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Assessment > Exam 1 - ECG > Flashcards

Exam 1 - ECG Flashcards

1
Q

How does an action potential spread from the SA node to the right and left atria?

A

Right atria - Internodal pathway
Left atria - Bachmann’s Bundle

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2
Q

What is the inherent rate of the SA node, AV node, Bundle of His, and bundle branches/purkinjie fibers?

A

SA node: 60-100 bpm
AV node and Bundle of His: 40-60 bpm
Bundle branches and purkinjie fibers: 20-40 bpm

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3
Q

How many seconds is 1 large box?
1 small box?

A

0.2 seconds
0.04 seconds

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4
Q

What is the voltage of 1 large box?
1 small box?

A

0.5 mV
0.1 mV

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5
Q

What is a normal p wave duration?
PR interval?

A

P wave: < 0.12 secs
PR: .10-.20 secs

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6
Q

Normal QRS duration?

A

< 0.12 secs

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7
Q

What is a significant ST segment elevation/depression?

A

> 1 mm, usually in contiguous leads

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8
Q

What identifies a junctional rhythm?

A

Rate 40 - 60 ( AP originating from AV node/Bundle of His)
Loss of p waves or inverted p waves from retrograde depolarization of the atria

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9
Q

What identifies a junctional tachycardia?

A

Loss of p wave, or inverted
Rate > 60

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10
Q

What defines supraventricular tachycardia?

A

Narrow complex QRS
P wave may be buried due to fast rate

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11
Q

How do you identify a PAC?

A

A complete complex that occurs immediately following another but at lower voltage

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12
Q

What is a first degree AVB?

A

Prolongation of the PR interval > .20 secs

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13
Q

What is a 2nd degree type I AVB?

A

Progressive elongation of the PR interval followd by a p wave without a QRS

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14
Q

What is a 2nd degree type II AVB?

A

Random P waves with unconducted QRS complexes, usually in a defined ratio

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15
Q

What anesthetics can induce arrythimias?

A

Halothane/enflurane - sensitize myocardium
Keatmine - tachyarrythmias
Sevoflurane - bradycardia in infants
Desflurane - prolonged QT during induction
Local anesthetics - severe bradycardia from sympathetic block

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16
Q

Where does lead V1 go? V2?

A
  • V1 - 4th ICS, right of sternum
  • V2 - 4th ICS, left of sternum
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17
Q

Where does lead V3 go?
V4?

A
  • V3 - between V2 and V4
  • V4 - 5th ICS, left of sternum
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18
Q

Where does lead V5 go?
V6?

A
  • V5 - 5th ICS, left of sternum
  • V6 - 5th ICS, mid axillary line
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19
Q

What wave is the first negative deflection after the p-wave on any lead?

A
  • Q-wave
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20
Q

What wave is the first positive deflection after a p-wave?

A
  • R-wave
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21
Q

Describe an s-wave.

A
  • Negative deflection below baseline after an R or Q wave.
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22
Q

What QRS is denoted by 1 in the figure below?

A

R

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23
Q

What QRS is denoted by 2 in the figure below?

A

QS

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24
Q

What QRS is denoted by 3 in the figure below?

A

qRs

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25
Q

What QRS is denoted by 4 in the figure below?

A

rS

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26
Q

What QRS is denoted by 5 in the figure below?

A

qR

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27
Q

What QRS is denoted by 6 in the figure below?

28
Q

What happens to the QRS in hyperkalemia?

A

QRS widening, fusion of QRS-T, loss of ST segment

29
Q

What is a characteristic ECG change caused by hyperkalemia?

A

Tall tented T waves

30
Q

What is a u-wave?
When might it be present?

A

Spike after T wave and before p wave
Hypokalemia, hypocalcemia

31
Q

What ECG changes are seen in hypercalcemia?

A

VERY wide QRS, low R wave, loss of p waves, tall peaked T waves

32
Q

What ECG changes are see in hypocalcemia?

A

Narrowed QRS, T wave flattened/inverted, prlonged QT, prominent U wave, ST depression

33
Q

What is a “J” wave?
When is it seen?

A

A positive deflection seen at the J point (precordial and limb leads) or negative reciprocial (aVR and V1)
Hypothermia and hypercalcemia

34
Q

What is a delta wave?
When is it seen?

A

Slurred upstroke of the QRS
WPW

35
Q

What drug should you avoid in patients with WPW?

36
Q

How many electrodes are there in a 12 lead ECG?

37
Q

What is the J point?

A

Where the QRS ends and the ST segment begins

38
Q

What creates a positive and negative deflection in any lead?

A

Positive: electricity flowing towards a positive lead
Negative: electricity flowing away from a positive lead

39
Q

What QRS deflections are seen in normal axis in leads I, II, and III?

A

Positive in all leads

40
Q

What degrees constitute a physiologic left axis deviation?

41
Q

What QRS deflections are seen with a physiologic left axis deviation?

A

Lead I: Positive
Lead II: Positive
Lead III: Negative

42
Q

What degrees consititue a pathological left axis deviation?
What are the causes?

A
  • -40 to -90
  • Anterior hemiblock
  • Hypertrophy of LV
  • Extreme exercise
43
Q

What QRS deflections are seen in pathological left axis deviations?

A

Lead I: positive
Lead II: negative
Lead III: negative

44
Q

What degrees constitute a right axis deviation?

45
Q

What QRS deflections are seen in right axis deviation?

A

Lead I: negative
Lead II: positive or negative
Lead III: positive

46
Q

What are causes of a right axis deviation?

A

All right axis are pathological:
posterior hemiblock, severe lung disease, valve disease, pulmonary embolus

47
Q

What axis deviation causes negative QRS in all limb leads?
What is the cause?

A

Extreme right axis
Ventricular injury of origins

48
Q

How do you determine a right or left BBB?

A
  • Must use lead V1
  • QRS must be wider than .12 secs
  • Find the J point
  • Draw a line back to the complex, then up or down to the QRS - fill in the triangle

Arrow up → turn signal up → RBBB
Arrow down → turn signal down → LBBB

49
Q

What is a bifasicular block?

A

RBBB + Anterior hemiblock
RBBB + Posterior hemiblock
LBBB (takes out both anterior and posterior fasicles)

50
Q

What 5 things does the RCA supply?

A
  • Inferior wall LV
  • Posterior wall LV
  • Right ventricle
  • SA and AV nodes
  • Posterior fasicle of LBB
51
Q

The LAD feeds what 3 things?

A
  • Anterior wall LV
  • Septal wall
  • Bundle of His and BB
52
Q

The circumflex artery feeds what 3 things?

A
  • Lateral wall of LV
  • SA and AV nodes
  • Posterior wall of LV
53
Q

What 2 drugs can interupt MI plaque formation?

A

Heparin and aspirin

54
Q

Chest pain on exertion equals what percent vessel occlusion?

55
Q

Chest pain at rest means what percent of vessel occulusion?

A

90 % occlusion

56
Q

Chest pain at rest unrelieved by nitro means what percent of vessel occlusion?

57
Q

Why is morphine not indicated for MI anymore?

A

Causes hypotension from histamine release

58
Q

What ECG changes accompany ischemia?

A

Symmetrical inverted T waves or ST depression in 2 or more leads

59
Q

What ECG changes accompany myocardial injury?

A

ST segment elevation of more than 1 mm in 2 or more related leads

60
Q

WHat ECG changes accompany infarction?

A

Pathologic Q waves (1/3 depth of R height)

61
Q

What is the system for assessing a 12 lead?

A

I See ALL Leads
Inferior = II, III, aVF
Septal = V1 and V2
Anterior = V3 and V4
Lateral = V5, V6, I, and aVL

62
Q

What ECG changes can be signs of posterior MIs?

A

Reciprocal changes of ST depression in V1-V4

63
Q

What other involvement do 1/2 of inferior MIs have?
What would you caution in these patients?

A

Posterior and RV involvement
Nitrates - preload already effected with RV dysfunction and can cause drop in BP, may need fluids

64
Q

What is the most lethal MI?

65
Q

What is the treatment for anterior wall MI?

A

Nitrates, spare fluids

66
Q

What 4 things can mimic an MI?
What makes an MI an MI per 12 lead ECG?

A
  1. LBBB
  2. LVH
  3. Pericarditis
  4. Dissecting thoracic aortic aneurysm
    MI on 12 lead will usually have reciprocal ST changes
67
Q

What are the symptoms of pericarditis?

A
  • ST elevation in all leads
  • No reciprocal ST depression
  • Feels better when leaning forward

Assessment (8 decks)

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