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CMP > EKGs and Diagnostics Exam II > Flashcards

EKGs and Diagnostics Exam II Flashcards

1
Q

What does each part of the conduction cycle represent?

A

P: atrial depolarization

QRS: ventricular depolarization

T: ventricular repolarization

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2
Q

what are the precordial leads and the limb leads?

A

precordial: v1-v6

limb: I, II, III, aVR, aVL, aVF

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3
Q

one large box and one small box on an EKG is equivalent to how much time?

A

1 large box: 0.2 seconds

1 small box: 0.04 seconds

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4
Q

what is the distance between R segments in a regular rhythm?

A

<0.12 seconds or 3 small boxes

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5
Q

what are the 3 irregularly irregular rhythms?

A

Atrial Fibrillation, Wandering Atrial Pacemaker and Multifocal Atrial Tachycardia

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6
Q

A normal axis has what? and what isoelectric leads are associated with what degree?

A

positive lead I and aVF
I: 90
aVL: 60
III: 30
aVF: 0

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7
Q

A left axis deviation has what? and what isoelectric leads are associated with what degree?

A

positive lead I and negative aVF
aVF: 0
II: -30
aVR: -60
I: -90

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8
Q

a right axis deviation has what? and what isoelectric leads are associated with what degree?

A

negative lead I and positive aVF
I: 90
aVR: 120
II: 150
aVF: 180

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9
Q

an extreme right axis deviation has what? and what isoelectric leads are associated with what degree?

A

negative lead I and negative aVF
aVF: -180
III: -150
aVL: -120
I: -90

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10
Q

describe normal sinus rhythm

A

60-100 bpm
P waves are present and similar in appearance
1 P wave for each QRS
QRS all look similar
There is equal time between each QRS (<0.12 seconds)

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11
Q

describe sinus bradycardia

A

<60 bpm
regular rhythm

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12
Q

describe sinus tachycardia

A

> 100 bpm
regular rhythm

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13
Q

what are the causes of irritable foci?

A

HISDEBS

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14
Q

describe PACs

A

unusual P wave
early QRS

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15
Q

describe PJCs

A

absent P
QRS is normal (<0.12 seconds)

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16
Q

describe PVCs

A

QRS >0.12 seconds
absent P
compensatory pause
If PVC= >15% of daily heart beats there is an increased risk of HF

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17
Q

How many beats does the SA node produce?

A

60-100

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18
Q

How many beats does the atria produce and what does the EKG show?

A

60-80
unusual P waves

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19
Q

How many beats does the AV junction produce and what does the EKG show?

A

40-60
absent P wave but normal QRS

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20
Q

How many beats do the ventricles produce and what does the EKG show?

A

wide QRS

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21
Q

describe wandering atrial pacemake

A

irregularly irregular
3 different P wave variations
atrial rate <100
can be normal

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22
Q

describe multifocal atrial tachycardia

A

irregularly irregular
3 different P wave variation
atrial rate >100 (what makes it different from WAP)
rare, treat with diltiazem

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23
Q

describe atrial flutter

A

atrial rate >300
sawtooth pattern

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24
Q

describe atrial fibrillation

A

irregularly irregular
absent P waves
anticoagulate

25
when do you send a-fib patients to the ED?
Hemodynamic instability/shock (hypotension, AMS< acute kidney injury) Suspected/confirmed myocardial ischemia/infarction Suspected/confirmed HF Pre-excitation e.g., WPW Severe bradycardia (40bpm + s/s) Comorbidities e.g., carditis, PE, HTN emergency, CHF, pneumonia
26
describe supraventricular tachycardia
includes AV node reentrant tachycardia sudden onset rate is 150-200 regular rhythm buried P waves narrow QRS
27
describe WPW
bundle of kent can skip over conduction delay in AV node delta wave PR <0.12 seconds wide QRD base
28
describe LGL syndrome
AV node is bypassed by james bundle PR <0.12 seconds no delta wave
29
describe ventricular tachycardia
100-220 bpm regular rhythm buried P wave 3+ consecutive PVCs
30
describe torsades de pointes
polymorphic vtach due to QT prolongation treat with magnesium and elctricity
31
describe ventricular fibrillation
>300 bpm irregular rhythm no identifiable waves not compatible with life
32
what rhythm is not shockable?
asystole
33
describe Brugada
occurs in structurally normal hearts, seen in 20-30 year old males increased risk of vtach and vfib and sudden cardiac death RBBB in v1-v3 ST elevation of >2mm in 2 of the following: v1-v3
34
describe type 1 brugada
down sloping ST, inverted T
35
describe type 2 brugada
saddle back ST-T, upright or biphasic T
36
describe Wellen's syndrome
deeply inverted or biphasic T wave in v2-v3 highly specific for proximal stenosis of LAD coronary artery
37
describe long QT
increased likelihood of vtach, vfib and suffer cardiac death can be congenital, caused by meds, or electrolyte imbalances QTc in makes > 440 ms QTc is females >460 ms QTC > 500 ms is associated with sudden cardiac death
38
describe first degree heart block
partial block regular rhythm prolonged PR >0.2 seconds (1 large box)
39
describe Morbitz I or Wenckebach heart block
second degree block in AV node progressively lengthening PR interval followed by dropped QRS
40
describe Morbitz II heart block
second degree block in bundle of His regular P-P interval dropped QRS
41
describe third degree heart block
indecent pacing
42
describe right bundle branch blocks
wide QRS >0.12 seconds wide S in I, aVL, v5-v6 can be normal or can be caused by CAD, MI, cardiomyopathies, myocarditis
43
describe left bundle branch blocks
wide QRS >0.12 seconds S is a deep V in v5-6 prolonged R peaks of >0.6 seconds in v5-6 almost always abnormal (pulm htn, COPD, RHF, PE, CAD, MI)
44
what is Sgarbossa criterial for determining MI with LBBB
Concordant = ST change = same direction as QRS Discordant = ST change = opposite direction as QRS 5pts = concordant ST elevation >1mm 3pts = ST depression >1mm in V1-V3 2pts = discordant ST elevation >5mm
45
describe left anterior fascicular block
marked LAD of -45 to -90 QR complex in I and aVL RS complex in II, II and aVF QRS <0.12 seconds
46
describe left posterior fascicular block
RAD of 90 to 180 RS complex in I and aVL QR in III and aVF
47
atrial enlargement is best evaluated in which leads?
II and v1
48
what is seen in right atrial enlargement?
>2.5 mm in II, III and aVF >1.5 mm in v1-v2 most common cause in severe lung disease
49
what is seen in left atrial enlargement?
negative deflection on P wave >1mm AND >0.04 seconds wide in v1 entire P wave is >0.12 seconds in lead II most common cause is mitral valve disease
50
describe right ventricular hypertrophy
RAD >110 large R in v1 progresses to small R in v6 R>S in v1 S>R in v6
51
describe left ventricular hypertrophy
R wave height change in V5 or V6 AND S wave amplitude >35mm in V1 R wave amplitude in V5 >26mm or V6 >20mm mm of S in V1 + mm R in V5 > 35mm = LVH R wave >11mm in aVL
52
describe ventricular strain pattern
ST depression and T wave inversion in precordial leads commonly mistaken for myocardial ischemia
53
describe EKG findings in pericarditis
may cause ST elevation and T wave inversion that can be mistaken for a MI ST elevation or T inversion tend to be diffuse ST depression in aVR + V1 ST = saddle shaped (concave) PR interval may be depressed or elevation in aVR = knuckle sign Spodick sign = down-sloping T-P segment
54
what does prinzmetal angina show on EKG?
localized or diffuse ST elevation only seen during spasms
55
what does moderate and severe hyperkalemia show on EKG?
Moderate: wide/flat P, wide QRS, peaked T Severe: absent P, extra wide QRS
56
what does moderate and severe hypokalemia show on EKG?
Moderate: flat T, U wave Severe: prominent U wave
57
describe benign early repolarization
widespread ST elevation more prominent in v2-v5 osborn J wave fishhook prominent, asymmetric T waves concordant with QRS
58
describe Arrhytmogenic RV dysplasia
second most common cause of sudden cardiac death in young patients epsilon wave best seen in ST of v1-v2 but can be seen from v1-v4 T wave inversion, prolonged S wave, wide QRS in v1-v3
59
what are the EKG evaluations for syncope?
LETSBAPHD

CMP (1 decks)

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