Mod 2 - EKG Acquisition Flashcards
1
Q
what is the sac around the heart called
A
pericardium
2
Q
what are the layers of the heart wall from inner to outermost
A
endocardium, myocardium, epicardium
3
Q
what is the purpose of the chordae tendineae
A
support valve leaflets
4
Q
the tricuspid valve is between the
A
right atrium and right ventricle
5
Q
the bicuspid valve separates the
A
left atrium and left ventricle
6
Q
aka bicuspid valve
A
mitral valve
7
Q
the pulmonary valve is between the
A
right ventricle and pulmonary arteries
8
Q
the aortic valve is in between the
A
left ventricle and aorta
9
Q
aortic and pulmonary valves are both ___ valves
A
semilunar
10
Q
the coronary arteries perfuse during ____ compared to the rest of the circulatory system which perfuses during _____
A
ventricular diastole; ventricular systole
11
Q
the right and left coronary arteries stem from the
A
root of the aorta
12
Q
the right coronary artery carries blood to
A
right atrium, right ventricle, part of left atrium, inferior wall of left ventricle, SA & AV node
13
Q
the left main coronary artery splits into the
A
left circumflex artery and left anterior descending artery
14
Q
the left main coronary artery carries oxygenated blood to the
A
myocardium
15
Q
the left circumflex artery supplies blood to
A
posterolateral aspect of left ventricle
16
Q
the left anterior descending artery supplies blood to the
A
anterior wall of the left ventricle
17
Q
LAD is called the widow maker bc occlusion can lead to
A
ventricular arrhythmias and death
18
Q
occlusion of the right coronary artery can cause
A
extreme sinus bradycardia
19
Q
the P wave is a result of
A
atrial depolarization
20
Q
what is the AV junction
A
AV node and bundle of His
21
Q
what can function as a backup pacemaker if the SA node fails
A
AV junction
22
Q
the AV junction fires at
A
40-60 bpm
23
Q
what is the purpose of AV node
A
hold electrical signal from SA node to allow ventricles to fill
24
Q
what does the PR interval signify
A
time needed for impulse to travel from SA to AV node
25
what is the expected PR interval
0.12-0.2 seconds
26
what can cause the PR interval to increase
AV node not conducting impulses
27
how do complete heart blocks happen
AV node can't conduct impulse from SA to ventricles
28
the AV node is perfused by the
av artery
29
occlusion of the AV node artery causes
high-degree heart block on EKG
30
the large coronary arteries are not interconnected, but ppl with this disease may cause collateral circulation through the formation of small arteries
coronary heart disease
31
define AUTOMATICITY
ability of cardiac cells to spontaneously generate electrical activity not from a node
32
define ECTOPIC BEATS
beats caused by area of heart other than SA node
33
how can ectopic beats manifest on an EKG
premature atrial, junctional, or ventricular complexes
34
what are the 3 internodal pathways that connect the SA and AV node
anterior, medial, and posterior
35
what is the internodal pathways connecting the right and left atrium
Bachmann's bundle
36
aka Bachmann's bundle
interatrial tract
37
aka bundle of His
atrioventricular bundle
38
the left bundle branch splits into the
left anterior fascicle and left posterior fascicle
39
the left anterior fascicle runs along the
anterior surface of the heart
40
the left posterior fascicle receives additional blood from the RCA in addition to the LAD causing it to be
more resistant to ischemia
41
in the absence of the SA and AV node, the purkinje fibers at a rate of
20-40/min
42
each small box on the y-axis represents
0.1 mV
43
each small box on the x-axis represent
0.04 seconds
44
1 large box on the x axis represents
0.2 seconds
45
1 large box on the y-axis represents
0.5 mV
46
the standard paper speed is
25 mm/seconds
47
aka standard amplitude
gain
48
what is the standard amplitude
10 mm/1mV
49
what is the standard calibration box size
10 mm tall by 5 mm wide
50
define PRECORDIAL LIEADS
6 EKGs placed on anterior chest to record unipolar electrical activity of the heart at a specific location
51
define AUGMENTED LEADS
unipolar leads created by combining 2 of 3 limb leads to create a positive electrode
52
define WILSON'S CENTRAL TERMINAL
reference point created by 3 limb leads and is center of Einthoven's triangle
53
what is the reference point of all unipolar leads
wilson's central terminal
54
unipolar leads are all
positive
55
which leads are bipolar
standard limb (1,2,3)
56
what does a thick band of color usually pink or red on the border of the EKG graph paper indicate
the paper is running low
57
the paper speed can be set to ____ to slow the appearance of an EKG in a person experiencing tachycardia
50 mm/sec
58
some ekgs can be set to ___ to interpret a pt with bradycardia
12.5 mm/sec
59
when should you increase the amplitude to 20 mm/mV
tracing produces very small waveforms
60
when is a decrease in amplitude to 5 mm/mV warranted
waveforms too large and exceed height of paper
61
which demographic often requires a decreased amplitude
children
62
the calibration marker will change in ___ when the speed is altered
width
63
the calibration marker will change in _____ based on the amplitude
height
64
how can pt's arms be positioned if they are nervous/have Parkinson's
palms downward under the glutes or crossed on the abdomen
65
how can late stage pregnant pts be positioned
slightly on left side with pillow supporting back
66
what should a pt do if they experience itching, swelling, or redness at the site of electrode placement during a telemetry monitoring
call provider's office
67
if you cannot place electrodes on the arms of a pt, where should they be placed
close as possible to point of shoulder attachment
68
what are the 12 leads on a 12 lead EKG
- Leads I, II, III
- avF, avR, avL
- V1-6
69
what does avR stand for
augmented vector right
70
what does aVL stand for
left wrist
71
what does aVf stand for
augmented vector foot
72
lead I records impulses inbetween
left and right arm
73
lead II records impulses between
right arm and left leg
74
lead III records impulses between
left arm and left leg
75
what is the leg used for leads I, II, III and AV leads
left
76
the AVL involves the
left leg and right arm
77
the AVR involves the
left arm and left leg
78
the AVF involves the
right and left arms
79
define ANGLE OF LOUIS
sternal angle
80
the color of the right arm lead is
white
81
the color of the left arm lead is
black
82
the color of the left leg lead is
red
83
the color of the right leg lead is
green
84
V1 is typically
red
85
V2 is typically
yellow
86
V3 is typically
green
87
V4 is typically
blue
88
V5 is typically
orange
89
V6 is typically
purple
90
holter monitors are commonly
5 leads
91
for a 12 lead, should electrodes be placed over bone
no
92
should electrodes for 5 lead ekgs be put on bone
yes
93
for a 5 lead, the white lead can be placed
right sternal border first rib OR right chest about 2 inches below clavicle
94
in a 5 lead, the red lead can be placed
right sternal border third rib OR left chest lower rib cage
95
in a 5 lead, the black lead can be placed
left side anterior axillar line fifth rib OR left chest opposite white lead
96
in a 5 lead, the brown lead can be placed
left sternal border first rib directly opposite white lead OR right chest fourth rib
97
in a 5 lead, the green lead is placed
right lower thoracic area anywhere on rib cage OR right lower chest over a rib
98
in a 3 lead, the white lead is placed
right shoulder just below clavicle
99
in a 3 lead, the black lead is placed
left shoulder just below clavicle
100
in a 3 lead, the red lead is placed
below left pectoral muscle at apex of the heart
101
which pts may need a right sided 12 lead ekg
- pts younger than 8
- pts with inferior wall ST segment elevation, myocardial infarction, dextrocardia,
102
what instance may require a posterior ekg
inferior wall infarction
103
where do V7, V8, and V9 go
underneath left scapula
104
define POSITIVE DEFLECTION
portion of waveforms above isoelectric line
105
positive deflection indicate that the leads are
appropriately attached
106
define NEGATIVE DEFLECTION
downward presentation of waveforms below isoelectric line
107
negative deflections indicate
improper attachment of leads
108
positive and negative deflection appears in
lead I
109
how does limb lead reversal appear as on the ekg
- lead I inverted
- leads II and III switch places
- AVR and AVL switch places
110
the baseline represents
repolarization
111
define REPOLARIZATION
relaxation
112
movement of the cables/leads, pt movement, loose or dry electrodes, pt's labored breathing, and improper skin preparation are causes of this artifact
wandering baseline
113
what are ways to eliminate wandering baseline
- clean attachment sites prior
- educate pt on how to breathe and when to not talk
- reposition limb leads on fleshy areas
114
aka AC interference
60 cycle interference
115
how does AC interference manifest
uniform sharp spikes throughout tracing
116
what are potential causes of AC interference
- table moved away from wall
- ekg plug is tight and snug into outlet
- cell phone
- metal
- medical devices like insulin pumps
117
how does an interrupted baseline manifest
break in baseline or fully nonrecorded lead
118
cause of interrupted baseline
broken lead wires or disconnected leads
119
how do you calculate target heart rate for a stress test
(220-age) x 0.85
120
how does a stress test work
increasing speed and incline of a treadmill every 3 min until reach target heart rate
121
how often is BP measured during a stress test
incremental readings within first 3 min and before every transition
122
how long should pts be monitored after a stress test
every 3-5 min for 10-15 min
123
the target heart rate is generally
60-85% of maximum heart rate
124
what are signs of pt distress during a stress test
dizziness, lightheadedness, nausea, severe SOB, tingling sensations, numbness, chest pain, extreme fatigue
125
what should you do if a pt experiences signs of distress during a stress test
stop the test and notify the provider
126
complications of stress testing include
excessive tachycardia, hypotension, arrhythmias
127
what should be done if a pt has hypotension after a stress test
notify provider and have pt lie supine with legs elevated
128
define DEXTROCARDIA
heart positioned on right side of chest
129
the calibration mark is 10 mm high and 10 mm wide, the machine must have used which of the following settings
A) 25 MM/SEC
B) 2 MM/MV
C) 50 MM/SEC
D) 0.5 MM/MV
c) 50 mm/sec
130
which of the following changes to settings of EKG will double height of tracing
A) 10 MM/MV
B) 25 MM/SEC
C) 20 MM/MV
D) 50 MM/SEC
c) 20 mm/mV
131
where does the ground lead for 5 lead on holter monitor go
right lower abdomen
132
where does V5 go on a pt with dextrocardia when doing a 12 lead
right anterior axillary line, fifth intercostal space
133
