Kim - EKG Flashcards
1
Q
How is an isoelectric ekg (Biphasic) gotten?
A
Current flow towards perpendicular electrode
2
Q
The ECG. Records time- dependent changes in the __________ within the heart
A
Mean electrical vector
3
Q
How many electrodes are there in ekg
A
9
4
Q
Position V1
A
4th intercostal space, 2cm to right of sternum
5
Q
Position V2
A
4th intercostal space, 2 cm to left of sternum
6
Q
Position v3
A
Midway between v2 and v4
7
Q
Position v4
A
5th intercostal space, left midclavicular linee
8
Q
Position V5
A
5th intercostal space, left anterior axillary line
9
Q
Position v6,
A
5th intercostal space, left mid axillary line
10
Q
If heart is depolarizing towards a positive lead, which way is deflection on ekg?
A
Up
11
Q
Normal direction of deflection of a wave in lead aVR
A
Negative, because direction is towards right arm
12
Q
Where does lead I go?
A
Negative right arm, positive left arm
13
Q
Where is lead II goin?
A
Negative right arm, positive left legg
14
Q
Where is lead three going
A
Negative left arm, positive left leg
15
Q
Bipolar limb leads
A
Lead I, II, III
16
Q
Augmented unipolar limb leads
A
AVR, AVL, AVF
17
Q
Normal axis is ?
A
-30 to +90
18
Q
Represents the terminal stages of ventricular repolarization or possibly the repolarization of the purkinje network.
Not always present
A
U Wave
19
Q
The Left bundle branch posterior division is also called?
A
Left posterior fascicle
20
Q
The left bundle branch anterior division is also called
A
Left anterior fascicle
21
Q
What is a Q wave
A
If the first part of the QRS. Complex is negative. That is Q wave
22
Q
____ may be normal if small, or may indicate an infarction
A
Q wave
23
Q
R’ is a second upward deflection in the QRS complex and is seen in ___
A
Bundle branch blocks
24
Q
What does “normal R wave progression mean”?
A
It means that the R wave gradually gets bigger as it goes from V1 to V6
25
Acute right heart strain (i.e PE), Right ventricular hypertrophy, and left posterior fascicular block are all causes of
Right axis deviation
26
The time represented by one small square on ekg paper`
.04 seconds
27
The time represented by one large square on ekg paper
0.2 seconds
28
The amount of voltage in one small sqaure (vertical)
0.1mV
29
The amount of voltage across one large squuare vertically
0.5mV
30
Part of left bundle branch that. Depolarizes the interventricular septum in a left to right direction
Septal fascicle
31
What is the difference between an interval and a segment on ekg?
Interval encompasses at least one wave plus the connecting line. Segment is just a straight line connecting two waves
32
Lead I angle of orientation
0*
33
Lead II angle of orientation
60*
34
Lead III angle of orientation
120*
35
Lead created by making the left arm positive and the other limbs negative. Angle of orientation is -30*
AVL
36
Lead created by making the right arm positive and the other limbs negative. Angle of orientation is -150*
aVR
37
Lead created by making the legs positive and the other limbs negative. Angle of orientation is 90*
AVF
38
Inferior leads
II, III, aVF
39
Left lateral leads
I, aVL
40
Right sided limb lead
AVR
41
Anterior leads
V2, V3, V4
42
Left lateral leads
V5, v6, I, aVL
43
Right ventricular leads
AVR, V1
44
The p wave amplitude is usually most positive in lead ___ and most negative in lead ____
II
AVR
45
Normal range of p wave vecto
0-70 degrees
46
Normal PR interval
0.12 -0.2 seconds
| PR interval is the time from start of atrial depolarization to the start of ventricular depolarization
47
Small q waves caused by septal depolarization are most commonly seen in what leads?
Left lateral leads. Because the septal depolarization is left to right, the left lateral leads show the q waves (which are negative)
(I, AVL, V5, v6)
48
Normal septal q wave amplitude
Less than or equal to 0.1mV
49
The precordial lead or leads in which the qrs goes from being predominantly negative to predominantly positive. Typically at leads v3 an v4
Transition zone
50
It is typical and normal to find positive T waves in the same leads that have tall _ waves
R
51
The QT interval is proportionate to __
Heart rate
52
Faster heart rates have ____ QT intervals
Shorter
53
Increased muscle mass
Hypertrophy
54
Dilatation of a particular chamber
Enlargement
55
Enlargement is most typically caused by?
Volume overload
56
What three things can happen to a wave on EKG when a chamber hypertrophies?
Takes longer to depol (increased duration of the wave)
Increased voltage (increase amplitude)
The electrical axis can shift (more current thru bigger muscle)
57
If the QRS is predominantly positive in leads ___ and ___ then the QRS axis must be normal
I and AVF
58
If the QRS complex in either lead I or AVF is not predominantly positive, then the QRS axis ________
Is not normal
59
Inferior wall I, LAFB, Left ventricular hypertrophy are all possible causes of ?
Left axis deviation
60
Very sensitive. Reflects electrolyte changes, ischemia, or drugs.
Part of EKG
T wave
61
Will the QRS complex of lead AVF be positive or negative in a pt with Right axis deviatioN?
It will be positive
| Lead I will be negative
62
The area in the atria that becomes repolarized first is the ?
Sinus nodal region
63
In the normal ekg, all complexes of ___ are normally positive
Lead II
64
In the normal ekg, the t wave in lead V1 may be positive, biphasic, or negative, but the T waves in leads V2 thru V6 are normally
Positive in adults
65
The point at which the ST segment originates from the QRS complex is called the ____ point
J
66
In a normal ekg, the QRS complex in lead V6
Typically begins w/ a narrow Q wave followed by a large R wave
67
A wide QRS indicates that
Conduction is slowed somewhere
68
The QT interval normalized for a heart rate of 60 beats per minute
Corrected QT
| QTc
69
Shortened PR can be indicative of ?
Wolf-parkinson-white
70
Sinus rhythm means
P wave is coming from the sinus node
71
P wave is upright in leads
I, II, III
72
Count off method sequences, what is the order. Starts AFTER the R way. Do not start this on the R wave, but on the next box that is after the R wave that falls on the big box
300, 150, 100, 75, 60, 50
73
When one ventricle greatly hypertrophies, the axis of the heart shifts _______
Towards the hypertrophied ventricle
74
R > S in V1
Right axis deviation
Right ventricular hypertrophy
75
S in V1 plus;
R in V5 or V6 >/= 35mm OR
R in aVL > 11mm
OR
R in lead I > 15mm
Left ventricular hypertrophy
76
Widened QRS
RSR’ in V1
Prominent S in lead V6
Right bundle branch block
| Flip this card when you get it to 5
77
Widened QRS
Absent R and prominent S in V1
Absent small Q and broad notched R in lead V6
Left bundle branch block
| Flip when at 5
78
LAFB —> negative to
II , III, AVF
79
The LBB. The left anterior fascicle runs through the ___, ____, and ____, portion of the left ventricle
Anterior, superior, and lateral
80
In the LBB. The left posterior fascicle runs through the _____, _____ and _____ portion of the left ventricle
Posterior, inferior and medial
81
In contrast to RBBB’s and LBBB’s, LAFB and LPFB do not result in _
Significant widening of the QRS
[ because rapidly conducting purkinje fibers bridge the territories served by the anterior and posteriro fascicles]
82
What recordings are most useful for evaluating LPFB and LAFB
The recordins in the limb leads
83
What kind of axis deviation is there in Left Posterior Fascicular Blocks?
Right axis deviation
84
What kind of axis deviation is there typically in left anterior fascicular block ?
Left axis deviation
85
Pathological Q waves have what width in duration and depth ?
Width greater than or equal to 1 small box
Depth > 25% total height in QRS complex
86
Pathologic Q waves develop in leads
Overlying infarcted tissue
87
In posterior wall MI , you will get taller than normal ____- in leads V1 and V2
R waves
88
What can be seen in STEMI which indicates that the area of infarction is much larger ?
Reciprocal depression opposite the ST elevation
89
What can be seen as a normal ekg finding when using the drug digoxin?
ST scooped depression.
Mild PR prolongation
90
Ekg finding associated with hyperkalemia?
Peaked T wave
91
Findings on EKG in severe hyperkalemia
Flattened P
Widened QRS
92
Finding on EKG in hypokalemia
ST depression, flattened T
Prominent U wave
93
Calcium affects ___ on EKG
QT interval
94
Hypercalcemia EKG finding?
Shortened QT interval
95
Hypocalcemia EKG finding?
Prolonged QT interval
96
Pathologic sinus bradycardia can result from ?
Aging, ischemia, cardiomyopathy
Medications (beta blockers, Ca channel blockers)
Metabolic causes (hypothyroid
97
A pronounced reduction of the heart rate can produce a fall in cardiac output with :
Fatigue
Light headedness
Confusion
Syncope
98
In Escape rhythms, no ____ waves are evident because impulse originates below the atria
P waves
99
Escape rhythm with widened QRS complex
Ventricular escape rhythm
100
PR interval lengthened (greater than 0.2 seconds)
Generally benign, asymptomatic condition
First degree AV block
101
Prolonged electrical inactivity
Asystole
