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CET > Mod 3 - EKG Analysis & Interpretation > Flashcards

Mod 3 - EKG Analysis & Interpretation Flashcards

1
Q

what is the most precise method to use to calculate heart rate

A

1500 method

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2
Q

what are the 3 ways to find heart rate from ekg

A

1500, sequence, and 6-second

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3
Q

how do you find the ventricular rate using the 1500 method

A

1500 divided by # of small boxes between R waves

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4
Q

how do you find the atrial rate using the 1500 method

A

1500 divided by # of small boxes between p waves

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5
Q

aka sequence method

A

300 method or R-R method

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6
Q

how do you use the sequence method

A

300 divided by # of large boxes between R waves

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7
Q

how do you use the 6 second method

A

number of QRS complexes in 6 seconds x 10

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8
Q

what do the hashmarks at the top of an ekg strip signify

A

3 second intervals

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9
Q

how do you calculate maximum heart rate

A

220 - pt age

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10
Q

how do you calculate target heart rate

A

(220 - pt age) x percent of maximum

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11
Q

what is the range for percent of maximum

A

60-85%

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12
Q

the QRS complex represents

A

ventricular depolarization

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13
Q

irregular intervals in Q waves can signify

A

ventricular dysfunction

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14
Q

which is the best method to find heartrate when it is fast or irregular

A

1500

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15
Q

what is the best method to calculate heart rate when it is slow

A

300

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16
Q

what is not visible but happens during ventricular depolarization

A

atrial repolarization

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17
Q

where does the QRS complex end

A

J point

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18
Q

QRS complexes normally range from

A

0.04-0.1 seconds

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19
Q

define J POINT

A

exact point in time where ventricular depolarization stops and ventricular repolarization starts

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20
Q

how can the j point be represented in an ekg during myocardial ischemia

A

elevate or depress below baseline

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21
Q

what does the T wave represent

A

ventricular repolarization

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22
Q

what does the U wave represent even if it is not always visible

A

repolarization of bundle of His and Purkinje fibers

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23
Q

the normal PR interval range is

A

0.12-0.2 seconds

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24
Q

what does the P-P interval represent

A

amount of time between atrial depolarization cycles

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25
Q

what does the R-R interval represent

A

amount of time between ventricular depolarization cycles

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26
Q

what does the QT interval represent

A

1 complete ventricular cycle (ventricular depolarization and repolarization)

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27
Q

how is the QT interval measured

A

beginning of Q wave to end of T wave

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28
Q

where is the PR interval located

A

beginning of P wave and ends at beginning of Q wave

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29
Q

what does the PR segment represent

A

end of atrial contraction and beginning of ventricular contraction

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30
Q

where is the PR segment located

A

end of P wave to beginning of Q wave

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31
Q

what does the ST segment represent

A

early phase of ventricular repolarization (end of ventricular depolarization to beginning of ventricular repolarization)

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32
Q

where is the ST segment

A

end of S wave to beginning of T wave

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33
Q

P wave and PR interval abnormalities indicate

A

atrial dysfunction

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34
Q

QRS and T wave abnormalities can demonstrate

A

ventricular dysfunction

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35
Q

how should T waves be shaped and oriented

A

peak toward end of wave and deflected in same direction as QRS complex

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36
Q

how does low potassium levels impact heart function

A

decreased heart rate

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37
Q

how does high potassium levels impact heart function

A

abnormal rate or rhythm

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38
Q

low concentrations of calcium can cause

A

slowed heart rate

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39
Q

high concentrations of calcium will cause

A

longer than normal contractions

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40
Q

what are the signs of normal sinus rhythm

A
  • p wave present, upright, and rounded
  • p wave has amplitude less than 2.5 mm
  • p wave duration less than 110 milliseconds
  • QRS complex usually narrow
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41
Q

sinus bradycardia can be normal in these pts

A
  • athletes
  • pt’s with hypothyroidism
  • older adults with sedentary lifestyle
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42
Q

tachycardia is expected under these conditions

A
  • during exercise
  • with pt’s who have hyperthyroidism
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43
Q

define SINUS DYSRHYTHMIA

A

slight irregularity in rhythm

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44
Q

sinus dysrhythmia is most likely associated with

A

normal breathing patterns

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45
Q

sinus arrest is not significant unless it is longer than

A

6 seconds

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46
Q

what is the cause of sinus arrest

A

failure of SA node to fire

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47
Q

define ATRIAL FLUTTER

A

atria contract faster than ventricles

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48
Q

define ATRIAL FIBRILLATION

A

atria quivering without organized contraction

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49
Q

where do junctional arrhythmias occur

A

at AV node/tissue

50
Q

how do junctional arrhythmias appear in an ekg and why

A

inverted P wave because the electrical activity flows backwards

51
Q

why does the AV node initiate the impulse

A

when SA node damaged

52
Q

describe PREMATURE JUNCTIONAL COMPLEXES

A

early impulse that occurs before next expected beat and P wave occurs before/after/buried in QRS complex

53
Q

how does the P wave appear in a junctional escape rhythm

A

inverted if not absent

54
Q

what is happening during a junctional escape rhythm

A

atria and ventricle receive impulse simultaneously bc the AV node is acting as a back-up pacemaker

55
Q

what are some characteristics of a junctional escape rhythm

A
  • heart rate maximum of 60/min
  • signs of reduced cardiac output
56
Q

define ATRIAL KICK

A

excitement of atria with rise in internal pressure to forcefully push blood into ventricles

57
Q

define ACCELERATED JUNCTIONAL RHYTHM

A

same as escape rhythm but at a rate of 60-100 bpm

58
Q

what are the characteristics of accelerated junctional rhythm

A
  • inverted if not absent p wave
  • ventricular rate 60-100 bpm
  • generally no signs of decreased cardiac output
59
Q

define JUNCTIONAL TACHYCARDIA RHYTHM

A

same as escape and accelerated rhythm but heart rate 100-150 bpm

60
Q

what is the characteristics of junctional tachycardia rhythm

A
  • 100-150 bpm
  • inverted if not absent p wave
  • sx of palpitations or fluttering
61
Q

aka supraventricular tachycardia

A

narrow complex tachycardia

62
Q

what are characteristics of supraventricular tachycardia

A
  • pulse greater than 150/min
  • p waves not usually visible
  • appear as a hump directly into QRS complex (“hopping motion”)
63
Q

list sinus arrythmias

A
  • sinus bradycardia
  • sinus tachycardia
  • sinus dysrhythmia
  • sinus arrest
64
Q

list atrial arrythmias

A
  • atrial flutter
  • atrial fibrillation
65
Q

list junctional arrhythmias

A
  • premature junctional complex
  • junctional escape rhythm
  • accelerated junctional rhythm
  • junctional tachycardia rhythm
66
Q

define PREMATURE VENTRICULAR COMPLEX

A

ventricles contract out of normal sequence initiated by ectopic focal point within ventricles

67
Q

what are characteristics of a PVCs

A
  • p wave not visible
    = QRS complex often wider than normal and unusual shape
  • palpitations/fluttering in throat/chest
68
Q

severity related to PVCs depend on

A

frequency and reduction in cardiac output

69
Q

what are the requirements for an occasional PVCs

A

1-5 in 1 minute

70
Q

what are the requirements for frequent PVCs

A

at least 6 per minute

71
Q

what is a unifocal PVC

A

single early PVC indicating one irritable area

72
Q

aka PVC

A

premature ventricular complex

73
Q

define a multifocal PVC

A

PVCs with multiple shapes indicating more than 1 irritable area

74
Q

define a interpolated PVC

A

PVC with no interruption in normal rhythm

75
Q

define bigeminy PVC

A

PVC occur every second beat

76
Q

define trigeminy PVC

A

occur every third beat

77
Q

define Quadgeminy PVC

A

occur every fourth beat

78
Q

define coupling pvc

A

two pvcs occur back to back

79
Q

list ventricular arrhythmias

A
  • premature ventricular complex
  • v tach
  • v fib
  • idioventricular rhythm
  • agonal rhythm
80
Q

define ventricular tachycardia

A

at least three PVCs in a row with ventricular rate greater than 100/min

81
Q

what are characteristics of v tach

A
  • no noticeable p waves
  • QRS wide and unusual
  • t wave deflected in opposite directions
  • few sx
  • ekg appears mountanous
82
Q

what are characteristics of idioventricular rhythm

A
  • ventricular rate 20-40 bpm
  • no discernible p waves
  • QRS complex wide and unusual
83
Q

if ekg presents as idioventricular rhythm but has a pulse of 40-100 bpm, then the pt has

A

accelerated idioventricular rhythm

84
Q

what are the 3 pacemakers of the heart

A

SA node, AV node, and Purkinje fibers

85
Q

when does idioventricular rhythm occur

A

only ventricular pacemaker is functioning

86
Q

when does agonal rhythm occur

A

when all 3 pacemakers fail

87
Q

what are characteristics of agonal rythm

A
  • wide, unusual QRS complex
  • no P or T wave
  • ventricular rate less than 20/min
88
Q

what is the difference in QRS shape of agonal rhythm and idioventricular rhythm

A

idioventricular rhythm looks like lumps and agonal rhythm has somewhat distinguishable QRS complex

89
Q

define HEART BLOCK

A

block in electrical conduction pathway causing delayed/absent ventricular depolarization

90
Q

when does a bundle branch block occur

A

interference somewhere in the bundle branches

91
Q

describe a left bundle branch block (LBBB)

A

instead of current going down left bundle branch it goes down septum to ventricle causing abnormal right to left stimulation

92
Q

describe a right bundle branch block (RBBB)

A

left ventricle sends impulses through myocardium to right ventricle to depolarize right ventricle (septum is depolarized normally)

93
Q

define a first-degree atrioventricular block

A

delay in conduction from SA node to AV node

94
Q

how does a first-degree atrioventricular block appear

A

PR interval greater than normal 0.2 seconds

95
Q

aka second-degree atrioventricular block type I

A

Mobitz I or Wenckebach

96
Q

how do 2nd degree AV block type I appear

A

PR interval progressively longer until QRS missing and pattern repeats

97
Q

what happens during a 2nd-degree AV block type I

A

non-conducted/blocked impulses from AV node to ventricles

98
Q

aka 2nd degree atrioventricular block type II

A

Mobitz II

99
Q

what are characteristics of a Mobitz II

A
  • PR interval constant
  • P wave present with no QRS complex or T wave
100
Q

what happens during a Mobitz II

A

AV node selectively blocked specific impulses

101
Q

aka third-degree atrioventricular block

A

complete heart block

102
Q

what happens during a complete heart block

A

all electrical impulses originating above ventricles blocked causing ventricles and atria to contract independently

103
Q

how does a complete heart lock appear

A
  • no pattern to cardiac cycle
  • atria contract at normal rate but ventricles contract at 20-40 bpm
104
Q

sx of Vfib

A

dizziness, feeling of impending doom, chest discomfort, SOB, seizure activity

105
Q

sx ventricular tachycardia

A
  • drops in blood pressure and level of consciousness
  • deterioration into pulseless rhythm/VFib
  • dizziness
  • feeling of impending doom
  • chest discomfort
  • SOB
106
Q

what is the response for Vtach

A

call code, initiate CPR and AED

107
Q

what are common causes of asystole

A
  • large pulmonary embolism
  • large myocardial infarction
  • respiratory arrest (hypoxia)
  • overdose
  • hypothermia
  • acidosis
  • electrolyte abnormalities
  • tension pneumothorax
  • trauma
108
Q

t/f: pts with 3rd degree AV block do not progress to cardiac arest

A

false

109
Q

define PACING SPIKE

A

artifact in tracing from artificial pacemaker

110
Q

how does a pacing spike appear as

A

thin spike at P wave, QRS, or both

111
Q

how does a pacing spike appear if atrial pacing is used

A

normal p wave followed by single thin line

112
Q

how does the pacing spike appear if ventricular pacing is used

A

QRS looks like a bundle branch block with a spike before QRS complex

113
Q

which two sets of leads are contiguous with each other

A
  • leads II, III, AVF
  • V1, V2, V3
114
Q

what does it mean for leads to be contiguous

A

look at the same part of the heart

115
Q

how does myocardial ischemia appear on ekg

A
  • ST segment depression of 1 mm or greater in two contiguous leads
  • T wave inversion
116
Q

ST elevation is the main indicator of a

A

ST elevation myocardial infarction (STEMI)

117
Q

what does a STEMI mean

A

complete blockage of coronary artery and tissue has not died yet

118
Q

what do pathologic Q wave changes in two or more continuous leads indicate

A

infarction and necrosis

119
Q

how do pathologic q wave changes appear

A

Q wave measures 0.04 sec and will be equal/greater than 1/3 height of R wave

120
Q

you are doing a 12 lead on an 8 year old, where do the leads go

A

V1, 2, 4, 5, 6 in normal spots but V3 on the right side left diagonal to V3 similar to V4

121
Q
A

CET (6 decks)

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