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ECG Mod 1 > Module 1 Basics > Flashcards

Module 1 Basics Flashcards

1
Q

Indications to Order an ECG (5 criteria)

A

1) unexplained syncope, near syncope, or episodic dizziness without obvious cause
2) Unexplained recurrent palpitation
3) Episodic SOB, angina or fatigue that is not otherwise explained
4) Neurologic events when transient atrial fibrillation or flutter is suspected (looking for strokes)
5) explained syncope, near syncope, episodic dizziness or palpitation in whom probable cause other than an arrhythmia has been identified but in whom symptoms persist despite treatment of this other cause

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2
Q

Depolarization - Define

A

At rest, the interior of the myocardium is negatively charged

Stimulation of the myocardium by the electrical conduction system

“Wave” of depolarization stimulates the heart’s myocytes causing them to become positive and contract

DEPOLARIZATION = POSITIVE

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3
Q

Repolarization - Define

A

Myocytes return to the negative resting state

REPOLARIZATION = NEGATIVE

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4
Q

Underlying physiology of the ECG Electrodes (hint: what do the waves mean on the ECG in relation to the electrodes)

A

As a wave of depolarization (POSITIVE CHARGE) moves within the cardiac myocytes, there is a positive (upward) deflection on the ECG

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5
Q

Sinoatrial (SA) Node (function and location)

A

Known as the “pacemaker” which sets the tone for the electrical impulses of the heart

Located in the right atrium

Automatically generates a positive wave of depolarization within the right atrium

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6
Q

Normal Sinus Rhythm

A

Pacing activity; pacemaker in charge (SA Node)

P wave is present; rate is 60-100BPM

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7
Q

Define P wave and what does it represent in relation to the physical activity by the heart

A

Represents the wave of depolarization from the SA node through both atria

Represents ATRIAL DEPOLARIZATION and ATRIAL CONTRACTION

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8
Q

Atrioventricular (AV) Node (function and what is it known as)

A

“Gatekeeper” in the electrical conduction pathway between the ATRIA and VENTRICLES

Electrical depolarization SLOWS down here

Electrical delay allows for blood to flow from the atria into the ventricles (heart wants the blood to fill up in the ventricles from the atria).

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9
Q

Describe the ventricular Conduction System Pathway in a normal functioning heart

A

SA Node -> AV node -> Bundle of His -> left and right bundle branch (Purkinje Fibers)-> left and right ventricle contract

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10
Q

Downward deflection on ECG represents what?

A

Electrical activity happening away from the leads (NEGATIVE)

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11
Q

What does the QRS Complex represent?

A

Ventricular Depolarization and Ventricular Contraction

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12
Q

What does the T Wave represent?

A

Ventricular repolarization

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13
Q

Difference between segments and intervals

A

Segments do not include waves - they are isoelectric

Intervals include waves

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14
Q

PR Interval

A

time between the beginning of atrial contraction until immediately before the ventricles contract

time the electrical conduction begins at the SA node until the impulse is sent to the AV node

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15
Q

PR Segment

A

Time from the END of atrial contraction to the BEGINNING of ventricular contraction

PR Interval - P wave included
PR Segment - NO wave included

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16
Q

ST Segment

A

Horizontal segment following the QRS complex and before the T wave

ST segment represents a portion of Ventricular Repolarization

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17
Q

QT Interval

A

Included the QRS complex, ST segment and T Wave

Represents the ENTIRE DURATION of VENTRICULAR CONTRACTION

18
Q

1x1 and 5x5 boxes on ECG (What are the mV and seconds for both types of boxes)

X-Axis is TIME (seconds)

Y-Axis is VOLTAGE (mV)

A

Small boxes: 0.1 mV and 0.04s

Big boxes: 0.5 mV and 0.2s

19
Q

Measuring Height (aka Amplitude)

A

Measured from the baseline in millivolts and is a measure of electrical voltage

Height is known as AMPLITUDE of the wave

20
Q

Normal range for QRS Complex. If it is greater than these values, what is it called?

A

Normal QRS Complex:
1 to <3 small boxes or 0.04-0.11

If it is greater, it is called “widened QRS complex” (3 small boxes or 0.12 or greater)

21
Q

T wave Height (normally)

A

Height is usually less than 2/3 the height of the preceding R wave

22
Q

Normal Range for PR Interval

A

Between 3-5 small boxes or 0.12-0.2s

23
Q

Normal range for QT interval (should not be on test since he never had us do these on the homework assignments)

A

Less than 1/2 the R-R distance

24
Q

A standard ECG is composed of how many leads? What is the overall purpose?

A

4 LIMB electrodes and 6 CHEST electrodes for a total of 10 electrodes place

Overall purpose of these 10 electrodes is to gather different viewpoints of the same cardiac activity even (12 leads generated on machine)

25
Q

Placement of the 4 limb electrodes

A

LA, LL, RA, RL

26
Q

V1 Chest Lead

A

Right of sternum, 4th ICS

27
Q

V2 Chest Lead

A

Left of sternum, 4th ICS

28
Q

V3 Chest Lead

A

Midway between V2 and V4

29
Q

V4 Chest Lead

A

5th ICS Mid Clavicular Line (MCL)

30
Q

V5 Chest Lead

A

5th ICS along the AAL (anterior axillary line)

31
Q

V6 Chest Lead

A

5th ICS MAL (mid-axillary line)

32
Q

Systemic Approach to ECG Interpretation ( 7 Steps)

A

Look at in order:

1) Rate
2) Rhythm
3) Axis
4) Waves, Intervals, Segments
5) Clinical Correlation
6) Compare to prior ECGs
7) Watch out for bad data

33
Q

What is the normal range for the rate of the SA node pace of the heart?

A

60-100 BPM

34
Q

Interpret/define “Normal Sinus Rhythm” when describing an ECG

A

“Sinus” means the heartbeat is originating from the SA Node

A normal sinus rhythm has a P wave preceding every QRS complex

Rate is 60-100BPM

35
Q

Sinus Bradycardia (what is the rate?)

A

SA node paces the heart at a rate slower than 60 BPM

P waves are present

36
Q

Sinus Tachycardia

A

SA node is pacing the heart at a rate greater than 100 BPM

P waves are present

37
Q

What are the two methods for determining the RATE?

A

Counting Method

6 Second Method

38
Q

Counting Method

A

Find an R wave that peaks on a heavy black line (start line)

Count off each thick line after the start line

Where the next R wave falls determines the rate

39
Q

What are the BPM intervals for the counting method when determining rate?

A 
300
150
100
75
60
50
40
Q

What is the 6 Second Method helpful for? What about the counting method?

A

6 Second Method is helpful when the rate is Bradycardic or Irregular

Counting method for regular rhythms

Honestly, you can use both, you just need the ticks on the strip for the 6 second method

41
Q

6 Second Method

A

Find two consecutive 3 second intervals to give you a 6 second strip. The tick marks at the top of the ECG paper indicate a 3 second interval

Count the number of QRS complexes in this second strip

Multiply the number of QRS complexes in the 6 second strip by 10 to give you the rate

ECG Mod 1 (2 decks)

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