Rule, Form, Def/s Flashcards
Systematic approach
- rate, 2. rhythm, 3. P waves, 4. PRI, 5. QRS
P wave:
Wandering atrial pacemaker:
Double hump morphology:
Sharp P morph/:
= Atrial depolarization
= dif/ pacemaker spots in atrium
= atrium ballooning or>1 firing
= pulmonale from R-atrium lungs
QRS complex:
T wave:
U wave:
QT segment:
= ventricular depolarization
= ventricular depolarization
= “late bloomer
= all ventricle’s action
RVR:
SVR:
= Rapid ventricular response
= Slow ventricular response
PRI:
ST segment:
P-T is:
RR:
= AV holding impulse for sync
= ventricular contraction
= 1 full cardiac cycle
= gives rate & rhythm
Rs 6sec strip method:
big box method:
Small box method:
Triplicate method:
= # of Rs x 10
= 1R to R BB#s then 300/BB#
= 1R-R SB#s then 1500/ SB#
= descend W/ SB 300, 150, 100, 75, 50, 43, 38
PAC:
PJC:
PVC:
= Premature Atrial Contraction
= Premature Junction Contraction (AV)
= Premature Ventricular Contraction
Re-entry loops
= stuck in nascar loop in a chambers pathway causing SVT / no P waves
Preexcitation Syndromes Arrhythmias Resulting from Most Common:
= Extra/s conduction pathways impulses used in assessory
= (WPW) bundle of Kent
= 2nd Lown-GanongLevine
= 3rd Mahaim Fiber
WPW definer:
Name of assessory pathway:
= has delta wave “wave leaning into R wave”
= Bundle of Kent
Lown-Ganong) definer:
Pathway name & path:
= has short PRI interval
= Bundle of James connects posterior internodal pathway to bundle of his
Paroxysmal Supraventricular Tachycardia (PSVT);
= SVT rules w/ stop or start; no P waves in SVT can be any rhythm before/after SVT
SA Pacemaker P wave shapes
Upright P waves & QRS WNL
Heart blocks are
blocks in AV node partial or complete
“Putting a rock or pebble on a cable”
- (Cardiac Pharmacology)
- NA Channel Blockers:
- Beta-Blockers:
- Potassium Channel Blockers:
- Calcium Channel Blockers:
- Miscellaneous:
1= (Vaugh-Will) Classes: 1]Na, 2]Beta, 3]K, 4]Ca, Misc] Adenosine
2= (Procainamide & Lidocaine) both Widened QRS & Prolongs QT
3= (Propranolol) Prolonged PRI & Bradycardias
4= (Amiodarone) Prolonged QT
5= (Diltiazem & Verapamil) Prolonged QT & Bradycardias
6= (Adenosine & Digoxin) Prolonged QT & Bradycardias
Propranolol, Labetalol, Metoprolol) class
Labetalol
Metoprolol
= class 2 Beta Blockers
= 2nd line med for SVT after Adenosine, A-fib/flutter w/RVR, Reduce myocardical ischemia in AMI PT’s w/elevated HR, Antihypertensive
= Hypertension, 2nd line med for A-Fib/A-Flutter w/ RVR, & SVT
(Procainamide & Lidocaine) class
= class 1A&B Na Channel Blockers
= Alterative to Amiodarone in cardiac arrest V-Fib/pVT, Stable monomorphic Ventricular TachyC w/ presserved LVF
= V-Tach with a pulse, pre-excitation rhythms (WPW) >50% QRS width
Amiodarone class & indication
Class 3 K channel blocker> VF/Pulseless VT unresponsive to shock, CPR & Epi, BradyCs to include AV blocks, Recurrent, hemodynamically unstable VT w/ pulse
Adenosine & Digoxin class & indication
class misc> Adenosine 1st line med for stable narrow complex SVT,
Regular & monomorphic wide-complex tachyC thought to be from a reentry SVT (SVT w/ BBB) Does not convert A-fib/flutter
Before shocking someone:
since unstable, contraindicated meds:
since unstable, Indicated meds:
= Sedate em! sedate to keep pain away
= Sodium Thiopental, Propofol (Diprivan), Diazepam (Valium), Midazolam (Versed)
= Etomidate (Amidate (0.2-0.4 mg/kg), Ketamine (Ketalar(1-2mg/kg)
(Diltiazem & Verapamil) class
Diltiazem
Verapamil
= class 4 Ca channel blocker
= 1st line med for A-Fib/Flutter w/ RVR >150 bpm, 2nd line med for SVT
refractory to adenosine
= 2nd line med for A-Fib/Flutter w/ RVR. May use as alterative after adenosine, narrow QRS complex tachycardia w/ preserved LV fn.
Cardiac Output:
Cardiac Output Formula:
Blood Pressure formula:
= amount of blood pumped by the heart in 1 min (70mL)
= SV x HR
= (SV x HR) x SVR
(Refractory periods) Absolute:
Relative:
= end of P to apex of T wave- cells absolute Beginning of repolarization
= “some really could happen” lot of cells repolar but not all so can throw out of rhythm Commodo cordis
When obtaining a 12 lead ECG, where do you place V2?
When obtaining a 12 lead ECG, where do you place V5?
When obtaining a 12 lead ECG, where do you place V6?
When obtaining a 12 lead ECG, where do you place V3?
When obtaining a 12 lead ECG, where do you place V1?
When obtaining a 12 lead ECG, where do you place V4?
When obtaining a 15 lead ECG, where do you place V4R?
= 4th ICS just left of Sternum
= Left 5th ICS anterior of auxiliary
= 5th ICS midaxillary
= ½ in between V2 & V4
= Right of Sternum 4th ICS
= 5th ICS left Midclavicular
= Right ICS midclavicular
Natural pacemaker of the heart is:
If SA Node failed to initiate a impulse, what is 1st back-up firing site?
If both SA & AV fails what is last firing site:
= SA node
= AV node
= Purjunkie
Leads V3 & V4 view
Leads V1 & V2 view
Leads 2,3, & aVF view
Leads 1, aVL, V5, V6 view
= Anterior
= Septal
= Inferior
= Lateral
DIgoxin for
heart failure usually fools refractory Na K pumps
Leads V1 and V2 look at what part of the heart?
Septal (blockages from LAD commonly)
Leads 1, aVL, V5, V6 look at what part of heart:
L-Lateral (low view : views LCX & LAD)
Leads V3 and V4 look at what part of the heart?
L-Anteriorwall (LAD & LMCA blocks)
Leads II, III and aVF look at what part of the heart?
Inferior wall (most common blockacke(RCA)
Orthodromic Re-entry loop:
Antidromic Re-entry loop
= Clockwise rentry conduction loop >narrow QRS
= counterclockwise reentry conduction loop > wide QRS
Digoxin) Typically for:
Dynamics
works bc
= CHF
= allows more Ca for better contraction
= confuses K/Na pumps
w/ (PJC) Premature Junctional Contraction) 1Rules:
2CANNOT HAVE B/C:
3Compensatory pause
4Non-compensatory pause
1= rate by rhythm, usually slightly irregular, P waves are either inverted before, +after, or hidden w/in QRS
2=have upright P wave (up P= PAC)
3= keeps cadence
4= doesn’t keep cadence
- (Junctional rhythms) aka know by:
- Definer:
1= junctional escape: “pick up workload b/c something failed”
2= AV P waves & AV node rate 40-60BPM, Regular rhythm
(Heart Blocks Raps) If the R is far from the P, then you have a:
Longer, longer, longer, drop, then you have a:
If some Ps don’t get through, then you have a:
If Ps and Qs don’t agree, then you have a:
= FIRST DEGREE!
= WENCKEBACH!
= MOBITZ II!
= THIRD DEGREE!
(Heart Blocks Raps) If the R is far from the P, then you have a:
FIRST DEGREE!
(Heart Blocks Raps) Longer, longer, longer, drop, then you have a
= WENCKEBACH!
(Heart Blocks Raps) If some Ps don’t get through, then you have a:
= MOBITZ II!
(Heart Blocks Raps) If Ps and Qs don’t agree, then you have a:
= THIRD DEGREE!
Re-entry loops
= stuck in nascar loop in a chambers pathway causing SVT / no P waves
WPW) Orthodromic loop;
Antidromic loop:
Treatmeats:
= Clockwise reentry w/ narrow complex
= Counterclockwise reentry w/ wide QRS
= procainamide 1a Na blocker, (if no procain) sedate & cardiovert) cardioversion
2nd-Degree Type I AV block) names
Mobitz 1 or Wenckebach
Wenckebach) Sir name
2nd-Degree Type I AV block
2nd-Degree Type 2 AV block) names:
Mobitz 2 or intranodal AKA “2:1 block” rhythm
Intranodal/Mobitz 2) Sir name
2nd-Degree Type 2 AV block
- (1st Degree AV Block) know:
- Definer:
1= “add to any rhythm” “gandolf slowly opening door(PRI)”
2= PRI: >than 0.20 seconds for every PRI & P-P cadence
- (2nd Degree Type I) AKA & Know:
- Definer:
1= “Morbitz 1”/“Wenckebach” rhythm & “AV turning off to fully down”
2= progressive longing PRI till drops beat then resets/starts over
- (2nd Degree Type II) AKA & know:
- Definer:
1= “Mobitz 2/Intranodal” & “random extra Ps”
2= some P’s w/o QRS & same PRI/No longing before drop beat
- (3rd Degree AV Block) AKA & know
- Definer:
1= “Complete AV-Block/dissociation” (always TCPP on) “gandalf died”
2= No relations w/ Ps & QRSs & no same PRI (top & bottom dif)
only condition A-Fib has cadence:
Afib w/ 3rd degree In rhythm “Gandalf dead so Atriums & Ventricles doing own thing
!!Poiseuille’s law:
Example:
= vessel w/ relative radius of 1 would transport 1mL per min at BP difference of 100mmHg. Keep pressure constant
= Less blood = vaso-press
Which coronary artery feeds the inferior wall of the heart?
Right Coronary Artery (RCA)
Which coronary artery feeds the left lateral wall of the heart?
Left Circumflex (LCX)
A blockage of which of the following would result in the entire left ventricle not receiving blood supply?
Left Main Coronary Artery (LMCA)
(T wave) Limb leads Amplitude:
Precordial “chest” leads amplitude:
= <5mm in LL
= <10mm in precordial
1Lateral Wall high view:
2Left Lateral low view:
3Inferior wall view:
4Septal wall view:
5L-Anterior view:
1= Lead I & aVL= LA
2= Lead 1, aVL, V5 & V6: views LCX & LAD
3= 2,3,aVF: LL most common block(RCA) Lots of blockages/infarcs
4= V1 & V2: Along sternal borders blockages from LAD commonly
5= V3 & V4: left anterior wall : LAD & LMCA blocks
Widowmaker :
clot in left coronary artery wiping out L side
The upward slurring of the isoelectric line after the P wave up into the QRS complex that is associated with Wolff Parkinson White Syndrome (WPW) is known as the:
The accessory pathway associated with Wolff Parkinson White Syndrome (WPW) is known as the:
= Delta wave
= Bundle of Kent
Typically, we don’t attempt to control the rate of Atrial Fibrillation unless it is
above 150 per minute and the patient is presenting with signs and symptoms related to the rhythm.
Electrodes 2 jobs:
= stick & conduct (Electrodes sealed, skin prep_
Einthoven’s triangle: green electrode:
Blue electrode:
Red electrode:
= neutral/ground
= Negative
= Positive
Einthoven’s triangle: Lead 1 & view:
Lead 2 & view:
Lead 3 & view:
= negative RA → positive LA (Left lateral camera view)
= negative RA→ positive LL (Inferior camera view)
= negative LA→ positive LL (slight lateral Inferior camera view)
Einthoven’s triangle) Negitive & Positive lead 1 sites:
Negitive & Positive lead 2 sites:
Negitive & Positive lead 3 sites:
=negative @ RA & positive @ LA
= negative @ RA & positive @ LL
= negative @ LA & positive @ LL
Unipolar Limb Leads:
aVR:
aVL:
aVF:
= Augmented by the cardiac monitor
= Right Arm positive (inferior)
= Left Arm positive (lateral )
= Left Leg positive (inferior)
Horizontal Boxes: Each small box ?secs:
5 small boxes equal:
Each large box is ?secs:
= 0.04 sec
= 1 large box
= 0.20 sec
Vertical Boxes Each small box is:
Each small box also equals:
5 small boxes equal:
Each large box is:
2 large boxes equal: 1 mV
= 0.1mV
= 1 mm
= 1 large box
= 0.5 mV
= 1 mV
ECG Heart waves – P wave:
QRS complex:
T wave:
= Atrial depolarization
= Ventricular depolarization
= Repolarization of ventricles
V1 V2 leads view:
Septum
V3 V4 leads look at
Left lateral wall
V5 V6 leads look at
Inferior
V1 & V2
V3 & V4
V5 & V6
SA node rate:
AV node rate:
Purjunkie rate:
=100-60BPM
=60-40BPM
=40-15BPM
Systematic approach
- rate, 2. rhythm, 3. P waves, 4. PRI, 5. QRS
Heart blocks are
blocks in AV node partial or complete
“Putting a rock or pebble on a cable”
Propranolol, Labetalol, Metoprolol) class
Labetalol
Metoprolol
= class 2 Beta Blockers
= 2nd line med for SVT after Adenosine, A-fib/flutter w/RVR, Reduce myocardical ischemia in AMI PT’s w/elevated HR, Antihypertensive
= Hypertension, 2nd line med for A-Fib/A-Flutter w/ RVR, & SVT
(Procainamide & Lidocaine) class
= class 1A&B Na Channel Blockers
= Alterative to Amiodarone in cardiac arrest V-Fib/pVT, Stable monomorphic Ventricular TachyC w/ presserved LVF
= V-Tach with a pulse, pre-excitation rhythms (WPW) >50% QRS width
(Diltiazem & Verapamil) class
Diltiazem
Verapamil
= class 4 Ca channel blocker
= 1st line med for A-Fib/Flutter w/ RVR >150 bpm, 2nd line med for SVT
refractory to adenosine
= 2nd line med for A-Fib/Flutter w/ RVR. May use as alterative after adenosine, narrow QRS complex tachycardia w/ preserved LV fn.
When obtaining a 12 lead ECG, where do you place V2?
When obtaining a 12 lead ECG, where do you place V5?
When obtaining a 12 lead ECG, where do you place V6?
When obtaining a 12 lead ECG, where do you place V3?
When obtaining a 12 lead ECG, where do you place V1?
When obtaining a 12 lead ECG, where do you place V4?
When obtaining a 15 lead ECG, where do you place V4R?
= 4th ICS just left of Sternum
= Left 5th ICS anterior of auxiliary
= 5th ICS midaxillary
= ½ in between V2 & V4
= Right of Sternum 4th ICS
= 5th ICS left Midclavicular
= Right ICS midclavicular
Leads V3 & V4 view
Leads V1 & V2 view
Leads 2,3, & aVF view
Leads 1, aVL, V5, V6 view
= Anterior
= Septal
= Inferior
= Lateral
Leads V1 and V2 look at what part of the heart?
Septal (blockages from LAD commonly)
Leads 1, aVL, V5, V6 look at what part of heart:
L-Lateral (low view : views LCX & LAD)
Leads V3 and V4 look at what part of the heart?
L-Anteriorwall (LAD & LMCA blocks)
Leads II, III and aVF look at what part of the heart?
Inferior wall (most common blockacke(RCA)
(Heart Blocks Raps) If the R is far from the P, then you have a:
Longer, longer, longer, drop, then you have a:
If some Ps don’t get through, then you have a:
If Ps and Qs don’t agree, then you have a:
= FIRST DEGREE!
= WENCKEBACH!
= MOBITZ II!
= THIRD DEGREE!
(Heart Blocks Raps) If the R is far from the P, then you have a:
FIRST DEGREE!
(Heart Blocks Raps) Longer, longer, longer, drop, then you have a
= WENCKEBACH!
(Heart Blocks Raps) If some Ps don’t get through, then you have a:
= MOBITZ II!
(Heart Blocks Raps) If Ps and Qs don’t agree, then you have a:
= THIRD DEGREE!
2nd-Degree Type I AV block) names
Mobitz 1 or Wenckebach
Wenckebach) Sir name
2nd-Degree Type I AV block
2nd-Degree Type 2 AV block) names:
Mobitz 2 or intranodal AKA “2:1 block” rhythm
Intranodal/Mobitz 2) Sir name
2nd-Degree Type 2 AV block
- (1st Degree AV Block) know:
- Definer:
1= “add to any rhythm” “gandolf slowly opening door(PRI)”
2= PRI: >than 0.20 seconds for every PRI & P-P cadence
- (2nd Degree Type I) AKA & Know:
- Definer:
1= “Morbitz 1”/“Wenckebach” rhythm & “AV turning off to fully down”
2= progressive longing PRI till drops beat then resets/starts over
- (2nd Degree Type II) AKA & know:
- Definer:
1= “Mobitz 2/Intranodal” & “random extra Ps”
2= some P’s w/o QRS & same PRI/No longing before drop beat
- (3rd Degree AV Block) AKA & know
- Definer:
1= “Complete AV-Block/dissociation” (always TCPP on) “gandalf died”
2= No relations w/ Ps & QRSs & no same PRI (top & bottom dif)
only condition A-Fib has cadence:
Afib w/ 3rd degree In rhythm “Gandalf dead so Atriums & Ventricles doing own thing
(T wave) Limb leads Amplitude:
Precordial “chest” leads amplitude:
= <5mm in LL
= <10mm in precordial
1Lateral Wall high view:
2Left Lateral low view:
3Inferior wall view:
4Septal wall view:
5L-Anterior view:
1= Lead I & aVL= LA
2= Lead 1, aVL, V5 & V6: views LCX & LAD
3= 2,3,aVF: LL most common block(RCA) Lots of blockages/infarcs
4= V1 & V2: Along sternal borders blockages from LAD commonly
5= V3 & V4: left anterior wall : LAD & LMCA blocks
Unipolar Limb Leads:
aVR:
aVL:
aVF:
= Augmented by the cardiac monitor
= Right Arm positive (inferior)
= Left Arm positive (lateral )
= Left Leg positive (inferior)
V1 V2 leads view:
Septum
V3 V4 leads look at
Left lateral wall
V5 V6 leads look at
Inferior
V1 & V2
V3 & V4
V5 & V6
SA node rate:
AV node rate:
Purjunkie rate:
=100-60BPM
=60-40BPM
=40-15BPM
Respiration ratio=
1 sec inhalation 2 sec exhalation
Pulsus paradoxus
BP drop more than 10→ can indicate severe obstructive lung disease.
(60%) Fluid compartments % of water:
45% intracellular
15% extracellular (outside cell)
Interstitial 10.5% Intravascular 4.5%
Cardiac Output:
Cardiac Output Formula:
Blood Pressure formula:
= amount of blood pumped by the heart in 1 min (70mL)
= SV x HR
= (SV x HR) x SVR
Pulse pressure:
MAP:
CPP Cerebral Perfusion:
= SBP-DBP
= (PP/3) + DBP
= (MAP-ICP) + 10
Celsius# to degrees Fahrenheit form
Fahrenheit# to Celsius form
C# to F=(C# -32) / 1.8
F# to C= (1.8 x F) + 32
EMD
Electrical Mechanical disassociation (same as PEA)
Stable & symptomatic doesnt always mean
medicate; ex vagal is all that is needed
