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EKG test 1
n/a
44
Medical
Graduate
10/02/2011

Additional Medical Flashcards

 


 

Cards

Term
Which ventricle dominates the visual view of the heart?

The electrical view?
Definition

visual: right

electrical: left

Term
Trace the electrical conduction system of the heart
Definition
SA --> AV --> His --> Bundle branches --> purkinje --> myocardial cells
Term
The little boxes are __ s x ___mm

The big boxes are __s
Definition

Little: 0.04s x 1mm

 

big: 0.2 s

Term
Which wave?

1. represents atrial depolarization
- normal is 0.08-0.11s
- Axis is 0-75 deg

2. Represents dead myocardium or is sometimes benign
- >0.03s is significant
- >1/3 hieght of R wave is significant
- Septal waves in I, aVL, and V6 are insignificant

3. represents ventricular depolarization
- normal 0.06-0.11s
Axis: -30-105

4. represents ventricular repolarization
- should be same direction as QRS

5. Unknown cause
- often seen in bradycardia and hypokalemia --> never hyperkalemia
Definition

P wave

2. Q wave

3. QRS complex

4. U wave

Term
Which segment/interval?

1. represents transmission from AV node to purkinjes
- bad if depressed below baseline = pericarditis or atrial infarct

2. represents the beginning of the beat to the purkinjes
- normal is 0.12-0.2s
- >0.2 = 1st degree AV block

3. represents an electrically neutral period btwn ventricular depolarizaiton and repolarization
- normal is at baseline
- 1 mm or greater variation in two contiguous leads is a problem

4. represents all events of ventricular systole
- should be <1/2 the RR, if it's greater, it indicates arrhythmia

5. beginning of QRS to downward slope of R
- represents time from purkinjes to epicardium
- should be 0.035 in right precordials and 0.045 in left
- Increased time = vent hypertrophy
Definition

1. PR segment

2. PR interval

3. ST segment

4. QT interval

5. intrinsicoid deflection

Term
How do you calculate rate for normal rates?

For irregular?
Definition

Regular: count big boxes between QRS's

300-150-100-75-60-50

 

Irregular/slow: count # of QRS's in 12 sec and multiply by 5

Term
isoelectric leads
Definition

90deg from another lead:

 

I and aVF

 

II and aVL

 

III and aVR

Term
causes of LAD
Definition

left anterior hemiblock

LVH

inferior MI

ectopic beats

Term
causes of RAD
Definition

kids

RVH

Left posterior HB

dextrocardia

ectopic beats

Term
RBBB criteria
Definition

1. QRS > 0.12

2. Leads 1 & V6: slow, slurring S waves

3. Lead V1: RSR' (rabbit ears)

 NEVER neg complexes in V1

Term
LBBB criteria
Definition

1. QRS >0.12s

2. I & V6: Broad, Monomorphic R waves (all pos or all neg)

3. V1: Broad, monomorphic S waves

Term
Left anterior hemiblock criteria
Definition

1. Axis in pathologic left (I+, aVF -, II-)

2. I: qR or Large R

3. III: rS

Term
left posterior hemiblock criteria
Definition

1. RAD - 1-, aVF+

2. I: s, III: q

3. Exclusion of RAE and RVH

Term
LAE (P mitrale) criteria
Definition

Leads I & II:

- P wave >0.12 s and notched

 

V1:

- biphasic P wave

 

height of P (mm) x width of P (sec) > 0.3  --> probability of LAE is 95%

Term
RAE (P pulmonale) criteria
Definition

Leads II & III:

peaked p waves (>2.5 mm high)

 

V1:

Biphasic P wave

 

Term
Intraatrial conduction delay (IACD) criteria
Definition

Def: non-specific conduction problem in atria

 

V1: biphasic

- if first half is taller --> RAE is likely

- if second half is taller --> LAE is likely

Term
LVH criteria
Definition

1. (S V1 or V2) + (R V5 or V6) > 35 mm

2. Any precordial QRS >45mm

3. R in aVL > 11mm

4. R in I > 12 mm

5. R in aVF > 20 mm

 

usually also signs of LAE

usually LAD

Term
RVH criteria
Definition

1. V1 and/or V2: R:S ratio >1

2. Sx of RAE

Term
LVH v. RVH strain
Definition

LVH:

1. V1-V3: ST elevation w/ upward concavity. T wave upright and asymmetric

2. V4-V6: ST depression w/ downward concavity. T wave inverted and asymmetric

 

RVH:

1. V1: Increased R:S

2. V1 or V2: ST segment depression w/ downward concavity and inverted asymmetric T wave

Term
ST elevation is __% accurate for AMI

Can't be used to R/O AMI
Definition
90%
Term
ST segment elevation greater than 1 mm in 2 or more contiguous leads OR presumed new LBBB
Definition
STEMI
Term
ischemic ST depression of 0.5 mm or more OR dynamic T wave inversion with pain and disocomfort OR transient ST elevation of 0.5mm or greater for less than 20 min
Definition
NSTEMI or unstable angina
Term
Door to balloon time (PCI) should be < __ min

Door to needle time (fibrinolytics) should be < ___ min
Definition
90, 30
Term
Transmural MI diagnostic criteria
Definition

Q waves

ST elevation

T wave inversion

 

AKA (but not really) Q wave MI

Term
what does "acute phase", "injury pattern" and "current of injury" mean?
Definition
progression of EKG changes as ischemia/MI gets worse
Term
Anterior MI key points:
- what leads?
- what reciprocal leads?
- tx?
- which BB are affected?
- What artery/
Definition

- leads: I, aVL, V1-V6

- reciprocal: II, III, aVF

- nitrates -- NOT fluids

- All bb are affected

- LAD

 

are most deadly - "widow makers"

 

 

Term
Inferior MI key points:
- what artery?
- what leads/reciprocal leads?
- what is a major sx?
- tx?
Definition

- RCA

- II, III, aVF
- reciprocal: I, aVL, V1-V6

-sx:: hypotensino

- Tx: fluids, NOT nitrates

Term
Post MI ST segment elevation persisting more than 2 weeks after an acute event indicates?
Definition
ventricular aneurysm
Term
what kind of MI?

- some tissue dies but necrosis doesn't extend through the wall. No Q waves.
- usually has ST depression

ACC defines diagnosis as CP + elevated enzymes
Definition
NSTEMI/subendocardial MI/non-Q wave MI
Term
Minor deviation sof the ST segment + flattening of T waves + slight T wave inversion

often seen in what dz?
Definition

Nonspecific ST-T changes

 

often seen in prinzmetal's

Term
early repolarization is benign and is indicated by non-ischemic ST segment elevation
Definition
Term
3 most common causes of pseduoinfarcts
Definition

WPW

Acute pericarditis

CNS disease

Term
Non-ischemic ST segment elevation with scooped ST segment + elevated T wave. creates "smiley" pattern

In all leads except aVR and VI\1
Definition
acute pericarditis
Term
Scooped ST depression in inferior and lateral leads
Definition
Digitalis effect
Term
Pre-excitation syndrome caused by accessory electrical pathway (bundle of kent) between the atrium and ventricle that causes pre-excitation of ipsilateral ventricle

EKG: delta R wave -- upsloping R wave + short PR interval
Definition
Wolff-Parkinson-White syndrome
Term
AV node is bypassed by an extension of the anterior internodal tract called the James bundle, which conducts depolarizations directly to bundle of His.

Causes significant atrial arrhythmias like atrial flutter

Causes flutter QRS complexes on EKG
Definition
lown-ganong-levine syndrome
Term
Einthoven's equation
Definition

(amplitude of) I + (amplitude of) III = (amplitude of) II

 

if this is not true, check lead placement

Term
bipolar leads
Definition
I, II, III
Term
"turn signal" rule
Definition

For BBB:

 

At V1, if you turn right, it's a RBBB, if you turn left, its a LBBB

Term
ST elevation on every lead + smiley face pattern (scooped ST segment)
Definition
pericarditis
Term
AV node circulation is always supplied by the ___?
Definition
RCA
Term
What is the one thing you should look for when you see a U wave?
Definition
hypokalemia
Term
slowing of the AV node may prolong what interval?
Definition
PR
Term
What 3 factors can prolong the QT interval?
Definition
hypokalemia, hypothermia, SAH
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