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CardioPulm Exam 2 > Exam 2: EKG > Flashcards

Exam 2: EKG Flashcards

1
Q

Why is it important to read ECG?

A

measuring electrical activity of the heart

  1. if there are abnormal rhythms it can lead to decreased CO which will effect activity tolerance
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2
Q

What is the path of the conduction system?

A
  1. SA node
  2. AV node
  3. purkinjee fibers
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3
Q

What branch of artery supplies SA node and what is pulse?

A

RCA, 60-100

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4
Q

What branch of artery supplies AV node and what is pulse?

A

RCA, 40-60

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5
Q

What branch of arteries supply ventricle and what is pulse?

A

LM and LAD, 20-40

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6
Q

If SA node is damaged what happens?

A

the heart must rely on AV node for rhythm which is not good bc HR is below normal

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7
Q

What are the 3 components of the ECG?

A
  1. P wave
  2. QRS wave
  3. T wave

coincides with cardiac cycle

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8
Q

What are characteristics of P wave?

A

this is the depolarization of the atrium, small wave as not much tissue or distance to push blood (atrial contraction)

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9
Q

What are the characteristics of the QRS wave?

A

systolic, ventricular squeeze

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10
Q

What are the characteristics of the T wave?

A

re polarization of ventricles, larger due to more tissue to move

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11
Q

What is important about the ST segment?

A

elevated- MI

depressed- ischemia

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12
Q

What is best way to read ECG strip?

A
  1. is it regular or irregular?( distance between QRS peaks)
  2. What is rate?
  3. Are there P waves? (atrial issue)
  4. does the QRS complex look the same? (ventricular issue? )
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13
Q

What does NSR stand for?

A

normal sinus rhythm

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14
Q

What are PT implications for sinus bradycardia?

A

yellow flag, could be normal with trained athlete

low BP and low HR = red flag

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15
Q

What are PT implications of sinus tachycardia?

A

yellow flag at rest, however monitor vitals closely during exercise

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16
Q

What is a premature atrial contraction?

A

early P wave that looks different from others (inverted), still getting atrial kick just not from SA node

causes: stress, infection, ischemia, hypoxia

NO PT implications due to no effect on CO

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17
Q

What is atrial fibrillation?

A

absent, twitching atrial waves, no atrial squeeze

causes: stress genetics, HTN, heart dz

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18
Q

What are PT implications of atrial fib?

A

yellow flag if there is a normal HR

if over 115-120 bpm then do not treat as it is affecting CO due to decrease diastolic filling time

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19
Q

What is atrial flutter?

A

p waves in sawtooth pattern

a lot of p waves so still getting atrial kick therefore not affecting CO- yellow flag

however, if pt develops a new flutter with no history that is big red flag

20
Q

What is supraventricular tach or paroxysomal atrial tach?

A

P waves are buried in QRS complex due to short burst of tach, HR 160-250

atrial impulses not coming from SA node

not safe to treat as decreasing diastolic filling time

causes: caffine, electrolyte imbalance

21
Q

What are heart blocks?

A

delay or complete block of in conduction of the conduction system

causes: MI, CAD, ischemic, necrotic tissue

block occurs between SA node and AV node

22
Q

What is 1st degree heart block?

A

prolonged P-R interval greater than .20 sec

conduction still going through AV node and can be seen in endurance athletes, also seen in digoxin and beta blockers

No PT implications as it benign and does not affect CO

23
Q

What is second degree heart block Type 1 Mobitz?

A

progressively longer P-R interval until QRS interval is dropped

AKA: Wenkebach

causes: MI, meds

yellow flag, slightly decreasing CO but not a ton

24
Q

What is 2nd Degree heart block Type 2 Mobitz?

A

P-R interval is prolonged but remains constant distance to QRS wave

one or several QRS waves dropped

don’t treat as the pt likely needs a pacemaker as you are losing CO

25
Q

What is a 3rd degree heart block?

A

all impulses from AV node are blocked

ventricular rates are 20-40 bpm

this is a medical emergency

26
Q

What is a premature ventricular contraction?

A

-irregular beat on top of a sinus rhythm

a wide and early QRS wave, due to ventricle firing early

causes: iscehmia, CAD, electrolyte imbalance, stress, MI—worsens with stressors

27
Q

What is PT implication for PVC?

A

yellow flag however if more than 7-10 per minute do not treat

CO affected due to abnormal squeeze

28
Q

What is a PVC trigeminy?

A

PVC occurs every third beat, normal QRS two beats in between

yellow flag

29
Q

What is a PVC bigeminy?

A

worse than trigeminy as PVC occurs every two beats, normal QRS in between

more on the red flag side

30
Q

What is a PVC couplet?

A

2 PVC’s in a row

1-3 in a minute yellow flag

more than that is a red flag

31
Q

What is PVC triplet?

A

3 pvc in a row worse than couplet

1-3 in a minute yellow flag

anymore than 3 is V tach

32
Q

What is a multifocal PVC?

A

PVC from multiple ectopical foci- different contractions

PVC all look different greatly affects CO- RED Flag

33
Q

What is ventricular tachycardia?

A

more than 3 PVC, absent or buried P waves- could be firing but hidden

widened QRS complex

causes: acute MI, ischemia, severe electrolyte imbalance

medical emergency as PT will likely pass out

34
Q

What is ventricle fibrillation?

A

erratic quivering of ventricular muscle

no CO , med emergency

35
Q

What is asystole?

A

no electrical activity

36
Q

What is artifact?

A

poor read of the ECG likely due to pt movement or poor lead connection

can palpate pulse to confirm

37
Q

What is a bundle branch block?

A

ventricle that is blocked and is depolarized more slowly
normal P wave

both wide QRS- slower conduction and left with “bunny ears” not smooth all the way back up

38
Q

What is a pacemaker?

A

device that uses electrical impulses to control beating of the heart

can stimulate heart of inhibit firing

39
Q

What are temporary pacemakers used for?

A

bradycardia after MI, during and after cardiac surgery

PT: don’t pull out the leads with mobility, 1 hour of bed rest after removal

40
Q

What are permanent pace makers used for?

A

complete heart block, symptomatic bradycardia, mobile type 2 block, suppress ventricular or atrial ectopy

41
Q

What are PM precautions?

A

no shoulder ROM above 90 for 6 weeks

no pushing or pulling greater than 5 pounds for more than 6 weeks

no driving 2 weeks

42
Q

What does atrial pacemaker on ECG look like?

A

pacemaker spike super imposed on P wave, normal QRS wave after

43
Q

What does a ventricular pacemaker look like on an ECG?

A

normal p wave with delay after due to impaired electrical conduction

pacemaker needed to initiate ventricular depolarization

spike right before QRS complex

44
Q

What does an A-V pacemaker look like on a ECG?

A

2 pacemaker spikes as PM required for atrial and ventricular depolarization

45
Q

Why are 12 lead ECG used?

A

assess likelihood of cardiac disease, detect cardiac rhythm disturbences, detect old/ acute MI or ischemia, detect atrial or ventricular hypertrophy

CardioPulm Exam 2 (6 decks)

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