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NPTE - Cardiopulm > Electrocardiogram (ECG) > Flashcards

Electrocardiogram (ECG) Flashcards

1
Q

Where are the 4 limb leads located?

Which is the ground electrode?

A 
Right Arm(RA): infraclavicular fossa
Left Arm (LA): infraclavicular fossa
Leg LEG (LL): left side of abdomen below rib cage
Right Leg (RL): right side of abdomen
RL IS GROUND ELECTRODE
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2
Q

How many leads vs. how many electrodes are used with ECG?

A 
12 lead
10 electrodes (4 limb leads and 6 precordial leads)
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3
Q

What is the location for the precordial leads?

A

V1: 4th intercostal space at right sternal border (start on other side of heart)
V2: 4th intercostal space on left sternal border
V3: midway between V2 and V4
V4: 5th intercostal space at left midclavicular line
V5: left anterior axillary line at V4 level
V6: left midaxillary line at V4/V5 level

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4
Q

What occurs during

  1. P wave
  2. PR interval
  3. QRS Complex
  4. QT Interval
  5. ST Segment
  6. T Wave
A
  1. P wave - atrial depolarization
  2. PR interval - time for atrial depolarization and conduction from SA node to AV node
  3. QRS Complex - ventricular depolarization and atrial repolarization
  4. QT Interval - time for both ventricular depolarization and repolarization (INCLUDES ENTIRE T WAVE)
  5. ST Segment - isoelectric period following QRS
  6. T Wave - ventricular repolarizations
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5
Q
  1. How long is the PR interval?
  2. How long is QRS complex?
  3. How long is QT interval?
A
  1. 0.12 - 0.20 seconds OR 12 to 20 ms (includes entire P wave)
  2. 0.06-0.10 seconds or 6 to 10 ms
  3. 0.20 - 0.40 or 20 to 40 ms (includes entire Q and T waves)
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6
Q

what is normal sinus rhythm?

A

60-100 bpm

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7
Q

Sinus brachy vs. tachycardia?

A

Brachy <60 bpm

Tachy > 100 bpm

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8
Q

What is a sinus rhythm but with intermittent failure of either SA nod impulse formation or AV node conduction that results in the occasional complete absence of P or QRS waves?

A

Sinus Arrest

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9
Q

What occurs when an ectopic foci in the atrium initiates an impulse before the SA node and the P wave is premature with ABNORMAL CONFIGURATION?

A

Premature Atrial Contractions (PACS)

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10
Q

What is the clinical significance of Premature Atrial Contractions?

A

very common and generally benign (stress, affeine, smoking, alcohol)
However may progress to atrial flutter, tachycardia, or fibrillation

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11
Q

what is ectopic very rapid atrial tachycardial with a rate of 250-350 bpm?

A

Atrial Flutter

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12
Q

What is the shape of the P waves with Atrial Flutter?

A

Saw-tooth P waves

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13
Q

What are 2 main conditions that Atrial Flutter occurs with?

A

Valvular Disease (especially mitral) and ischemic heart disease

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14
Q

Common arrhythmia where atria depolarized 350-600 times per minute?

A

Atrial Fibrilation

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15
Q

What does the ECG look like with Atrial Fibrilation?

A

irregular undulations of ECG without discrete P waves

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16
Q

What 3 conditions does A-Fib appear in?

A

Coronary artery disease, hypertension, and valvular disease

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17
Q

What does a 1st degree AV block look like on ECG and what are symptoms?

A

PR interval longer than 0.2 seconds but constant beat to beat
No symptoms or significant change in cardiac function

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18
Q

what causes first degree AV block?

A

many reasons including medication to suppress AV conduction

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19
Q

How does a second degree AV block appear on ECG?

A

AV conduction disturbance in which impulses between atria and ventricles fail intermittently

20
Q

What are the two types of Second Degree AV blocks and whats the differenc?

A

Mobitz I: progressive prolongation of PR interval until 1 impulse is not conducted (GENRALLY BENIGN)
Mobitz II: consecutive PR intervals are same and normal followed by non-conduction of one or more impulses (more serious)

21
Q

What occurs with 3rd degree heart block?

A

ALL impulses are blocked at AV node and none are transmitted to ventricles

atria and ventricles paced independently with atria>ventricles

22
Q

What degree of AV block is a medical emergency requiring a pacemaker?

A

3rd degree AV block

23
Q

what are 4 causes of third degree AV block?

A

degenerative changes of conduction systems, digitalis, heart surgery, and acute MI

24
Q

How does a Premature Ventricular Contraction (PVC) generally appear on the ECG?

A

P wave is usually absent and QRS complex has a wide and abberant shape

GOOGLE

25
Q

What is a Bigeminy vs Trigeminy?

A

Bigeminy: normal sinus impulse followed by a PVC
Tigeminy: PVC occurs after every two normal sinus impulses

GOOGLE

26
Q

What is 3 or more consecutive PVCs at a ventricular rate >150 bpm?

A

Ventricular Tachycardia (V-Tach)

27
Q

How does ventricular tachycardia appear on ECG?

A

P waves are absent and QRS complexes are wide adn abberant in appearance

GOOGLE

28
Q

When does V-tach become life threatening?

A

When it lasts longer than 30 seconds or if it degenerates into ventricular fibrillation

29
Q

what is it called when ventricles do not beat in a coordinated fashion but fibrillate or quiver asynchronously and ineffectively?

A

Ventricular Fibrillation

30
Q

How does Ventricular Fibrillation appear on ECG?

A

fibrallatory waves with irregular pattern that is either fine or course

GOOGLE

31
Q

What is the immediate intervention required for Ventricular Fibrillation?

A

Defibrilation

32
Q

What shows a stright line pattern on ECG and requires immediate CPR and medications to stimulate cardiac activity?

A

Ventricular Asystole

33
Q

what are 4 possible areas to find signs of Myocardial Ischemia and Infarction on an ECG?

A
  1. ST Segment depression
  2. ST Segment Elevation
  3. Q Wave
  4. T Wave Inversion
34
Q

Where is ST elevation seen on ECG?

A

0.08 seconds AFTER (2 small boxes) the J point (junction between end of QRS complex and beginning of ST segment)

35
Q

What are 3 causes of ST segment depression?

A
  1. Subendocardial Ischemia
  2. Digitalis Toxicity
  3. Hypokalemia
36
Q

What is the earliest sign of acute transmural infarction on ECG?

TRANSMURAL: MI is characterized by ischemic necrosis of the full thickness of the affected muscle segment(s), extending from the endocardium through the myocardium to the epicardium

A

ST Segment Elevation

37
Q

What is a characteristic marker of infarction?

A

Q wave longer than 0.04 sec and larger than 1/3 the amplitude of the R wave

Small box is 0.04 seconds and 1 mm

38
Q

When does T wave inversion occur?

A

hours or days after MI as the result of delay in repolarization produced by injury

39
Q

Other than infarction, what is another reason a T-Wave inversion may occur? (2)

A

with right and left bundle branch blocks and after a CVA

40
Q

How many seconds are typically on an ECG strip?

A

10 seconds

41
Q

how many millimeters is each large and small box on ECG?

what is the time interval per box????

**KNOW BOTH OF THESE**

A

Small box: 1 mm
LArge box: 5 mm

Small box: 40 ms
Large box: 200 ms

42
Q

How to caculate HR?

A

Multiple QRS complexes by 6 in 10 second strip OR

count the number of large squares between two consecutive P waves and divide by 300

43
Q

Measuring the PR interval will determine what?

A

Determine if a conduction block is present

Normal time is 0.12 to 0.20 seconds

44
Q

Where is ST segment evaluated?

A

0.08 seconds after the J point

45
Q

What is the difference between ST segment depression and ST segment elevation on ECG?

A

ST Segment Depression inidicates subendocardial (non-full thickness) ischemia

ST Segment Elevation indicates acute transmural (full thickness) infarction

NPTE - Cardiopulm (22 decks)

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