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EKG > Exam 2 review > Flashcards

Exam 2 review Flashcards

1
Q

Determine axis?

A 
Lead 1 and Lead aVF.
Normal=+,+
Left deviation=+,-
Right deviation=-,+
Extreme right deviation=-,-
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2
Q

Normal QRS duration? Wide?

A

Normal=0.06-0.1sec

Wide= >0.1sec

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3
Q

RVH criteria?

A

Right axis deviation.

Poor R-wave progression=R-wave larger than S-wave in V1 and S-wave larger than R-wave in V6

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4
Q

R waves tallest in which two leads?

A

V4 and V5

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5
Q

LVH criteria?

A

Left axis deviation

R-wave amp in V5 or V6 plus S-wave amp in V1 or V2 exceeds 35mm (7 boxes)

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6
Q

Causes of Sinus Arrythmia?

A

Hypoxia, ischemia, irritability, sympathetic stimulants, drugs, lyte imbalance, enlargement/hypertrophy

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7
Q

What does the term “Sinus Arrythmia” imply?

A

A benign slight irregularly which is a variant of normal

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8
Q

Sinus tach rate?

A

> 100bpm

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9
Q

Sinus Brady rate?

A

<60bpm

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10
Q

What stops firing in a Sinus Arrest?

A

SA node stops firing

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11
Q

What does a rescue beat do?

A

Restarts sinus node.

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12
Q

Inhalation and sinus rate?

A

Increases

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13
Q

Exhalation and sinus rate?

A

Decreases

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14
Q

Where does a rescue beat originate from?

A

AV-node (most common)

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15
Q

When rescue beat originates from the AV node what’s it called?

A

Junctional Pacemaker

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16
Q

Which wave does the junctional rhythm lack?

A

P-waves

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17
Q

Sick Sinus Syndrome is a dysfunction of which node?

A

SA- node

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18
Q

Sick Sinus Syndrome is the inability of the heart to do what?

A

Inability to generate heart rate to meet physiologic needs

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19
Q

Sick Sinus Syndrome can cause what rates?

A

Profound bradycardia, sinus pause, sinus arrest, paroxysmal SVT

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20
Q

Most common ventricular arrythmia?

A

Premature Ventricular Contraction (PVC)

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21
Q

The QRS-complex of a PVC looks like?

A

Wide and bizarre. ≥0.12sec

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22
Q

When to PVCs become dangerous?

A

Run of >3, variable morphology, during MI

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23
Q

Premature Atrial Contraction (PAC) due to what?

A

Ectopic focus which fires at random

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24
Q

What do the P-waves of PACs look like compared to other beats?

A

Different from other beats

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25
Q

PAC aka

A

Atrial Premature Beat

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26
Q

Where do Supraventricular Arrythmias originate from?

A

Above ventricles in AV-node or atria

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27
Q

How long can Supraventricular Arrythmias last for?

A

Single beats or sustained rhythms lasting for seconds to years

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28
Q

Supraventricular Tachycardia rate?

A

150-250bom

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29
Q

Does Supraventricular Tachycardia have P-waves?

A

NO!

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30
Q

Supraventricular Tachycardia QRS-complex wide or narrow?

A

Narrow

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31
Q

Supraventricular Tachycardia initiatedby?

A

Premature supraventricular beat atrial or junctional

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32
Q

Supraventricular Tachycardia driven by?

A

Reentrant circuit looping within the AV-node (AVNRT)

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33
Q

Causes of Supraventricular Tachycardia?

A

Alcohol, coffee, exitement

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34
Q

First tx for Supraventricular Tachycardia?

A

Valsalva

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35
Q

Second tx for Supraventricular Tachycardia?

A

Adenosine

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36
Q

MC type of Supraventricular Tachycardia?

A

Atrioventricular Nodal Reciporcating Tachycardia

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37
Q

Supraventricular Tachycardia is what type of rhythm?

A

Reentrant rhythm

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38
Q

Supraventricular Tachycardia is a disorder of what?

A

Disorder of impulse transmission

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39
Q

Supraventricular Tachycardia on-set and cessation time?

A

Sudden on-set, sudden cessation

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40
Q

Does Supraventricular Tachycardia have P-waves?

A

No P-waves!

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41
Q

Why doesn’t Supraventricular Tachycardia have P-waves? (Hint: where originates)

A

Originates below atria in AV-node or ventricules

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42
Q

Which MC- Afib or AFlutter?

A

Afib

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43
Q

HTN, mitral valve dz, thyrotoxicosis, pericarditis can all cause which rhythm abnormality?

A

Afib

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44
Q

Afib rhythm regular or irregular?

A

irregular

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45
Q

Afib rate?

A

120-180

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46
Q

P-waves in Afib?

A

No true P-waves due to completely chaotic atria

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47
Q

Which rhythm is irregularly irregular, narrow complex, with no discernable P-waves at a rate of 120-180?

A

Afib

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48
Q

Does A-Flutter have P-waves?

A

Yes, in saw tooth pattern

49
Q

How many P-waves to ventricular beats in A-flutter?

A

2:1

“2:1 AV block”

50
Q

A-flutter rate regular? Rapid?

A

Regular rate but very rapid

51
Q

What is a random firing of several different ectopic atrial foci?

A

Multifocal Atrial Tachycardia

52
Q

Multifocal Atrial Tachycardia rhythm regular or irregular?

A

Irregular rhythm 100-200bpm

53
Q

If Multifocal Atrial Tachycardia <100 bpm called what?

A

Wandering Atrial Pacemaker

54
Q

Wandering Atrial Pacemaker seen in normal hearts?

A

Yes

55
Q

Multifocal Atrial Tachycardia common in PTs with what severe disease?

A

Lung dz

56
Q

Multifocal Atrial Tachycardia P-waves?

A

Vary in morphology ≥3

57
Q

If P-wave morphology is ≥3 then what called?

A

Multifocal Atrial Tachycardia

58
Q

QTc normal duration?

A

<440ms

59
Q

QTc dangerous for ventricular arrythmias?

A

> 500ms

60
Q

QTc >500ms danger for what rhythm?

A

Torsades

61
Q

VTach rate?

A

≥120BPM

62
Q

2 types of VTach?

A
  1. Non-sustained

2. Sustained

63
Q

Non-sustained VTach lasts for how long?

A

≤30 seconds “short runs:

64
Q

Non-sustained VTach benign?

A

Yes usually benign if no structural heart dz

65
Q

Sustained VTach duration?

A

≥30 seconds “long runs”

66
Q

Does Sustained VTach have a pulse? Conscious?

A

+/- pulse

+/- conscious

67
Q

What does Sustained VTach lead to?

A

Vfib and death

68
Q

QRS in Sustained VTach?

A

Wide. Only wide QRS in Sustained VTach.

69
Q

Torsades is a unique form of which rhythm?

A

VTach

70
Q

Normal or prolonged QT intervals in Torsades?

A

Prolonged QT intervals

71
Q

QRS comples does what in Torsades?

A

Spirals around baseline, changes axis and amplitude

72
Q

Torsades likened to what fun thing?

A

Party streamer

73
Q

VTach can degenerate into which rhythm?

A

VFib

74
Q

Is there a QRS in VFib?

A

No discernable QRS

75
Q

Cardiac output in VFib

A

None

76
Q

What does VFib require?

A

CPR and defibrillation

77
Q

First-degree AV block is a conduction block between where?

A

SA-node and purkinje fibers (including AV-node and His bundle)

78
Q

First-Degree AV block common in what kind of hearts?

A

Normal hearts

79
Q

First-Degree AV block is a prolonged conduction delay where?

A

At AV-node

80
Q

Do impulses from Atria make it through the AV-node?

A

Yes, but slowed

81
Q

Every QRS-complex in First-Degree AV block preceeded by what?

A

Single P-wave

82
Q

Do atrial impulses in Second-Degree AV block make it through?

A

Not all pass through AV-node

83
Q

2 types of Second-Degree AV block?

A
  1. Type 1 “Wencheback”

2. Type 2

84
Q

Atrial impulses encounter what in Type 1 Second-Degree AV block?

A

Encounter progressively longer delays in AV-node

85
Q

Which atrial impulse fails to get through in Type 1 Second-Degree AV block?

A

3rd or fourth

86
Q

What happens to PR-interval in Type 1 Second-Degree AV block? ____ isn’t followed by ___

A

Progressively lengthens until atrial impulse fails to get through. P-wave not followed by QRS

87
Q

Is pacemaker indicated in Type 1 Second-Degree AV block?

A

No indication for pacemaker

88
Q

Where is block in Type 2 Second-Degree AV block? (where? in?)

A

Below AV-node in His Bundle

89
Q

Does all atrial impulses get to ventricles in Type 2 Second-Degree AV block?

A

Nope

90
Q

Ratio of atrial impulses to ventricle in Type 2 Second-Degree AV block?

A

Varies!

91
Q

Which rhythm: Two or more beats with normal PR-interval then P-wave without QRS?

A

Type 2 Second-Degree AV block

92
Q

Pacemaker indicated in Type 2 Second-Degree AV block?

A

Yes

93
Q

Do atrial impulses get through to the ventricles in Third-Degree AV block?

A

Nope

94
Q

Which block when Atria and Ventricles driven by different pacemakers?

A

Third-Degree AV block

“AV-dissociation”

95
Q

Where is block in Third-Degree AV block?

A

At AV-node or lower

96
Q

Where is the escape rhythm generated in Third-Degree AV block?

A

Below conduction block

97
Q

QRS if escape rhythm is generated within conduction pathway in Third-Degree AV block?

A

Narrow QRS

98
Q

QRS if escape rhythm is generated within ventricles in Third-Degree AV block?

A

Wide QRS

99
Q

Is the QRS generated within conduction pathway in complete heart block reliable or not?

A

Unreliable

100
Q

Is the QRS generated within ventricles in complete heart block fast enough?

A

Too slow! 30-45bpm

101
Q

Is pacemaker indicated in Third Degree AV-block?

A

Yes!

102
Q

What is obstructed in Right Bundle Branch Block?

A

Conduction through Right Bundle

103
Q

QRS in Right Bundle Branch Block?

A

Widens

104
Q

Why does QRS widen in Right Bundle Branch Block?

A

RV depolarization delays

105
Q

Which leads are r-R’ (rSR’) created in Right Bundle Branch Block?

A

V1 and V1

106
Q

What does the S-wave in V6 look like in Right Bundle Branch Block?

A

Wide S-wave

107
Q

Can Right Bundle Branch Block be found in a normal heart?

A

Yes

108
Q

What is obstructed in Left Bundle Branch Block?

A

Conduction through Left Bundle

109
Q

What causes widened QRS in Left Bundle Branch Block?

A

LV depolarization delay

110
Q

What does QRS-complex look like in leads over LV in Left Bundle Branch Block?

A

Broad or notched

111
Q

Broad or notched QRS seen in which leads in Left Bundle Branch Block?

A

Leads overlying LV

112
Q

Broad or notched QRS in Left Bundle Branch Block due to which wave being prolonged?

A

Prolonged R-wave rise

113
Q

Left Bundle Branch Block had broad S-wave in leads over which ventricle?

A

RV

114
Q

What does Left Bundle Branch Block suggest to arteries?

A

Coronary artery dz

115
Q

ST-depression indicates?

A

Cardiac ischemia

116
Q

STEMI height criteria in limb leads? Precordial leads?

A

Limb leads=1mm height

Precordial leads=2mm height

117
Q

Pathologic Q-waves due to?

A

Irreversible myocardial damage

118
Q

Patholotic Q-wave criteria? (Hint: R-wave, duration)

A

≥0.04sec duration

≥1/3 height of R-wave

EKG (7 decks)

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