Unit 1 Flashcards
PR interval duration
0.12-0.20
P wave duration
0.06-0.10
QRS interval
0.06-0.11
What is the J point
Where QRS complex meets ST segment
QT interval
0.36-0.44
What does QT interval measure?
Time of ventricular depolarization and repolarization
What is the standard signal amplitude?
1.0 mV or 10 small vertical square
View of aVR
Atria and great vessels
View of aVL
Lateral wall of LV
View of aVF
Inferior wall of left ventricle
Anterior leads
V1-4
Lateral leads
I, aVL, V5-6
Inferior leads
II, III, aVF
A normal rate that suddenly accelerates to as rapid rate producing irregularity in the rhythm
Paroxysmal tachycardia
Patterned irregularities
Repeats itself in a cyclic fashion
-sinus dysrhythmia, second degree av block type 2
Totally irregular
-irregularly irregular
A fib
P wave amplitude
0.5-2.5mm
P wave amp >2.5
RAE
P pulmonale
RAE
P wave width >0.10s
LAE
P mitrale
LAE
Saw tooth pattern
Flutter waves; atrial flutter
Inverted P wave originates from?
Lower RA near the AV node, in the LA or the AV junction
Causes of tall QRS complexes
Ventricular hypertrophy, abnormal pacemaker, aberrantly conduct beat
Low voltage QRS
Obese patients, hypothyroid, pericardial effusion
PR interval denotes depolarization of
Heart from the SA node through the atria, AV node, and his-purkinje system
Shorter p waves occur when
The impulse originates in the atria close to the AV junction or in the AV junction
- through abnormal accessory pathways
- preexcitation
Delta wave
WPW
Longer PR interval
Usually AV block
Varying PR intervals
Wandering atrial pacemaker
Normal axis
0 and 90 degrees
LAD degrees
0 to -90
RAD degrees
90-180
Extreme axis deviation degrees
180 to -90
Causes of LAD
LVH, chronic CAD, hyperkalemia, WPW
Causes of RAD
Normal in children and tall thin adults, RVH, pulmonary embolus
Who is likely to have a vertical heart?
Tall thin individuals
Who’s likely to have a horizontal heart?
Obese and pregnant people
Leads diagnostic for RAE
II and V1
Clinical conditions with RAE
Pulmonic stenosis, mitral stenosis/regurgitation
P wave in V1 for LAE
Negative
One small block
RVH criteria
RAD R wave(7mm tall usu)>s wave V1
Causes of RVH
Pulm stenosis or pull HTN
Causes of LVH
HTN and valvular heart disease
LVH criteria
Sum of deepest S in V1 or V2 + the tallest R in V5 or V6 is >35mm
- R in aVL >11mm
- R in lead I plus S in lead III >25mm
Sinus bradycardia
<60
Pts are less tolerant of rates <
45
Sinus tachycardia
> 100
Patterned irregularity slowing, speeding up, then slowing
Sinus dysrhythmia
Heart rate _____ during inspiration and ______ during expiration
Increases; decreases
What can cause sinus dysrhythmia?
Inferior wall MI, digitalis, morphine, increased intracranial pressure
Sinus pause
1-2 beats dropped
Sinus arrest
3+ beats dropped
Sinus node dysfunction
Periods of bradycardia, tachycardia, prolonged pauses or alternating brady and tachy
3 mechanisms that cause atrial dysrhythmias
Automaticity, triggered activity, reentry
Atrial dysrhythmias can lead to
Decreased CO and decreased tissue perfusion
Key characteristic of atrial dysrhythmias
P waves looks different in appearance
Drug toxicity hat causes wandering atrial pacemaker
Digitalis
PACs have a ______ pause
Non compensatory
Types of PACs
Bigeminal, trigeminal, quadrigeminal
PAC with wide QRS complex
PAC with aberrant ventricular conduction
-check to see if noncompensatory to distinguish between PVC
Atrial tachycardia
Rate 150-250
-short PR and P waves may be different
Paroxysmal atrial tachycardia(PAT)
Short bursts of atrial tach
Multifocal atrial tachycardia
Irregular rhythm with HR 120-150
- p waves look different from beat to beat
SVT
The P waves cannot be seen sufficiently
-can include PAT, nonPAT and multi focal atrial tachy
Saw tooth
Atrial flutter
Atrial flutter
Atrial rate of 250-350 with saw tooth appearance
-common 3:1 conduction ratio
Irregularly irregular
Atrial fibrillation
A fib causes ________ of atrial kick
Loss
P wave characteristic in junctional dysrhythmias
Inverted p wave
PJC
Inverted P with early QRS complex
-noncompensatory pause
Junctional escape rhythm
AV junction rate of 40-60bpm
Accelerated junctional rhythm
60-100bpm
Junctional tachycardia
100-180bpm
Features of ventricular dysrhythmia
Wide bizarre QRS
- absent P waves
- T waves in opposite direction of the R wave
PVC
Wide, bizarre QRS
- compensatory pause
- can be unifocal or multifocal
- bigeminal, trigeminal, quadrigeminal
2 PVCs in a row are called
A couplet
PVCs that fall between 2 regular complexes and do not interrupt the normal cardiac cycle are called
Interpolated PVCs
PVCs occurring on or near the previous T wave is called
R on T PVCs
R on T PVCs may precipitate what?
V tach or v fib
Idioventricular rhythm
20-40bpm
- no p wave
- wide QRS
Accelerated idioventricular rhythm
40-100bpm
No p wave
Wide QRS
V tach
100-250 bpm
No p wave
Wide QRS
3+ PVCs in a row
V tach
Sustained VT
6-10 complexes
Tx of torsades without cardiac arrest
Magnesium sulfate
Tx of torsades with cardiac arrest
Defibrillation
V fib
300-500bpm, chaotic
Most common cause of prehospital cardiac arrest in adults?
V fib
1st degree av block
PR Interval longer than 0.20
2nd degree av block type I
Wenckebach
PR interval progressively increases until a QRS complex is dropped
2nd degree AV block type II
Prolonged and constant PR interval
Intermittent P wave with no QRS complex
3rd degree AV block
No correlation between p wave and QRS