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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
Q

What is amplitude measurement of one small box

A

1 mm

0.1 mV

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26
Q

Sinus Rhythm

- what to look for

A
  • 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
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27
Q

In which leads should P wave be upright?

downward?

A

Upright in II, III, AVF

Downward in AVR

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28
Q

when is sinus arrhythmia common?

A

young people

not in old people!

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29
Q

P wave normal morphology

A
  • sinus node depolarization
  • before every QRS
  • duration <0.12ms
  • amplitude <2.5 mm
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30
Q

multiple P waves in a row suggest

A

P wave being blocked by AV node, not allowing to ventricles

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31
Q

lack of P wave with scribbly baseline suggests

A

atrial fibrillation

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32
Q

Multiple “shark fin” P waves suggests

A

atrial flutter

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33
Q

PR interval normal morphology

A
  • pause in conduction at AV node

- if duration >0.20ms suggests AV nodal block Type I

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34
Q

QRS normal morphology

A
  • ventricular depolarization

- duration <0.10 ms

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35
Q

what does wide and weird QRS without a P wave suggest

A

likely PVC

premature ventricular contraction

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36
Q

What does wide QRS suggest?

A

inter ventricular conduction delay

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37
Q

T wave normal morphology

A
  • upright, rounded
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38
Q

ST segment normal morphology

A
  • should be flat or upsloping
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39
Q

what does convex ST segment suggest

A

injury pattern

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40
Q

What does a concave ST segment suggest

A
  • ischemia per guest lecturer

- normal per Dr. V.

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41
Q

What does inverted T wave suggest

A

ischemia

42
Q

what does a tall, peaked T wave suggest

A

hyperkalemia

43
Q

Premature atrial contraction

- define

A
  • site outside normal conduction pattern fires erratically

- usually asymptomatic

44
Q

how know if premature atrial contraction is ectopic and not sinus node?

A
  • will have some normal P waves and then a few that don’t fit in
45
Q

Atrial fibrillation

  • how common?
  • increased risk for what
  • outcome
A
  • most common irregular rhythm >65 yo
  • increased risk for stroke
  • not malignant or fatal (unless stroke I guess)
46
Q

Atrial fibrillation

- what happens

A
  • 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
Q

Why is there pretty normal ventricular contraction during atrial fibrillation

A
  • the AV node protects the ventricles

- if AV node doesn’t protect well enough CAN have a rapid ventricular response

48
Q

Key characteristics of atrial fibrillation

A
  • 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
Q

cause of atrial fibrillation

A
  • structural heart disease or chronic HTN irritates area where pulmonary veins dump back into atria
50
Q

treatment of atrial fibrillation

A

pulmonary vein isolation - scar the pulmonary veins

51
Q

Atrial flutter

- describe

A
  • Isthmus between inferior vena cava and tricuspid valve becomes irritable
  • fires at rapid rate, 300 bpm typically
52
Q

How to determine atrial flutter rate

A
  • 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
Q

What be suspicious of if have tachycardia locked in at a rate

A

suspect atrial flutter! don’t get fooled!

54
Q

Issues associated with atrial flutter

A
  • stroke risk less than atrial fibrillation

- less dangerous but can still cause issues, should be fixed

55
Q

What see on lead II during atrial flutter

A

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
Q

AV nodal block types

A
  • 1st degree
  • 2nd degree type 1
  • 2nd degree type 2
  • 3rd degree
57
Q

AV nodal block 1st degree

A
  • AV node holds conduction longer
  • lengthen PRI
  • PRI will be longer than 5 boxes on EKG
58
Q

PRI

A

PR interval

59
Q

AV nodal block 2nd degree type 1

A
  • 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
Q

AV nodal block 2nd degree type 2

A
  • 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
Q

AV nodal block type 3

A
  • 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
Q

what does it mean if the P wave is inverted?

A
  • “Junctional rhythm”
  • tells you P wave is coming from lower in atrium
  • retrograde conduction
63
Q

what does it mean if there is not a P wave

A
  • “Idioventricular rhythm”
  • ventricle is pacing itself without input from AV node
  • QRS will be weird and wide
  • very bad
64
Q

Types of ventricular ectopy

A
  • PVCs
  • Bigeminal PVCs
  • Trigeminal PVS
  • NSVT
65
Q

what is a PVC

A
  • 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
Q

What if PVCs are not isolated but are instead in patterns and runs

A 
very bad
- Bigeminal
- Trigeminal
- Quadrageminal
etc
- could be sign of heart disease
67
Q

What does the width and height of a PVC tell you?

A

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
Q

How to name runs of ventricular tachycardia

A

two is couplet
three is triplet
etc i assume

69
Q

how to treat sustained ventricular contraction

A

electrical shock

70
Q

Torsades de pointes

A

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
Q

how to treat Torsades de pointes

A

magnesium STAT

72
Q

can you shock systole back to a normal rhythm?

A

nope, only on TV

73
Q

which type of bundle branch block is more dangerous

A

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
Q

EKG signs of RBBB

A
  • rabbit ears on V1

- broad, deep S-wave on V6

75
Q

EKG signs of LBBB

A
  • deep QRS on V1

- two R waves but both small and above baseline (small right ventricle)

76
Q

Hemiblock

  • which branch most likely to be affected
  • typical EKG pattern
A
  • Left anterior fascicle

- negative R in II, III, & AVF

77
Q

Prolonged QT

A
  • represents depolarization and beginning of depolarization

- lots of drugs prolong QT

78
Q

what is dangerous about prolonged QT

A

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
Q

QT measurement

A
  • varies with rate, use corrected QT based on patient’s weight
  • prolonged if corrected is >440 for men >470 for women
80
Q

causes of prolonged QT

A

drugs
hypocalcemia
hypothermia
etc.

81
Q

EKG signs of atrial enlargement

A
  • 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
Q

Right ventricular hypertrophy

- EKG signs

A
  • large R in V1

- R wave amplitude progressively smaller V2-V4

83
Q

Left ventricular hypertrophy (LVH)

- EKG

A
  • 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
Q

Quick glance to check for LVH

A

how tall is AVL
how deep is V2
how tall is V5

85
Q

ST segment depression indicates what

A
  • ischemia
  • can be pattern associated with LVH
  • look like left handed checkmarks
86
Q

what is best next step after signs of LVH

A

echocardiogram - easiest, cheapest way to look for heart disease.
- measures cardiac output, valve function, dimensions of walls/chambers

87
Q

What is elevated in acute MI

A

ST segment

- if in contiguous leads is a problem

88
Q

V1 and AVL look at

A

high lateral wall of heart

89
Q

V5 and V6 look at

A

low lateral wall of heart

90
Q

V2, V3, AVF look at

A

inferior wall of heart (right ventricle)

91
Q

V1 and V2 look at

A

anterior heart

92
Q

V3 and V4 look at

A

septum of heart

93
Q

How many members of “group” of leads is needed to claim significant change

A

the whole family, not just isolated leads

94
Q

What is a reciprocal change

A

ST change elevation in one location and depression in another

95
Q

STEMI

A

ST segment elevation MI

  • do something right away!!
  • don’t know for sure is MI until further testing
96
Q

special signs

A
  • Wellen’s sign
  • WPW
  • Dig effect
  • Brugada
97
Q

Wellen’s sign

A
  • ST elevation
  • biphasic T wave in V2 and V3
  • sign of large LAD lesion
98
Q

Wolff-Parkinson-White Syndrome

A
  • Short PR interval <0.12 sec
  • prolonged QRS >0.10 sec
  • delta wave
  • can simulate ventricular hypertrophy, BBB, previous MI
99
Q

Digitalis on EKG

A

ST looks like Dali mustache

100
Q

Brugada syndrome

A
  • 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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