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Cardio Exam 2 > Lec 31-32 ECG > Flashcards

Lec 31-32 ECG Flashcards

1
Q

Which walls of heart does LADA supply? Which leads represent this?

A

anterior septum
anterior wall
antero-lateral wall of LV

V1-V6

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2
Q

Which walls of heart does circumflex artery supply? Which leads represent this?

A

high lateral and posterior wall of LV

I and aVL

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3
Q

Which walls of heart does right coronary artery supply? Which leads represent this?

A

SA node, inferior LV/ septum, RV

II, III, aVF

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4
Q

Which leads represent inferior wall?

A

leads II, III, aVF

== RCA

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5
Q

Which leads represent septal walll?

A

V1, V2

== LADA

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6
Q

Which leads represent anteroseptal wall?

A

leads V1 through V4

== LADA

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7
Q

Which leads represent lateral wall of LV?

A

leads I, aVL, V5, V6

I/aVL = circumflex = high lateral
V5/V6 = LADA = anterolateral
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8
Q

Which leads represent RV?

A

right sided leads V4R to V6R

== RCA

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9
Q

Which leads represent posterior wall?

A

leads V7 to V9

leads V1 and V2 might reflect these

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10
Q

What is the first part of the heart to get ischemic in a partial occlusion?

A

subendocardium

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11
Q

What signifies ischemia [not infarction] on EKG?

A

ST depression or T wave inversion

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12
Q

How can you tell if ST is depressed?

A

compare ST segment to PR segment

if ST is at a lower voltage box than PR that means its depressed

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13
Q

What does ST elevation mean?

A

complete occlusion of epicardial artery = tells you acute injury occuring

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14
Q

What is the first change in EKG with infarction?

A

hyperacute T wave = tall T wave and within sec to min ST segment starts to rise

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15
Q

What is evolution of EKG changes in acute mI

A
  • hyperacute T wave
  • ST elevation
  • t wave inversion
  • Q wave formation
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16
Q

What does presence of pathological Q wave signify?

A

infarct = muscle death

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17
Q

If hours have passed since start of MI what will EKG show?

A

ST elevation and T wave reversed; maybe small Q starting to form

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18
Q

What happens to EKG in LBBB?

A
  • broad QRS

- down V1

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19
Q

What is treatment if RV + inferior infarct vs just inferior infarct?

A

RV + inferior: if RV dying pt may become hypotensive b/c RV can’t pump blood to left side –> may go into cardiogenic shock; need to give fluids and avoid nitroglycerin [reduces preload]

basically: give fluids before you go to catch lab

if just inferior infarct –> don’t need to give fluids

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20
Q

What do ST depressions in V1 and V2 suggest?

A

alert us to the fact that posterior wall may be involved so we may need to put EKG leads on posterior wall

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21
Q

What is length of QRS in narrow complex vs broad complex tachycardia?

A

narrow: QRS < 0.12 sec [< 3 small sq]
broad: QRS > 0.12 sec [> 3 small sq]

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22
Q

What does narrow complex tachycardia mean vs broad?

A 
narrow = its coming from supraventricular
broad = its coming from ventricle
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23
Q

What kind of rhythm is atrial flutter?

A
  • regular
  • saw tooth P wave pattern
  • seen best in II, III, aVF
  • atrial rate ~300/min = 1 big box between
  • classified as typical or atypical
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24
Q

What type of rhythm is atrial tachycardia?

A
  • regular
  • usually long PR interval
  • atrial rate 150-200
  • p wave morphology different than sinus
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25
What type of rhythm is AVRT/AVNRT?
- regular - short PR interval - fast > 100/min - narrow QRS
26
What type of rhythm is multifocal atrial tachycardia?
- irregularly irregular | - clear p waves but > 3 different P wave morphologies b/c different foci give rise to different P waves
27
What type of rhythm is atrial fibrillation?
- irregularly irregular ventricular rhythm | - absent P waves --> have fibrillary activity but no clear P waves
28
What type of rhythm is atrial flutter with variable block?
irregular
29
What types of rhythms should you think if narrow complex tachycardia with irregular rhythm?
- Afib - atrial flutter with variable block - multifocal atrial tachycardia
30
What type of rhythms should you think if narrow complex tachycardia with regular rhythm?
- sinus tach - atrial flutter - or any of the re-entrant tachycardias
31
Who most commonly gets multifocal atrial tachycardia?
acutely ill elderly patients especially with COPD
32
What kind of rhythm is sinus tachycardia?
- regular - long PR interval - upright in 1 and 2; inverted in aVR - > 100/min
33
What is AVNRT/AVRT?
- re-entrant arhythmia AVNRT = extra path for re-entry is within AV node hence dual AV nodal physiology AVRT = accessory path not within AV node
34
What do you give to pt that has SVT?
give adenosine = blocks AV node so will block accessory path and shut it off; go back to sinus rhythm
35
How do you treat atrial flutter?
ablation and anti-arrhythmic
36
What is typical vs atypical atrial flutter?
typical = p waves upright in II, III, aVF | atypical is not
37
What distinguishes atrial flutter from AFib?
Atrial flutter = clear p waves actively going really fast
38
What causes atrial flutter?
macro re-entrant arrhythmia involving atria [either right or left]
39
What causes atrial tachycardia?
ectopic focus in atrium can be enhanced by digitalis toxicity
40
What causes wide complex tachycardia?
- ventricular tachycardias [VT/VF/torsades]
41
What should you think with wide QRS tachycardia?
wide QRS tachycardia is VT until proven otherwise
42
What signs of ventricular tachycardia?
- wide QRS tachycardia - evidence of AV dissociation --> independent P waves, capture or fusion beats - history of ischemic heart disease or CHF
43
What kind of shock do you give pt with VTach?
synchronized cardioversion
44
When do you give synchronized cardioversion vs non-synchronized defibrillation?
synchronized cardioversion = if there are any QRS waves present defibrillation = in VFib
45
What can happen if you give non-synchronized shock to pt with ventricular tachycardia?
- can set off extra burst of energy and become VFib
46
What is AV dissocation?
no association between rhythm of P waves and QRS waves = happens in ventricular tachycardia
47
What is capture beat?
p wave is able to capture a narrow normal QRS in the middle of VT pattern happens in ventricular tachycardia
48
What is fusion beat?
have QRS in between supraventricular and ventricular beat = not as broad as ventricular or as narrow as supraventricular happens in ventricular tachycardia
49
What is rhythm of ventricular fibrillation?
- chaotic and irregular deflections of varying amplitude and contour - no p waves, QRS complexes, or T waves
50
What is torsade de pointes?
- associated with long QT interval [congenital or due to drugs, electrolyte imbalances] - form of polymorphic VT - dancing/twisting around an axis
51
How do you treat torsade de pointes?
don't cardioverst or fibrillate | just give a huge bolus of Mg
52
How do you differentiate WPW from other causes of wide QRS?
``` VT/VF = regular rhythm WPW = wide QRS ```
53
How would you treat patient with WPW with AFib?
procainamide or pronesta
54
What do you use lidocaine for?
VT
55
What happens if you give adenosine to pt with WPW?
block AV node and everything will come down accessory path --> will become a VF
56
When is adenosine indicated/contraindicated?
indicated in narrow complex tachycardia | contraindicated in broad complex tachycardia
57
What kind of rhythm with a first degree AV block?
- PR interval > 0.2 sec [> 5 small boxes] - each p wave followed by QRS - usually constant PR interval just a slowed down AV node
58
What happens in mobitz type 1 [wenkebach] second degree AV block?
progressive prolongation of PR until P wave fails to conduct | group/pattern beating
59
What happens in mobitz type 2 second degree AV block?
intermittent non-conducted P waves with no evidence of atrial prematurity
60
What kind of pattern is mobitz type 1 second degree AV block?
- irregularly irregular - pr interval gradually prolongs short --> longer --> longest --> dropped p wave --> subsequent PR interval after dropped P wave is the shortest
61
What kind of pattern is mobitz type 2 second degree AV block?
- irregularly irregular - lots of extra p waves - > 3 p waves for each QRS but no group beating like in wenkebach - have fixed PR length
62
What happens in complete heart block?
- p waves not conducted to the ventricles because of blood at AV node - p waves show no relation to QRS complexes - ventricles depolarized by a ventricular escape rhythm
63
What is sinus pause?
longer than 2 seconds [10 big boxes] of NO sinus activity
64
What is sinus arrest/asystole?
no sinus activity
65
What do you normally see in pacemaker EKG?
- wide QRS - usually LBBB pattern --> wide and down in V1 - pacemaker spikes before P, before QRS, or both
66
Why do you get LBBB pattern in pacemaker KEG?
you put pacemaker leads into R side of heart because you can't get leads into L [atrial] side of heart. depolarization via R ventricle first --> then L depolarized via intramyocardial conduction
67
What does you see in hyperkalemia EKG?
peaked T waves | long PR --> no P at high level
68
What is treatment for hyperkalemia?
Iv calcium gluconate for membrane stabilization insulin + Bicarb to shift K into cells
69
What do you see in serum potassium < 5.5?
normal EKG
70
What do you see in serum K5.5-6.5?
- peaked T wave | - prolonged PR
71
What do you see in serum K 6.5-8?
- peak T - loss of P - prolonged QRS - ST elevation
72
What do you see in serum K > 8?
- progressive widening of QRS = looks like sine wave | - ventricular fibrillation/asystole/axis deviation/ bundle branch block
73
What do you see on EKG in hypokalemia?
- prominent U waves [best in leads V2, V3] = major finding | - can have small/absent T waves
74
What do you see on EKG in acute pericarditis?
- diffuse concave upward ST elevation [w/ no reciprocal changes] - PR depression in V3, PR elevation in aVR - maybe tachycardia
75
What is electrical alternans?
- QRS axis/amplitude alternates between beats | - sign of cardiac tamponade
76
What do you see on EKG in cardiac tamponade?
- electrical alternans --> voltage changes in QRS between successive beats, axis changes [sometimes + or -] - low voltage QRS due to so much fluid around the heart
77
What do you see on EKG in pulmonary embolism?
- sinus tachycardia | - S1Q3T3 pattern --> promiment S wave in lead 1 + Q wave and inverted T in lead III
78
What are 3 things that cause ST elevations
- acute MI [STEMI], unstable angina - hyperkalemia - acute pericarditis
79
What do you see on EKG with digoxin?
- scooped out ST depression = reverse check mark sign | - also will see AFib [since its treating AFib] --> no Ps and irregularly irregular
80
What does it mean for there to be sinus rhythm?
- upright in II, II, down in aVR | - p before every Q
81
What is normal variation in HR with respiration?
< 10%
82
What are some causes of sinus tachycardia?
- pain - fever - hypoxia - pulm embolism - hypovolemia - sepsis
83
What are some causes of right axis deviation?
- right ventricular hypertrophy - left posterior fascicular block - lateral/apical MI - acute right heart strain [due to acute lung disease like pulm embolus] - chronic lung disease [COPD] - dextrocardia - WPW via LV free wall accessory path - hyperkalemia - secundum ASD
84
What is most common cause of right axis deviation?
right ventricular hypertrophy
85
What do you have to worry about diagnosing left axis deviation in prescence of inferior infarct?
LAD = big down in aVF = S | need to make sure its an S not a Q which would signal infarction
86
What are some causes of left axis deviation?
- left ventricular hypertrophy - left anterior fascicular block - LBBB - inferior MI - aced beats - WPW - primum ASD
87
What is extreme axis deviation?
180 to -90 degrees
88
What are some causes of extreme axis deviation?
- right ventricular hypertrophy - apical MI - VT - hyperkalemia
89
What is sokolow LVH criteria?
S in V1 + R in V5 or in V6 > 35

Cardio Exam 2 (19 decks)

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