Lecure 5: ECG Flashcards
what are the 4 steps to ECG interpretation
- too fast , too slow?
- QRS wide or narrow?
- Check the P wave
4> is the rhythm regular or irregular
if the HR is to slow/low then it does not produce enough what
CO
if Hr is to high then it doesn’t give the heart enough time to ___ the ventricles which then leads to ___ CO and ____ BP
fill
decrease 2x
if HR is < 60 then what is that called
bradycardia
if HR is >100 then what is that called
tachycardia
what represents the depolarization of the R and L atria
P wave
what complex represents the R and L ventricular depolarization
QRS complex
what wave represents the ventricular repolarization
ST wave
what represents the time it takes ventricles to depolarize and repolarize
QT interval
if the QT interval is to long then it can lead a Patient into what
V tac
what interval is the time it takes for the nerve impulse to go from teh SA node to the AV node which then depolarizes the ventricles
PR interval
if the ST segments elevates or depresses what can we suspect
myocardial infarction or ischemia
how many beats per minute is the SA node
60-100
how many beats per minute is the AV junction
40-60 bpm
how many beats per mins at the purkinje networks
20-40 bpm
how many beats per minute from bundle of his
40-60 bpm
if the ST segment is elevated 2 boxes then it indicates what
myocardial infarction
if the ST segment is depressed 2 boxes then it indicates what
myocardial ischemia
if the T wave is upside down when it is suppose to be upright then what does that indicate
myocardial infarction or ischemia
if there is a long QT interval what can that lead to
arrhythmias
Limb lead 1 is going in what direction
from R to L
limb lead 2 is going in what direction
right to Left downwards
limb leads 3 is going in what direction
from L to right going downwards
aVF lead is going in what direction
from top to bottom
aVL is going from what direction
middle to left
aVR is going in what direction
middle to right
which limb lead is the most important
lead 2
V1, V2, V3, and V4 are on which wall of the heart
anterior wall
which precordial leads are on the lateral wall
V5 V6
which precordial lead presents lead 2
V2
which precordial lead represents limb lead 1
V5
which precordial lead represents limb lead 3
V1
limb lead 2, 3 and AVF are looking at which part of the heart
inferior
limb lead 1, AVL , V5, V6 are looking at what part of the heart
lateral
if the heart rate is to fast then there is ____ filling time
insufficient
if the heart rate is to slow then there is an ___-rate
insufficient
impulses traveling away from a positive electrode and/or towards a negative electrode will produce a ____ deflection
downward
impulses traveling toward a positive electrode will produce a ____ deflection
upwards
if there is an impulse coming from the ventricle what will that change in the ECG
QRS wave will become wider
what is it called when we have cells in ventricles that depolarize and causes a wider QRS wave
PVCs
what is teh compensatory pause during a PVC
the time for the ventricles to repolarize
what is it called when there is a PVC every 2 complexes ( so normal QRS and then PVC and then normal QRS then PVC)
ventricular bigeminy
what is it called if there is a PVC every 3rd complex
ventricular trigeminy
what is ventricular couplet
when there are 2 PVCs in a row
what is a ventricular triplet
3 PVCs in a row
what is it called is someone has a ventricular triplet but it subsides within 30 secs with HR >100
non sustained ventricular tachycardia
what do you do if you see a ventricular triplet for a patient
stop doing everything
what can ventricular triplet lead to
V fib
if there is a negative P wave what can that indicate
something wrong in atria
if there is no P wave on the ECG what can that indicate
impulse is not coming from SA node
if the P wave going up and down then what does that indicate
impulse not coming from SA node
if there is a ventricular rate about 120 bpm or below 45 bpm what can we consider
ischemia , hypotension or sepsis
if someone presents with atrial fibrillation what can we suspect
mitral valve disease
alcoholism
ischemia
infection
if someone has a complete heart block or 2nd degree heart block what we can consider
any heart disease
if there is an abnormal T wave inversion than what we can suspect
infraction
ischemia
pulmonary embolism
wide QRS width can be bc of
any heart disease
is A fib life threatening?
naur
what can A-fib lead to
stroke
complete heart block can lead to what
A systole
what does V tac look like
a lot for steep hills
what happens when impulse comes from atria but not SA node
supra ventricular tachycardia
is the QRS wide or narrow in supracentircular tachycardia
narrow
what does it mean if QRS is really narrow ?
impulse is not coming from ventricles
is a junctional rhythm fast or slow
slow ( 40-60 bpm)
is there P waves with junctional rhythm?
no
since there is no P wave with junctional rhythm where does the pulse come from
prob AV junction
P wave inversion is normal for lead ___ , ____ lead and precordial leads ___ and ____
– Lead III
– Is normal for AVR lead
– Leads V1 and V2
P wave inversion is not normal when looking at which side of the heart
L side
for all other leads besides 3 and AVR , P wave inversion is NORMAL (T/F)
F only at leads 3 and avr is it normal)
if the P wave is buried within the QRS what can we suspect
junctional rhythm
digoxin causes teh ST segments to ___ sometimes
depress below the isoelectric line
after having an MI what will happen to the QRS complez
may be irregular
if the patient has hyperkalemia what may happen to the T wave
peaked bc of electrolyte imbalance
if there is an inverted T wave what can we consider
myocardial infarction or ischemia
is T wave inversion normal or not normal for the following things
– Myocardial ischaemia and infarction
– Bundle branch block
– Ventricular hypertrophy (‘strain’ patterns)
– Pulmonary embolism
– Hypertrophic cardiomyopathy
– Raised intracranial pressure
not normla
Is T wave inversion normal or to normla for the following things
– Lead III
– Lead V1 (adults)
– AVR leads
– Leads V1, V2, V3 children
normal
what are premature beats
beats before the SA node
what are beats within the heart that take on its own role ?
ectopic beats
what does V fib look like
a bunch of little mountains
what does A fib look like
little mountains before the QRS complex
what is multiple etopic cells firing at different rates
A fib
what does A flutter look like
a saw (little hills) before the QRS complex
what is it called when 1 ectopic cell creates spiral like circular current patterns
atrial flutter
which one is worse A flutter or A fib
A fib
what is ventricular tachycardia from prolonged QT interval
torsades de pump
what does torsades de pump look like
a bunch of lines goes up and down w QRS complex being hard to tell
the right bundle branch block cause a ____ depolarization of the R ventrical
delayed
Right Bundle is blocked causing delayed depolarization of the right ventricle; it will not start until the ___ ventricle is almost fully depolarized.
left
how does the right bundle branch block change on the ECG when looking at the right side of the heart
you will see 2 R’s
how does the right bundle branch block change on the ECG when looking at the left side of the heart
deep s wave
when there is a left bundle branch block it causes a delayed ____ of the ___ ventricle and will not stat until the ___ ventricle is almost fully depolarized
depolarization
left
right
how does the left bundle branch block change on the ECG when looking at the right side of the heart
deep S wave
how does the left bundle branch block change on the ECG when looking at the left side of the heart
double R wave
what does “william morrow” meant
for leads V1 and V6
if LBBB then V1 will have a “w” and V6 will have a “m” (bc reading form left to right )
if RBBB then V1 will have “m” and V6 will have “w” (bc reading from right to left)
which lead is best to see LBBB
V6
what is it called if impulses are blocked or delayed from atria to ventricles
AV blocks
someone with a first degree AV block will have a long ____ interval
P-R
first degree AV block causes the HR to
slow down
First degree AV block is common in
athletes
second degress block: type 1 is what
PR interval gets longer and longer then you have a drop of ARS and then you have a wenckebach
what is another name for second degree AV block type 1
mobitz 1 ( wenckebach)
if you are reading someone ECG and you see they have normal PR interval length and then alll the sudden no QRS what does this indicate
second degree AV block type 2
what is another name for second degree AV block
mobitz 2
second degree AV block type 2 is a sudden drop in QRS without prior change in PR interval which can cause what
systole or sinus arrest
is second degree AV block type 1 or 2 more dangerous
2 do not work w patient
what is 3rd degree heart block (complete)
you have p waves and QRS complex but it does not match up
If your P’s and Q’s don’t agree then you have a _____ degree
third
can you work with pateint if that present with 2nd degree as block type 2 or third degree heart block if they have a pacemaker
yes
prolonged QT interval can lead to ___
torsades de pump whcih then can lead to vtac
V1 , V2 and aVR looks at what side of the heart
right vent
Lead 2 , lead 3 and aVF look at what part of the heart
inferior wall
lead 1 , aVL, V5 and V6 look at what side of the heart
lateral wall of left ventricle
V1-V4 look at what part of the heart
anteriorseptal part of the ventricles
