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SMP - Cardiopulmonary Exam 1 > EKG Tutorial & PSW 1 - Introduction to EKG > Flashcards

EKG Tutorial & PSW 1 - Introduction to EKG Flashcards

1
Q

By convention, how can we conceive of the electrical waves traveling in the heart?

A

As waves of positive electrical charges moving through space

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2
Q

What does an upright wave on the EKG mean?

A

Means that a positive wave moves toward a positive electrode

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3
Q

Is an upright EKG wave positive or negative?

A

Positive

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4
Q

How fast are both ventricles depolarized normally?

A

Very rapidly, in less than 120 ms

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5
Q

What does the QRS represent on the EKG?

A

Ventricular depolarization

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6
Q

What does an downright wave on the EKG mean?

A

Means that a negative wave moves toward a positive electrode

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7
Q

What is the Q wave on the EKG?

A

Initial negative deflection of the QRS complex

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8
Q

What is the R wave on the EKG?

A

Any positive deflection of the QRS complex

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9
Q

What is the S wave on the EKG?

A

Any negative deflection following a positive deflection

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10
Q

Do all QRS complexes have a S wave?

A

NOPE => QR wave

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11
Q

Do all QRS complexes have a Q wave?

A

NOPE => RS wave

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12
Q

How do you call a negative deflection by its own?

A

Q wave

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13
Q

Describe the waves of a cardiac cycle on an EKG, including the 2 segments.

A
  1. P wave: atrial depolarization
  2. PR segment: AV node conduction (including delay)
  3. QRS complex: ventricular depolarization (phase 0)
  4. ST segment: plateau phase of ventricular repolarization (phase 2)
  5. T wave: phase 3 of ventricular repolarization
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14
Q

What does the direction of the T wave follow?

A

The overall direction of the QRS complex because they are opposite sign waves moving in opposite directions => concordant direction on an EKG

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15
Q

Is repolarization a positive or a negative wave?

A

Negative

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16
Q

Why doesn’t atrial repolarization appear on an EKG?

A

Because they represent such a small volume of cells in the heart and is included somewhere in the QRS complex which overwhelms that small electrical activity

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17
Q

Unit of EKG axes?

A
  • x: time

- y: voltage

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18
Q

Dimensions of EKG squares?

A
  • Small ones: 1 mm x 1mm

- Large ones: 5 mm x 5 mm

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19
Q

Speed of EKG paper? 3 ways of saying it.

A
  • 25 mm/s
  • 0.2 s/5mm = 200 ms/5mm
  • 0.04 s/1mm
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20
Q

Duration of P wave + PR interval?

A

0.16 s

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21
Q

Duration of QRS complex?

A

0.08 s

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22
Q

Where are electrodes for normal limb leads on the body of the patient? Describe the polarity of the electrodes placed.

A
  1. Right arm: (-) and (-)
  2. Left arm: (+) and (-)
  3. Left leg: (+) and (+)
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23
Q

What do the bipolar limb leads form?

A

Frontal plane

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24
Q

Define lead I

A
  • Negative electrode on right arm

- Positive electrode on left arm

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25
Q

Define lead II

A
  • Negative electrode on right arm

- Positive electrode on left leg

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26
Q

Define lead III

A
  • Negative electrode on left arm

- Positive electrode on left leg

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27
Q

Define lead AVF

A
  • Negative electrodes on right and left arms

- Positive electrode on left leg

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28
Q

Define lead AVR

A
  • Negative electrodes on left arm and left leg

- Positive electrode on right arm

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29
Q

Define lead AVL

A
  • Negative electrodes on right arm and left leg

- Positive electrode on left arm

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30
Q

Do you need to move the electrodes around as you obtain different leads?

A

No the EKG can change the polarity of the electrodes

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31
Q

What are the 6 limb leads of the standard EKG?

A

I, II, II, AVL, AVR, AVF

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32
Q

In what direction do we say a limb lead looks toward?

A

Toward the (+) electrodes

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33
Q

What are the 3 augmented limb leads?

A

AVL, AVR, AVF

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34
Q

What are the 2 lateral limb leads?

A

AVL, I

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35
Q

What are the 3 inferior limb leads?

A

II, III, AVF

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36
Q

What are the 6 chest leads? Positive or negative?

A

V1-V6

All positive

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37
Q

What are the 2 types of leads necessary to record an EKG?

A
  1. Limb leads

2. Chest leads

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38
Q

How do the chest leads QRS complexes change from V1 to V6?

A
  • R wave gets larger

- S wave gets smaller

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39
Q

What are the 2 right chest leads? Where exactly?

A

V1, V2

RV

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40
Q

What are the 2 left chest leads? Where exactly?

A

V5, V6

LV

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41
Q

Where are V3 and V4 located? What part of the heart do they transmit info on?

A

Between the R and L chest leads

Interior more medial walls of the ventricles

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42
Q

Where to start reading HR?

A

R wave

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43
Q

What are the 2 triplets to read HR on an EKG?

A

300, 150, 100

75, 60, 50

44
Q

How to calculate a more precise HR without using the triplets?

A

Divide 1500 by number of small boxes between 2 R waves

45
Q

How to find HR using the 6 s strips (3 lines on top total)?

A

Count number of cardiac cycles and multiply by 10 = HR

46
Q

How to read an EKG strip with all leads on it?

A

Everything in a straight line is happening at the same time and straight longitudinal lines separate lead readings

47
Q

What does the first mark of each horizontal reading on an EKG mean? What does it look like?

A

Calibration mark: tells you the EKG is well calibrated

Looks like upright rectangle

48
Q

Other name for chest leads? Why?

A

Precordial leads: they are on the precordium

49
Q

Purpose of having multiple leads?

A

Each lead shows the electrical activity of the heart from a different angle, so gives us a 3D image of its electrical activity

50
Q

Which EKG lead points away from all others?

A

AVR

51
Q

What angle does lead I point in?

A

0 degrees

52
Q

At what point of the heart do all EKG leads meet?

A

Point where AV bundle divides into R and L bundle branches = Wilson central terminal

53
Q

What angle does lead II point in?

A

+ 60 degrees

54
Q

What angle does lead III point in?

A

+ 120 degrees

55
Q

What angle does lead AVF point in?

A

+90 degrees

56
Q

What angle does lead AVR point in?

A

-150 degrees

57
Q

What angle does lead AVL point in?

A

-30 degrees

58
Q

What is a positive angle and what is a negative one when talking about lead directions?

A

Positive: below the horizontal place

Negative: above the horizontal plane

59
Q

Towards what parts of the heart do most EKG leads point? What is the exception?

A

R and L ventricles

Exception: AVR points toward the RA

60
Q

How will a current that is going away from a lead appear on the EKG?

A

As a negative/downward wave

61
Q

What is the precordium?

A

Area of the anterior chest wall over the heart

62
Q

What information do chest leads V1, V2 and V3 provide?

A

Whether the electrical signal is going toward the anterior or posterior side of the heart

63
Q

What information do chest leads V4, V5, and V6 provide?

A

Whether the electrical signal is going toward the left or right side of the heart

64
Q

What are the 2 lateral chest leads?

A

V5 and V6

65
Q

What are the 2 anterior chest leads?

A

V3 and V4

66
Q

What are the 2 septal chest leads?

A

V1 and V2

67
Q

What are the 4 lateral EKG leads?

A

I, AVL, V5, V6

68
Q

Through what structure does the conduction from the RA to the LA happen?

A

Bachman’s bundle

69
Q

At what HR would a heart beat in a petri dish?

A

100 bpm

70
Q

Do all muscle cells conduct electricity?

A

Yes, but conduction fibers do so at a much faster rate allowing for proper contraction of the heart

71
Q

What is the amplitude of each EKG wave dependent on?

A
  1. Number of cells sending the electrical signal

2. Amplitude of the electrical signal

72
Q

Which ventricle is depolarizing during the QRS complex?

A

BOTH

73
Q

Do we always call the QRS complex by its name even if it doesn’t have all 3 waves?

A

YUP

74
Q

How many mV in one large square? What is this called?

A

0.5 mV

I signal

75
Q

Are the rates of atrial and ventricular depolarizations the same?

A

Yes, unless there is a pathology

76
Q

What are the 3 EKG intervals during 1 cardiac cycle? What does each correspond to?

A
  1. PR interval = how long it takes for the electrical signal to get from the SA node and start ventricular depolarization
  2. QRS interval = how long it takes the electrical signals to go through the ventricles
  3. QT interval = how long ventricular depolarization AND repolarization takes
77
Q

Normal PR interval?

A

< 0.2 s (= 1 big square)

78
Q

How does the QRS complex change for all EKG leads?

A 
I: mostly positive
II: mostly positive
III: half positive/half negative
AVR: mostly negative
AVL: mostly positive
AVF: mostly positive
V1: mostly negative
V2: mostly negative
V3: mostly negative
V4: mostly positive
V5: mostly positive
V6: mostly positive
79
Q

What does a PR interval longer than 0.2 seconds indicate?

A

1st degree AV block

80
Q

Normal QRS interval?

A

< 0.12 s (=3 small boxes)

81
Q

What 2 conditions cause abnormal aka lengthened QRS intervals? How to differentiate between the 2?

A
  1. Right bundle branch block (RBBB)
  2. Left bundle branch block (LBBB)

To differentiate: look at V1

  • If V1 is positive = RBBB
  • If negative = LBBB
82
Q

What particular QRS pattern can an RBBB cause? What is it due to?

A

Rabbit ears: R-S-R’ wave pattern

Due to the fact that the LV is receiving signals BEFORE the RV

83
Q

Which leads point toward the LV?

A

AVL, I, II, V3-V6

84
Q

Which leads point toward the RV?

A

AVF, III, V1, V2

85
Q

Is a PR interval below 0.2 seconds pathological?

A

NOPE

86
Q

Normal QT interval?

A

< 450 ms

87
Q

What is long QT? What does it indicate?

A

QT interval is longer than normal

Indicates there is an issue with ventricular repolarization (if the QRS complex is normal)

88
Q

Quick cheat to find long QT?

A

IN NORMAL HEART RATES: if it takes more than half way between 2 R waves for the T wave to end => long QT

89
Q

How do we call the triangle that is made up of the 3 limb leads?

A

Einthoven’s triangle

90
Q

What parts of the lead clock are considered normal axis? How to check for this? What does it mean?

A

AVL to AVF:

  • I is positive
  • AVF is positive
  • IF AVF is negative: check II - if it’s positive you’re good

=> QRS is somewhere in this zone, which is considered normal

91
Q

What parts of the lead clock are considered left axis? How to check for this? What does it mean?

A

Lead AVL to -90 degrees

  • Lead I is positive
  • AVF is negative
  • Lead II is negative

=> left axis deviation due to extra muscle = LV hypertrophy

92
Q

What parts of the lead clock are considered right axis? How to check for this? What does it mean?

A

AVF to +180 degrees

  • AVF is positive
  • Lead I is negative

=> right axis deviation due to extra muscle = RV hypertrophy

93
Q

What does it mean when the QRS complex is isoeletric?

A

It is as negative as it is positive

94
Q

How is RA hypertrophy seen on an EKG?

A

P wave amplitude > 2.5 mm in lead II

95
Q

How is LA hypertrophy seen on an EKG?

A
  1. P wave duration > 0.12 s in frontal plane (aka in limb leads)
  2. Notched P wave in limb lead II
  3. Terminal P wave in V1 is biphasic (positive and then negative), lasts over 0.04 s and is over 1 mm high
96
Q

How is RV hypertrophy seen on an EKG?

A
  1. Right axis deviation
  2. Tall positive R waves in V1
  3. Incomplete RBBB
  4. RAE = right atrium enlargement
97
Q

How is LV hypertrophy seen on an EKG?

A
  1. Increased QRS amplitude
  2. Widened QRS
  3. Leftward axis shift
  4. LAE = left atrium enlargement
98
Q

Why does the QRS widen when there is hypertrophy of the left ventricle?

A

Because there are more cells to depolarize in the ventricle, so it takes longer

99
Q

What disease in LV hypertrophy seen with?

A

HT

100
Q

What is coronary artery disease?

A

Myocardial infarction and ischemia

101
Q

How is coronary artery disease (aka MI) seen on an EKG? Explain.

A
  1. ST segment elevation (no S wave) => means acute or recent because there is less time between depolarization and repolarization (less cells to do this to) and so the QRS complex and T wave basically merge
  2. Pathological Q waves
102
Q

How can we tell if a Q wave is pathological or not? What does the pathological one mean?

A
  1. NORMAL = Q wave narrower than 1 small box and smaller in amplitude than 1/3 of the QRS complex
  2. PATHOLOGICAL = large amplitude Q wave => patient has had an MI (dead muscle) but no idea when
103
Q

What does a non-pathological Q wave represent?

A

As the impulse goes down the septum in the His-Purjinke system, electrical signals go through the septum itself - very small signals

104
Q

What does the EKG horizontal plane correspond to?

A

Plane of chest leads

105
Q

How would a anterior coronary infarction appear on an EKG?

A

Large amplitude Q wave in V1-V4

106
Q

How would a circumflex coronary infarction appear on an EKG?

A

Large amplitude Q wave in leads I and AVL

SMP - Cardiopulmonary Exam 1 (28 decks)

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