Week 13 - EKG Flashcards
Rhythm
Rate
P:QRS internal ratio
NSR
60-100
1:1
represent a slowing of conduction through the AV node
SR with first degree block
PR > 0.2 sec
Rhythm
SR with 1st degree block
represent a slowing of conduction through the AV node
T or F: pts with SR with degree AV block are ususally symptomatic
F- usually not symptomatic
How do P-P intervals differ in Mobitz type I
Mobitz Type I = SR with 2nd degree AV block
P-P are constant
Wenckebach is a 2nd degree AV block _______ type _____
Mobitz type I
Name Rhythm
Sinus Rhythm with Second Degree AV block- Mobitz Type I (Wenckebach)
Name Rhythm
Sinus Rhythm with Second Degree AV block- Mobitz Type II
Sinus Rhythm with Second Degree AV block- Mobitz Type II PR intervals are > 0.20 seconds and ________
constant
Sinus Rhythm with Second Degree AV block- Mobitz Type II are usually (asymptomatic/symptomatic)
symptomatic
represents a complete dissociation between atria and ventricles
3rd degree AV block
T or F: P waves normal in 3rd degree heart block
True
T or F: P-P intervals are irregular in 3rd degree heart block
F - NORMAL
What rhythm:
QRS morphology and width vary depending on where the escape pacemaker is located in the conduction system
Third degree AV block
What Rhythm:
P waves and QRS have nothing to do with eachother
Third degree AV block
what rhythm
Third degree AV block
what rhythm
Third degree AV block
what rhythm
Third degree AV block
what rhythm
Third degree AV block
patients with third degree AV blokc are usually (asymptomatic/symptomatic)
symptomatic
Relationship btwn atrial and ventricular rate in third degree AV block
atrial rate always faster than ventricular rate
Where does Junctional rhythm originate from
AV node
T or F: junctional rhythm p waves never present
F - may or may not be present
what rhythm
junctional rhyth,m
in junctional rhythm, where is the P wave sometimes at
after QRS complex
what rhythm
what is the blue portion of the strip’s rhythm
junctional rhythm,
where does the acelerated junctional rhythm, come from
AV junction
what rhythm
accelerated junctional rhythm
describe AFib QRS interval
normally WNL
uncontrolled rate of afib >100 often called
rapid ventricular reponse
what rhythm
a fib
T or F: A flutter has a P wave present
T
most common A flutter conduction ratio
2:1
describe Atrial flutter QRS interval
usually WNL
is atrial flutter rate usualy regular or irregular
regular
what rhythm
A flutter
firs thing that should come to mind when you hear “a fib”
irregular
HR range for SVT
140-220 bpm
is SVT usually regular or irregular
regular
where are SVT impulses coming from
collection of tissue around and involving the AV node
what rhythm
SVT
if a patient crept up on SVT… NSR higher then higher then higher, what is a likely cause
hypovolemia d/t blood loss
Vtach rate ususally
100-220 BPM
T or F: Vtach rate is always symptomatic
F - usually symptomatic not always
what rhythm
V tach
rhythm with no observable QRS
VFib
rhythm with chaotic electrical activity
VFib
what rhythm
VFib
rhythm where is is usually last ditch attempt to maintain cardiac output
idioventricular rhythm
rate of idioventriucl;ar rhythm
usually < 40 BPM
what rhythm
idioventricular rhythm
why look at lead II first?
it is most sensitive to changes
direction Lead II reads
RU to LL
which leads should have positive deflections in EKG
I, II, III
V4, V5, V6
which leads should have negative deflections in EKG
aVR and VI
which leads should have both + and - deflections in EKG
aVL, V2, and V3
bipolar leads
leads I, II, III
unipolar leads
aVL, aVR, aVF
is left or roight axis deviation more common
left axis deviation (Lead I up and aVF down)
axis deviations for Lead I and aVF:
both up
normal
axis deviations for Lead I and aVF:
I up and aVF down
left
axis deviations for Lead I and aVF:
I down and aVF up
right
axis deviations for Lead I and aVF:
both down
severe right… youre in trouble!
if leads II, III, and aVF are negative its what issue
left hemiblock
what leads should you look at for BBB
leads I, V1, and V6
what block
wide QRS and R, S, R1 configuration in V1
RBBB
what block: large wide R, S pattern in V1
LBBB
what is seen in lead 1 for LBBB
positive deflection and wide
what is usualy seen in V6 of LBBB
“bunny ears” but if not a notched QRS somewhere in V leads
what block
RBBB check V1 should be negative deflectiopn
what block
RBBB
check V1
what block
LBBB
what type of hemiblock is rare
left posterior hemiblock
- right axisd deviation
- normal QRS but widening
negative deeflectionsin II, III, and aVF is a
left anterior hemiblock
what block
left anterior hemiblokc (LAFB)
what leads are best to view ventricular hypertrophy
V1, V2, and V5, V6
other name for a LEft Anterior hemiblock
fasicular block
how to determine if ventricular hypertrophy is present
add depth of s wave in V1 or V2 (whichever is deepest) to the height of the R wave in V5 or V6 (whichever is tallest)
> /= 35 mm is LVH
what additional measurements may signify LVH on 12 lead ekg
- any precordial >/= 44 mm
- R wave of aVL >/= 11 mm
- R wave of LEad I >/= 12 mm
- R wave of lead aVF >/= 20 mm
- if precordial lead QRS complexes overlap its probably LVH)
what is this
Left ventricular hypertrophy
LAD supplies
anterior wall
LAD changes seen in what leads
V1 to V4
what rhythm
anterior wall MI
lateral wall of heart supplied by
LAD or obtuse marginal
seen in I, aVL, V5 and V6
what does this ekg show
lateral wall mi
inferior wall supplied by
RCA
inferior wall mi seen in what leads
II, III, aVF
what does this ekg show and what blood supply is in trouble
inferior wall MI
RCA
postrerior wall of heart blood supply from
PDA
posterior wall mi seen as depression in what leads
V1 and V2
ST depression signifies ______ and ST elevation signifies
ischemia
infarct
in what leads is there ST depression
what part of heart is this
what supplies blood here
V4-V6
lateral
obtuse marignal
Q waves are pathologic if:
- more than 1/3 total height of QRS
- wider than 0.03 sec (more significant)
where are the ST elevations and what is the blood supply to this area
II, III, aVF
RCA
what rhythm
atrial flutter
what rhythm
AFib
a couplet is
2 PVC in a row
if you think you have an MI, which is better for perfursion
ephedrine
neosynephrine
neosynephrine
bc ephedrine is “weak epi” which will make heart squeeze harder and decrease o2 to brain
do inferior wall MI need more or less fluids
more fluids
what rhythm
RBBB in V1
if you think youre having anterior wall mi should you give fluids or restrict fluids
restrict fluids because could cause congestive HF
what rhythm
LBBB
what rhythm
RBBB
RSR1 pattern
what rhythm
AFib
