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EKG Use and Interpretation > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

(2) Vagus Nerve Stimulation

A
  1. Carotid Massage
  2. Valsalva Maneuver
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2
Q

12-lead EKG lead Placement

1 lead on each extremity ___, ____, ____, ____

A

RA, LA, RL, LL

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3
Q

12-lead EKG lead Placement

V1?

A

Right 4th ICS at Sternal Margin

*ICS = Intercostal Space

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4
Q

12-lead EKG lead Placement

V2

A

Left 4th ICS at Sternal Margin

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5
Q

12-lead EKG lead Placement

V3

A

Midway between V2 and V4

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6
Q

12-lead EKG lead Placement

V4?

A

5th ICS at L MCL

ICS - Intercostal Space

MCL - Mid-Clavicular Line

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7
Q

12-lead EKG lead Placement

V5?

A

5th ICS at L AAL

ICS - Intercostal Pace

AAL - Anterior Axillary Line

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8
Q

12-lead EKG lead Placement

V6?

A

5th ICS at L MAL

ICS = Intercostal Space

MAL = Midaxillary Line

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9
Q

24-48 hours of continuous EKG recording

Used in conjunction with the patient diary for when they feel symptomatic.

A

Holter Monitor

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10
Q

Gradually lengthening PR interval until a QRS complex is dropped.

A

2nd Degree AV Block: Mobtiz Type I

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11
Q

A power source connected to electrodes, is inserted into the heart muscle

A

Pacemaker

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12
Q

A rhythm is caused by an interruption of the electrical conduction from the SA node to the atria.

A

Sinus Node Block

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13
Q

A rhythm originating paroxysmally (abruptly) at a re-entry circuit in the AV junction.

A

Paroxysmal Supraventricular Tachycardia (PSVT)

More commonly an Atrioventricular Node Re-entry Tachycardia (AVNRT) is the mechanism behind this.

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14
Q

A run of more than 3 PVCs in a row where the R-R interval is regular and the rate is > 100 bpm. The beat originates in the ventricles.

A

Ventricular Tachycardia

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15
Q

A supraventricular beat is conducted aberrantly through the ventricles.

Produces a wide, bizarre-looking QRS complex (like a PVC)

There is a visible P Wave

A

Aberrancy

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16
Q

All PVCs come from the same irritable foci in the ventricle.

A

Unifocal PVC

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17
Q

Any disturbance in the rate, regularity, site of origin, or conduction of the cardiac electrical impulse.

A

Arrhythmia

*Anything but normal sinus rhythm.

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18
Q

Any obstruction or delay of the normal conduction between the SA node and the Purkinje fibers.

A

Conduction Block

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19
Q

Application of a synchronized electrical current to a patient with the goal of depolarizing all cells to reset the excitable cells causing an arrhythmia.

Allows the SA node to regain control at a normal rate.

A

Cardioversion

*Delivery of the shock is time to avoid the T-Wave. It can induce ventricular fibrillation.

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20
Q

Artificially induces electronic stimulus that paces the patient’s rhythm causing a blip or spike on the ECG waveform.

A

Singel Chamber Pacemaker

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21
Q

Augmented Leads

A

aVR

aVL

aVF

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22
Q

AV Block with no relationship between P and QRS complex.

More P waves than QRS complexes.

A

3rd Degree AV Block (Complete Heart Block)

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23
Q

AV Node depolarization rate

A

40-60 beats/min

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24
Q

Beat (of atrial origin) that arrives earlier than expected next beat.

Caused by irritable foci in the atria spontaneously depolarizing.

Associated with a different shape to P Wave.

This was followed by a compensatory pause.

A

Premature Atrial Contraction (PAC)

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25
Q

Beat originates in the ventricles and occurs when the ventricular myocytes depolarize at a faster rate than the SA and AV nodes, making the ventricular cells the pacemaker.

A

Idioventricular Rhythm (IVR)

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26
Q

Bipolar Leads

Lead III

A

Left Arm > Left Leg

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27
Q

Bipolar Leads

A

Leads I, II, III

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28
Q

Bipolar Leads

Lead I

A

Right Arm > Left Arm

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29
Q

Bipolar Leads

Lead II

A

Right Arm > Left Leg

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30
Q

Cardiac cells become _______ during repolarization.

A

Negative

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31
Q

Cardiac cells become _________ charged during depolarization.

A

Postively

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32
Q

Cardiac cells carry a relatively _______ charge at rest.

A

Negative

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33
Q

Cause:

A

Idioventricular Rhythm (IVR)

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34
Q

Causes:

Hypoxia

Hyperkalemia

Sleep Apnea

Drugs such as Digoxin

Muscle Damage secondary to Myocardia Infarction

A

Sinus Node Block

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35
Q

Causes:

Electrolyte Imbalance (Commonly: K+, Ca+, Mg+)

Drugs that prolong the QT Interval

A
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36
Q

Causes:

Severe Bradycardia

Sinus Arrest, SA Exit Block

AV Block

Hyperkalemia

A
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37
Q

Chaotic, Irregular Rhythm, no true QRS.

No pulse on physical exam.

A

Ventricular Fibrillation.

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38
Q

Compare and Contrast PAC and PVC:

A
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39
Q
  • Compromise the majority of the heart tissue.
  • Responsible for the physical work of contraction and relaxation of the heart muscle.
  • Depolarization results in calcium release within the cell causing contraction.
A

Cardiac Myocytes

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40
Q

Delivery of a high voltage shock to treat arrhythmias such as Ventricular Fibrillation and pulseless Ventricular Tachycardia.

A

Defibrillation

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41
Q

Depolarization is caused by (2):

A
  • Spontaneous depolarization (Automaticity Property)
  • Propagated current from an adjacent cell.
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42
Q

Depolarization is driven by the AV node, not the SA node.

A

Junctional Rhythm

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43
Q

Descriptors of Ventricular Tachycardia

A

Monomorphic Tachycardia

Polymorphic Tachycardia

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44
Q

Different QRS Complex Variations (5)

A

QRS, RSR’, RS, QR, R

Lecture 2; Slide 24

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45
Q

Do EKGs tell you the structure of function of the heart?

A

No

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46
Q

Dominant pacemaker cells

A

The sinoatrial (SA) node.

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47
Q

Each PVC comes from different (or several) irritable foci in the ventricle.

A

Multifocal PVC

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48
Q

Early junctional beat (absent, inverted, or retrograde P Wave) followed by a compensatory pause.

A

Premature Junctional Contraction (PJC)

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49
Q

Electrical activity is measured by “views” produced y looking between two leads (from the positive lead perspective).

A

Bipolar Leads

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50
Q

Electrical conduction is the result of _______.

A

Depolarization

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51
Q

Enhanced automaticity of an ectopic atrial focus or from a reentrant circuit.

May be associated with digitalis toxicity, but often with a normal heart.

A

Paroxysmal Atrial Tachycardia (PAT)

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52
Q

Escape beat during Sinus Arrest comes from:

A

SA Node (Sinus Escape)

AV Node (Junctional Escape)

Ventricle (Ventricular Escape)

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53
Q

First negative (downward) deflection after the R Wave.

A

S Wave

*A Q can never follow an R, even if it is the “the first downward deflection”.

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54
Q

First negative (downward) deflection in the QRS complex

A

Q Wave

*May not be present.

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55
Q

Following mapping of arrhythmia pathway, radio waves (other methods include cryo/freezing or thermal/heat) are applied to specific pathways to ablate aberrant electrical conduction.

A

Radiofrequency Ablation

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56
Q

Four varieties of the AV Block:

A

1st Degree AV Block

2nd Degree AV Block: Mobitz Type I

2nd Degree AV Block: Mobitz Type II

3rd Degree AV Block

The PR interval is key to distinguishing the type of block.

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57
Q

From the start of atrial depolarization to the start of ventricular depolarization.

A

PR Interval

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58
Q

High-energy shock

Used to treat Ventricular Fibrillation or Pulseless Ventricular Tachycardia

Not timed only use when the patient is pulseless.

A

Defibrillator

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59
Q

How to perform a Valsalva Maneuver?

A

Bear down like you are having a bowel movement.

Squat and stand with a closed mouth.

60
Q

If the rate is > ____ or < ______, use the ________ estimation method.

A

300, 38, 6-Second Method

61
Q

Precordial Leads

II, III, aVF

A

Inferior Heart

62
Q

Impulses originate from three or more different foci in the atria, so we see at least 3 different p wave morphologies.

A

Wandering Pacemaker

63
Q

In which direction does the mean electrical vector travel?

A

From the SA node down and to the left.

Right Atria to the Left Ventricle

64
Q

In which populations are 1st Degree AV Blocks found:

A

Athletes.

May be seen in people with myocarditis or rheumatic fever.

65
Q

In whom can we expect Sinus Bradycardia?

A

Well-trained athletes

Patients taking Beta-Blockers

Most common rhythm disturbance seen in early stages of Acute Myocardial Infarction.

66
Q

In whom can we expect to see Sinus Tachycardia?

A

Exercise, Fever, Hyperthyroidism, Congestive Heart Failure (CHF), COPD

67
Q

Isolated PVC

A

Single PVC

68
Q

Key Features:

Junctional Rhythm

A

Absent, Retrograde, Inverted P Waves depending on the direction of the depolarization.

The rate usually 40-60 bpm.

69
Q

Lead ___ mimics the mean electrical vector the best.

A

II

70
Q

Limitation of EKG

A

The ectopic beat must be occurring during the time the EKG is done.

Only captures 6 seconds!

71
Q
  • Long, thin cells that carry current to distant regions of the heart.
  • Divided into atrial and ventricular conducting systems.
A

Electrical Conduction Cells

72
Q
  • Look at the electrical activity of the heart.
  • Allow you to infer certain conditions
A

Electrocardiograms (EKG)

73
Q

Low Energy Shock

Timed or Synchronized to be delivered at a specific point in the QRS complex. (The goal is to prevent inducing Ventricular Fibrillation by shocking during the T-Wave (Ventricular Repolarization))

Used to treat conditions such as Atrial Fibrillation, Atrial Flutter, Sinus Tachycardia, AVNRT, Ventricular Tachycardia with a Pulse

A

Cardioversion

74
Q

Method of temporarily taking over the rate at which the heart depolarizes.

A

Cardiac Pacing (Transcutaneous)

75
Q

Most common cause of Atrial Fibrillation

A

Long-Standing Hypertension

76
Q

The most common cause of Sudden Cardiac Death.

A

Ventricular Fibriallation

77
Q

Most common location of the delay for an AV block is:

A

Between the AV node and the Bundle of His.

78
Q

Most common rhythm after a return of circulation after cardiac arrest in the immediate recovery phase.

A

Accelerated IVR

79
Q

Most common ventricular arrhythmia.

A

Premature Ventricular Contraction (PVC)

80
Q

Most frequent cause of Pulseless Electrical Activity (PEA)?

A

Hypoxia

81
Q

No electrical activity. (Isoelectric Baseline)

A

TP Interval

82
Q

No electrical activity.

Not able to defibrillate.

Look for cause and treat specific abnormalities.

A

Asystole

83
Q

Normal Cycle of Electrical Activity

A
  1. The Sinoatrial (SA) node fires.
  2. The signal travels across atria through the internodal pathway to the Atrioventricular (AV) node.
    1. Simultaneously signal travels via Bachman’s Bundle to the right atrium.
  3. A slight pause, then signal travels down Bundle of His.
  4. His Bundle branches into Right and Left bundles.
  5. Ending at the Purkinje fibers.
  6. Slight pause, then repolarization occurs.
84
Q

Normal 12-lead EKG lead Layoout

A

I AVR. V1. V4

II AVL V2 V5

III AVF V3 V6

Six-second rhythm strips at bottom of 12-lead (usually lead II, but V1, V5, but any can be used)

85
Q

Often associated with long QT intervals.

A

Polymorphic Ventricular Tachycardis

86
Q

One spike followed by an abnormal P (Atrial capture) followed by a second spike producing a wide QRS (ventricular capture)

A

Dual-Chamber Pacing

87
Q

One spike producing an abnormal P wave (atrial capture) followed by a normal QRS.

A

Atrial Pacing

88
Q

Pacemaker Error

No pacer spikes/activity when needed.

A

Pacemaker failure

89
Q

Pacemaker Error

Pacer firers, but heart does not respond.

A

Failure to capture.

90
Q

Patient exercises (treadmill/bike) and EKG is obtained.

If ectopic beats resolve with exercise, they are okay.

A

Exercise Stress Test

91
Q

Patients push a button when they feel symptomatic and recording starts.

Backdates ~30 Seconds

A

Event Recorder

92
Q

PR interval remains constant, but the intermittent dropping of QRS

A

2nd Degree AV Block: Mobitz Type II

Usually associated with heart disease.

93
Q

Precordial Leads

aVR, V1

A

Right Ventricle

94
Q

Precordial Leads

V2, V3, V4

A

Anterior Heart

95
Q

Precordial Leads

I, aVL, V5, V6

A

Lateral Heart

96
Q

Presence of EKG recording/tracing without actual physical contraction of the heart muscle.

There is no pulse.

A

Pulseless Electrical Activity (PEA)

97
Q

PVC Morphology (2):

A

Unifocal - All PVCs look the same.

Multifocal - PVCs do not look the same.

98
Q

R wave of the PVC occurs during the T wave of the preceding beat.

A

R-on-T Phenomenon

99
Q
  • Recurrent, spontaneous depolarization at a set rate (eg. SA node at 60-100 bpm)
  • Depolarization results in an action potential
A

Pacemaker Cells

100
Q

Represents repolarization of the ventricles.

A

T Wave

101
Q

Represents the depolarization of the atrium.

A

P Wave

102
Q

Represents the depolarization of the ventricles and the repolarization of the atrium.

A

QRS Complex

103
Q

Rhythms that have a consistent R-R interval throughout the rhythm strip

A

Regular Rhythms

104
Q

Rhythms that have an inconsistent* R-R interval throughout the rhythm strip.

A

Irregular Rhythms

*R-R intervals that are off by 2 little boxes (0.08s) or less are considered regular.

105
Q

SA Node depolarization rate:

A

60-100 beats/min

106
Q

Sinus Node ceases to fire for at least 2 seconds (10 big boxes).

A

Sinus Arrest

107
Q

Sites of Origin of Arrhythmias:

A
  • Sinus Origin
  • Atrial Origin
  • Junctional Origin
  • Ventricular Origin
108
Q

How to detect PVC and other Ectopic Beats

A

EKG

Holter Monitor

Event Recorder

Stress Test

109
Q

Sources of Arrhythmias are mapped in EP lab; then appropriate therapy is determined.

A

Electrophysiologic studies

110
Q

A special pattern of PACs where they occur every other beat.

A

Atrial Bigeminy

111
Q

T/F?

The mean vector changes depending on which lead you are looking at?

A

True

112
Q

The change in ______ ______ from depolarization to repolarization is what is recorded by the EKG.

A

Electrical Charge

113
Q

The first positive (upward) deflection of the QRS complex.

A

R Wave

114
Q

The left side of the P Wave represents ____ Atrial depolarization.

A

Right

115
Q

The mean direction (average direction) of all electrical activity of the heart can be summarized by the yellow arrow.

A

Mean Electrical Vector

116
Q

The pacing lead is inserted into the atrium to cause atrial depolarization.

A

Atrial Pacing

117
Q

The pacing lead is inserted into the ventricle to cause ventricular depolarization.

A

Ventricular Pacing

118
Q

The pacing leads are inserted both into the Atria and the Ventricle stimulating at set intervals.

A

A-V Sequential Pacing

119
Q

The purpose of this device is to “wall-off” the opening to the left atrial appendage and keep any clots from traveling via the circulation to the brain.

A

Watchman Device

120
Q

The right side of the P Wave represents the ____ Atrial depolarization.

A

Left

121
Q

The time elapsed between two successive R waves (two successive ventricular depolarizations).

A

R-R Inteval

122
Q

Three cells that can spontaneously depolarize:

A

SA Node

AV Node

Ventricles

123
Q

Three Major Classifications of Blocks

A

Sinus Node Block

Atrioventricular (AV) Block

Bundle Branch Block

124
Q

Time from the beginning of ventricular depolarization to the end of ventricular repolarization.

A

QT Interval

125
Q

Time from the end of atrial depolarization to the start of ventricular depolarization.

A

PR Segment

126
Q

Time from the end of ventricular depolarization to the start of ventricular repolarization.

A

ST Segment

127
Q

Two types of cardiac cell types:

A
  • Conducting Cells
    • Pacemaker cells
    • Bundles
  • Myocytes
128
Q

Unipolar measurement

A

aVL, aVR, aVF, V1-V6

129
Q

Utilizing an EKG machine you can measure and interpret three things:

A

Amplitude (mV)

Duration (time)

Configuration of a Cardiac Cell

130
Q

Valid for both regular and irregular rhythms.

A

6-Second Estimation Method

131
Q

Valid for regular rhythms only.

A

300 estimation method

132
Q

Ventricle depolarization rate

A

20-40 beats/min

133
Q

Ventricular Fibrillation is associated with greater success with defibrillation.

A

Fine Ventricular Fibrillation

134
Q

Ventricular Fibrillation is associated with more recent onset.

A

Coarse Ventricular Fibrillation

135
Q

Ventricular Fibrillation

Amplitude > 3mm

A

Coarse Ventricular Fibrillation

136
Q

Ventricular Fibrillation Amplitude < 3mm

A

Fine Ventricular Fibrillation

137
Q

Ventricular Tachycardia with multiple QRS shapes.

A

Polymorphic Ventricular Tachycardia

138
Q

Ventricular Tachycardia with one QRS shape.

A

Monomorphic Ventricular Tachycardia

139
Q

What are the two descriptors for describing a PVC?

A

Morphology (What does it look like?)

Frequency

140
Q

What causes an arrhythmia?

A
  • Hypoxia
  • Ischemia
  • Sympathetic Stimulation
  • Drugs
  • Electrolytes
  • Bradycardia
  • Stretch (Enlargement/Hypertrophy)
141
Q

What is the danger of a R-on-T phenomenon?

A

Creates a prolonged PVC, which may initiate Ventricular Tachycardia or Ventricular Fibrillation.

142
Q

What is the main danger of Atrial Fibrillation?

A

Potential for blood to coagulate in LA, which will send a clot to the brain and result in a CVA/stroke!

Transesophageal echo required before electrical interventions

143
Q

What is the most common conduction block?

A

Atrioventricular Block

144
Q

What is the order for the 300 estimation method?

A

300, 150, 100, 75, 60, 50, 43, 38, 33

145
Q

What is the purpose of Carotid Massage?

A

Parasympathetic Nervous System innervation, which slows the heart rate down.

146
Q

Which is the more accurate 300 estimation method or the 6-second estimation method?

A

300 estimation method

EKG Use and Interpretation (5 decks)

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