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cardiovascular system > electrocardiomyography 2 > Flashcards

electrocardiomyography 2 Flashcards

1
Q

where does a supraventricular arrhythmia start

A

abvove the SAN

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2
Q

where does a junctional arrhythmia start

A

in the AVN or bundle branches

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3
Q

where does a ventricular arrhythmia start

A

in the ventricle muscle itself

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4
Q

what 3 things can a ECG detect

A

conduction abnormalities
structural abnormalities
perfusion abnormalities

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5
Q

how can you see electrical abnormalities

A

measuring electrical conduction

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6
Q

how can we see the structural abnormality left ventricular hypotrophy

A

increase in muscle in L wall - reduce vol
left ventricle to base
L axis deviation
(can tell it is L axis deviation because the axis is deviate clockwise)

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7
Q

what is cardiac axis

A

the net direction of cardiac depolarisation

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8
Q

how can you tell if there are perfusion abnormalities, ie a blockage in the coronary artery

A

the tissue is ischemic so cannot contract,

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9
Q

endocardium

A

inside of the heart

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10
Q

myocardium

A

muscle

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11
Q

epicardium

A

outside of the heart

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12
Q

what are the 4 things you do before reading the ECG

A

check it is the correct recording ie the name
review the signal quality (can be changed by muscular movement, controlled by signals from the brain) and the leads - ie 12 leads, check not noisy
verify the voltage and the paper speeds (paper speed = 25ml/s, V= 10ml/mvol
review the patient and background info - will help to explain things

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13
Q

steps when looking at an ECG

A
  1. rate and rhythm - gap between r waves regular, or is rate irregular on rhythm strip, 60-100bpm normal rate
  2. check the p wave and PR interval - how long takes for wave of depolarisation to go through the atrial myocardium and AVN (meant to impede)
  3. QRS duration - 160, broad/narrow
  4. QRS axis
  5. ST segment - isoelectric, look at height
  6. QT interval
  7. T wave - tall and tented/small aand narrow- can see electrolyte disturbance and repolarisation of the heart beat.
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14
Q

characteristics of a sinus rhythm

A

1:1 ratio of P:QRS - P always followed by QRS
rate regular and normal
otherwise unremarkable

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15
Q

how do you calculate a rate from an ECG

A

calculate the average number of little squares * 0.04

ANS/60 = rate

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16
Q

what is bradycardia

A

slow heart

17
Q

characteristics of sinus bradycardia

A

1:1 ratio
rate regular
rate slow
can be healthy - just have bigger heart, mediatation, extra vagal (ie PNS stimulation)

18
Q

quick way to calculate the rate

A

300/number of big squares

19
Q

what is tachycardia

A

fast heart

20
Q

characteristics of tachycardia

A 
1:1 
rate regular 
rate fast 
not healthy 
but it is physiological eg response to overactive adrenal gland/SNS, or SV lower than it should be because of a smaller venous return
21
Q

why is resting heart rate difficult to measure

A

always going to be some excitation

in sleep - underestimate

22
Q

how can you tell axis deviation from an ECG

A

L axis deviation = L1 +ve, L3 -ve both leaving the paper

R axis deviation = L1 -ve and L3 +ve - both entering the paper

23
Q

characteristics of sinus arrhythmia

A

1:1
irregular rate - variable R-R intervals
reading depends on where it is taken
varies with breathing cycle

24
Q

characteristics of atrial fibrillation

A

oscillating baseline - atria contract asynchronously
rhythm irregular
rate may be slow
turbulent flow = blood sitting and not circulating = increased clot risk
atria not essential for the cardiac cycle - passive filling does most of it, only important in terms of contraction
QRS normal
T wave present - less obvious because smaller and baseline oscillates

25
Q

characteristics of atrial flutter

A

regular sawtooth pattern in baseline in leads 2, 3 and aVF
2:1 or 3:1 or higher
not always visible in all leads
T wave can be obscured or have similar morphology to the P waves
has a vector because regular pattern
duration of the P wave is the same

26
Q

characteristics of the 1st degree block

A 
prolonged PR segment - slower AV conduction 
regular rhythm 
1:1 
benign but progressive disease of aging 
QRST fine 
AV valve healthy so no backflow 
V still contract normally
27
Q

characteristics of a 2nd degree heart block - Mobitz 1

A

gradual prolonged PR, until beat is skipped
most P waves followed by QRS, some not
regularly irregular - caused by diseased AVN
also called Wencebach
each part is independently regular

28
Q

characteristics of a 2nbd degree heart block - Mobitz 2

A

p wave regular - only some followd by QRS
no P-R prolongation
regularly irregular eg successes: failures 2:1
can rapidly deteriorate into 3rd degree heart block
detected by patient as palpitations

29
Q

characteristics of 3rd degree heart block

A

complete
P waves regular, QRS regular - no relationship
P waves can be hidden in bigger vectors
non-sinus ie no pacemaker
pacemaker intrinsic setting at 75bpm
AVN 50bpm
ventricular myocardium- 30bpm
normally because SAN is the highest rate it controls everything
here ventricles act independently
looks like P waves are moving L because they are less frequent than QRS

30
Q

characteristics of ventricular tachycardia

A

P waves hidden, dissociated atrial rhythm
V fast and coordinated
need it to be coordinated - other wise it contracts faster than it can fill
rate regular and fast
high risk of deteriorating into fibrillation
shockable rhythm
regular vectors

31
Q

characteristics of ventricular fibrillation

A 
unable to talk - brain getting no oxygen 
HR .250bpm 
heart unable to generate an output 
shockable rhythm 
no filling 
irregular
32
Q

characterisitics of ST elevation

A 
any deviation- blood flow problem
regular rhythm and normal rate  
P wave visible 
1:1 
ST segment elevated >2mm above isoelectric line 
caused by infarction
33
Q

characteristics of ST depression

A

regular rhythm and normal rate
P wave visible
1:1
ST segment depressed >2mm below isometric line
caused by myocardial ischemia - coronary arties cannot supply the myocardium with enough O2

cardiovascular system (22 decks)

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