimate HR when rhythm is REGULAR

A

LARGE box method:
6 boxes - 50bpm
5 boxes - 60bpm
4 boxes - 75bpm
3 boxes - 100bpm
2 boxes - 150bpm
1 boxes - 300bpm

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2
Q

How do you estimate HR when rhythm is irregular or SLOW

A

count how many QRS complexes occur in the running lead on standard EKG and multiply by 6

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3
Q

what method would you use for this? what is the HR

A

Large box method because the rhythm is regular. this HR is about 75.

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4
Q

what method woul dyou use for this and what is the HR

A

QRS complex method because this is an irregular rhythm. HR = 84
14x6=84

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5
Q

what method couldyou use if the heart rate is fast or you wnat to get a more precise HR

A

count the number of small squares and then divide 1500 by this number

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6
Q

calculate the HR by counting the SMALL boxes

A

12 small boxes between QRS complexes
1500/12 = 125

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7
Q

calculate by using the small box method

A

43 boxes.
1500/43 = about 34

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8
Q

what are the 4 questions to use to start your interpretation of an EKG?

A
  1. are normal P waves present?
  2. are the QRS complexes wide or narrow?
  3. what is the relationship between P waves and the QRS complexes
  4. is the rhythm regular or irregular
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9
Q

what are the 5 types of arrhythmias

A
  1. sinus rhythm (brady, tachy, arrest, block)
  2. ectopic rhythm (supraventricular and ventricular)
  3. reentrant rhythms
  4. conduction block (av block, BBB)
  5. pre-excitation syndromes
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10
Q

what is sinus arrhythmia

A
  1. normal
  2. narrow QRS
  3. P wave for every QRS
  4. irregularity in rhythm.
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11
Q

What is sinus arrest? how will this present?

A

When the sinus node pauses or stops firing completely and somewhere else in the heart takes over and becomes the conductor.

this will present with irregular rhythm, and P waves presenting later than usual (ectopic escape beat).

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12
Q

How do PACs look on EKG

A
  • early contraction
  • P wave of different morphology followed by narrow QRS complex
  • Occasionaly P wave comes in so early that it may be embedded in the T wave

a regularly irregular pattern

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13
Q

What do we call PACs that are happening after EVERY normal beat?

A

Atrial bigeminy

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14
Q

WHat do you call a strip with a single PAC or infrequent PACs

A

Sinus rhythm with PACs

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15
Q

How do you name multiple and frequent PACs

A

Name them based on how frequent they are

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16
Q

What is a nonconducted PAC

A

A long break/pause in QRS complexes, usually with an abnormal T wave prior to the pause.

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17
Q

How do junctional beats present on an EKG

A
  • typically no visible P wave
  • If P wave is visible then it will be retrograde and may come before or after the QRS
  • narrow QRS complex follows
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18
Q

this is an example of a retrograde p wave in junctional beats

A
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19
Q

How does junctional rhythm present on an EKG

A
  • same as junctional beats/contractions but they are sustained
  • normal rate of junctional pacemaker cell sin 40-60 bpm
  • may be accelerated to 60-100
  • possible to even have junctional tachycardia
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20
Q

here is an example of accelerated junctional rhythm

A
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21
Q

here is an example of junctional tachycardia

A
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22
Q

How does multifocal atrial tachycardia present on an EKG

A
  • p waves of different morphology
  • varying PR segments
  • Narrow QRS
  • irregular rhythms
  • when HR >100 it is MAT (example below)
  • when heart rate is <100 it is WAP (wandering atrial pacemaker)
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23
Q

example of WAP

A
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24
Q

how does paroxysmal atrial tachycardia present on EKG

A
  • regular rhythm
  • may not see P wave if buried in T wave
  • typical HR of 100-200 bpm
  • abrupt onset
  • often difficult to discern from SVT
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25
Q

how does atrial fibrillation present on EKG

A
  • irregularly irregular rhythm
  • may have normal fast or slow rate
  • atrial activity may cause disturbances along baseline but no true P waves are visible.
26
Q

a more controlled example of afib

27
Q

how does atrial flutter present on EKG

A
  • regular rhythm
  • p waves (atrial rate) usually 250-350 bpm
  • conduction through to the ventricles varies, so HR may be variable
  • described as Atrial flutter with 2:1 block, 3:1 block and so on
  • classic “sawtooth” pattern

“Atrial fibrillations organized cousin is atrial flutter”

28
Q

what is 2:1 atrial flutter difficult to discern from sometimes

A

A tach and SVT

29
Q

example of atrial flutter with 2:1 block

30
Q

how do you discern what atiral to ventricular ratio is in atrial flutter?

A

its the atrial rate: ventricular rate

in this picture, atrial rate is 300bpm and ventricular rate is 75 therefore 300/75 is 4:1 block.

31
Q

how does paroxysmal supraventricular tachycardia present on EKG

A
  • regular rhythm
  • abrupt onset
  • abrupt cessation
  • HR of 150-250 at most
  • includes junctional tachy which is also AV nodal reentrant tachycardia (AVNRT)

very narrow, very fast QRS

32
Q

what are the two types of conduction blocks

A

intranodal (1st and 2nd degree type 1 AV node blocks)
infranodal (second degree type 2)

(3rd degree could be either or both)

33
Q

what occurs during AV blocks

A
  • conduction occurs normally in SA node and through the atria (so normal P waves)
  • followed by conduction delay or block in the AV node or His Bundle (can be 1st, 2nd, 3rd)
34
Q

describe a 1st degree AV block

A
  • still a p wave present with every QRS
  • PR interval must be greater than .2 seconds 9normal is 0.12-.2)

in this example the p wave is buried in the T wave, we know its a p wave because it follows along the same rhythm each time

35
Q

How does a second degree AV block present

A
  • come of conduction makes it through and some does not which causes an unequal P:QRS
  • 2 types (mobitz type 1 WENCKEBACH, and type 2)
36
Q

whats goin on here

A

2nd degree AV block type 1 (wenckebach)

37
Q

whats goin on here

A

second degree AV block type 2

38
Q

How does a third degree AV block present

A
  • no communication.between A and V
  • normal P waves marching along but NO relation to the QRS
  • ventricular rate usually around 30-45 bpm
  • since its coming from ventricles, QRS is now wide!!
39
Q

notice in this 3 rd degree block, the p waves occur every 18 boxes but have no relation to the QRS

A

Also! the QRS are occuring every 6 large boxes, but no relation to p wave

40
Q

How does a RBBB present on EKG

A
  • wide QRS in V1 and V2 with rSR’ pattern
  • Wide QRS in V5 and 6 but super wide “s”
41
Q

12 lead demosntration of RBBB

42
Q

How does LBBB present on EKG

A
  • in V1 and V2 we see rS pattern
  • in V5 and V6 we see a “R” pattern
43
Q

How do left anterior fascicular blocks present on an EKG

A
  1. left axis deviation
  2. small Q waves in leads I and aVL, slong with tall R waves
  3. small R waves in leads II, III and aVF, along with deep S waves.
  4. QRS duration less than .12 ms
44
Q

how does a left posterior fascicular block present on EKG

A
  1. RAD
  2. small R waves in leads ! and aVL with deep S waves
  3. small Q waves in leads II, II, and aVF along tall R waves
  4. QRS duration less than .12 ms

rare to see this along, usually occurs with RBBB as a bifascicular block

45
Q

what is a bifascicular block

A

combo of RBBB with either LAFB or LPFB

46
Q

how does a nonspecific intraventricular conduction delay present on EKG

A

QRS wider than .1 but no other criteria met

47
Q

how does a incomplete BBB present on EKG

A

BBB appearance but QRS is not wider than .12ms

48
Q

what is preexcitation syndrome

A
  • presence of a accessory pathway that allows for faster conduction to the ventricles
  • this creates a short PR interval (less than 0.12) on EKG
49
Q

what are the 2 tyeps of preexcitation syndromes

A
  • wolff parkinson white syndrome (WPW syndrome)
  • lown ganong levine syndrome (LGL syndrome)
50
Q

what is the accessory pathway for WPW syndrome

A

bundle of kent

51
Q

what is the presentation of WPW syndrome on EKG

A
  • QRS complex wider than .1 second
  • QRS complex delta wave
52
Q

what is a delta wave in WPW syndrome and what causes it

A

a small region of the myocardium that is depolarized early gives the WRS complex a characteristic slurred initial upstroke called a delta wave

53
Q

another good example of delta waves

54
Q

what is the accessory pathway for LGL syndrome

A

james fibers

goes past AV node causing a faster onset QRS (short PR)

55
Q

how does LGL syndrome present on EKG

A
  • PR interval less than .12 sec
  • QRS is NOT wide
  • no delta wave
56
Q

what can preexcitation syndromes lead to?

A

SVT following a premature complex

57
Q

what is orthodromic tachycardia

A

when SVT caused by preexcitation syndromes activates the ventricles in an antegrade manner through the AV node, generating a narrow QRS complex

58
Q

what is antidromic tachycardia

A

when SVT caused by preexcitation syndromes activates the ventricles through the accessory pathway, generating a wide QRS complex

59
Q

how does hypothermia affect the heart and therefore the EKG

A
  • everything slows down this leads to prolonged PR, QRS, QT ect. and sinus bradycardia
  • diagnostic ST-segment elevation may be seen (abrupt rise at the J point then a sudden depression back to baseline) called J wave or Osborn wave
60
Q

what is the effect of Digitalis/Digoxin on EKG at a therapeutic level

A
  • ST segment depression with flattening or inversion of T waves
  • depressed ST segments have very gradual downslope and are asymmetric
61
Q

How dos digitaliz/digoxin toxicity present on EKG

A
  • can result in bradyarrhythmias or tachyarrhythmias and can combine with AV blocks

the left is ischemia, right is digitalis effect

Cardiology (Fall 2023) (45 decks)

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