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EKG & Physiology > Intro to EKG > Flashcards

Intro to EKG Flashcards

1
Q

What are the leads on a 12 Lead EKG

A 
V1 - V6
RA
LA
RL
LL

*placement matters!

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2
Q

What does a positive wave of depolarization spreading towards a positive EKG lead result in on the EKG

A

an upward or positive deflection

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3
Q

What does a negative wave of depolarization (depolarization) spreading away from a positive lead result in on the EKG

A

upward or positive deflection on the EKG

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4
Q

What does a current of depolarization traveling away from a positive electrode result in on EKG

A

downward or negative deflection

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5
Q

Lead I

  • what kind of lead
  • what does it look at
A
  • Bipolar limb lead
  • across the heart from the side (left to right arm)
  • lateral view
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6
Q

Lead II

  • what kind of lead
  • what does it look at
A
  • bipolar limb lead
  • negative to positive
  • looks at inferior portion of heart (from feet to right arm)
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7
Q

Lead III

  • what kind of lead
  • what does it look at
A
  • bipolar limb lead
  • negative to positive
  • looks at inferior part of the heart (from feet to left arm)
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8
Q

What type of leads are AVL, AVR, and AVF?

A

augmented vector leads

  • unipolar
  • use the same electrodes as the bipolar, just connect them in different ways
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9
Q

AVR

- what is positive and what is negative

A
  • LA and LL negative

- RA positive

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10
Q

AVL

- what is positive and what is negative

A
  • RA and LL negative

- LA positive

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11
Q

ARF

- what is positive and what is negative

A
  • LA and RA negative

- LL positive

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12
Q

What are the precordial/chest leads

A
  • horizontal plane

- rotating group of lines that run through the AV node in anterior-posterior plane

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13
Q

What do V1 and V2 look at

A
  • anterior heart

- “right chest leads”

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14
Q

what do V3 and V4 look at

A
  • the septum
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15
Q

what do V5 and V6 look at

A
  • lateral wall
  • “left chest leads”
  • share a view with lead I
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16
Q

What leads look at the lateral wall

A

Lead I
V5
V6

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17
Q

Automaticity Foci

A
  • focal areas of automaticity (spontaneously depolarize)
  • located throughout the heart
  • have inherent rates based on where in the heart they are located
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18
Q

Overdrive Suppression

A
  • fastest are of automaticity paces the heart
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19
Q

what is the normal area that paces the heart

A

SA node

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20
Q

what happens when SA node fails

A
  • other automaticity foci “escape” SA node overdrive and take over, act as backup
  • “ectopic” foci
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21
Q

Inherent rates:

  • SA node
  • Atrial foci
  • AV junctional foci
  • Ventricular foci
A
  • SA: 60 to 100 bpm
  • Atrial: 60 to 80
  • AV junctional: 40 to 60
  • ventricular: 20 to 40
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22
Q

EKG paper

  • how many seconds in each small box
  • how many seconds in each big box
A
  • small: 0.04 seconds

- big: 0.20 seconds

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23
Q

How many big box make 1.0 seconds

A

5 big boxes

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24
Q

EKG paper

  • what does vertical axis measure
  • what does horizontal axis measure
A
  • vertical: amplitude

- horizontal: time

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25
What is amplitude measurement of one small box
1 mm | 0.1 mV
26
Sinus Rhythm | - what to look for
- distance should be the same between similar waves (R to R interval) - P wave should be the same, don't want P' waves! - Narrow QRS - P before every QRS - T after every QRS
27
In which leads should P wave be upright? | downward?
Upright in II, III, AVF Downward in AVR
28
when is sinus arrhythmia common?
young people | not in old people!
29
P wave normal morphology
- sinus node depolarization - before every QRS - duration <0.12ms - amplitude <2.5 mm
30
multiple P waves in a row suggest
P wave being blocked by AV node, not allowing to ventricles
31
lack of P wave with scribbly baseline suggests
atrial fibrillation
32
Multiple "shark fin" P waves suggests
atrial flutter
33
PR interval normal morphology
- pause in conduction at AV node | - if duration >0.20ms suggests AV nodal block Type I
34
QRS normal morphology
- ventricular depolarization | - duration <0.10 ms
35
what does wide and weird QRS without a P wave suggest
likely PVC | premature ventricular contraction
36
What does wide QRS suggest?
inter ventricular conduction delay
37
T wave normal morphology
- upright, rounded
38
ST segment normal morphology
- should be flat or upsloping
39
what does convex ST segment suggest
injury pattern
40
What does a concave ST segment suggest
- ischemia per guest lecturer | - normal per Dr. V.
41
What does inverted T wave suggest
ischemia
42
what does a tall, peaked T wave suggest
hyperkalemia
43
Premature atrial contraction | - define
- site outside normal conduction pattern fires erratically | - usually asymptomatic
44
how know if premature atrial contraction is ectopic and not sinus node?
- will have some normal P waves and then a few that don't fit in
45
Atrial fibrillation - how common? - increased risk for what - outcome
- most common irregular rhythm >65 yo - increased risk for stroke - not malignant or fatal (unless stroke I guess)
46
Atrial fibrillation | - what happens
- Atria don't contract rhythmically from single discharge of sinus node - depolarize more like 4th of July sparkler - rate might be as high as 300 bpm
47
Why is there pretty normal ventricular contraction during atrial fibrillation
- the AV node protects the ventricles | - if AV node doesn't protect well enough CAN have a rapid ventricular response
48
Key characteristics of atrial fibrillation
- no distinct P before QRS - complex, scribbly, erratic baseline (sparker) - R to R interval is irregular - broad variability between R waves - correct number of ventricular beats but not at a normal rate
49
cause of atrial fibrillation
- structural heart disease or chronic HTN irritates area where pulmonary veins dump back into atria
50
treatment of atrial fibrillation
pulmonary vein isolation - scar the pulmonary veins
51
Atrial flutter | - describe
- Isthmus between inferior vena cava and tricuspid valve becomes irritable - fires at rapid rate, 300 bpm typically
52
How to determine atrial flutter rate
- don't count, do math! - calculate ventricular rate - divide 300 by ventricular rate ex. if ventricular rate is 100, ratio is 3:1 (300 atrial / 100 ventricular)
53
What be suspicious of if have tachycardia locked in at a rate
suspect atrial flutter! don't get fooled!
54
Issues associated with atrial flutter
- stroke risk less than atrial fibrillation | - less dangerous but can still cause issues, should be fixed
55
What see on lead II during atrial flutter
negative SOMETHING (not sure what?!?!) - because the electrical signal is kicked back at the AV node so it moves in a counter clockwise motion - because moving backwards, causes negative line (positive wave of depolarization heading towards negative right arm)
56
AV nodal block types
- 1st degree - 2nd degree type 1 - 2nd degree type 2 - 3rd degree
57
AV nodal block 1st degree
- AV node holds conduction longer - lengthen PRI - PRI will be longer than 5 boxes on EKG
58
PRI
PR interval
59
AV nodal block 2nd degree type 1
- normal first beat - second beat held at AV node - third beat held longer at AV node - fourth beat held even longer and not passed on to ventricles - lengthening PRI and finally dropped QRS - not a bad arrhythmia, might be caused by a beta blocker, just need to take pt off med
60
AV nodal block 2nd degree type 2
- normal sinus rhythm - then pause at AV node - then a few dropped QRS in a row - PRI length same each time - AV node gets snippy, ignores ventricles
61
AV nodal block type 3
- Total heart block at AV node - no ventricular contractions - ectopic sites kick in at 20 to 40 bpm in ventricles - will die if not fixed - "AV disassociation"
62
what does it mean if the P wave is inverted?
- "Junctional rhythm" - tells you P wave is coming from lower in atrium - retrograde conduction
63
what does it mean if there is not a P wave
- "Idioventricular rhythm" - ventricle is pacing itself without input from AV node - QRS will be weird and wide - very bad
64
Types of ventricular ectopy
- PVCs - Bigeminal PVCs - Trigeminal PVS - NSVT
65
what is a PVC
- ventricle "sneezes" - can have all the time and not know it, rarely symptomatic - often see when heart is overstimulated or during hypoxia - if isolated, not a problem
66
What if PVCs are not isolated but are instead in patterns and runs
``` very bad - Bigeminal - Trigeminal - Quadrageminal etc - could be sign of heart disease ```
67
What does the width and height of a PVC tell you?
where the PVC is coming from! - more normal looking QRS means from higher in ventricle (more like normal electrical conduction) - weirder QRS means lower in ventricle, more odd electrical conduction
68
How to name runs of ventricular tachycardia
two is couplet three is triplet etc i assume
69
how to treat sustained ventricular contraction
electrical shock
70
Torsades de pointes
TSD - twisting of points - polymorphic ventricular tachycardia (like twisting crepe paper) - no P waves before QRS - QRS all wide and weird - rapid rate - potentially deadly, can easily descent to ventricular fibrillation - dead
71
how to treat Torsades de pointes
magnesium STAT
72
can you shock systole back to a normal rhythm?
nope, only on TV
73
which type of bundle branch block is more dangerous
Left - results in ventricular dys-symmetry from repeated depolarization from the right ventricle which is kind of like driving a car for a long time on the spare tire...
74
EKG signs of RBBB
- rabbit ears on V1 | - broad, deep S-wave on V6
75
EKG signs of LBBB
- deep QRS on V1 | - two R waves but both small and above baseline (small right ventricle)
76
Hemiblock - which branch most likely to be affected - typical EKG pattern
- Left anterior fascicle | - negative R in II, III, & AVF
77
Prolonged QT
- represents depolarization and beginning of depolarization | - lots of drugs prolong QT
78
what is dangerous about prolonged QT
incoming and outgoing wave crash into each other analogy - if depolarize before finished repolarizing = chaos - prolong QT creates more opportunity for the two to overlap - can be fatal
79
QT measurement
- varies with rate, use corrected QT based on patient's weight - prolonged if corrected is >440 for men >470 for women
80
causes of prolonged QT
drugs hypocalcemia hypothermia etc.
81
EKG signs of atrial enlargement
* p wave is actually two atrial waves on top of each other. - right atrium enlarged = tall witch hat, sums early - left atrium enlarged = shift out of phase with each other "diphasic", left will creep out from behind and create two humps (camel hump)
82
Right ventricular hypertrophy | - EKG signs
- large R in V1 | - R wave amplitude progressively smaller V2-V4
83
Left ventricular hypertrophy (LVH) | - EKG
- large S in V1 - large R in V5 - amplitude of S in V1 + R in V5 >35 mm, there is a voltage criteria for LVH
84
Quick glance to check for LVH
how tall is AVL how deep is V2 how tall is V5
85
ST segment depression indicates what
- ischemia - can be pattern associated with LVH - look like left handed checkmarks
86
what is best next step after signs of LVH
echocardiogram - easiest, cheapest way to look for heart disease. - measures cardiac output, valve function, dimensions of walls/chambers
87
What is elevated in acute MI
ST segment | - if in contiguous leads is a problem
88
V1 and AVL look at
high lateral wall of heart
89
V5 and V6 look at
low lateral wall of heart
90
V2, V3, AVF look at
inferior wall of heart (right ventricle)
91
V1 and V2 look at
anterior heart
92
V3 and V4 look at
septum of heart
93
How many members of "group" of leads is needed to claim significant change
the whole family, not just isolated leads
94
What is a reciprocal change
ST change elevation in one location and depression in another
95
STEMI
ST segment elevation MI - do something right away!! * don't know for sure is MI until further testing
96
special signs
- Wellen's sign - WPW - Dig effect - Brugada
97
Wellen's sign
- ST elevation - biphasic T wave in V2 and V3 - sign of large LAD lesion
98
Wolff-Parkinson-White Syndrome
- Short PR interval <0.12 sec - prolonged QRS >0.10 sec - delta wave - can simulate ventricular hypertrophy, BBB, previous MI
99
Digitalis on EKG
ST looks like Dali mustache
100
Brugada syndrome
- autosomal dominant genetic mutation of Na channels - syncope, v-fib, self terminating VT, sudden cardiac death - can be intermittent on EKG - middle-aged males - need ICD (implanted defibrillator)

EKG & Physiology (3 decks)

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