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Adv Phys & Hlth Ass. Spring 2024 > Exam 1/ Lecture 7: Advance EKG Interpreation > Flashcards

Exam 1/ Lecture 7: Advance EKG Interpreation Flashcards

1
Q

2/1/24

Why does this 12 lead not have great tracing and what are the causes?

A

There is movement artifact.

Possible cause of artifact:
* shivering
* shaking due to adrenaline up
* diphoretic and leads not sticking

Slide 23

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2
Q

2/1/24

What is a Q wave?

A

the first negative deflection after the P wave in any lead

(negative deflection means going below the isoelectric line following the P wave)

Slide 24

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3
Q

2/1/24

What is a R wave?

A

First positive deflection after the P waves in any lead

Slide 25

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4
Q

2/1/24

What is a S wave?

A

Negative deflection below the baseline after an “R” or “Q” wave

Slide 26

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5
Q

2/1/24

What is the “J” Point?

A

the Junction Point where the QRS complex ends and the ST segment begins

Slide 27

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6
Q

2/1/24

What QRS is denoted by 1 in the figure below?

A

R

Slide 28

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7
Q

2/1/24

What QRS is denoted by 2 in the figure below?

A

QS

Slide 28

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8
Q

2/1/24

What QRS is denoted by 3 in the figure below?

A

qRs

Slide 28

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9
Q

2/1/24

What QRS is denoted by 4 in the figure below?

A

rS

Slide 28

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10
Q

2/1/24

What QRS is denoted by 5 in the figure below?

A

qR

Slide 28

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11
Q

2/1/24

What QRS is denoted by 6 in the figure below?

A

rSR’

Slide 28

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12
Q

2/1/24

Why do we determine the Axis of our patient’s EKG?

A
  • Axis can be significant
  • Used to diagnose hemiblock
  • Can be helpful in calling VT
  • Helps to identify possible complications (that maybe we might have done)

Slide 29

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13
Q

2/1/24

What is an Axis of EKG and how do we look for it?

A

It is predominant flow of electricity through the heart

We look at the QRS complexes for ventricular axis

Slide 30

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14
Q

2/1/24

What kind of deflection is made when electricity flows towards a positive electrode?

A

a positive deflection

Slide 31

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15
Q

2/1/24

What kind of deflection is made when electricity flows away from a positive electrode?

A

a **negative **deflection

Slide 31

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16
Q

2/1/24

What do the complexes (leads) look like on a Normal axis?

A

All compleses / leads I, II, and III will be upright
because we’re moving through the heart following the normal pathway.

Slide 32

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17
Q

2/124

What do the complexes (leads) look like on a Left axis?

A

Lead I = positive / upright
Lead I and Lead III = negative / down

Slide 33

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18
Q

What do the complexes (leads) look like on a Right axis?

A

Lead I and II= negative deflection
Lead III= positive deflection

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19
Q

What do the complexes (leads) look like on a Right axis?

A

Lead I, II, II= negative deflection.
Lead V1= positive deflection.

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20
Q

What do you need to do to determine QRS axis?

A

Run Leads I, II, III (leads in correct place)
Determine whether the QRS complex in each lead is more positive or negatively deflected
Compare to the Rapid Axis and Hemiblock chart to get axis

20
Q

What causes the hypertrophy of the R ventricle?

A

severe lung disease; other causes are pulmonary embolus and pulmonary valve disease.

21
Q

What causes the hypertrophy of the L ventricle?

A

Hypertension; other less common causes include hypertrophic cardiomyopathy, extreme exercise, and aortic disease

22
Q

What is BBB?

A

A Bundle Branch Block is a block of one of the two bundle branches, left or right.

A Bundle Branch is a fascicle of electrical conduction system cells designed to carry impulses to the ventricles.

Bundle Branches facilitate “syncytium” or both ventricles contracting in sync.

23
Q

what 2 things you should remember when using BBB turn signal theory?

A

First, in order to be a bundle branch block the QRS complex must be wider than 120 milliseconds. Secondly, this theory only works in lead or V1

24
Q

In BBB turn signal theory:
Arrow points up - turn signal up is_____
Arrow points down - turn signal down is____

A

Right BBB
Left BBB

25
Q

What is Bifascicular Block? What drugs are contraindicated with it?

A

This is a very severe degree of intraventricular block and drugs such as Lidocaine and Procainamide are contraindicated.

26
Q

aWhat are 3 types of Bifascicular block?

A

RBBB + Anterior Hemiblock
RBBB + Posterior Hemiblock
Left Bundle Branch Block

27
Q

What are the benefits of a 12 lead EKG

A

90% specific
Rapid identification of MI
Other complications can be identified
S.55

28
Q

What does inverted T wave mean in a 12 lead

A

Ischemia- transient reduction in blood flow in the myocardium. Characterized by inverted T waves in >2 leads

29
Q

How is injury seen in a EKG

A

-ST segment elevation of >1 mm in 2 or more leads. Means injury yet salvageable.
-ST depression- characterizes ischemia.
Recoprocal changes to other ST elevations. Can indicate subendocardial injury, ischemia, drug or electrolyte imbalances
S.62&63

30
Q

What are the inferior leads? septal? anterior? lateral?

A

Inferior Leads II, III, AVF
Septal Leads V1, V2
Anterior Leads V3, V4
Lateral Leads V5, V6, I, AVL

(slide 68)

31
Q

What is the system for assessing a 12 lead?

A
  • Scan the 12-lead using I.S.A.L. method
  • Write down the leads that you see ST elevation
  • Look on this chart and name the location
  • Look for reciprocal changes (ST depression)

(slide 68)

32
Q

What are some caveats for inferior MI?

A
  • Most common seen -> Can be fatal
  • 50% have posterior and right ventricle involved
  • Patients may have bradycardia and hypotension
  • Could also have 1st degree or Mobitz 1 blocks
  • Nausea is common, antiemetics
  • Use nitrates with caution, may need fluids

(slide 69)

33
Q

Some caveats for anterior wall MI?

A
  • most lethal (highest mortality)
  • can suddenly develop, CHB, VF or VT
  • if seen with hemiblocks or BBB, place quick combo pads on the patient and prepare for the worst
  • can extend to septum (anteroseptal) or lateral (anterolateral)
  • nitrates are great, fluids are spared

(slide 70)

34
Q

What are some common infarct imitators?

A
  • left BBB
  • left vent hypertrophy
  • pericarditis
  • dissecting thoracic aortic aneurysm

(slide 71-73)

35
Q

How may a left vent hypertrophy present compared to an infarct?

A

Left ventricular hypertrophy (or chamber enlargement) will generally have very large complexes in the V-leads with possible elevation.

LVH however, will not show reciprocal changes as an MI rule.

(slide 71)

36
Q

How may pericarditis appear on ECG?

A
  • ST elevation in all leads
  • Patient feels better when they lean forward
  • will not have reciprocal ST depression

(slide 72)

37
Q

Which infarct imitator is the most worrisome/serious?

A

Dissecting Thoracic Aortic Aneurysm

  • This condition can have ST segment elevation, however it will not have reciprocal changes.
  • Many physicians will not order heparin for a patient unless the EKG shows both ST elevation AND reciprocal changes indicating an MI.

Heparin could prove fatal if given to this patient!!!!

  • nitro with caution if at all

(slide 73)

38
Q

Lecture 2/1/24

What type of electrolyte imbalance causes:
* P-waves are widened and of low amplitude due to slowing of conduction
* loss of the ST segment
* Tall tented T-waves
* The initial part of the QRS complex is often spared as Purkinje fibers are less sensitive to the condition

A

Hyperkalemia

Slide 3

39
Q

Lectue 2/1/24

What type of electrolyte imbalance causes:
* ST depression and flattening of the T wave
* Negative T waves
* A U-wave may be visible

A

Hypokalemia

Slide 4

40
Q

Lecture 2/1/4

What type of electrolyte imbalance causes:
* Mild: broad-based tall peaking T waves
* Severe: extremely wide QRS, low R wave, disappearance of p waves, tall peaking T-waves
* Osborne J- wave

A

Hypercalcemia

41
Q

Lecture 2/1/24

Osborne J wave can be seen on an EKG with what two electrolyte imbalance

A

Hypercalcemia, hypothermia

42
Q

Lecture 2/1/24

What two types of electrolyte imbalance cause a wide QRS?

A

Hyperkalemia and hypercalcemia

43
Q

Lecture 2/1/24

What type of electrolyte imbalance causes:
* Narrowing of the QRS complex
* Reduced PR interval
* T wave flattening and inversion
* Prolongation of the QT-interval
* Prominent U-wave (Can be found in hypokalemia)
* Prolonged ST and ST depression

A

Hypocalcemia

Slide 6

44
Q

Lecture 2/1/24

  • What is the wave name with a positive deflection at the J point in precordial and proper limb leads? These changes will also appear as a reciprocal, negative deflection in aVR and V1.
A

Osborne “J” wave

Slide 7

45
Q

Lecture 2/1/24

  • What is the wave name with a slurred upstroke in the QRS complex? It relates to pre-excitation of the ventricles and, therefore, often causes an associated shortening of the PR interval. It is most commonly associated with pre-excitation syndromes such as WPW?
A

Delta Wave

Slide 8

46
Q

Lecture 2/1/24

What medications are contraindicated for patients with WPW?

A
  • Adenosine
  • Calcium channel blockers
47
Q

Lecture 2/1/24

Label the five leads
* RA
* LA
* C
* RL
* LL

A
  • A = RL
  • B= LL
  • C= LA
  • D = C
  • E = RA

Slide 11

Adv Phys & Hlth Ass. Spring 2024 (6 decks)

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