Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

S7- Cardiopulmonary > Week 6- ECG > Flashcards

Week 6- ECG Flashcards

1
Q

PART 1: INTRODUCTION

A

PART 1: INTRODUCTION

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  • Routine cardiac events are triggered by _______ events.
  • Electrical events can be detected and visualized via _____.
  • Altered ECG patterns reflect a pathology in what?
A
  • electrical events
  • ECG
  • conduction system or a process that alters these electrical events
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the (3) unique properties of cardiac myocytes?

A
  • Automaticity
  • Rhythmicity
  • Conductivity

CARdiac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Automaticity:

  • What is automaticity?
  • They __________ discharge.
  • Think ________ heart.
A
  • They are able to discharge/depolarize without stimulation from a nerve.
  • automatically discharge
  • transplanted heart
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Rhythmicity:

  • What is rhythmicity?
  • Describe the hierarchy of rhythmicity and their discharge rates. (3)
  • What creates the sinus rhythm?
A
  • Depolarization occurs at regular intervals, therefore cardiac muscle cells can depolarize at regular intervals.
  • SA Node (60-100/min), AV Node (40-60/min), His-Purkinje Fibers (30-40/min)
  • SA Node
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  • What is important to know about the hierarchy of rhythmicity?
  • What does this mean?
A
  • The faster/higher discharge rate predominates. (Autonomic influence > SA > AV > Purkinje)
  • This means that if the normally predominating (SA Node) one is malfunctioning, the next highest will take over.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Conductivity:

  • What is conductivity?
  • _____like squeeze. What is the purpose of this?
A
  • Heart muscle cells have ability to spread impulses to adjoining cells very quickly without nerve involvement.
  • Wavelike squeeze (to promote movement of blood through atria into ventricles, and out of heart)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the AP in a 0-4 step process.

A
  1. ) Na+ influx making inside of cell more +.
  2. ) K+ leaves cell causing slight repolarization until plateau.
  3. ) Ca+ (in) and K+ (out) leads to sustained plateau.
  4. ) Eventually Ca+ (in) stops and K+ (out) remains, leading to repolarization.
  5. ) AP remains until next depolarization.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PART 2: WIGGERS DIAGRAM (ECG) & PQRST COMPLEX

A

PART 2: WIGGERS DIAGRAM (ECG) & PQRST COMPLEX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  • When the wave of depolarization is moving a positive electrode located under the skin, the ECG records a simultaneous _______ deflection.
  • A wave of repolarization moves over a positive electrode results in a _________ deflection.
A
  • upward

- downward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ECG tracings are _________ recordings of electrical events/ionic events occurring within the myocytes.

A

superficial recordings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

P Wave:

  • ______ ________ is depicted on the ECG tracing as the P wave.
  • Initiated via the ________.
  • The impulse is spread to the L side via the _________ bundle.
A
  • atrial depolarization
  • SA Node
  • Bachmann bundle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PR Interval:

  • Determines time it takes impulse to travel from ________ to _________.
  • How is this useful?
A
  • SA Node to AV Node

- Helps to determine how healthy the heart is in terms of how fast it is able to spread electricity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

QRS Complex:

  • ________ ________ is depicted on the ECG tracing as the QRS complex.
  • What is the pathway of the His-Purkinje fibers and why does this matter?
  • Higher QRS = ______ muscle
A
  • ventricular depolarization
  • His-Purkinje fibers travel in wall of ventricle and help to promote wavelike contraction. This directs blood flow into the pulmonary/aortic valves.
  • Higher QRS = bigger muscle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

T Wave:

  • ________ _________ is depicted on the ECG tracing as the T wave.
  • The interval from the beginning of the QRS Complex to the apex of the T wave corresponds to the ______ _______ period. What is this?
  • In most leads, the T wave is _________ and reflects to repolarization of the myocytes.
A
  • ventricular repolarization
  • absolute refractory period, this is where it can no longer depolarize
  • positive (upward deflection)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PART 3: ECG RECORDING/LEADS

A

PART 3: ECG RECORDING/LEADS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the isoelectric point?

A
  • When looking at an ECG, the x-axis line that the ECG is hovering around.
  • Above = + voltage change, Below = - voltage change
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q
  • The standard 12-lead ECG consists of ___ limb leads and ___ chest leads.
  • Think of each lead as what?
A
  • 6 limb leads and 6 chest leads

- Lead is a different view of the heart from a different angle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q
  • Standard limb leads = ?

- Augmented limb leads = ?

A
  • I, II, and III

- aVR, AVL, and aVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Chest Leads (views):

  • Thee six chest leads of the ECG are ___, ____, ____, ____, ___, and _____.
  • Show gradual changes in all the recordings.
  • Record in a ________ plane.
A
  • V1-V6

- horizontal plane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q
  • Leads V1/V2 are placed over the ______.
  • Leads V3/V4 located over ____________.
  • Leads V5/V6 look at ________.
A
  • V1/V2 = R side of heart
  • V3/V4 = interventricular septum
  • V5/V6 = L side of heart
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe all 6 chest leads placement.

A
  • V1 = 4th IC space to R of sternum
  • V2 = 4th IC space to L of sternum
  • V3 = Directly between leads V2 and V4
  • V4 = 5th IC space at midclavicular
  • V5 = level with V4 at left anterior axillary line
  • V6 = level with V5 at left midaxillary line

-V4r = 5th IC space at R midclavicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe telemetry lead placement.

A
  • Right arm, left arm, right leg, left leg

- Can be done at shoulders/hips or wrists/ankles, but most often done proximal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a way to remember telemetry lead placement?

A
  1. ) White right
  2. ) Snow over grass
  3. ) Brown ground
  4. ) Smoke over fire
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Why does the amplitude of the QRS complex increase as we move from V1 to V6?

A

The larger the muscle mass, the higher the amplitude of the complex. (LV stronger than RA/RV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Limb Leads:

  • Lead I = ___ to ___
  • Lead II = ______ to _______
  • Lead III = ______ to _______
  • Lead aVR = ____ to _____
  • Lead aVL = ____ to _____
  • Lead aVF = ____ to ____
A
  • I = R to L
  • II = top R to bottom L
  • III = top L to bottom L
  • aVR = whole L to top R
  • aVL = whole R to top L
  • aVF = top to bottom
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

The direction of the heart based on anatomical orientation is bests correlated with which lead?

A

Lead II (main lead of reference)

28
Q

What (3) things are we looking for with a single lead assessment?

A
  • Heart Rhythm/Rate
  • Normal Waveforms
  • Abnormal Waveforms
29
Q

ECG Recording:

  • Vertical deflections = voltage (__ mV/mm, small square)
  • Horizontal = time (___s, small box)
  • 5 big squares = __s, 30 big squares = __s
A
  • Vertical = 1mV/mm
  • Horizontal = 0.04s
  • -5 big squares = 1s, 30 big squares = 6s
30
Q

Determine HR From ECG Strip:

  • Describe the 300, 150, 100 method.
  • Describe an alternative method.
A
  1. ) Locate R wave on heavy black line.
  2. ) Count off “300, 150, 100, 75, 60, 50” for each heavy black line that follows until the next R wave falls.
  3. ) Bold line it falls on represents the HR.
  4. ) Count the number of large boxes between two adjacent R waves.
  5. ) 300/ this count
  6. ) Yields estimated HR
31
Q

Single limb monitoring can only accurately assess _____ and _______.

A

rate and rhythm

32
Q

Assessment of the Cardiac Cycle. (8)

A
  1. ) Evaluate the P wave. (Is it normal and upright, and is there a P wave before every QRS? Do all the P waves look alike?)
  2. ) Evaluate the P-R interval. (Normal duration is 0.12 to 0.20 seconds)
  3. ) Evaluate the QRS complex. (Do all QRS complexes look alike?)
  4. ) Evaluate the QRS interval. (Normal duration is 0.06 to 0.10 seconds)
  5. ) Evaluate the T wave. (Is it upright and normal in appearance?)
  6. ) Evaluate the R-R wave interval. (Is it regular?)
  7. ) Evaluate the heart rate (6-second strip if regular rhythm; normal rate is 60 to 100 beats per minute).
  8. ) Observe the patient and evaluate any symptoms. (Do the observation, symptoms, or both correlate with the arrhythmia?)
33
Q

PART 4: AV BLOCKS

A

PART 4: AV BLOCKS

34
Q

How many degrees of AV Block are there?

A
  • 1st Degree AV Block
  • 2nd Degree AV Block
  • 3rd Degree AV Block
35
Q

1st Degree AV Block:

  • When do 1st Degree AV Blocks occur?
  • What does this result in on an ECG?
  • How would we classify a 1st Degree AV Block?
A
  • Occurs when the impulse is initiated in the SA Node, but DELAYED on the way to the AV Node.
  • Results in a prolonged PR interval. (AV conduction time prolonged)
  • PR interval >.2s, normal QRS complex (.06-.1s)
36
Q

2nd Degree AV Block (Wenckeback/Mobitz 1):

  • What are 2nd Degree Wenckeback AV Blocks? Where do they occur?
  • What does this result in on an ECG?
  • Does the lengthening of PR interval followed by a dropped QRS occur in a repetitive cycle?
A
  • Transient disturbance that occurs high in AV junction and prevents conduction of SOME impulses through the AV node.
  • Initial P wave precedes each QRS complex, but eventually a P wave may stand alone. Progressive lengthening in PR interval, with eventual drop of QRS complex.
  • Yes
37
Q

2nd Degree AV Block (Mobitz II):

  • What are 2nd Degree Mobitz II AV Blocks?
  • What does this result in on an ECG?
A
  • Intermittent non-conducted P waves without progressive prolongation of PR interval.
  • P waves “march through” at a constant rate.
38
Q

3rd Degree AV Block:

  • What are 3rd Degree AV Blocks?
  • ______ and ________ fire at their own inherent rate.
  • What does this result in on an ECG?
  • ______ can be wide (>.1s)
A
  • No impulses that are initiated above the ventricles are conducted to the ventricles.
  • atria and ventricles
  • QRS complex
39
Q
  • What is a way to remember 1st Degree AV Block?
  • What is a way to remember 2nd Degree (Wenckeback) AV Block?
  • What is a way to remember 2nd Degree (Mobitz II) AV Block?
  • What is a way to remember 3rd Degree AV Block?
A
  • 1st Degree = “If R is far from P, then you have first degree”
  • 2nd Degree (Wenckeback) = “Longer, longer, drop, then you have Wenckeback”
  • 2nd Degree (Mobitz II) = “If some p’s don’t get through, then you have Mobitz II”
  • 3rd Degree = “If P’s and Q’s don’t agree, then you have 3rd degree”
40
Q

Which AV Block is the most dangerous and why?

A

3rd Degree because we are not having correlated electrical activity, the heart itself will start to malfunction.

41
Q

How are each of the blocks treated?

A

1st degree
-benign and usually not treated

2nd degree

  • Dependent on the type of 20 block
  • No treatment necessary or
  • Pacemaker placement
  • Result of an MI

3rd degree (LIFE THREATENING)

  • MI, degeneration of the conducting system
  • Permanent pacemaker placement
  • Medical emergency
42
Q

PART 5: ARRHYTHMIAS

A

PART 5: ARRHYTHMIAS

43
Q

What are some different Atrial Arrhythmias? (2)

A
  • Paroxysmal Atrial Tachycardia (PAT)

- Atrial Fibrillation

44
Q

PAT:

  • What is Paroxysmal Atrial Tachycardia?
  • How do we know it is atrial tachycardia?
A
  • A sudden recurrence of atrial tachycardia.

- There is a P-wave, if it wasn’t atria we wouldn’t have a P-wave.

45
Q

Atrial Arrhythmias:

  • P-wave may be merged with previous ______.
  • P-R interval may be difficult to determine but are
A
  • T-wave
  • <0.2s
  • identical
  • 0.06s-0.1s
  • regular
46
Q

What are some things that can cause PAT?

A

-Emotional factors; overexertion; hyperventilation; potassium depletion; caffeine; nicotine and aspirin sensitivity; rheumatic heart disease; mitral valve dysfunction, PE

47
Q

What are some symptoms that can occur if PAT rapid rate continues for a period of time? (3)

A
  • Dizziness
  • Weakness
  • SOB
48
Q

Atrial Fibrillation:

  • What is A.fib?
  • _______ are absent, thus leaving a flat or wavy baseline.
  • How is the R-R interval defined?
  • QRS complex is between ___-___s.
A
  • Erratic quivering/twitching of atrial muscle caused by ectopic foci in atria that emit electrical impulses constantly.
  • P-waves
  • irregularly irregular
  • 0.06s-0.1s
49
Q

How do you calculate HR with A.fib since it is irregular?

A

Look at QRS complexes in a 6s ECG strip and multiply it by 10.

50
Q

Atrial Fibrillation:

  • What are some things that can cause A.fib?
  • Not considered life-threatening unless what?
  • lack of atrial “kick” = decrease CI by ___-___%
  • Potential for developing mural thrombi
A
  • Advanced age, CHF, ischemia or infarction, cardioyopathy, digoxin toxicity, drug use, stress or pain, rheumatic heart disease, renal failure
  • Unless HR is elevated
  • 15-30%
51
Q

What are some different Ventricular Arrhythmias? (3)

A
  • Premature Ventricular Complexes (PVCs)
  • Ventricular Tachycardia (Vtach)
  • Ventricular Fibrillation
52
Q

Premature Ventricular Complexes (PVCs):

  • What is PVC?
  • The QRS complex is classically described as what?
  • When the heart _____ __ _____.
  • Each specific site in ventricles has different looking ECG complex.
  • PVC generally followed by compensatory ______.
A
  • Occurs when an ectopic focus originates an impulse from somewhere in one of the ventricles.
  • Wide and bizarre looking QRS without a P-wave and followed by a complete compensatory pause.
  • Skips a beat
  • pause
53
Q

Treatment of PVCs depends on what (3) things?

A
  • Underlying cause
  • Frequency and severity of PVCs
  • Symptoms associated
54
Q

When are PVCs considered life threatening? (5)

A
  1. ) Are paired together.
  2. ) Are multifocal in origin.
  3. ) Are more frequent than 6 per minute.
  4. ) Land directly on the T-wave.
  5. ) Are present in triplets or more.
55
Q

When are PVCs usually considered benign?

A

-When isolated, without symptoms, and fewer than 6/min.

56
Q

Vtach:

  • What is Vtach?
  • What does this result in on an ECG?
  • Ventricular rate of ventricular tachycardia is between ____-___ bpm.
  • It can be the precursor to what?
A
  • Series of 3 or more PVCs in a row, occurs because of rapid firing by a single ventricular focus with increased automaticity.
  • P-waves are absent, 3 or more PVCs in a row, prolonged Q-T interval, and “Torsade de Pointes”
  • 100-250 bpm
  • Vfib
57
Q

What are some causes of Vtach? (4)

A
  • ischemia or acute infarction
  • CAD
  • hypertensive heart disease
  • medication reaction
58
Q

What are some treatment options for Vtach? (3)

A
  • Cardioversion
  • Defibrillation
  • Medication (lidocane, bretylium tosyliate, or procainiamide)
59
Q
  • With Vtach, CO is severely diminished and often converts to _______.
  • Is it a medical emergency?
  • Individuals who remain conscious with this arrhythmia may be lightheaded or near __________.
A
  • Vfib
  • Yes
  • syncope
60
Q

Ventricular Fibrillaton (Vfib):

  • What is Vfib?
  • How does this present on an ECG?
A
  • Defined as erratic quivering of ventricular muscle resulting in no CO. (multiple ectopic foci fire, creating asynchrony)
  • ECG shows grossly irregular up/down fluctuations of the baseline in an irregular zigzag pattern.
61
Q
  • Is Vfib a medical emergency?
  • What are the causes?
  • Treatment is _________ as quickly as possible followed by cardiopulmonary resuscitation, supplemental O2, and med injections.
A
  • Yes
  • Same as Vtach
  • defibrillation
62
Q

Ventricular Arrhythmia Tiered Therapy. (3)

A
  1. ) Antitachycardia Pacing (Vtach)
  2. ) Cardioversion Shock (Vtach
  3. ) Defibrillation (Vfib)
63
Q

PART 6: OTHER FINDINGS FROM A 12-LEAD ECG

A

PART 6: OTHER FINDINGS FROM A 12-LEAD ECG

64
Q

Hypertrophy:

  • Determined by looking at voltage in ___ and ____.
  • RV hypertrophy is defined as a large ___-wave in V1, which gets progressively smaller in V2, V3, and V4.
  • LV hypertrophy defined as a large ___-wave in V1 and a large R-wave in ___ that have combined voltage of >35mV.
A
  • V1 and V5
  • RV Hypertrophy = large V1
  • LV Hypertrophy = large S-wave in V1 and large R-wave in V5.
65
Q

Ischemia:

-How does this present on an ECG?

A
  • Inverted T-wave

- S-T segment depression

66
Q

Ischemia, Infarction, or Injury:

  • ST segment depression at rest in presence of chest pain = ____________, may indcate a pending transmural infarction.
  • ST segment depression in absence of ischemia or angina may be due to _________ toxicity.
  • ST segment elevation or depression is diagnostic for ___________; presence of Q-wave is also diagnostic of infarction.
  • Leads that demonstrate presence of T-wave inversion, ST segment changes, or Q-waves identify _______ of ischemia, injury, or infarction.
A
  • subendocardial infarction
  • digitalis
  • acute infarction
  • location
67
Q
  • STEMI = _________

- NSTEMI = ________

A
  • STEMI = full occlusion (MI)

- NSTEMI = artery narrowing

S7- Cardiopulmonary (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions