EKG Tutorial Part 1 & 2 Flashcards by Billy Harrah

What is the Tx for sinus tachycardia?

Treat underlying cause

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What is the pacemaker of the heart?

SA node

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What effect does acute inferior MI have on the heart rate?

Bradycardia

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What is the tx for sinus bradycardia if it is symptomatic?

Atropine

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What is automaticity?

Cardiac cell depolarizes spontaneously during phase 4 of action potential which leads to generation of an impulse

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What is seen in a absence of significant heart disease; associated with stress, alcohol, tobacco, coffee, COPD, and CAD?

Premature Atrial Contraction

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What does a non-conducted premature atrial contraction look like on ecg?

No QRS following a premature P wave

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What is the Tx of premature atrial contractions?

1) Stop the underlying cause

2) Beta blocker such as metoprolol

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What is paroxysmal atrial tachycardia?

Sudden onset heart rate greater than 100

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What is seen on ecg with paroxysmal atrial tachycardia with AV block?

What is the most likely cause?

1) Spiked P waves and a 2:1 ration of P:QRS

2) Digitalis toxicity

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What is multifocal atrial tachycardia characterized by?

What intervals vary?

What is the rhythm?

What is the rate?

1) 3 or more different P waves
2) P-R interval varies
3) Irregular ventricular rhythm
4) HR > 100

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Multifocal Atrial Tachycardia is associated with?

What is the axis in this situation?

1) Lung disease

2) Right axis

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What should you avoid when treating multifocal atrial tachycardia due to the pulmonary problems?

Beta blockers

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What is the Tx for multifocal atrial tachycardia?

Calcium channel blockers such as diltiazem and verapamil

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What is the atrial rate for atrial fibrillation?

What does it look like on ecg?

What interval is irregular?

What is the ventricular rhythm described?

1) >350-600/min
2) Undulating baseline (not flat) and no P waves
3) RR interval
4) Irregularly irregular

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What characteristic appearance does atrial flutter have?

What leads is it best seen in?

1) Saw tooth

2) Leads II, III, AVF, V

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What does Paroxysmal junctional tachycardia look like on ecg?

P waves can be lost in QRS complex, inverted before QRS or after QRS

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Paroxysmal supraventricular tachycardia includes?

Paroxysmal atrial tachycardia and paroxysmal junctional tachycardia

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What does premature ventricular contractions look like on ecg?

1) Premature wide QRS
2) No preceding P wave
3) ST-T wave moves in opposite direction of QRS

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When should you use metoprolol to treat premature ventricular contractions?

When should you use amiodarone, lidocaine, or procainamide?

1) Stable PVC but still symptomatic

2) Unstable PVC

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Ventricular Tachycardia is defined by?

What is the ventricular rate?

What happens to the P wave?

How long does it last?

What type of beat is it associated with?

1) 3 or more consecutive wide QRS complexes
2) 120-200
3) Lost
4) Longer than 30 seconds
5) Fusion beats (Dressler)

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What does Torsades de Pointes look like on ECG?

QRS swings from positive to negative direction

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If Torsades de Pointes is inherited it is associated with?

Long QT

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How is Torsades de Pointes treated?

MgSO4

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What is characterized by disorganized depolarization and ineffective pumping of blood?

Ventricular fibrillation

A block that causes a disruption of atrial-to-ventricular electrical conduction is known as?

AV block

What indicates 1st degree AV block?

PR interval more than 0.2 seconds

What are some causes of 1st degree AV block?

1) Atherosclerosis 2) Hypertension 3) Diabetes 4) Fibrosis

What are the two types of 2nd degree AV block?

1) Mobitz I (Wenckebach) | 2) Mobitz II

What indicates Mobitz I (Wenckebach) 2nd degree AV block? What indicates Mobitz II?

1) Progressive PR interval prolongation prior to dropped QRS | 2) PR interval uniform and dropped QRS

Mobitz I (Wenckebach) 2nd degree AV block can be seen with? What can Mobitz II be seen with?

1) Inferior MI | 2) Anterior MI

Which 2nd degree AV block has a worse prognosis?

Mobitz II

Where is the site of block for Mobitz II?

Lower than AV node such as Bundle of His

What indicates 3rd degree heart block aka complete heart block?

P waves that beat independently from QRS complexes

When is a 3rd degree block characterized as a junctional rhythm? What does this result in?

1) Block is above AV node | 2) Narrow QRS

When is a 3rd degree block characterized as a ventricular pacemaker? What does this result in?

1) Block is below AV node | 2) Wide QRS

What are common features of bundle branch block (BBB)?

1) Wide QRS complex | 2) ST segment – T waves slope off in opposite direction to QRS

How do you differentiate between left and right BBB?

1) In LBBB the QRS complex is downwardly deflected in lead V1 2) In RBBB the QRS complex is upwardly deflected in lead V1

What are hemiblocks?

Term for blockage of one of two main division of left bundle branch

Which hemiblock is more common, left anterior hemiblock or left posterior hemiblock?

Left anterior hemiblock

What is the criteria for left anterior hemiblock?

1) Left axis deviation 2) Small Q in leads I and AVL 3) Small R in leads II, III and AVF

What is the criteria for left posterior hemiblock?

1) Right axis deviation 2) Small R in leads I and AVL 3) Small Q in leads II, III, AVF

What are some ways that cause atrial enlargement?

1) Increase in volume of blood in the chamber | 2) Increase in resistance to blood flow out of chamber

What leads is atrial enlargement best seen in?

I, II, III, V1

Which atrium is activated first in atrial enlargment?

What does right atrial enlargement look like on ecg?

Tall, pointed p wave

Right atrial enlargement is associated with what condition?

Pulmonary HTN

What does left atrial enlargement look like on ecg?

M shaped P wave called P-mitrale

What is right atrial enlargement caused by?

Mitral stenosis or regurgitation

What is the most common cause of left ventricular hypertrophy?

HTN

What does left ventricular hypertrophy look like on ecg?

1) Deep S waves and tall R waves in limb leads 2) Deep S waves in V1, V2, or V3 3) Tall R waves in V5, V6

What is the most common cause of right ventricular hypertrophy?

COPD

What does right ventricular hypertrophy look like on ecg?

1) Right axis 2) Tall R waves in V1 3) Deep S waves in V6 4) R/S ratio in V1 > 1 5) S/R ratio in V6 > 1

What effect does acidosis have on the heart?

Increased risk for Vfib

What does hypokalemia look like on ecg?

1) Prominent U waves 2) Long QT 3) Flat or inverted T wave

What is a common cause of hypokalemia?

Diuretics

What is a common cause of hyperkalemia?

Renal failure

What does hyperkalemia look like on ecg?

1) Peaked T wave 2) Wide QRS 3) Long PR interval 4) No P wave

What are common causes of hypercalcemia?

1) Hyperparathyroidism | 2) Malignancy

What does hypercalcemia look like on ecg?

1) Short QT interval | 2) Short ST segment

What does hypocalcemia look like on ecg?

1) Long QT interval | 2) Long ST segment

What is hypothermia defined as? What happens to HR? What is the characteristic finding on ecg?

1) Less than 35◦ C (95◦ F) 2) Bradycardia 3) J wave or Osborne wave (notch after QRS complex)

What effect does a pulmonary embolus have on HR?

Tachycardia

What does a PE look like on ecg?

1) Large S wave in lead I 2) ST depression in II 3) Large Q wave in III 4) T wave inversion in V1-V4 5) RBBB

What does Wolff-Parkinson – White Syndrome look like on ecg?

1) Short PR interval | 2) Slurred upstroke (delta wave) of QRS complex

What conduction pathway is involved with Wolff-Parkinson – White Syndrome?

Bundle of Kent

What does acute pericarditis look like on ecg?

1) Concave ST segment elevation in leads I, II, aVL, aVF, and V2-6 2) ST segment depression in lead aVR