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EKGs > EKGs > Flashcards

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
Q

What is it called when PVCs alternate between normal sinus beats?

A

bigeminy

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26
Q

Can PVCs be suppressed without consequence?

A

Yes

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27
Q

Can ventricular escape beats be suppressed without consequence?

A

No, could be fatal.

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28
Q

Criterion for ventricular escape rhythm/idioventricular rhythm?

A 
30-40 bpm 
No p wave*
Wide QRS 
usually regular rhythm
PR interval not measurable
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29
Q

Causes of ventricular escape rhythms?

A

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)

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30
Q

Treatment of ventricular escape rhythms?

A

Pacemaker

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31
Q

Diseases that cause ventricular escape rhythms?

A

advanced heart disease

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32
Q

What are aberrantly conducted beats through the ventricles? Cause?

A

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).

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33
Q

Criterion of aberrantly conducted beats through the ventricles?

A

early P wave with weird morphology

wide QRS

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34
Q

How to treat aberrantly conducted beats through the ventricles?

A

As premature atrial contraction

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35
Q

Criterion for NSR?

A 
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
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36
Q

Criterion for sinus tachycardia?

A

100-160bpm

QRS less than 0.12

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37
Q

Treatment of sinus tachycardia?

A

ID cause and treat.

Hyperthyroidism: CCB or BBlockers

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38
Q

Causes of sinus tachycardia?

A

CHF, volume depletion, hyperthyroidism

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39
Q

Criterion for PSVT?

A

Regular rhythm
narrow QRS
150-250 bpm
Usually no P waves

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40
Q

Common cause of PSVT?

A

Premature atrial contraction followed by a re-entry circuit (refiring of AV node simultaneously with ventricular depolarization)

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41
Q

Treatment goal of PSVT?

A

block conduction of impulses through AV node to terminate re-entry circuit

slow AV node conduction and increase AV node refractory period

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42
Q

Treatment options for PSVT?

A

1st line: vagal maneuvers
2nd line: adenosine
3rd line: CCB or BBlockers
4th line: Syncronized cardioversion

Unstable patient: syncronized cardioversion immediately

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43
Q

Atrial flutter criterion?

A 
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

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44
Q

Treatment goal of atrial flutter?

A

control ventricular rate by slowing conduction of impulse through AV node (which will increase the refractory period and prevent impulses from reaching ventricles)

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45
Q

Treatment for atrial flutter?

A

1st line: CCB or BBlockers

Unstable patient: syncronized cardioversion
stable patient that’s anti coagulated: synchronized cardioversion possible

46
Q

If you are considering synchronized cardioversion in a stable patient with atrial flutter, what must you first consider?

A

risk of systemic embolization from atrial thrombi

need to anticoagulant

47
Q

Criterion for Atrial fibrillation?

A 
Narrow QRS
irregular ventricular rhythm
No p waves
fibrillating atrial waves
fibrillating wave greater than 350x/min
48
Q

Treatment for A fibrillation?

A

CCB or BBlockers

unstable: syncronized cardioversion

stable w/ anticoagulation: syncronized cardioversion

49
Q

Causes of A fibrillation?

A

ETOH, thyroid problems, disease that cause dilation of left atrium

50
Q

Right BBB criterion?

A 
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
Q

What leads to look at for RBBB?

A

V1, V2

V5. V6

52
Q

When does a RBBB look like ventricular tachycardia?

A

When the heart rate is so fast that the P wave occurs during the QRS

53
Q

Criterion for LBBB?

A 
"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
Q

Leads to look at for LBBB?

A

V6

V1, aVL, V5

55
Q

Ventricular tachycardia criterion?

A

140-250 bpm
no p wave
wide QRS
ST segment and T wave slope in opposite direction as QRS deflection

56
Q

when is monomorphic Vtach most common?

A

with healed infarctions

57
Q

what is polymorphic Vtach associated with?

A

acute coronary ischemia
infarction
profound electrolyte imbalances
conditions that cause QT prolongation

58
Q

what are torsades de pointes?

A

Polymorphic VT in a patient with a prolong QT interval prior to the tachycardia

59
Q

How is torsades treated?

A

IV magnesium
drugs to increase HR

unstable: unsyncronized cardioversion

60
Q

causes of prolonged QT interval (drugs)?

A 
antipsychotics
quinolones
erythromycin
azithromycin
clarithromycin
some antihistamines
61
Q

sustained vs non sustained torsades?

A

sustain is greater than or = 30s

non sustained is less than 30s

62
Q

treatment of unstable monomorphic VT

A

syncronized cardioversion

63
Q

treatment of unstable/pulseless Vtach?

A

unsyncronized cardioversion

64
Q

treatment of stable monomorphic or polymorphic VT without prolonged QT?

A

amioderone
procainamide
sotalol

65
Q

Criterion for VF?

A

250-300 bpm
no CO
only in it transiently

66
Q

causes of VF?

A 
MI
CHF
hypoxemia
hypercapnia
hypotension
hyperkalemia/hypokalemia
ODs of stimulants 
shock
67
Q

Treatment for VF?

A

Epi, shock, epi, shock, amioderone until asystole

vasopressin can replace 1st or 2nd dose of epi

68
Q

How should you treat pulseless wide complex VT?

A

As VF

69
Q

Criterion for bradycardia?

A 
less than 60 bp
regular
positive p wave in L2
1:1 P wave and QRS
PR interval 0.12-0.2s
QRS
70
Q

treatment for bradycardia?

A

only if symptomatic

1st line: atropine
2nd line: transcutaneous pacemaker, dopamine, or epi
chronic: pacemaker

stable: observe

71
Q

what type of drug is atropine?

A

anticholinergic

72
Q

Criterion for first degree heart block?

A

narrow QRS

prolonged PR interval (greater than 5 blocks)

73
Q

treatment of first degree heart block?

A

only if symptomatic bradycardia

unstable: atropine
2nd line: transcutaneous pacing, dopamine, epi
stable: observe

74
Q

Criterion for type 1/wenkebach second degree heart block?

A

atrial rate regular
ventricle rate irregular
progressive prolongation of PR interval until QRS is dropped
narrow QRS

75
Q

treatment of type 1/wenkebach second degree heart block?

A

only if symptomatic bradycardia

unstable: atropine
2nd line: transcutaneous pacing, dopamine, epi
stable: observe

76
Q

Causes of type 1/wenkebach second degree heart block?

A

increased vagal tone (athletes)
meds that block AV node (BBlockers, CCB, digoxin, amioderone)
inferior MI (RCA supplies inferior heart and AV node)

77
Q

Why is atropine dangerous to give in second degree heart block?

A

could make ischemia worse (type 1)

can decrease ventricular rate (type 2)

78
Q

Criterion for type 2 second degree heart block?

A 
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
Q

treatment of type 2 second degree heart block?

A

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
Q

Third degree heart block criterion?

A

more p waves than QRS
atrial and ventricle rates regular
PR interval varies
ventricular rate less then 60

81
Q

treatment of third degree heart block?

A

Unstable: atropine
Failure: transcutaneous pacing, dopamine, or epinepherine

82
Q

criterion for asystole

A

no QRS wave

maybe P waves

83
Q

treatment of asystole

A

epi or vasopressin

CPR until D/C efforts

84
Q

should you shock someone in asytole?

A

no, unless drugs convert them to a shockable rhythm

85
Q

most common cause of asytole?

A

hypovolemia

86
Q

causes of asytole?

A

PE, acidosis, cardiac tamponade, hypothermia/hyperthermia, hypokalemia/hyperkalemia, MI, OD, hypoxia, hypotension, tension pneumothorax, HYPOVOLEMIA #1 CAUSE

87
Q

what is pulseless electrical activity?

A

A cardiac rhythm other than VT or VF without a pulse or cardiac output.

88
Q

most common causes of PEA

A

Hypovolemia or hypoxia is the most common causes.

89
Q

treatment of PEA?

A

Epi/vasopressin, CPR, ID cause and treat, if convert to shockable rhythm shock

90
Q

normal QT interval length?

A

less than half of the RR interval

or less than 0.5s

91
Q

increasing HR _____ the QT interval

A

decreases

92
Q

benefits of increasing HR with prolonged QT wave?

A

could prevent patient from going into polymorphic Vtach

93
Q

Treatment for revival from sudden cardiac death?

A

pacemaker

94
Q

when to use unsynchronized shocks?

A

pulseless, prearrest (severe shock, unstable polymorphic VT, delay in rhythm will result in cardiac arrest), when unsure if unstable monomorphic or polymorphic VT

95
Q

what to do if unsynchronized cardioversion causes VF?

A

defibrillation

96
Q

when to synchronized cardioversion?

A

A fib, A flutter, PSVT, unstable monomorphic Vtach with pulses

97
Q

When not to cardiovert?

A

junctional tachycardia, ectopic or multifocal atrial tachycardia. asystole, PEA

98
Q

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

A
  1. 2s

0. 5mV

99
Q

what is the PR interval in a BBB like?

A

Normal (0.12-0.20s)

100
Q

What is the P wave like in a BBB?

A

sinus P wave

101
Q

What is the rhythm like in a BBB?

A

regular

102
Q

ST segment in RBBB in V1 and V2?

A

ST segment depression

103
Q

T wave in RBBB in V1 and V2?

A

inverted T wave

104
Q

What is a possible orientation for ST segment and T wave in V5 and V6 of a LBBB?

A

ST segment depression

Inverted T wave

105
Q

What does the P wave look like in PVCs?

A

absent or inverted

106
Q

what does the QRS look like in type 1 second degree heart block?

A

narrow

107
Q

What does the QRS look like in first degree heart block?

A

narrow

108
Q

what does the QRS look like in third degree heart block?

A

wide

109
Q

what does the QRS look like in type 2 second degree heart block?

A

narrow or wide depending on site of block

110
Q

PSVT rate

A

150-250

111
Q

vtach rate?

A

140-250

EKGs (1 decks)

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