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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
Q

What type of rhythm is AVRT/AVNRT?

A
  • regular
  • short PR interval
  • fast > 100/min
  • narrow QRS
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26
Q

What type of rhythm is multifocal atrial tachycardia?

A
  • irregularly irregular

- clear p waves but > 3 different P wave morphologies b/c different foci give rise to different P waves

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27
Q

What type of rhythm is atrial fibrillation?

A
  • irregularly irregular ventricular rhythm

- absent P waves –> have fibrillary activity but no clear P waves

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28
Q

What type of rhythm is atrial flutter with variable block?

A

irregular

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29
Q

What types of rhythms should you think if narrow complex tachycardia with irregular rhythm?

A
  • Afib
  • atrial flutter with variable block
  • multifocal atrial tachycardia
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30
Q

What type of rhythms should you think if narrow complex tachycardia with regular rhythm?

A
  • sinus tach
  • atrial flutter
  • or any of the re-entrant tachycardias
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31
Q

Who most commonly gets multifocal atrial tachycardia?

A

acutely ill elderly patients especially with COPD

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32
Q

What kind of rhythm is sinus tachycardia?

A
  • regular
  • long PR interval
  • upright in 1 and 2; inverted in aVR
  • > 100/min
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33
Q

What is AVNRT/AVRT?

A
  • 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

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34
Q

What do you give to pt that has SVT?

A

give adenosine = blocks AV node so will block accessory path and shut it off; go back to sinus rhythm

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35
Q

How do you treat atrial flutter?

A

ablation and anti-arrhythmic

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36
Q

What is typical vs atypical atrial flutter?

A

typical = p waves upright in II, III, aVF

atypical is not

37
Q

What distinguishes atrial flutter from AFib?

A

Atrial flutter = clear p waves actively going really fast

38
Q

What causes atrial flutter?

A

macro re-entrant arrhythmia involving atria [either right or left]

39
Q

What causes atrial tachycardia?

A

ectopic focus in atrium

can be enhanced by digitalis toxicity

40
Q

What causes wide complex tachycardia?

A
  • ventricular tachycardias [VT/VF/torsades]
41
Q

What should you think with wide QRS tachycardia?

A

wide QRS tachycardia is VT until proven otherwise

42
Q

What signs of ventricular tachycardia?

A
  • wide QRS tachycardia
  • evidence of AV dissociation –> independent P waves, capture or fusion beats
  • history of ischemic heart disease or CHF
43
Q

What kind of shock do you give pt with VTach?

A

synchronized cardioversion

44
Q

When do you give synchronized cardioversion vs non-synchronized defibrillation?

A

synchronized cardioversion = if there are any QRS waves present

defibrillation = in VFib

45
Q

What can happen if you give non-synchronized shock to pt with ventricular tachycardia?

A
  • can set off extra burst of energy and become VFib
46
Q

What is AV dissocation?

A

no association between rhythm of P waves and QRS waves = happens in ventricular tachycardia

47
Q

What is capture beat?

A

p wave is able to capture a narrow normal QRS in the middle of VT pattern

happens in ventricular tachycardia

48
Q

What is fusion beat?

A

have QRS in between supraventricular and ventricular beat = not as broad as ventricular or as narrow as supraventricular

happens in ventricular tachycardia

49
Q

What is rhythm of ventricular fibrillation?

A
  • chaotic and irregular deflections of varying amplitude and contour
  • no p waves, QRS complexes, or T waves
50
Q

What is torsade de pointes?

A
  • associated with long QT interval [congenital or due to drugs, electrolyte imbalances]
  • form of polymorphic VT
  • dancing/twisting around an axis
51
Q

How do you treat torsade de pointes?

A

don’t cardioverst or fibrillate

just give a huge bolus of Mg

52
Q

How do you differentiate WPW from other causes of wide QRS?

A 
VT/VF = regular rhythm
WPW = wide QRS
53
Q

How would you treat patient with WPW with AFib?

A

procainamide or pronesta

54
Q

What do you use lidocaine for?

A

VT

55
Q

What happens if you give adenosine to pt with WPW?

A

block AV node and everything will come down accessory path –> will become a VF

56
Q

When is adenosine indicated/contraindicated?

A

indicated in narrow complex tachycardia

contraindicated in broad complex tachycardia

57
Q

What kind of rhythm with a first degree AV block?

A
  • 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
Q

What happens in mobitz type 1 [wenkebach] second degree AV block?

A

progressive prolongation of PR until P wave fails to conduct

group/pattern beating

59
Q

What happens in mobitz type 2 second degree AV block?

A

intermittent non-conducted P waves with no evidence of atrial prematurity

60
Q

What kind of pattern is mobitz type 1 second degree AV block?

A
  • irregularly irregular
  • pr interval gradually prolongs
    short –> longer –> longest –> dropped p wave –> subsequent PR interval after dropped P wave is the shortest
61
Q

What kind of pattern is mobitz type 2 second degree AV block?

A
  • 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
Q

What happens in complete heart block?

A
  • 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
Q

What is sinus pause?

A

longer than 2 seconds [10 big boxes] of NO sinus activity

64
Q

What is sinus arrest/asystole?

A

no sinus activity

65
Q

What do you normally see in pacemaker EKG?

A
  • wide QRS
  • usually LBBB pattern –> wide and down in V1
  • pacemaker spikes before P, before QRS, or both
66
Q

Why do you get LBBB pattern in pacemaker KEG?

A

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
Q

What does you see in hyperkalemia EKG?

A

peaked T waves

long PR –> no P at high level

68
Q

What is treatment for hyperkalemia?

A

Iv calcium gluconate for membrane stabilization

insulin + Bicarb to shift K into cells

69
Q

What do you see in serum potassium < 5.5?

A

normal EKG

70
Q

What do you see in serum K5.5-6.5?

A
  • peaked T wave

- prolonged PR

71
Q

What do you see in serum K 6.5-8?

A
  • peak T
  • loss of P
  • prolonged QRS
  • ST elevation
72
Q

What do you see in serum K > 8?

A
  • progressive widening of QRS = looks like sine wave

- ventricular fibrillation/asystole/axis deviation/ bundle branch block

73
Q

What do you see on EKG in hypokalemia?

A
  • prominent U waves [best in leads V2, V3] = major finding

- can have small/absent T waves

74
Q

What do you see on EKG in acute pericarditis?

A
  • diffuse concave upward ST elevation [w/ no reciprocal changes]
  • PR depression in V3, PR elevation in aVR
  • maybe tachycardia
75
Q

What is electrical alternans?

A
  • QRS axis/amplitude alternates between beats

- sign of cardiac tamponade

76
Q

What do you see on EKG in cardiac tamponade?

A
  • 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
Q

What do you see on EKG in pulmonary embolism?

A
  • sinus tachycardia

- S1Q3T3 pattern –> promiment S wave in lead 1 + Q wave and inverted T in lead III

78
Q

What are 3 things that cause ST elevations

A
  • acute MI [STEMI], unstable angina
  • hyperkalemia
  • acute pericarditis
79
Q

What do you see on EKG with digoxin?

A
  • scooped out ST depression = reverse check mark sign

- also will see AFib [since its treating AFib] –> no Ps and irregularly irregular

80
Q

What does it mean for there to be sinus rhythm?

A
  • upright in II, II, down in aVR

- p before every Q

81
Q

What is normal variation in HR with respiration?

A

< 10%

82
Q

What are some causes of sinus tachycardia?

A
  • pain
  • fever
  • hypoxia
  • pulm embolism
  • hypovolemia
  • sepsis
83
Q

What are some causes of right axis deviation?

A
  • 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
Q

What is most common cause of right axis deviation?

A

right ventricular hypertrophy

85
Q

What do you have to worry about diagnosing left axis deviation in prescence of inferior infarct?

A

LAD = big down in aVF = S

need to make sure its an S not a Q which would signal infarction

86
Q

What are some causes of left axis deviation?

A
  • left ventricular hypertrophy
  • left anterior fascicular block
  • LBBB
  • inferior MI
  • aced beats
  • WPW
  • primum ASD
87
Q

What is extreme axis deviation?

A

180 to -90 degrees

88
Q

What are some causes of extreme axis deviation?

A
  • right ventricular hypertrophy
  • apical MI
  • VT
  • hyperkalemia
89
Q

What is sokolow LVH criteria?

A

S in V1 + R in V5 or in V6 > 35

Cardio Exam 2 (19 decks)

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