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Cardio Exam 2 > Lec 2-3 EKG > Flashcards

Lec 2-3 EKG Flashcards

1
Q

What is normal p-wave height/width?

A

height < 2.5 mm [< 2.5 small sq]

width < 0.11 sec [<3 small sq]

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2
Q

What is normal PR interval?

A

0.12-0.2 sec [3-5 small sq] = P wave + PR segment

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3
Q

What is normal QRS complex duration?

A

< 0.12 sec [3 small sq]

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4
Q

What is normal QTc interval duration?

A

< 460 ms [11 small sq]

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5
Q

What are the standard 12 leads of ECG?

A

6 precordial [chest] leads V1 to V6 right to left= cross-sectional view of heart

6 limb leads [I, II, III, aVR, aVL, aVF] = frontal view of heart

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6
Q

What are characteristics of normal sinus rhythm?

A
  • p waves axis upright in I, II, inverted in AVR
  • each p wave followed by a QRS
  • p wave rate 60-100 bpm
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7
Q

In normal sinus rhythm, which leads have upright p wave and which inverted?

A
  • p waves upright in I, II

- p waves inverted in AVR

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8
Q

What does the pr segment represent?

A

time from atria to AV node

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9
Q

What does the p wave represent?

A

depolarization of the atria

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10
Q

What does the pr interval represent?

A

p wave + pr segment = time from SA node to AV node

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11
Q

How many mV is one small square on EKG?

A

0.1 mV

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12
Q

How much time is one small square on EKG

A

0.4 seconds = 40 mS

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13
Q

What does the QRS complex represent?

A

duration of depolarization of the ventricles

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14
Q

What is the ST segment?

A

time from end QRS to T wave → duration of repolarization of ventricles

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15
Q

What is QT interval?

A

start of Q though end of T = everything depolarizing and repolarizing in ventricles

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16
Q

What are the 2 leads that are essentially negative normally?

A

AVR, V1

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17
Q

How does HR change in inspiration?

A

INspiration = Increase; variation from inspiration to expiration should be less than 10%

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18
Q

What does premature atrial contraction look like?

A
  • early QRS complex originated/preceded by abnormal P wave

- QRS complex itself looks normal

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19
Q

What does premature ventricular contraction look like?

A

broad QRS wave, not preceded by P wave

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20
Q

What is cheat method for determining rate of HR from EKG?

A

distance between QRS waves: 300 = 1 big square; 150 = 2 big sq; 100 = 3 big sq; 75 = 4 big sq; 60 bpm = 5 big sq
Thus if 5 big squares between QRS waves = 60 bpm
3-6 big boxes = normal

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21
Q

What is non-cheat method for determining HR from EKG?

A

1500/n → n = number of small squares between R-R

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22
Q

What is sinus bradycardia?

A

rate < 60/min; normal P wave axis

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23
Q

What is sinus tachycardia?

A

rate > 100/min; normal P wave axis

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24
Q

What is lead II direction?

A

toward left foot [+60]

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25
What is lead III direction?
down and right [+120]
26
What is einthoven’s triangle?
leads 1, 2, and 3 together
27
What is aVR direction?
-150
28
What does it mean” normal people stand upright”?
normal = both lead I and AVF are upright
29
What does it mean “right people always meet”?
right axis deviation = lead 1 down, AVF up
30
What does it mean “leftists don’t see eye to eye”?
left axis deviation = lead I upright, AVF down
31
What is normal heart axis?
range: 0 to +90
32
What axis degree if right axis deviation?
+90 though + 180
33
What axis degree if left axis deviation
0 though -90
34
What axis if lead 1 upright and AVF negative?
left axis deviation
35
What axis if both lead 1 and AVF negative?
indeterminate
36
What axis if lead 1 negative and AVF upright?
right axis deviation
37
How do you get lead I?
right arm --> left arm [1 L]
38
How do you get lead II?
right arm --> left leg [2 Ls]
39
How do you get lead III?
left arm --> left leg [3 Ls]
40
What is meant by S1Q3 pattern of right axis deviation?
- lead 1 has a deep S wave | - lead 3 has a deep Q wave
41
What is moderate vs marked right axis deviation?
``` moderate = 90 to 120 marked = 120 to 180 ```
42
What should you look out for when you are diagnosing left axis deviation?
make sure it is an S wave causing the big negative wave in AVF --> do this by looking to make sure theres a tiny little blip of a R wave right before the down wave if its a Q wave --> might be an infarct
43
What is most important cause of left axis deviation?
left anterior fascicular block
44
How do you determine if left anterior fascicular block?
1. extreme left axis devation [-45 to -90 | 2. negative lead II
45
What should you think if broad > 120 ms QRS looking down in V1 but normal p and pr?
think left bundle branch block
46
What produces rabbit ears of QRS?
two ventricles are depolarized separately = two R waves due to bundle branch block in one side
47
What do you see in right bundle branch block?
- prolonged QRS > 0.12 sec - secondary R wave [R'] with R' greater than initial R - wide S wave - positive V1 QRS
48
Where do you see QRS rabbit ears in RBBB? LBBB?
RBBB = in V1 [+ V2 right precordial leads] LBBB = in V4 and V5 [left precordial leads]
49
What do you see in left bundle branch block?
- prolonged QRS > 0.12 sec | - negative V1 QRS
50
Normal QRS in V1 is pos or neg?
negative
51
What 4 common conditions can cause big positive V1 QRS wave?
- RBBB - posterior wall MI - WPW syndrome [wolf-parkinson-white] - RVH [right ventricle hypertrophy
52
What are sokolow criteria for LVH?
S in V1 + R in V5 or V6 > 35 mV | add the two together
53
What are cornell criteria for LVH?
S in V3 + R in AVL > 28 mV in men | S in V3 + R in AVL > 20 mV in women
54
What are framingham criteria for LVH?
R in AVL > 11 mV or R in I > 13 mV
55
What should you see in LVH?
- large QRS in left precordial [V4, V5, V6] | - repolarization abnormalities [ST depression, T wave inversion]
56
What are criteria for RVH?
- right axis deviation > + 100 - positive V1 plus one or more of the following: - R in V1 + S in V5 or V6 > 10 - right atrium enlarged - R wave in V1 > 7 - S wave in V1 < 2 - etc
57
What should you think if positive V1 QRS and deviation?
RVH
58
What are criteria for Wolf-parkinson-white?
- short PR interval less than 3 squares (< 120 ms) - delta wave on upstroke QRS [pre-excitation] - broad QRS - secondary ST and T wave changes [inverted T, ST depression]
59
What are 3 types of rhythms with ST/T wave changes from which you can't interpret ischemia/infarction?
- LBBB - LVH - WPW
60
What does direction of V1 tell you about WPW?
V1 negative --> accessory path on right side | V1 positive [upright] --> accessory path on left side

Cardio Exam 2 (19 decks)

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