midterm

Question 1

What is an ECG

Answer 1

A test that records the electrical activity of the heart through electrodes attached to the skin and limbs

Question 2

What are the 5 types of ECG

Answer 2

Resting (monitors heart at rest)
Exercise (stress test)
Signal-averaged (multiple ECG in 15-30 minutes)
Holter monitor (portable ECG)
Event/loop recording (for weeks or months)

Question 3

Why do a 12 lead ECG

Answer 3

To find cause of unexplained chest pain
Find cause of symptoms of heart disease
Check how well meds are working
Check how well mechanical devices are working

Question 4

Why do you print 2 copies of the ECG

Answer 4

One goes to the nurse or doctor which is written “copy” on it
Second stays with ECG machine to go to cardiologist

Question 5

Where does V1 go

Answer 5

4th intercostal space to right of sternum

Question 6

Where does V2 go

Answer 6

4th intercostal space to left of sternum

Question 7

Where does V3 go

Answer 7

Between V2 and V4

Question 8

Where does V4 go

Answer 8

5th intercostal space at left midclavicular line

Question 9

Where does V5 go

Answer 9

5th intercostal space at left anterior axillary line

Question 10

Where does V6 go

Answer 10

5th intercostal space at left mid axillary line

Question 11

How much time is represented by a large 5X5mm box on the ECG

Answer 11

0.2 seconds

Question 12

How much time does one 1X1mm block represent on an ECG

Answer 12

40 millisecond

Question 13

Why do we do a right sided ECG

Answer 13

For patients with inferior myocardial infarct, or when right ventricular infarct is suspected
Patients with dextrocardia of situs inversus

Question 14

Explain the lead placement for a right sided ECG

Answer 14

V1, V2 stay same
V3R on a line midway between electrodes V1 and V4R
V4R in 5th right intercostal space mid clavicular
V5R level with V4R at right anterior axillary line
V6R level with V4R and V5R in right mid axillary line

Question 15

What must you do on the ECG paper when doing a right sided ECG

Answer 15

Write in header that it is a right sided ECG and put the letter “R” after V3-V6 to clarify it is a right sided ECG

Question 16

Why do we do a 15 lead ECG

Answer 16

When there is a possibility of an inferior STEMI (ST-elevated MI)
If the 12 lead is non diagnostic
If the issue is inferior or posterior

Question 17

Why do we do a 15 lead ECG

Answer 17

If the patient has an inferior STEMI (ST-elevated MI)
If the issue is inferior or posterior
If the ST is depressed in V1-V3 it’s a symptom of acute coronary syndrome

Question 18

How do you do a 15 lead ECG

Answer 18

Run a normal 12 lead ECG
V4 gets switched to V4R
V5 gets moved to the 5th intercostal space mid scapular line (is now V8)
V6 gets moved to between V8 and the spine (is now V9)
*make sure to label as a 15 lead and reliable V8 and V9)

Question 19

Why do we use Holter monitors

Answer 19

To evaluate symptoms suggesting arrhythmia or myocardial is ischemia
Evaluation of patients with ST segment changes
Evaluate patients response after going back to normal after MI or cardiac surgery
Monitor medication effectiveness
Evaluate pacemaker
Further investigate abnormal ECG

Question 20

Why do you place the electrodes over bones for Holter monitors

Answer 20

To minimize artifacts from muscular activity

Question 21

Where is the lead placement for a Holter monitor

Answer 21

Red: at top of sternum
Green: 8th rib at right mid clavicular line
Brown: 5th rib at left anterior axillary line
White: below right clavicle, lateral to mid clavicular line
Black: 8th rib left mid clavicular line

Question 22

What is a stress loop

Answer 22

It’s used to reinforce electrodes to skin by taping over each electrode and wire

Question 23

What must you do when installing a Holter monitor

Answer 23

Put new batteries
Impure patient and operator data
Make sure it works properly
Show patient the “event” button
Instruct patient to maintain normal daily activity

Question 24

What to avoid when wearing a Holter monitor

Answer 24

Absolutely no baths or showers
Electric blankets
Magnets
Electric razors and toothbrushes
Metal detectors
Microwave ovens
High voltage areas
Try not to get monitor close to cellphones

Question 25

Explain the Holter diary

Answer 25

Patient name at top
Write start date and time
Record date and time monitor is removed
If a lead falls off patient must write approximate time and what lead fell off
Write list of medication they’re on
Need to record any unusual symptoms by pressing “event” button and write down the event
Write down how they feel every hour
Diary returned when patient returns to take monitor off

Question 26

What do the right leads V1 and V2 show you in the heart walls

Answer 26

Inter-ventricular septum and right ventricle

Question 27

What do the anterior leads V3 and V4 show you for the heart wall

Answer 27

The anterior wall of the left ventricle

Question 28

What do the low lateral leads V5 and V6 show you for the heart walls

Answer 28

The low lateral wall

Question 29

What do the high leads I and AVL show you for the heart

Answer 29

The high lateral wall

Question 30

What do the inferior leads II, III, and AVF show you for the heart?

Answer 30

The inferior wall

Question 31

What does the PQ segment show you?

Answer 31

Atrial depolarization/contraction

Question 32

What does the ST segment show you?

Answer 32

Ventricular depolarization/contraction

Question 33

What does the QRS complex show you?

Answer 33

The atria depolarization/contraction

Question 34

What happens after the T wave?

Answer 34

Ventricular depolarization/relaxation