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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
Q

when do you send a-fib patients to the ED?

A

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
Q

describe supraventricular tachycardia

A

includes AV node reentrant tachycardia
sudden onset
rate is 150-200
regular rhythm
buried P waves
narrow QRS

27
Q

describe WPW

A

bundle of kent can skip over conduction delay in AV node
delta wave
PR <0.12 seconds
wide QRD base

28
Q

describe LGL syndrome

A

AV node is bypassed by james bundle
PR <0.12 seconds
no delta wave

29
Q

describe ventricular tachycardia

A

100-220 bpm
regular rhythm
buried P wave
3+ consecutive PVCs

30
Q

describe torsades de pointes

A

polymorphic vtach due to QT prolongation
treat with magnesium and elctricity

31
Q

describe ventricular fibrillation

A

> 300 bpm
irregular rhythm
no identifiable waves
not compatible with life

32
Q

what rhythm is not shockable?

A

asystole

33
Q

describe Brugada

A

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
Q

describe type 1 brugada

A

down sloping ST, inverted T

35
Q

describe type 2 brugada

A

saddle back ST-T, upright or biphasic T

36
Q

describe Wellen’s syndrome

A

deeply inverted or biphasic T wave in v2-v3
highly specific for proximal stenosis of LAD coronary artery

37
Q

describe long QT

A

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
Q

describe first degree heart block

A

partial block
regular rhythm
prolonged PR >0.2 seconds (1 large box)

39
Q

describe Morbitz I or Wenckebach heart block

A

second degree
block in AV node
progressively lengthening PR interval followed by dropped QRS

40
Q

describe Morbitz II heart block

A

second degree
block in bundle of His
regular P-P interval
dropped QRS

41
Q

describe third degree heart block

A

indecent pacing

42
Q

describe right bundle branch blocks

A

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
Q

describe left bundle branch blocks

A

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
Q

what is Sgarbossa criterial for determining MI with LBBB

A

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
Q

describe left anterior fascicular block

A

marked LAD of -45 to -90
QR complex in I and aVL
RS complex in II, II and aVF
QRS <0.12 seconds

46
Q

describe left posterior fascicular block

A

RAD of 90 to 180
RS complex in I and aVL
QR in III and aVF

47
Q

atrial enlargement is best evaluated in which leads?

A

II and v1

48
Q

what is seen in right atrial enlargement?

A

> 2.5 mm in II, III and aVF
1.5 mm in v1-v2
most common cause in severe lung disease

49
Q

what is seen in left atrial enlargement?

A

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
Q

describe right ventricular hypertrophy

A

RAD >110
large R in v1 progresses to small R in v6
R>S in v1
S>R in v6

51
Q

describe left ventricular hypertrophy

A

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
Q

describe ventricular strain pattern

A

ST depression and T wave inversion in precordial leads
commonly mistaken for myocardial ischemia

53
Q

describe EKG findings in pericarditis

A

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
Q

what does prinzmetal angina show on EKG?

A

localized or diffuse ST elevation only seen during spasms

55
Q

what does moderate and severe hyperkalemia show on EKG?

A

Moderate: wide/flat P, wide QRS, peaked T
Severe: absent P, extra wide QRS

56
Q

what does moderate and severe hypokalemia show on EKG?

A

Moderate: flat T, U wave
Severe: prominent U wave

57
Q

describe benign early repolarization

A

widespread ST elevation more prominent in v2-v5
osborn J wave
fishhook
prominent, asymmetric T waves concordant with QRS

58
Q

describe Arrhytmogenic RV dysplasia

A

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
Q

what are the EKG evaluations for syncope?

A

LETSBAPHD

CMP (1 decks)

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