Normal ECG part 1 and 2

Question 1

what is the P wave and what leads are upright, inverted, and variable

Answer 1

P wave: atrial depolarization

upright: 1,2, V4-V6, AVF

Inverted: AVR

Variable: 3, AVL, and V1-3

Question 2

what is the PR interval and how long should it be

Answer 2

beginning of p-wave to the beginning of QRS complex
time it takes for signal to go from SA node to ventricular muscle fiber

should be about .12 to .20 seconds

Question 3

what is QRS complex, how long should it last, how long should the Q wave be, and where is it normal to see narrow/small Q waves

Answer 3

Ventricular depolarization

Duration: .05-.10 sec

width of Q wave: .03 sec

normal to see a narrow/small 1-2mm Qwave: AVL, AVF, V5, V6

Question 4

what on the ST segment are we looking at? and what is considered normal

Answer 4

observing for the level of the ST segment in regards to baseline
-should be isoelectric, and a straight line

normal limits for standard leads is elevation of 1mm

normal limits for chest leads is 2mm

Never normally depressed 1/2 mm

Question 5

what is the underlying issue if ST is elevated or depressed

Answer 5

ST depression: subendocardial issue

ST elevation: subepicardial or transmural injury or ischemia

Question 6

what is the T wave, where is it upright, inverted, and variable, and how tall is it supposed to be

Answer 6

Ventricular repolarization

upright: 1,2,V3-V6,
inverted: AVR

Variable: AVL, AVF, V1-V2

should be slightly rounded and asymmetrical

height should not be greater than 5mm in standard leads
not greater than 10 mm in precordial leads

Question 7

What is the QT interval and what type of issues can we see in a QT interval

Answer 7

contains the Q wave and T wave, the duration is the length of ventricular systole

can see Myocardial ischemia, Myocardial Injury, and Myocardial infarction

Question 8

what is associated with problematic T waves

Answer 8

T wave ischemic pattern is associated with inverted T waves

Hyperkalemia is associated with Tall upright T waves

Question 9

what is associated with a Q wave or QS complex

Answer 9

this is if their is just a Q wave, or just a QS wave (no R)

and is associated with pattern of necrosis or infarction

Question 10

what is associated with wide broad P waves

Answer 10

P-mitrale disease

Question 11

what is associated with a flat P wave in 1, and pointed P wave in 2, and 3

Answer 11

P-pulmonale

Question 12

what is inverted P in leads 2 and 3 and with short PR interval inter

Answer 12

A-V junctional rhythm

Question 13

how does the naming process work for the QRS complex

Answer 13

first deflection down is the Q wave
first deflection up is the R wave
any negative deflection following a R wave is considered a S wave

any deflections up after the first deflection up is R’

any deflection down after the first S wave is called S’

primes are then just added on as the number of times increase

Question 14

what is the significance of a PR segment less than 0.2 sec

Answer 14

No AV block

Question 15

what is the significance of a QRS complex less than 0.12 sec

Answer 15

no bundle branch block

Question 16

what are the best leads for reading a P-wave

Answer 16

leads II and V1

Question 17

what is it called if a heart rate is greater than 100 bpm, less than 60 bpm?

Answer 17

> 100 is tachycardia

<60 is bradycardia

Question 18

what does each dark line on an ECG represent on the x axis? smaller box?

Answer 18

each dark line = 0.2 sec

each smaller box = 0.02 sec

Question 19

what are the numbers to memorize for the fast way to calculate heart rate

Answer 19

300/(every dark line it passes)

300
150
100
75
60
50
43
37
33

Question 20

how to determine a slow or irregular rhythm heart rate

Answer 20

identify the 3 second markers on top of ECG

count number of QRS complexes that appear in 6 seconds

multiply by 10

Question 21

how to determine if the EKG is a sinus rhythm

Answer 21

if their is a P wave that preceeds every QRS complex

P:QRS = 1

Question 22

what are som examples of other rhythms

Answer 22

Ectopic atrial rhythm

Multifocal atrial tachycardia (MAT) (think pulmonary disease)

Wandering atrial pacemaker

others

Question 23

what happens if the P wave follows the QRS

Answer 23

SVT (AV nodal re-entry tachycardia)
or
Junctional rhythm

Question 24

what are some causes of a no P wave rhythm

Answer 24

atrial fibrillation
atrial flutter
junctional or ventricular escape rhythms
Junctional tachycardia
Ventricular tachycardia (VT)

Question 25

determining axis: Normal axis

Answer 25

(0-90)

Lead 1: positive

aVF: positive

Question 26

determining axis: Normal variant

Answer 26

(0- -30)

lead 1: positive

aVF: negative

lead II: positive

Question 27

determining axis: left axis deviation

Answer 27

(-30 - -90)

lead 1: positive

aVF: negative

LEad II: negative

Question 28

determining axis: right axis deviation

Answer 28

(>100)

lead 1: negative

aVF: positive

Question 29

determining axis: right superior axis

Answer 29

(-90 to +180)

Lead 1: negative

aVF: negative