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Clinical Skills > McCarthy EKG > Flashcards

McCarthy EKG Flashcards

1
Q

a normal P wave axis lies between what two degrees? (for adults and children)

A

0 and +70 for adults

0 and +90 for kids

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2
Q

lead II’s positive electrode is at what degree?

A

+60

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3
Q

what is the isoelectric line?

A

flat line between beats when there is no electrical activity

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4
Q

beats originating in the SA node should generate what type of P wave?

A

upright (seen in lead II)

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5
Q

what two arrhythmias are seen with a wide complex?

A

ventricular arrhythmia or SV arrhythmia aberrant

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6
Q

BPM for SA node, atria, AV node, ventricles

A

SA- 60-100
Atria- 60-75
AV- 40-60
ventricles- 30-45

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7
Q

how does the action potential spread from the SA node to left and right atria?

A

via the atrial internodal tracts

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8
Q

why is conduction through the AV node slow?

A

to insure that the ventricles have enough time to fill before they are activated and contract (has a refractory period)

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9
Q

what three things does increasing the conducting velocity of the AV node lead to?

A

decreased ventricular filling, stroke volume, and cardiac output

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10
Q

what makes up the AV junction?

A

AV node and bundle of His

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11
Q

junctional pacemaker cells = ?

A

AV node

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12
Q

what makes up the ventricular conducting system?

A

right and left bundle branches plus purkinje system

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13
Q

what is an ectopic pacemaker?

A

when failure of the SA node leads to another pacemaker taking over and setting the new rhythm

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14
Q

besides SA node failure, how could other pacemaker cells (besides the SA node) take over?

A

altered automaticity- events that increase automaticity such as myocardial ischemia, increase sympathetic tone, HYPOkalemia

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15
Q

describe escape or premature beats narrow complex VS wide complex

A

narrow complex escape/premature beats arise from above the bundle branches (AV node or atrium); wide complex beats are originating in the ventricles

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16
Q

what is an escape beat?

A

rescue beats taking over rhythm from SA node (ALWAYS a pause before escape beat)

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17
Q

is a P wave seen with an escape beat?

A

not usually since the pacemaker cell isn’t the SA node (and can hide within the QRS complex)

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18
Q

narrow vs wide complex numbers?

A

narrow is less than 0.12 sec

wide is greater than 0.12 sec

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19
Q

what is a premature beat?

A

a beat that occurs early within normal sinus rhythm

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20
Q

atrial vs junctional premature beat

A

atrial p wave occurs early and ABNORMAL contour

junctional occurs early but usually doesn’t have p wave (sometimes retrograde, inverted)

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21
Q

what are the three types of junctional rhythms?

A

1) . inverted p wave before QRS- atria depolarizing from bottom to top before ventricles depol
2) . atria and ventricles depolarizing at same time- p wave hidden in QRS
3) . inverted p wave after QRS- atria depolarizing bottom to top after ventricles depol

22
Q

NSR PR interval and QRS complex

A

PR interval- 0.12-0.2 sec

QRS- NARROW (<0.12)

23
Q

sinus tachy and sinus brady rates

A

tachy: 100-160
brady: 40-60

24
Q

PSVT also called what two things?

A

AV nodal reentry tachycardia

Paroxysmal atrial tachycardia

25
Q

PSVT: complex? rate? p waves?

A

narrow complex tachy, 150-250 bpm, usually no p waves seen (grouped with T wave)

26
Q

what is PSVT usually initiated by?

A

a premature supraventricular beat (atrial or junctional)

27
Q

atrial flutter: complex? rate? p wave? pattern?

A

narrow complex tachy, 250-350 rate, multiple p waves between QRS
“sawtooth”- no flat baseline

28
Q

three different types of conduction rates for atrial flutter?

A

variable- differing amounts of atrial vs ventricle rates

4: 1- 4 p waves to every 1 QRS
2: 1- 2 p waves for every 1 QRS

29
Q

Afib: complex? rate? p waves? ventricle rate?

A

narrow complex tachy, >350 rate, no true p waves, ventricle rate is irregularly irregular (only occasional impulses passed from atria to ventricles)

30
Q

what are the two main types of afib?

A

controlled rate (<100 BPM) vs uncontrolled rate (>100 BPM)

31
Q

BBB- complex? rate? p wave?

A

WIDE complex, tachy rate, sinus p wave (if significant tachy, p waves might be buried in T wave)

32
Q

PVC: complex? p wave? what is a PVC?

A

wide complex, usually no p wave seen

PVC: premature ventricular contraction

33
Q

what is an escape ventricular beat?

A

PVC looking ventricular contraction that occurs after a pause (OCCURS LATE- compared to PVC)

34
Q

should a ventricular escape rhythm be suppressed?

A

NO, could be life saving if its the only pacemaker the heart has left

35
Q

what is ventricular tachy? complex? rate? p waves?

A

run of 3 or more PVC’s in a row; WIDE complex tachy, 140-250 rate, no p waves

36
Q

what is often seen in VT waves?

A

ST segment and T wave slope opposite direction than the deflected QRS

37
Q

what is monomorphic vs polymorphic VT?

A

monomorphic- all the QRS complexes have the same appearance

polymorphic- varying amplitudes, shapes sizes

38
Q

what is ventricular escape rhythm?

A

pause and then ventricles take over pacing

39
Q

what three electrolyte imbalance can cause Torsades? why?

A

Hypocalcemia- because it prolongs the QT interval

hypokalemia and hypomagnesemia

40
Q

what is torsades? how is it usually started?

A

it is polymorphic VT with prolonged QT interval; usually started by a premature PVC falling on a prolonged T wave

41
Q

Vfib: complex? rate? p wave?

A

wide complex tachy, undistinguishable rhythm, NO p waves, QRS or T waves
NO ASSOCIATED PULSE

42
Q

first degree heart block: complex? special criteria?

A 
narrow complex (unless BBB is present)
**prolonged PR interval >0.2 seconds
every p wave has a corresponding QRS
43
Q

second degree heart block: two types? difference between the two?

A

Mobitz 1 “wenckebach” or Mobitz 2
- in both, a QRS is eventually dropped by PR interval in type 1 increases with every beat until QRS is gone (type 2= PR stays consistent)

44
Q

Mobitz Type 1 complex? Type 2 complex? type 2 p waves?

A

type 1: narrow (unless BBB is present)
type 2: narrow or wide depending on site of block
type 2 p waves have multiple to every QRS

45
Q

third degree heart block: complex? p waves?

A

narrow or wide; more p waves than QRS (looks like separation of p wave from t wave)

46
Q

atrial vs ventricular rate for Type 1, 2nd degree heart block?

A

atrial- rate regular

ventricular- rate irregular

47
Q

atrial vs ventricular rate for Type 2, 2nd degree block?

A

atrial- rate regular

ventricular- rate usually regular and a multiple of the atrial rate

48
Q

atrial vs ventricular rate for 3rd degree block?

A

both rates usually regular (ventricular under 60 BPM)

49
Q

what is asystole? what two ways can it present on EKG?

A

no ventricular activity, no QRS complexes EVER

presentation- as ONLY p waves or straight line

50
Q

what is pulseless electrical activity (PEA)? what two things can it be due to?

A

an organized cardiac rhythm other than VT without a pulse

due to hypovolemia or hypoxia

51
Q

what two things do you see with wolf Parkinson white?

A

PR interval less than 0.12

delta wave

52
Q

what happens in wolf Parkinson white?

A

an accessory pathway called “bundle of kent” is used to bypass slow conduction of AV node

Clinical Skills (15 decks)

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