WEEK 5 ECG Flashcards
1
Q
What are the 4 quick steps to ECG interpretation?
A
- too fast/slow
- QRS wide/narrow
- P wave
- rhythm
2
Q
What are some parameters that affect CO?
A
- HR, SV
- diastole, systole
- atrial kick
- filling time, frank-starling’s law
- pre-load, afterload
3
Q
If HR is too fast, what happens to CO & why?
A
CO will decrease because there’s not enough time to fill.
4
Q
Which part of ECG represents activation (depolarization of R & L atria)?
A
P wave
5
Q
Which part of ECG is the time from SA –> AV node which can be increased by exercise & certain meds?
A
PR interval
6
Q
Which part of ECG is R & L ventricular depolarization?
A
QRS complex
7
Q
Which part of ECG is time for ventricles to de & repolarize?
A
QT interval
8
Q
Which part of ECG is time b/t de & repolarization?
A
ST interval
9
Q
Which part of ECG is ventricular repolarization?
A
ST wave
10
Q
Which part of ECG is ventricular after depolarization?
A
U wave
11
Q
What effect do stretch receptors in muscles and low pH in blood have on HR?
A
Increase
12
Q
HR will decrease when high BP is detected by __________ _________.
A
carotid sinus
13
Q
Where does ‘normal’ HR originate?
A
SA node
14
Q
What are the beats/min of SA node?
A
60-100
15
Q
What are the beats/min of AV junction?
A
40-60
16
Q
What are the beats/min of bundle of his?
A
40-60
17
Q
What are the beats/min of purkinje networks?
A
20-40
18
Q
What does a long QT interval indicate?
A
arrhythmias
19
Q
What does an upside down T wave indicate?
A
MI or ischemia
20
Q
What does an elevated ST segment indicate?
A
MI
21
Q
What does a depressed ST segment indicate?
A
myocardial ischemia
22
Q
Which lead is the most typical & shows from RA –> LV?
A
Lead II
23
Q
Which of the V leads shows the right side?
A
V1 & V2
24
Q
Which of the V leads shows the anterior side?
A
V3 & V4
25
Which of the V leads shows the lateral wall?
V5 & V6
26
What does it mean if QRS is too wide?
Heart beat is coming from ventricles instead because myocardial cell is being depolarized in ventricle ahead of time.
27
How does age impact CO & HR?
Decreases it
28
Atrial kick is seen in HTN & makes heart get (less/more) blood.
more
29
Impulses traveling away from pos electrode &/or towards neg will produce (upward/downward) deflections.
downward
30
Impulses traveling perpendicular to pos electrode may produce _________ waveform (both pos & neg).
biphasic
31
Impulses traveling towards __________ electrode will produce upward deflection.
positive
32
What do the compensatory pauses b/t PVCs indicate?
Ventricles need longer time to repolarize.
33
What's the difference b/t ventricular bigeminy & trigeminy?
Bi: PVC alternates w/ single sinus beat. Tri: PVC is after 2 sinus beats.
34
What's the difference b/t ventricular couplet & triplet? Which one would you stop working a patient?
Couplet: 2 PVCs in a row. Triplet: 3 in a row (STOP WORKING!!!!)
35
What does a ventricular triplet indicate?
Nonsustained tachycardia if less than 30 sec, if more then it's sustained.
36
What does an inverted P wave indicate?
Heart block w/ junctional rhythm.
37
What is indicated by P waves being too close?
Premature atrium contraction.
38
True or False: You stop a pt that is showing v-tach on ECG (huge & wide beats).
True
39
What does a P wave that is too close to T wave & doesn't start @ isoelectric line indicate?
SVT where impulse is from atria but not SA node.
40
Besides P wave inversion, what are other ways a junctional rhythm can present?
- Absent P wave
- P wave buried in QRS
- Flat P wave
41
In which leads can P wave inversion be normal?
- Lead III
- AVR (this IS normal)
- Leads V1 & V2
42
True or False: You don't have to stop working pt if they have PVCs.
False
43
What do you do with a pt w/ ST elevation or depression?
STOP working.
44
What does digoxin dip refer to?
Curve below isoelectric line due to taking med.
45
What happens to Q wave after MI?
Becomes deeper (especially 1-3 days) but as weeks go on it goes back to how it was almost (never goes back completely because scar).
46
What does peaked T wave indicate?
Hyperkalemia.
47
What does inverted T wave indicate?
MI or ischemia in the past.
48
In which leads is a T wave inversion normal?
- Lead III
- Lead V1 (in adults)
- AVR
- Leads V1, V2, V3 (in children)
49
What does a T wave inversion indicate?
- MI or ischemia
- Bundle branch block
- Ventricular hypertrophy
- PE
- Hypertrophic cardiomyopathy
- Raised intracranial pressure
50
_________ beats are before SA node.
Premature
51
What type of beats arrive late to help reset?
Escape
52
If there's chaos in ECG, what should you think of?
- V fib
- Leads loose/off
- A fib
- A flutter
- Artifact
- Polymorphic VT
53
What would you do w/ a pt that has short & a lot of beats on ECG w/ no clear differences b/t waves, etc? Why?
STOP because v-fib.
54
What is the difference b/t A fib & A flutter?
- A fib: Multiple cells, narrow QRS, P waves not clear & irregularly irregular.
- A flutter: 1 cell, normal QRS, P waves fast but regularly irregular (looks like sawtooth pattern).
55
What would you see on ECG for torsades de pointes?
- Fast
- Narrow & unclear QRS
- Unclear P
- Irregularly irregular
56
What is the name of condition of v tach which can be seen w/ prolonged QT interval that can be potentially fatal?
Torsades de pointes.
57
Bundle branch blocks are usually not life threatening, however, in combo w/ what other condition leads to premature mortality?
Structural heart disease.
58
What occurs in right BBB?
Delayed depolarization of RV which won't start until LV is almost fully depolarized.
59
What changes can be seen in ECG for RBBB?
- QRS >= 0.12 s
- Deep S waves (w-shaped) in leads I & V6
- RSR' (M) pattern in V1
60
What occurs in left BBB?
Delayed depolarization of LV which won't start until RV is almost fully depolarized.
61
What changes can be seen in ECG for LBBB?
- QRS >= 0.12 s
- Broad, monomorphic R waves in I & V6 (best to see in V6)
- No Q wave
62
Where does first degree heart block occur?
SA
63
Where does second degree type 1 HB occur?
AV
64
Where does second degree type 2 HB occur?
Bundle of His or bilateral bundle branches.
65
Where does third degree HB occur?
B/t atria & ventricles.
66
What changes on ECG can be seen for 1st degree HB (not a problem)?
Prolonged PR interval.
67
What occurs in 1st degree HB? Which population is this common in?
- Conduction delay through AV node but still reaches ventricles.
- Seen in endurance trained athletes.
68
What changes on ECG can be seen for 2nd degree type 1 HB (not a big problem)?
- Slow AV node conduction & prolonged PR
- Conduction fails & QRS disappears because no ventricular depolarization.
- Resets & PR normal again.
69
Which types of HB should you stop working w/ pt unless they have pacemaker?
2nd degree type 2 & 3rd.
70
What changes on ECG can be seen for 2nd degree type 2 HB (sinus arrest)?
PR interval normal but sudden dropped QRS that stays dropped (even if there's still depolarization).
71
In which type of HB is asystole a risk since there's no sync b/t atria & ventricle?
3rd.
72
What changes on ECG can be seen for 3rd degree HB?
- Normal P wave but not related to QRS.
- No PR interval.
73
What direction does the mean QRS vector point? Why?
Inferior & to the left because LV is larger.
74
What does right axis deviation indicate?
- RV hypertrophy
- Embolus
75
What does left axis deviation indicate?
- LV hypertrophy
76
What does no man's land mean?
Extreme axis deviation.
77
True or False: Normal axis is 20 deg - 100 deg.
False (30-110)
78
Which V electrode is placed at 4th ICS right of sternum?
V1
79
Which V electrode is placed at 5th ICS midclavicular line?
V4
80
Which V electrode is placed at 5th ICS midaxillary line?
V6
81
Electrodes to the right of LV has waveforms w/ (upward/downward) deflection.
downward
