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Year 2 > Electrocardiogram > Flashcards

Electrocardiogram Flashcards

1
Q

What is an EKG

A

Representation of the electrical events of the cardiac cycle

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2
Q

What is an arrythmia

A

Tachycardia, Bradycardia or fibrillation

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3
Q

What are the electrodes attached to the surface detecting

A

Depolarisation in the heart chambers

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4
Q

SA Node rate

A

60-100 bpm

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5
Q

AV Node rate

A

40-60 bpm

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6
Q

Ventricular cell rate

A

20-45bpm

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7
Q

Pacemaker cells of the heart

A

SA
AV
Ventricular

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8
Q

What is the standard calibration of the ECG

A
  1. 25 mm/s

2. 0.1 mV/mm

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9
Q

What do we see if the electrical impulse travels towards the electrode

A

A positive deflection

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10
Q

Describe the physiological process happening from the p-wave through the QRD complex

A
  1. SA Node
  2. AV Node
  3. Bundle of His
  4. Bundle Branches
  5. Purkyne fibres
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11
Q

What does the P wave show

A

atrial depolarisation

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12
Q

What is the PR interval

A

Atrial depolarisation AND delay in AV Node

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13
Q

What does each small box on ECG paper represent horizontally

A

0.04 s

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14
Q

What does each large box represent on an ECG paper

A

0.20 s

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15
Q

What does each large box on ECG paper represent vertically

A

0.5 mV

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16
Q

What are EKG leads needed for

A

Measure the difference in electrical potential between two points

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17
Q

What are bipolar leads

A

Two different points on th body

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18
Q

What are unipolar leads

A

One point on the body and a virtual reference point with 0 mV, located in the centre of the heart

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19
Q

How many leads does an EKG have

A

12

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20
Q

What are the 12 leads of a EKG

A
  1. Standard Limb
  2. Augmented Limb
  3. Precordial leads
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21
Q

How are the precordial leads subdivided

A

Septal - V1 +2
Anterior - V3 + 4
Lateral - V5 + 6

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22
Q

Describe the placing of the four precordial leads

A
  1. Fourth Intercostal Space right of the sternum - V1
  2. Fourth Intercostal space to the left of the sternum - V2
  3. Directly between leads V2 + V4 - V3
  4. Fifth intercostal space at left midclavicular line - V4
  5. Level with Lead V4 at left anterior axillary line - V5
  6. Level with lead V5 at left midaxillary line - V6
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23
Q

What are the four lateral leads

A

V5, V6, aVL, I

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24
Q

What are the three inferior leads

A

III, II, aVF

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25
Q

What should the normal PR interval be

A

120-200 ms (3-5 squares)

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26
Q

What should the width of the QRS complex be

A

less than 3 little squares (less than 110ms)

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27
Q

What should the QRS complex look like in leads I and II

A

Upright

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28
Q

What should the QRS and T waves have in common in all limb leads

A

The same general direction

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29
Q

What do all waves in aVR look like

A

Negative

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30
Q

What should happen to the R wave from V1 to V4

A

Should grow in each reading

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31
Q

What should happen to the S waves from V1 to V3

A

Must grow in each reading

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32
Q

What should happen to both the R and S wave in V6

A

They should disappear

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33
Q

What should we see in a normal ST segment and where is the exception

A

Should be isoelectric

EXCEPT for V1 and V2 where it may be elevated

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34
Q

In what leads does the P wave be upright in

A

I, II, V2 to V6

35
Q

What should the Q wave be in appearance in I, II, V2 to V6

A

Not smaller than 0.04 s in width

36
Q

What should the T wave look like in leads I, II, V2 to V6

A

Must be upright

37
Q

Where is P wave always positive

A

I and II

38
Q

Where is P wave negative

A

aVR

39
Q

How long should the p wave be

A

less than 3 small squared in duration

40
Q

What should be the amplitude of a p wave be

A

Less than 2.5 small squares

41
Q

What is a sign of right atrial enlargement

A

Tall (more than 2.5 squares tall) and POINTED p waves

42
Q

What does left atrial enlargement look like

A

M shaped P wave in limb leads

43
Q

What does a short PR interval indicate

A

WPW syndrome

44
Q

What does a long PR interval indicate (longer than 200ms)

A

First degree heart block or hypokalemia

45
Q

What does a short PR interval indicate (less than 120 ms)

A

WPW Syndrome

46
Q

Why would the PR interval be short physiologically

A

Accessory pathway (Bundle of Kent) allows early activation of the ventricle

47
Q

Where may NON-PATHOLOGICAL q waves be seen

A

I, III, aVL, V5 and V6

48
Q

R wave in lead V6 vs V5

A

Smaller

49
Q

What should the depth of the S wave in the QRS complex normally be

A

30 mm or less

50
Q

What is a pathological Q wave in the QRS complex

A

Greater than 2mm deep and 1mm wide

51
Q

What characteristics in an EKG would indicate LEFT VENTRICULAR HYPERTROPHY

A

S in V1 + R in V5/6 is greater than 35 mm

R wave of 11 to 13 mm in aVL

52
Q

What is a pathological ST segment

A

Elevation by 1mm or more

53
Q

What is the J segment

A

Point between QRS and ST segment

54
Q

What does a normal T wave look like

A

Asymmetrical (first half is more gradual)

At least 1/8 but less than 2/3 of the amplitude of R

Same direction as QRS

55
Q

What is an abnormal size for a T wave

A

10mm or more

56
Q

What do abnormal T waves look like

A

Symmetrical
Tall
Peaked
Biphasic or inverted

57
Q

Where is the QT interval usually investigated

A

In lead aVL as Uwave is not prominent (very small)

58
Q

What is the QT interval

A

Total duration of depolarisation and depolarisation

59
Q

What happens to the QT interval when HR increases

A

It decreases

60
Q

What is the QT for 70 bpm

A

Less than 0.40 s

61
Q

What should a normal QT interval be

A

0.35-0.45 s

62
Q

What is U wave

A

After depolarisation which follow depolarisation

63
Q

What do U waves look like

A

Small, round and symmetrical

64
Q

In what lead are U waves positive

A

II

65
Q

Amplitude of a U wave

A

Less than 2mm

66
Q

When are U waves more prominent

A

As heart rate slows

67
Q

How do we calculate heart rate from an EKG for regular rhythms

A

Count the number of big boxes between TWO QRS complexes and divide 300 by the number

68
Q

How do we calculate heart rate from an EKG for irregular rhythms

A

Count number of beats present on EKG and * by 6

69
Q

What is the QRS axis

A

Represents overall direction of the heart’s electrical activity

70
Q

What do abnormalities in the QRs complex hint at

A

Ventricular enlargement

Conduction Blocks

71
Q

What does the normal QRS axis run from

A

-30 to +90 degrees

72
Q

What is Left axis deviation

A

-30 to - 90

73
Q

What is right axis deviation

A

+90 to +180

74
Q

What is the equiphasic approach to determining the QRS axis

A

Locate the most isoelectric limb lead and identify a second lead 90 degrees away from original

Determine if lead shows a positive or negative QRS

75
Q

Symptoms of AF

A
  1. Asymptomatic
  2. Palpitations
  3. Syncope
  4. Dyspneoa
  5. Chest pains
76
Q

What features of an ECG allow us to see an AF

A
  1. NO P WAVE

2. Irregular heart rate

77
Q

How is AF managed

A
  1. If acutely needed: Heparin > warfarin
  2. If chronic: Warfarin > Heparin
    CARDIOVERSION
    ABLATION techniques (removing cells causing AF)
78
Q

What is cardioversion

A

Conversion of irregular heartbeat to normal heartbeat using AMIODARONE etc (anti-arhythmic drugs) or electrically

79
Q

Rate control measures for ECG

A
  1. Beta-blockers (BISOPROLOL or ATENOLOL)
  2. Calcium-channel blockers (VERAPAMIL or DILIMIAZEM)
  3. Digoxin
80
Q

What type of heart disease is atrial flutter

A

Supraventircular tachycardia

81
Q

What causes atrial flutter

A

CAD
High BP
Cardiomyopathy

82
Q

Atrial Flutter ECG

A

Saw tooth (jaggered) P waves

P:QRS ratio is 2:1

83
Q

Atrial rate in Atrial Flutter

A

300 BPM

84
Q

What is sinus tachycardia

A

Basically heart is in rhythm (everything’s fine) BUT qrs complexes are very frequent

Year 2 (155 decks)

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