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Cardiopulmonary > Reading EKGs > Flashcards

Reading EKGs Flashcards

1
Q

What is a segment on an EKG?

A

Horizontal flat line that connect 2 or more waveforms

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2
Q

What is an interval on an EKG?

A

Include one segment and one or more waveforms

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2
Q

What are the 2 segments on an EKG?

A

PR segment
ST segment

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3
Q

What is the PR interval composed of?

A

Entire P wave
PR segment

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4
Q

What are the 5 intervals on an EKG?

A

PR interval
ST interval
QRS interval/complex
QT interval
RR interval

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5
Q

What does the PR interval represent?

A

Atrial depolarization
Conduction delay through AV node

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6
Q

What does the PR segment represent?

A

Conduction delay through the AV node

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7
Q

What is the ST interval composed of?

A

ST segment
T wave

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8
Q

What is the QRS interval composed of?

A

Q wave
R wave
S wave

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9
Q

What is the R-R interval?

A

Everything that comes between 2 R wave peaks

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10
Q

What is the j-point?

A

The junction between the end of the QRS complex and the beginning of the ST segment

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11
Q

Where should the ST segment be evaluated?

A

1 box past the J point

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12
Q

What is the QT interval composed of?

A

From just after the PR segment to just after the T-wave

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13
Q

What is on the y axis of an EKG?

A

Voltage

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14
Q

What does the QT interval represent?

A

Ventricular depolarization
Ventricular repolarization

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15
Q

What is on the x axis of an EKG?

A

Time

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16
Q

What are the methods to counting heart rate on an EKG?

A

300 method
1500 method

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17
Q

Describe the 300 method for counting heart rate on an EKG

A

300 divided by the number of large boxes between 2 R waves

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18
Q

Describe the 1500 method for counting HR on an EKG

A

1500 divided by the number of small boxes between 2 R waves

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19
Q

Describe the 6 second method for counting HR on an EKG

A

The number of P waves in 6 seconds multiplied by 10

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20
Q

How much time do the large boxes measure on an EKG?

A

0.2 seconds

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21
Q

How much time do the small boxes measure on an EKG?

A

0.04 seconds

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22
Q

How much voltage do the small boxes on an EKG represent?

A

0.1 mV

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22
Q

How much voltage do the large boxes on an EKG represent?

A

0.5 mV

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23
Q

What does the PR interval tell us?

A

Indicates AV conduction time
Represents the time from the SA node firing to the end of AV node delay

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24
Q

What is the normal time for a PR interval?

A

0.12-0.20 seconds
3-5 small boxes

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25
Q

What can cause the timing of the PR interval to change?

A

Elevated HR
Age
Pathological process

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26
Q

Where is the PR interval measured from?

A

The beginning of the P wave to the beginning of the QRS complex

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27
Q

What is indicated by a PR interval of greater that 0.2 seconds?

A

1st degree heart block
Aka 1st degree AV block

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28
Q

What is a normal time interval for the QRS complex/interval?

A

0.06-0.12 seconds
1.5-3 small boxes

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29
Q

Where is represented by the QRS complex?

A

Ventricular depolarization

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30
Q

What does the QRS complex “hide”?

A

Atrial repolarization

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31
Q

What could a widened QRS complex indicate?

A

Left ventricular enlargement
Ectopic foci
Electrical conduction block in the bundle branches

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32
Q

What is the standard time for a R-R interval?

A

0.6-1.2 seconds
3-6 large boxes

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33
Q

What is the normal time interval for the QT interval?

A

0.4-0.44 seconds

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34
Q

Where is the QT interval measured from?

A

The end of the PR segment to the end of the T wave

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35
Q

When is the QT interval considered prolonged?

A

When the QT interval extends beyond midpoint of R-R interval

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36
Q

What can cause a long QT interval?

A

Side effect of various medications
Metabolic abnormalities
Electrolyte imbalances (low levels of potassium)
Long QT syndrome

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37
Q

What is the risk associated with Long QT syndrome?

A

The delay in repolarization may result in another electrical stimulus occurring before the ventricles have repolarized resulting in depolarization before repolarization is complete

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38
Q

Describe long QT syndrome

A

Congenital or acquired heart condition where there is delayed repolarization of the ventricles

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39
Q

What can Long QT syndrome cause?

A

Dangerous dysrhythmias
Tosades de points (type of ventricular tachycardia)

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40
Q

What does the ST segment represent?

A

The interval between depolarization and rapid repolarization of the ventricles
The plateau phase of repolarization, very slow at the beginning of repolarization of the ventricles

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41
Q

Describe an ST elevation

A

Defined as the ST segment occurring above the baseline

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42
Q

What can cause an ST elevation?

A

Myocardial infarction
Myocardial ischemia

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43
Q

What is the acronym for ST elevation?

A

STEMI
ST Elevation, Myocardial Infarction

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44
Q

Describe ST depression

A

Defined as the ST segment occurring below the baseline

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45
Q

What do ST depressions caused by myocardial ischemia look like?

A

Characterized by a horizontal or down sloping ST segment

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46
Q

What can cause an ST depression?

A

Myocardial ischemia

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47
Q

What is the acronym for ST segment depression?

A

NSTEMI
Non ST Elevation MI

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48
Q

What are common causes of ST elevation

A

MI
Myocardial ischemia
Coronary vasospasm
Pericarditis
LBBB
LV hypertrophy
Ventricular aneurysm

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49
Q

What are common causes of ST depression

A

MI
Myocardial ischemia
Digoxin effect
Ventricular hypertrophy
PE
LBBB
Drugs
Metabolic conditions (hypokalemia)
Misc conditions

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50
Q

What is deflection on an EKG?

A

The deflection of a wave is the direction in which it records the electrical activity on the EKG

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51
Q

When does a wave have positive deflection?

A

When it is moving upward

52
Q

When does a wave have a negative deflection?

A

When it is moving downward

53
Q

What is voltage on an EKG measured in?

A

Millivolts

54
Q

What is voltage generally expressed as on an EKG?

A

Amplitude

55
Q

Describe amplitude in regards to an EKG

A

Measures how far and in what direction a waveform differs from the isoelectric baseline

56
Q

T/F: Amplitudes are always a positive number

A

False. Can be either positive or negative

57
Q

T/F: magnitudes can be either positive or negative

A

False. Magnitudes can only be positive

58
Q

On an EKG, magnitude is typically expressed in _______

A

Millimeters

59
Q

On an EKG, amplitude is expressed as ____

A

Millivolts

60
Q

Describe a normal sinus rhythm

A

Electrical impulse initiated by SA node
Will have P wave, QRS complex and T wave
Rate of 60-100

60
Q
A

Chest pain
SOB
Dizziness
Anxiety

61
Q

Describe sinus tachycardia

A

Rhythm appears with all normal waves but at an accelerated rate
Greater than 100 bpm

62
Q

Describe sinus bradycardia

A

Rhythm appears with all normal waves but at a depressed rate
Less than 60 bpm

63
Q

What can cause a sinus bradycardia?

A

Vagal maneuver/valsalva maneuver
Medications
MI
SA node dysfunction
Increased ICP
Hypothermia
Hypokalemia

64
Q

Describe ventricular fibrillation

A

A life threatening cardiac dysrhythmia in which coordinated contraction of the ventricular myocardium is replaced by chaotic and disorganized release of multiple electrical impulses from ectopic foci

65
Q

What is the main cause of ventricular fibrillation

A

Hypoxia

66
Q

Why is ventricular fibrillation so dangerous?

A

The fibrillation compromises the ventricles ability to effectively pump blood

66
Q

What are the two types of ventricular fibrillation patterns?

A

Fine and coarse

67
Q

What is indicated by a fine ventricular fibrillation pattern

A

Fine ventricular fibrillation is indicative of the back end of cardiac arrest approaching asystole

67
Q

What does ventricular fibrillation look like on an EKG?

A

Saw teeth
Erratic, no patterns or regular deflections

68
Q

What is indicated by a coarse ventricular fibrillation pattern

A

Coarse ventricular fibrillation is indicative of the front end of cardiac arrest

69
Q

How does hypoxia cause ventricular fibrillation

A

Hypoxia causes hyperirritability of the cardiac muscle tissue prompting the release of electrical stimuli from ectopic foci

70
Q

What are ectopic foci?

A

Abnormal myocytes that act as pacemakers and display automaticity with the myocardium by releasing electrical stimuli causing premature uncoordinated polarization and contraction

71
Q

What is asystole?

A

An absence of electrical activity in the myocardium

72
Q

Describe sinus dysrhythmia

A

Changing intervals from one cardiac complex to the next
Resembles normal sinus rhythm

73
Q

Who is sinus dysrhythmia considered to be normal in?

A

Young healthy individuals
Athletes

74
Q

What is the cause of sinus dysrhythmia in healthy individuals?

A

Changing pressures on the heart as they inhale and exhale

75
Q

Define fibrillation

A

A rapid twitching of muscle fibers of the heart that is caused by an abnormal discharge of electrical nerve impulses

76
Q

Define morphology in regards to EKGs

A

The size shape and waveforms on an EKG

77
Q

Define monomorphic

A

Having but a single form or structure

78
Q

Define polymorphic

A

Having two or more clearly different morphs, forms or structural patterns

78
Q

What normally keeps ectopic foci or automaticity foci from causing ventricular fibrillation ?

A

They are normally overridden by the higher rate of the SA or AV node

78
Q

What does a premature ventricular contraction look like on an EKG?

A

Increased width and amplitude
Not preceded by a P wave
> .10 seconds

79
Q

Describe premature ventricular contraction

A

A sudden and irregular contraction of the ventricles due to ectopic foci

79
Q

What causes a premature ventricular contraction?

A

Irritated ectopic foci, generally responding to hypoxia
Hypokalemia
Long QT syndrome

79
Q

What can the shape of a PVC wave tell us?

A

The location of the ectopic foci

80
Q

When can a PVC cause a ventricular tachycardia or ventricular fibrillation?

A

When the PVC occurs in the vulnerable period when myocytes have not been completely repolarized it can result in VT or VF

81
Q

What is occurring if you see a bigeminy pattern? Trigeminy? Quadgeminy?

A

Bigeminy = PVC every other beat
Trigeminy -= PVC every 3 beats
Quadgeminy = PVC every 4 beats

82
Q

When 2 PVCs occur one after the other, what is it called?

A

A couplet

83
Q

What is it called when you have 3 PVCs or more in a row?

A

Ventricular tachycardia

84
Q

Describe ventricular tachycardia

A

Characterized by a large QRS complex > 0.12 seconds
Originates from ventricles
>100 bpm

85
Q

What are the two clinical types of V-tach?

A

Stable
Unstable

86
Q

When is V-tach considered sustained?

A

When it lasts more than 30 seconds or is symptomatic

87
Q

When is V-tach considered unsustained?

A

When it lasts <30 seconds AND is asymptomatic

88
Q

Describe monomorphic V-tach

A

Every single QRS complex looks exactly the same
Coming from the same ectopic foci

89
Q

Describe polymorphic V-tach

A

Each QRS complex varies in magnitude and duration indicating multiple ectopic foci

90
Q

Describe torsades de pointes

A

Cyclic progressive increase in magnitude followed by progressive decrease in magnitude of waves
Very life threatening

91
Q

Describe stable V-tach

A

Hemodynamics are WNL
HR, RR, SAP
Patient presents “normal”

92
Q

What are the clinical interventions for stable V-tach?

A

Vagal maneuver
Start IV
Obtain 12 lead EKG
Cardiology consult

93
Q

Describe unstable V-tach

A

Hypotensive
Altered mental state, potentially unresponsive
SOB
Chest pain

94
Q

What are the clinical interventions for unstable V-tach?

A

Attempt valsalva maneuver if patient can follow commands
Immediate cardioversion

95
Q

How might a patient in unstable V-tach present?

A

Pale or cyanotic
Diaphoretic
Weak
Dizzy

96
Q

Describe atrial fibrillation

A

Atria quiver due to ectopic foci
Chaotic asynchronous electrical activity
No P waves

97
Q

What does A-fib look like on an EKG?

A

No discernable P or T wave
Erratic disorganized tracing without any type of tracing regularity or deflections or identifiable waves between QRS complexes

98
Q

Describe how atrial flutter looks on an EKG

A

A sawtooth pattern between QRS complexes

99
Q

What is the difference between A-fib and A-flutter

A

A-fib has multiple ectopic foci
A-flutter has a singular ectopic foci

100
Q

Which types of heart block are typically asymptomatic?

A

1st degree heart block
2nd degree Type 1 (wenckebach)

101
Q

Which types of heart blocks are potentially life threatening?

A

2 degree type 2 (mobitz)
3rd degree AV block aka complete heart block

102
Q

A first degree heart block is characterized by what?

A

A prolonged PR interval
> 0.2 seconds or 1 big box

103
Q

Describe 2nd degree heart blocks

A

2nd degree heart blocks allow some atrial depolarization (P waves) to conduct electrical stimuli to the ventricles producing a QRS response, while some atrial depolarizations are blocked leaving lone P waves without an associated QRS response

104
Q

What is happening during a second degree heart block?

A

PR interval is increasing due to a delay of AV node conduction of the electrical impulse
AV node does not depolarize completely or adequately by the time the next impulse arrives

105
Q

What can cause a second degree heart block?

A

AV nodal ischemia during an inferior wall MI
AV blocking drugs
Increased vagal tone

106
Q

Describe the PR interval in a 2nd degree type 1 heart block

A

PR interval is not constant, becomes increasingly longer until QRS complex is skipped entirely

107
Q

Is treatment typically needed for second degree type 1 heart block?

A

no

108
Q

What is the difference in the PR interval when comparing type 1 and type 2 second degree heart blocks?

A

Type 1 = PR interval grows longer until QRS complex is absent
Type 2 = PR interval is constant

109
Q

What is happening in a second degree type 2 heart block?

A

A blockage is occuring in the electrical conduction system at the bundle of His or bundle branches

110
Q

What happens if a 2nd degree type 2 heart block isnt treated?

A

Will progress to a 3rd degree heart block

111
Q

What are other terms for 2nds degree type 2 heart block?

A

Mobitz
Hay

112
Q

What is another term for a 3rd degree heart block?

A

Complete heart block

113
Q

What is happening in 3rd degree heart block?

A

Atria and ventricles have rates that are independent of each other

114
Q

Describe the P-P interval and R-R interval in 3rd degree heart block

A

Both are constant
P wave may be hidden, but it is regular

115
Q

Describe the atrial and ventricular rate in 3rd degree heart block

A

Completely independent of one another
Atrial rate is normal
Ventricular rate is typically slow

116
Q

What does a bundle branch block indicate?

A

A conduction block somewhere in the ventricles

116
Q

Describe the PR interval in 3rd degree heart block

A

Absent

117
Q

How are bundle branch blocks diagnosed?

A

By recognizing a wide QRS complex

118
Q

How are bundle branch blocks differentiated?

A

By determining where they originate from

119
Q

What is the main cause of atrial flutter?

A

coronary artery disease

120
Q

What is a complication associated with atrial fibrillation?

A

Increased risk of blood clots

Cardiopulmonary (6 decks)

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