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*Summative Evaluation > EKGs > Flashcards

EKGs Flashcards

1
Q

what bundles caries the message from the RA to the LA?

A

bachmann’s bundle

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2
Q

what does the p wave indicate

A

atrial depolarization

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3
Q

with a right bundle branch block what will happen?

A

The QRS will be wider

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4
Q

what does the t wave represent

A

ventricular repolarization

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5
Q

what should the QRS be less than?

A

120 msec

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6
Q

time it takes to conduct through the AV node

A

PR segment

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7
Q

how long should the PR interval be?

A

0.12-0.20 sec

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8
Q

if there is an incomplete bundle branch block what will the length of the QRS be?

A

100-120

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9
Q

when would the PR interval be less than 120 msec? there is a delta wave

A

Wolff-Parkinson-White

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10
Q

What causes the delta wave with Wolff-Parkinson-White

A

accessory pathway
get an early depolarization of ventricles
“slurring” of the R wave

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11
Q

why is the only way to get the conduction from atria to ventricles an AV node?

A

non-conductive material between

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12
Q

if the PR interval is longer than 200 msec what in there?

A

a block

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13
Q

when should the T wave end?

A

before 1/2 the distance b/w each R wave

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14
Q

what happens when the T wave ends longer than 1/2 the distance b/w R waves

A

Long QT interval

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15
Q

what is limb lead I

A

right arm to left arm

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16
Q

what is limb lead II

A

right arm to left leg

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17
Q

avR

A

right shoulder

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18
Q

avF

A

foot (vertical line)

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19
Q

avL

A

left shoulder

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20
Q

for inferior what 3 leads do you look at?

A

II, III, aVF

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21
Q

what leads tell you the lateral side of the heard?

A

I, aVL, V5, V6

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22
Q

what leads tell you the septal part of the heart

A

Vi, V3

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23
Q

what leads for anterior part of the heart

A

V3,V4

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24
Q

if the movement of electricity is traveling towards the positive end of the lead what do you get?

A

a positive deflection above baseline

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25
Q

will the QRS with aVR point up or down?

A

down

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26
Q

II, III, and aVF should look how?

A

very similar

they are all looking up at the heart

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27
Q

do you look at aVR for pathology

A

rarely

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28
Q

what should you look at with the precordial leads

A

normal R wave progression

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29
Q

how does the R wave change as you go from V1-V6

A

R wave should have a large amplitude (can drop a bit a V5 and V5 since it is more lateral)

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30
Q

how is limb lead III orientated?

A

down and to the right

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31
Q

5 things to look for on an EKG

A 
Rate
Rhythm and Blocks
Axis
Hypertrophy
Infarction
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32
Q

what is the ectopic atrial rate

A

60-80

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33
Q

what is the AV junctional rate

A

40-60

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34
Q

what is the ventricular rate

A

20-40

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35
Q

what is bradychardia

A

<60

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36
Q

what is tachycardia

A

> 100

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37
Q

one small box is how many sec

A

0.04

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38
Q

how many sec in a big box

A

0.20 sec

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39
Q

one large box is equal to how much of a minutes

A

1/300 of a minutes

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40
Q

what is the order for the rate (when counting from R to R with big boxes) can only use for regular rate and rhythm

A 
300
150
100
75
60
50
43
37
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41
Q

if someone’s rhythm isn’t regular how do you identify the rate?

A

count the R waves in the 6 second interval and multiply by 10

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42
Q

should you count R waves or cycles

A

cycles (should count between R waves, not actual R wave)

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43
Q

how many large boxes are associated w/ 3 seconds

A

15 boxes

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44
Q

a-fib longer than how long is there a risk of developing a clot/ stroke?

A

48 hours

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45
Q

what should you check for rhythm on an EKG?

A

Is there a p wave before every QRS
Is the rhythm regular?
Check to R to R interval
Make sure p waves are rounded and point in the same direction as the QRS

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46
Q

how do you tell supraventricular versus ventricular rhythm

A

will be narrow complex with SVT

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47
Q

Premature atrial complex
premature junctional complexes captures the atria (retrograde) and the ventricles (Antegrade)
Retrograde P wave may appear before during or after the QRS

A

Supraventricular arrhythmia

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48
Q

is a fast rhythm usually fatal?

A

generally not unless there is an underlying problem

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49
Q

common cause of ectopic beats in the heart

A

stimulants

50
Q

If P to P interval of 2 normal cycles is shorter than it should be what type pause is there?

A

incomplete pause

PAC- resets SA node

51
Q

what type pause is a PVC associated with?

A

Complete pause

52
Q

ventricular response is irreguarly irregular and may be fast (HR>100)

A

a-fib

R to R interval is consistently inconsistent

53
Q 
Saw tooth appearance 
May see p waves in V1
Atrial rate 300
Often 2:1 conduction, so HR = 150
Drugs can slow conduction to 3:1, 4:1 etc
A

A flutter

54
Q

what can slow conduction to AV node

A

vagal maneuvers (bearing down)

55
Q

if they have a-fib and their heart rate is >100 what is it called?

A

a-fib w/ a rapid ventricular response (RVR)

56
Q

Lots of p waves of different shapes and sizes
Irregularly Irregular
Most often found in severe COPD patients

A

Multi focal Atrial Tachycardia

57
Q

how do you treat SVT?

A

adenosine

58
Q

what do you Rx for someone w/ a-fib w/ RVR

A

CCB or digoxin (to slow conduction)

and coumadin

59
Q

how many different morphologies of the p waves for it to be multifocal atrial tachycarida

A

3 or more

60
Q

where are multi focal atrial tachycardia seen?

A

people w/ COPD

61
Q

anything that originates above the ventricles that isn’t sinus tachycardia

A

SVT

62
Q

narrow complex, junctional re-entry

narrow QRS, may see a retrograde p wave

A

Paroxysmal supraventricular tachycardia

63
Q

3 types of SVT

A

AV reentry tachycardia
AV Nodal reentry tachycardia
Atrial tachycardia

64
Q

SVT that doesn’t involve AV node

just between atrial and ventricles

A

AV reentry tachycardia

Wolff Parkinson White

65
Q

ectopic area w/i area that likes to depolarize at faster rate than SA node so it overdrives it.

A

Atrial tachycardia

66
Q

treatment for Wollf Parkinson White

A

ablation

beta blocker

67
Q

how do you treat AV nodal reentry tachycardia to prevent it.

A

CCB (Diltiazem, verpamil)

68
Q

tx for ectopic atrial tachycardia

A 
Beta blocker (decreases ionotropic and chronotropic) 
ablation is 2nd line
69
Q

will the QRS complex with reentry SVT be narrow or wide?

A

narrow (normal)

70
Q

if you have a wide complex tachycardia what must you consider

A

that this is coming from the ventricles

71
Q

with re-entry will p waves be normal?

A

No, may be inverted or retrograde

72
Q

what will a retrograde p wave look like

A

a notched t wave
can but right up against QRS
see within QRS

73
Q

what should the QRS duration be?

A

<0.1 sec

74
Q

what do significant q waves mean?

A

significant for a heart attack

75
Q

are PVCs common?

A

Yes

76
Q

3 variations of V tach

A

monomorphic
polymorphic
torsade de pointes

77
Q

what is a Q wave considered significant

A

width of the q wave is greater than 0.04 sec (wider than one box)
or amplitude of Q wave is >1/3 the height of the R wave

78
Q

definition of a Q wave

A

first downward deflection (must be before an upward deflection)

79
Q

ventricular rhythms have a _______ QRS

A

wide (ventricles depolarizing at different times)

80
Q

how do you treat torsades de pointes

A

magnesium

81
Q

if every third beat is a PVC what is it called

A

trigemy

82
Q

If every other beta is a PVC what is in?

A

bigemy

83
Q

Delay or total failure of impulse conduction through a part of the heart

A

Blocks

84
Q

PR Interval longer than 200 msec

A

1st degree AV block

85
Q

PR interval gets longer until a nonconducted P wave occurs

A

Mobitz Type I- Second degree AV block

Wenckebach

86
Q

PR intervals are constant until a nonconducted P wave occurs

A

Mobitz Type II

87
Q

what is another way to identify 2nd degree blocks

A

grouped beating

88
Q

Complete block of signals from atria to Ventricles
No synchronization between Ps & QRS
P waves normal
HR nodal in 60s or Ventricular in 40s

A

3rd Degree AV Block

89
Q

with a bundle branch block the QRS is wider than 0.12 sec

A

Bundle branch blocks

90
Q

Mobitz Type I goes away with what?

A

activity

generally isn’t treated

91
Q

Tx for mobitz Type II

A

pacemaker

92
Q

tx for 3rd degree AV block

A

pacemaker

93
Q

what do you see with a bundle branch block

A

R-R’ waves due to separate depolarizations

QRS must be >120 msec

94
Q

what leads will a Right BBB show up in?

A

V1 and V2

95
Q

What leads will a left BBB shop up best in?

A

V5 and V6

96
Q

normal QRS axis is

A

-30° to +90°.

97
Q

30° to -90° is referred to as

A

a left axis deviation (LAD)

98
Q

+90° to +180° is referred to as a

A

right axis deviation RAD

99
Q

what lead do you use to tell if north or south hemisphere

A

aVF

100
Q

what lead do you use to tell if axis is in left or right 1/2

A

lead 1

101
Q

for atrial hypertrophy what do you look at

A

Look at lead V1 for biphasic p waves- front end will be bigger with RAH and trailing end will be bigger with LAH (deeper trough)
Or p qwave > 1.5 mm

102
Q

what is the rule for LV hypertrophy

A

If amplitude of S wave in lead V1 and R wave in V 5 or 6 exceed 35 mm = LVH

103
Q

what is the rule for RV hypertrophy

A

Right axis deviation (>90 degrees)
Tall R-waves in RV leads, deep S waves in LV leads
slight increase in QRS duration

104
Q

if just the subendocardium dies what do you see

A

ST segment depression

105
Q

if the entire endocardium dies what is seem?

A

STEMI

106
Q

what does t wave inversion mean

A

ischemia

107
Q

what serves the front wall of the heart?

A

LAD

108
Q

what serves the posterior lateral part of the heart

A

left circumflex

109
Q

what serves the right ventricle, interior

A

right ventricle

inferior

110
Q

what does the AV node get it’s blood supply from

A

RCA in 90%

111
Q

what will you see on a treadmill stress test w/ a blockage

A

onset of >2 mm ST segment depression

112
Q

where do you measure ST segment elevation?

A

At the “J” point where the S wave joints the ST segment

113
Q

Tx for inferior MI

A

lots of fluids- need to up the volume to keep blood moving

114
Q

what is ST depression in V1-3

A

posterior MI

115
Q

what is a tall S wave in limb lead 1 and a deep r wave in aVF

A

left anterior fasicular block

116
Q

what is a deep S wave in limb lead I and a tall R wave in aVF

A

left posterior fasicular block

117
Q

where does a pacemaker lead go?

A

through superior vena cava into right atria then down into right ventricle
will have a LBBB on ECG

118
Q

if there is diffuse ST segment elevation what is it?

A

pericarditis

119
Q

peaked T waves indicates what

A

hyperkalemia

120
Q

with hypokalemia what do you see

A

prominent U wave

121
Q

downsloping ST-segment elevation in leads V1 and V2 and QRS morphology resembling a RBBB

A

brugada syndrome

*Summative Evaluation (7 decks)

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