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Clinical Patient Care 2023 > Intro To EKGs > Flashcards

Intro To EKGs Flashcards

1
Q

What is Einthoven’s Triangle?

A

Lead I: - right arm, + left arm (right to left)
Lead II: - right arm, + left leg (right to left)
Lead III: - left arm, + left leg (left arm to left leg)

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2
Q

Where is the SA node?

A

In the right upper atrium

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3
Q

Where are the percordial lead located?

A

V1: right 4th intercostal
V2: left 4th intercostal
V4: mid clavicular line
V3: between 2 and 4 intercostal space
V5: 5th or 6th anterior axillary line
V6: mid axillary line

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4
Q

What is the lead placement right sided EKG

A

V4 is placed on the right side and is now “VAR”

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5
Q

What is the lead placement of posterior EKG?

A

V4, V5. V6 is now V7, V8, V9 behind the scapula on the left side

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6
Q

How can you improve diagnostic quality? For EKG

A
  1. Remove hair
  2. Skin preparation
    *scratch the surface of the skin with an abrasive pad to remove excess oils and establish better conductivity
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7
Q

What are some causes of artifacts on a EKG?

A
  1. Patient movement
  2. Cable movement
  3. Vehicle movement
  4. EMI (electro magnetic interference)
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8
Q

What is the biggest cause of artifacts?

A

Patient movement
1. Make the patient as comfortable as possible
2. Check for subtle movements
*top tapping
*shivering
3. Look for muscle tension
*hand grasping rails

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9
Q

What is EMI?

A

Electro-magnetic interference
1. EMI can interfere with electronic equipment
2. Try to maintain awareness of possible EMI interference
*due to cell phones, radios, most electrical devices

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10
Q

What are the steps of the heart conduction pathway?

A
  1. SA node creates an excitation signal
  2. The signal travels to the atria, telling them to contract
  3. The AV node, delays the signal until the atria are empty of blood
  4. The bundle of His carrying the signal to the Purkinjie fibers
  5. The Purkinjie fibers to your ventricles, cause them to contract
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11
Q

What does an EKG record?

A

Conduction not contraction

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12
Q

What does the P-wave signify?

A

Atrial depolarization

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13
Q

When does conduction slow down?

A

At the AV node
*which allows the ventricles to fill

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14
Q

What happens if there wasn’t an impulse at the AV node?

A

The ventricles would contract immediately and would not have time to fill
*there would be ineffective cardiac output

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15
Q

What does the QRS complex signify

A

Depolarization of the ventricles
*there will be contraction of the right and left ventricle and will disperse blood into pulmonary arteries and aorta

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16
Q

What is the normal resting state of a myocyte?

A

Negatively charged

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17
Q

What happens during an action potential (hypopolarization)

A
  1. The initial increase of the membrane potential to the value of the threshold potential
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18
Q

What happens during an action potential? (depolarization)

A
  1. The threshold potential open voltage-gated sodium channels and causes a large influx of sodium ions
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19
Q

What happens during an action potential (overshoot)

A
  1. The inside of the cell becomes more electropsitive until the potential gets closer to the equilibrium for sodium which is +61mV
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20
Q

What happens during an action potential (Repolarization)

A
  1. After the overshoot, the sodium permeability suddenly decreases due to the closing of its channels
  2. The overshoot value of the cell potential opens the voltage-gated potassium channels
  3. There is then a large effluent of potassium, decreasing the cell’s electropositivity.
  4. The purpose is to restore the resting membrane potential
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21
Q

What do the boxes represent on EKG paper?

A

1x1: .04 seconds
5x5: 0.20 seconds
(5) 5x5: 1.0 second

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22
Q

What does voltage represent on EKG paper?

A

The height and depth of waves (mm)

23
Q

What is the definition of a segment and interval?

A

S: A straight line connecting two waves
I: A wave plus the connecting line

24
Q

What are the 3 characteristics of waves on a EKG?

A
  1. Duration (seconds) horizontal
  2. Amplitude (mV) height, depth, vertical
  3. Configuration (shape and appearance)
25
Q

When would there be an upward deflection on a EKG?

A

Wave of depolarization TOWARD a positive electrode

26
Q

When would there be a negative (downward) deflection on an EKG?

A

The wave of depolarization AWAY from a positive electrode

27
Q

When would there be a biphasic wave?

A

When the wave of depolarization is perpendicular to a positive electrode

28
Q

What are the characteristics of a P wave?

A
  1. There is a positive wave of depolarization within the myocytes flows toward a positive electrode, there is a positive (upward) deflection recorded on the EKG
  2. Atrial depolarization is recorded as a P wave on a EKG
    *depolarization is then slowed at the AV node to allow filling of the ventricles
29
Q

What does a normal P wave indicate?

A

Indicates the normal sinoartrial node firing

30
Q

What is the amplitude, duration, and positioning of the P wave?

A

A: < (or equal) 2.5mm (vertical height)
D: < (or equal) 0.12sec (3 small boxes)
Upright/positive: I, II, aVL, aVF, V4-6 (best seen in lead II)
*biphasic in V1 or downward deflection

31
Q

What are the characteristics of a PR interval?

A

When depolarization is slowed at the AV node to allow filling of the ventricles
1. Beginning of P-wave to beginning of QRS complex
2. 0.12-0.20sec (3-5 small squares)
3. 1 (degree) AV block=increased PR interval (more then 5 squares)

32
Q

What are the characteristics of a QRS complex?

A

Depolarization of ventricular myocytes produces a QRS complex on the EKG and initiates contraction of ventricles
*represents ventricular contraction
1. Duration: 0.06-0.10/0.11sec
2. >0.12sec (3 boxes) consider a conduction block

33
Q

What are the characteristics of a Q wave?

A
  1. Normal Q wave <0.03
  2. Not seen in all leads
  3. Deep and wide considered pathological
  4. Represents ventricular depolarization of the interventricular septum
34
Q

Where would small Q waves occur?

A

In left lateral leads (I, aVL), inferior leads (II, III, AVF), V3 and V4

35
Q

What are characteristics of an abnormal Q wave?

A

D: > (or equal) 0.04 sec (1 small box)
A: > (or equal) 1/3 of the R wave

36
Q

What are the characteristics of a R wave?

A
  1. V1-V2: very small, gets progressively taller in the lateral precordial leads (V6)
  2. Should see prominent R wave in V3-V4
37
Q

What does poor R wave progression indicate?

A

Indicates previous anterior MI

38
Q

What are the characteristics of the ST segment?

A

Following the QRS complex
1. Horizontal segment, flat and at baseline
2. Represents the “plateau” and initial phase of ventricular repolarization
3. Should be isoelectric with PR segment (baseline)

39
Q

What are the characteristics of a T-wave

A

Indicates ventricular repolarization
*potassium ions move out of the cells via potassium channels

40
Q

What are the characteristics of a QT interval?

A

Beginning of Q wave (or R wave if no Q wave present) to the end of the T wave
1. QT interval generally <1/2 of the RR interval

41
Q

What is the normal Qt interval?

A

0.42 +/- 0.02 secs

42
Q

What does a prolonged QT mean?

A
  1. Tornadoes De Point
  2. Metabolic causes, drug ingestions
43
Q

What are the normal intervals throughout the EKG?

A

PR interval: <0.2 secs (one big square)
QRS complex <0.12 sec (3 little squares)
QT interval: <0.44 sec
QTc is the corrected QT for heart rate

44
Q

What are the limb leads?

A

3 standard leads (one negative and one positive lead)
*leads I, II, III
*positive pole towards the left or downward
3 augmented leads (single positive lead and all others negative)
*aVR (augmented voltage right)
*aVL (augmented voltage left)
*aVF (augmented voltage foot)
*were the positive poles are the body makes up the negative

45
Q

What limb leads are positive or negative?

A

Positive: I, II, III, aVL, aVF
Negative: aVR

46
Q

Where are the positive and negative electrodes in lead aVR?

A

+ electrode on right arm
- is between left arm and left foot electrodes

*negative deflection b/c wave of depolarization is going away from + electrode

47
Q

Where are the positive and negative electrodes in lead aVL?

A

+ electrode on left arm
- is formed between right arm and left foot

*usually positive deflection b/c wave of depolarization is headed toward the left

48
Q

Where are the positive and negative electrodes in lead aVF?

A

+ electrode on left foot
- is formed between left and right arm

*usually positive deflection b/c wave of depolarization is downward

49
Q

What are the chest leads?

A
  1. 6 precordial leads
  2. View heart in a horizontal plane (anterior and posterior)
  3. Each chest electrode is positive
50
Q

What are the advantages to a rhythm strip?

A
  1. Can quickly and accurately diagnose a variety of serious dysthymia’s
  2. Easy to obtain
  3. Excellent for continuous monitoring of rhythm
  4. Can accurately diagnose AV blocks and demonstrate presence of bundle branch blocks
51
Q

What are the disadvantage of a rhythms strip?

A

Cannot diagnose many extremely important cardiac conditions
*ischemia
*infarction
*type of bundle branch blocks
*axis deviations
2. Can misdiagnose certain rhythm disturbances if only one lead is used

52
Q

What are the indication to use a resting 12 lead EKG?

A
  1. Must be used to diagnose suspected serious cardiac disease
  2. Can be helpful as a screen in some
    *diabetes
    *HTN
    *certain cardiomyopathies
53
Q

What are the advantages of a resting 12 lead EKG?

A

Can diagnose most of the extremely important cardiac conditions
1. Ischemia
2. Infarction
3. Type of BBB
4. Axis deviations

54
Q

What are the contiguous leads?

A
  1. I, aVL, V5, V6 (lateral)
  2. II, III, aVF (inferior)
  3. V1, V2 (septal)
  4. V4, V3 (anterior)
  5. AVR

Clinical Patient Care 2023 (33 decks)

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