Normal ECG part 1 and 2 Flashcards
what is the P wave and what leads are upright, inverted, and variable
P wave: atrial depolarization
upright: 1,2, V4-V6, AVF
Inverted: AVR
Variable: 3, AVL, and V1-3
what is the PR interval and how long should it be
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
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
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
what on the ST segment are we looking at? and what is considered normal
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
what is the underlying issue if ST is elevated or depressed
ST depression: subendocardial issue
ST elevation: subepicardial or transmural injury or ischemia
what is the T wave, where is it upright, inverted, and variable, and how tall is it supposed to be
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
What is the QT interval and what type of issues can we see in a QT interval
contains the Q wave and T wave, the duration is the length of ventricular systole
can see Myocardial ischemia, Myocardial Injury, and Myocardial infarction
what is associated with problematic T waves
T wave ischemic pattern is associated with inverted T waves
Hyperkalemia is associated with Tall upright T waves
what is associated with a Q wave or QS complex
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
what is associated with wide broad P waves
P-mitrale disease
what is associated with a flat P wave in 1, and pointed P wave in 2, and 3
P-pulmonale
what is inverted P in leads 2 and 3 and with short PR interval inter
A-V junctional rhythm
how does the naming process work for the QRS complex
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
what is the significance of a PR segment less than 0.2 sec
No AV block
what is the significance of a QRS complex less than 0.12 sec
no bundle branch block
what are the best leads for reading a P-wave
leads II and V1
what is it called if a heart rate is greater than 100 bpm, less than 60 bpm?
> 100 is tachycardia
<60 is bradycardia
what does each dark line on an ECG represent on the x axis? smaller box?
each dark line = 0.2 sec
each smaller box = 0.02 sec
what are the numbers to memorize for the fast way to calculate heart rate
300/(every dark line it passes)
300 150 100 75 60 50 43 37 33
how to determine a slow or irregular rhythm heart rate
identify the 3 second markers on top of ECG
count number of QRS complexes that appear in 6 seconds
multiply by 10
how to determine if the EKG is a sinus rhythm
if their is a P wave that preceeds every QRS complex
P:QRS = 1
what are som examples of other rhythms
Ectopic atrial rhythm
Multifocal atrial tachycardia (MAT) (think pulmonary disease)
Wandering atrial pacemaker
others
what happens if the P wave follows the QRS
SVT (AV nodal re-entry tachycardia)
or
Junctional rhythm
what are some causes of a no P wave rhythm
atrial fibrillation atrial flutter junctional or ventricular escape rhythms Junctional tachycardia Ventricular tachycardia (VT)
determining axis: Normal axis
(0-90)
Lead 1: positive
aVF: positive
determining axis: Normal variant
(0- -30)
lead 1: positive
aVF: negative
lead II: positive
determining axis: left axis deviation
(-30 - -90)
lead 1: positive
aVF: negative
LEad II: negative
determining axis: right axis deviation
(>100)
lead 1: negative
aVF: positive
determining axis: right superior axis
(-90 to +180)
Lead 1: negative
aVF: negative
