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EKGs Flashcards

1
Q

Length of time/voltage of 1 small square of EKG?

A
  1. 04s

0. 1mV

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2
Q

Length of time/voltage of 1 small square of EKG?

A
  1. 04s

0. 1mV

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3
Q

Length of time/voltage of 1 Large square of EKG?

A
  1. 2s

0. 5mV

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4
Q

SA node firing rate?

A

60-100 bpm

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5
Q

AV node/junction firing rate?

A

40-60 bpm

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6
Q

Ventricular firing rate?

A

30-45 bpm

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7
Q

Pacemaker cells other than the SA node may become the hearts pacemaker because of altered automaticity. Events that increase automaticity include:

A

MI
increased SNS tone
hypokalemia

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8
Q

Narrow complex QRS time? Where do the beats originate?

A

less than 0.12s or 3 small boxes

above the bundle of His

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9
Q

Wide complex QRS? Where do these beats originate?

A

greater than 0.12s or 3 small boxes
Below bundle of His
Or above bundle of His with BBB

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10
Q

Criterion for junctional rhythm? What lead should you look at?

A

Inverted or absent P wave in L2 (L3 and aVF)
Narrow QRS*
40-60 bpm
PR interval shortened (less than 0.12s)

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11
Q

Length of normal PR interval?

A

0.12s to 0.2s (3 small boxes to 5 small boxes)

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12
Q

Why is there sometimes an absent p wave in a junctional rhythm?

A

P wave is occurring during the QRS complex (simultaneous depolarization of atria and ventricles)

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13
Q

What is sinus arrest?

A

When the SA node stops firing

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14
Q

What are escape beats?

A

Beats that originate outside the SA node

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15
Q

Criterion for a junctional escape rhythm?

A

3 consecutive beats of firing by AV junction:

Late beat
Inverted or absent P wave in L2 (L3 and aVF)
Narrow QRS*
40-60 bpm
PR interval shortened (less than 0.12)
P wave can come before, after, or during QRS

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16
Q

How to calculate HR?

A

divide 300 by number of large boxes between R waves.

Add 0.2 for every additional small box

Example: 2 large boxes between R waves + 2 small boxes

300/2.4= 125 bpm

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17
Q

Do junctional premature beats usually have a P wave?

A

No

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18
Q

Do junctional escape beats usually have a P wave?

A

No, but if there is one it is inverted.

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19
Q

How are junctional premature beats different than junctional escape beats?

A

Junctional premature beats come early.

Junctional escape beats come late.

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20
Q

Criterion for dx PVCs?

A

Wide/bizarre QRS in most leads (greater than 0.12s)
Early beat
Inverted or absent P wave

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21
Q

What is the most common ventricular arrhythmia?

A

PVCs

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22
Q

Is it common to see a P wave in PVCs?

A

No

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23
Q

What NORMALLY occurs after a PVC?

A

Prolonged compensatory pause

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24
Q

When are isolated PVCs dangerous, why?

A

In setting of acute MI, they can trigger VT or VF if they fall on a T wave of a previous beat (called R on T phenomenon)

PVC run of 3+ beats

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25
What is it called when PVCs alternate between normal sinus beats?
bigeminy
26
Can PVCs be suppressed without consequence?
Yes
27
Can ventricular escape beats be suppressed without consequence?
No, could be fatal.
28
Criterion for ventricular escape rhythm/idioventricular rhythm?
``` 30-40 bpm No p wave* Wide QRS usually regular rhythm PR interval not measurable ```
29
Causes of ventricular escape rhythms?
Damage to SA/AV nodes impulses from SA/atria/AV node fail to reach ventricles due to 3rd degree AV block (increased vagal effect on SA/AV node)
30
Treatment of ventricular escape rhythms?
Pacemaker
31
Diseases that cause ventricular escape rhythms?
advanced heart disease
32
What are aberrantly conducted beats through the ventricles? Cause?
Atrial premature beat. When a supra ventricular beat causes a wide QRS (looks like PVC but isn't one). Usually right bundle branch repolarizes after impulses more slowly than left bundle branch. This premature atrial beat reaches the right bundle branch while it is still refractory so only the left bundle branch is originally stimulated. The left bundle branch than depolarizes the right ventricle after the right bundle branch finishes repolarizing (why you see a wide QRS).
33
Criterion of aberrantly conducted beats through the ventricles?
early P wave with weird morphology | wide QRS
34
How to treat aberrantly conducted beats through the ventricles?
As premature atrial contraction
35
Criterion for NSR?
``` 60 to 100 bpm regular positive p wave in L2 1:1 P wave and QRS PR interval 0.12-0.2s QRS less than 0.12s ```
36
Criterion for sinus tachycardia?
100-160bpm | QRS less than 0.12
37
Treatment of sinus tachycardia?
ID cause and treat. | Hyperthyroidism: CCB or BBlockers
38
Causes of sinus tachycardia?
CHF, volume depletion, hyperthyroidism
39
Criterion for PSVT?
Regular rhythm narrow QRS 150-250 bpm Usually no P waves
40
Common cause of PSVT?
Premature atrial contraction followed by a re-entry circuit (refiring of AV node simultaneously with ventricular depolarization)
41
Treatment goal of PSVT?
block conduction of impulses through AV node to terminate re-entry circuit slow AV node conduction and increase AV node refractory period
42
Treatment options for PSVT?
1st line: vagal maneuvers 2nd line: adenosine 3rd line: CCB or BBlockers 4th line: Syncronized cardioversion Unstable patient: syncronized cardioversion immediately
43
Atrial flutter criterion?
``` regular or irregular rhythm narrow complex QRS atrial rate: 250-350 (usually 300) flutter waves ventricular rate is multiple of atrial rate ``` example: atrial rate of 300 is ventricular rate of 150
44
Treatment goal of atrial flutter?
control ventricular rate by slowing conduction of impulse through AV node (which will increase the refractory period and prevent impulses from reaching ventricles)
45
Treatment for atrial flutter?
1st line: CCB or BBlockers Unstable patient: syncronized cardioversion stable patient that's anti coagulated: synchronized cardioversion possible
46
If you are considering synchronized cardioversion in a stable patient with atrial flutter, what must you first consider?
risk of systemic embolization from atrial thrombi need to anticoagulant
47
Criterion for Atrial fibrillation?
``` Narrow QRS irregular ventricular rhythm No p waves fibrillating atrial waves fibrillating wave greater than 350x/min ```
48
Treatment for A fibrillation?
CCB or BBlockers unstable: syncronized cardioversion stable w/ anticoagulation: syncronized cardioversion
49
Causes of A fibrillation?
ETOH, thyroid problems, disease that cause dilation of left atrium
50
Right BBB criterion?
``` regular rhythm sinus P wave wide QRS normal PR interval RSR' complex (bunny ears) inverted T wave (V1 and V2) Deep S waves in V5 and V6 ST segment depression (V1 and V2) ```
51
What leads to look at for RBBB?
V1, V2 | V5. V6
52
When does a RBBB look like ventricular tachycardia?
When the heart rate is so fast that the P wave occurs during the QRS
53
Criterion for LBBB?
``` "notched" R complex (V6) inverted T wave (V6) prolongation in rise of R waves Large S wave in V1 and V2 Possible ST segment depression (V5 and V6) ```
54
Leads to look at for LBBB?
V6 | V1, aVL, V5
55
Ventricular tachycardia criterion?
140-250 bpm no p wave wide QRS ST segment and T wave slope in opposite direction as QRS deflection
56
when is monomorphic Vtach most common?
with healed infarctions
57
what is polymorphic Vtach associated with?
acute coronary ischemia infarction profound electrolyte imbalances conditions that cause QT prolongation
58
what are torsades de pointes?
Polymorphic VT in a patient with a prolong QT interval prior to the tachycardia
59
How is torsades treated?
IV magnesium drugs to increase HR unstable: unsyncronized cardioversion
60
causes of prolonged QT interval (drugs)?
``` antipsychotics quinolones erythromycin azithromycin clarithromycin some antihistamines ```
61
sustained vs non sustained torsades?
sustain is greater than or = 30s | non sustained is less than 30s
62
treatment of unstable monomorphic VT
syncronized cardioversion
63
treatment of unstable/pulseless Vtach?
unsyncronized cardioversion
64
treatment of stable monomorphic or polymorphic VT without prolonged QT?
amioderone procainamide sotalol
65
Criterion for VF?
250-300 bpm no CO only in it transiently
66
causes of VF?
``` MI CHF hypoxemia hypercapnia hypotension hyperkalemia/hypokalemia ODs of stimulants shock ```
67
Treatment for VF?
Epi, shock, epi, shock, amioderone until asystole vasopressin can replace 1st or 2nd dose of epi
68
How should you treat pulseless wide complex VT?
As VF
69
Criterion for bradycardia?
``` less than 60 bp regular positive p wave in L2 1:1 P wave and QRS PR interval 0.12-0.2s QRS ```
70
treatment for bradycardia?
only if symptomatic 1st line: atropine 2nd line: transcutaneous pacemaker, dopamine, or epi chronic: pacemaker stable: observe
71
what type of drug is atropine?
anticholinergic
72
Criterion for first degree heart block?
narrow QRS | prolonged PR interval (greater than 5 blocks)
73
treatment of first degree heart block?
only if symptomatic bradycardia unstable: atropine 2nd line: transcutaneous pacing, dopamine, epi stable: observe
74
Criterion for type 1/wenkebach second degree heart block?
atrial rate regular ventricle rate irregular progressive prolongation of PR interval until QRS is dropped narrow QRS
75
treatment of type 1/wenkebach second degree heart block?
only if symptomatic bradycardia unstable: atropine 2nd line: transcutaneous pacing, dopamine, epi stable: observe
76
Causes of type 1/wenkebach second degree heart block?
increased vagal tone (athletes) meds that block AV node (BBlockers, CCB, digoxin, amioderone) inferior MI (RCA supplies inferior heart and AV node)
77
Why is atropine dangerous to give in second degree heart block?
could make ischemia worse (type 1) can decrease ventricular rate (type 2)
78
Criterion for type 2 second degree heart block?
``` Narrow or wide QRS atrial regular rate PR interval constant ventricular rate usually regular and multiple of atrial rate more P waves than QRS complexes ```
79
treatment of type 2 second degree heart block?
only if symptomatic unstable or wide QRS in setting of acute anterior MI: pacemaker 1st line: atropine 2nd line: transcutaneous pacing, dopamine, epi stable: observe
80
Third degree heart block criterion?
more p waves than QRS atrial and ventricle rates regular PR interval varies ventricular rate less then 60
81
treatment of third degree heart block?
Unstable: atropine Failure: transcutaneous pacing, dopamine, or epinepherine
82
criterion for asystole
no QRS wave | maybe P waves
83
treatment of asystole
epi or vasopressin | CPR until D/C efforts
84
should you shock someone in asytole?
no, unless drugs convert them to a shockable rhythm
85
most common cause of asytole?
hypovolemia
86
causes of asytole?
PE, acidosis, cardiac tamponade, hypothermia/hyperthermia, hypokalemia/hyperkalemia, MI, OD, hypoxia, hypotension, tension pneumothorax, HYPOVOLEMIA #1 CAUSE
87
what is pulseless electrical activity?
A cardiac rhythm other than VT or VF without a pulse or cardiac output.
88
most common causes of PEA
Hypovolemia or hypoxia is the most common causes.
89
treatment of PEA?
Epi/vasopressin, CPR, ID cause and treat, if convert to shockable rhythm shock
90
normal QT interval length?
less than half of the RR interval | or less than 0.5s
91
increasing HR _____ the QT interval
decreases
92
benefits of increasing HR with prolonged QT wave?
could prevent patient from going into polymorphic Vtach
93
Treatment for revival from sudden cardiac death?
pacemaker
94
when to use unsynchronized shocks?
pulseless, prearrest (severe shock, unstable polymorphic VT, delay in rhythm will result in cardiac arrest), when unsure if unstable monomorphic or polymorphic VT
95
what to do if unsynchronized cardioversion causes VF?
defibrillation
96
when to synchronized cardioversion?
A fib, A flutter, PSVT, unstable monomorphic Vtach with pulses
97
When not to cardiovert?
junctional tachycardia, ectopic or multifocal atrial tachycardia. asystole, PEA
98
Length of time/voltage of 1 Large square of EKG?
0. 2s | 0. 5mV
99
what is the PR interval in a BBB like?
Normal (0.12-0.20s)
100
What is the P wave like in a BBB?
sinus P wave
101
What is the rhythm like in a BBB?
regular
102
ST segment in RBBB in V1 and V2?
ST segment depression
103
T wave in RBBB in V1 and V2?
inverted T wave
104
What is a possible orientation for ST segment and T wave in V5 and V6 of a LBBB?
ST segment depression | Inverted T wave
105
What does the P wave look like in PVCs?
absent or inverted
106
what does the QRS look like in type 1 second degree heart block?
narrow
107
What does the QRS look like in first degree heart block?
narrow
108
what does the QRS look like in third degree heart block?
wide
109
what does the QRS look like in type 2 second degree heart block?
narrow or wide depending on site of block
110
PSVT rate
150-250
111
vtach rate?
140-250

EKGs (1 decks)

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