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EKG > Intro to EKG and interpretation > Flashcards

Intro to EKG and interpretation Flashcards

1
Q

Automaticity

A

produce impulse without outside stimulation

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2
Q

excitability

A

ability to respond to an electrical stimulus

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3
Q

conductivity

A

ability to transmit electrical signal from cell to cell

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4
Q

pacemaker cells

A
  • SA node/ R atrium
  • normal electrical power source
  • automaticity
  • 60-100 bpm
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5
Q

electrical conduction cells

A
  • hardwiring of the heart
  • excitability and conductivity
  • AV node, HIS branch, LBB/RBB, anterior and post fascicles, purkinge fibers
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6
Q

myocardial cells

A
  • contractile machinery of heart

- excitability and conductivity

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7
Q

what determines HR?

A
  • innate electrical characteristics of the cell

- external neurohormonal input

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8
Q

factors that influence rate of pacemaker cell discharge

A
  • catecholamines (increase HR)

- acetylcholine (decrease HR)

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9
Q

what does the P wave represent?

A
  • atrial depolarization

- Should proceed each QRS complex

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10
Q

what does the QRS complex represent?

A

ventricular depolarization

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11
Q

what does the T wave represent?

A

ventricular repolarization

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12
Q

Lead I

A
  • L arm is positive

- R arm is negative

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13
Q

Lead II

A
  • leg positive

- R arm negative

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14
Q

Lead III

A
  • leg positive

- L arm negative

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15
Q

AVL

A
  • L arm positive

- other limbs negative (-30)

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16
Q

AVR

A
  • R arm positive

- other limbs negative ( -150)

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17
Q

AVF

A
  • Leg positive

- other limbs negative (+90)

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18
Q

what are the standard limb leads?

A

I, II, III

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19
Q

what are the augmented limb leads?

A

AVR, AVL, AVF

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20
Q

inferior leads

A

II, III, AVF

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21
Q

left lateral leads

A
  • I, AVL

- V5, V5

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22
Q

Right leads

A
  • AVR

- V1

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23
Q

Anterior leads

A

V2, V3, V4

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24
Q

how many seconds is one small square?

A

0.04 seconds

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25
Q

how many seconds is one large square?

A

0.2 seconds

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26
Q

in what leads is there a positively deflected P wave?

A
  • I, II
  • AVL, AVF
  • V5, V6
27
Q

in what leads is there a biphasic P wave?

A

III and V1

28
Q

in what leads is there a negatively deflected P wave?

A

AVR

29
Q

in what leads is the P wave variable?

A

V2, V3 and V4

30
Q

what is a normal P wave amplitude and duration?

A
  • amplitude= 0.5-2.5 mm

- duration= 0.06-0.10 seconds

31
Q

right atrial enlargement

A
  • taller than 2.5 mm
  • initial component of biphasic P wave is taller in V1
  • normal duration
32
Q

left atrial enlargement

A
  • wide, often notched
  • wide biphase wave in V1
  • amplitude is normal or increased
33
Q

what does the PR interval represent?

A
  • the time from the start of atrial depolarization to start of ventricular depolarization
  • is the distance from beginning of P wave to beginning of Q wave
34
Q

what is a normal PR interval?

A
  • 0.12- 0.2 seconds or up to one big box

- larger than one box means heart block

35
Q

what does the PR segment represent?

A
  • time from end of atrial depolarization to beginning of ventricular depolarization
  • from end of P wave to beginning of Q wave
36
Q

what does the Q wave represent?

A
  • septal depolarization

- negative deflection at start of QRS complex

37
Q

what is a pathologic Q wave?

A
  • abnormally large Q wave
  • generally indicates previous MI and irreversible damage
  • occurs hours to days after MI
  • can have simultaneous loss of R wave
38
Q

what are the criteria to be considered a pathologic Q wave?

A
  • duration greater than 0.04 seconds

- depth > 1/3 the height of the R wave

39
Q

what is the average vector of current flow?

A

0 degrees to +90 degrees

40
Q

what is R wave progression?

A
  • R wave progressively increases in amplitude moving L to R in precordial leads
  • usually largest in V5 at apex of the heart
41
Q

what is considered a normal QRS complex duration?

A
  • 0.06- 0.1 seconds

- should not be larger than 3 small boxes

42
Q

why would someone have a wide QRS complex?

A
  • impulse generated in ventricle

- impulse takes an aberrant pathway through the ventricle

43
Q

what does the ST segment represent?

A
  • time from end of ventricular depolarization to start of ventricular repolarization
44
Q

what does ST segment elevation represent?

A

MI

45
Q

what does ST segment depression represent?

A

ischemia

46
Q

what is the J point

A

termination of QRS complex at start of ST segment

47
Q

what are the criteria to be considered a STEMI

A
  • 1 mm in heigh in limb leads
  • 2 mm in height in precordial leads
  • has non-concave shape
48
Q

what does J point elevation look like?

A

concave in appearance

49
Q

what does the T wave represent?

A
  • ventricular repolarization/ relaxation

- variable in appearance

50
Q

what does the QT interval represent?

A
  • from beginning of ventricular depolarization to end of ventricular repolarization
  • inversely proportionate to HR
  • normally 40% of cardiac cycle
51
Q

what is an easy way to check the QT interval?

A

should be less than half way between the two QRS complexes

52
Q

AV Node pacemaker rate

A

40-60 bpm

53
Q

ventricular pacemaker rate

A

20-40 bpm

54
Q

methods for determining HR

A
  • 300, 150, 100, 75, 60, 60

- count QRS in 6 sec interval then multiply by 10

55
Q

common reasons for cardiac hypertrophy

A
  • chronic HTN
  • congenital
  • more common in ventricles
56
Q

common reasons for cardiac enlargement

A
  • volume overload

- more common in atria

57
Q

mean axis

A
  • summation of all vectors in the heart
  • normally falls between 0-90 degrees
  • positive QRS in leads I and aVF
58
Q

right axis deviation

A
  • QRS negative in lead I

- QRS positive in aVF

59
Q

left axis deviation

A
  • QRS positive in lead I

- QRS negative in aVF

60
Q

extreme right axis deviation

A
  • QRS negative in lead I

- WRS negative in aVF

61
Q

characteristics of right axis deviation

A
  • poor R wave progression
62
Q

characteristics of left ventricular hypertrophy

A
  • left axis deviation (sometimes)
  • increased R wave amplitude in leads over L ventricle
  • increased S wave amplitude in leads over R ventricle
  • down sloping ST segment
  • T wave inversion
63
Q

criteria for dx of L ventricular hypertrophy

A

R wave amplitude in V5 or V6 plus S wave amplitude in V1 or V2 exceeds 35 mm/7 boxes

EKG (4 decks)

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