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EKG
general
46
Other
03/14/2010

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Cards

Term
Inferior leads
Definition
Lead II 60
Lead III 120
Lead aVF 90
Term
Left Lateral leads
Definition
Lead I 0
Lead aVL -30
V5
V6
Term
Right sided lead
Definition
(Right ventricular)
Lead aVR -150
V1
Term
Anterior leads
Definition
V2, V3, V4
Term
P wave
Definition
atrial depolarization

right first half
left second half

< 2.5 mm high
< 0.12 sec in duration

+ in Lead I, aVL, II, aVF, V5, V6
biphasic in III and V1
- in aVR
Term
QRS complex
Definition
ventricular depolarization
Term
T wave
Definition
ventricular repolarization

+ in leads with large, + R waves
Term
How long should the QRS interval be?
Definition
0.06 - 0.1 secs
Term
How long should PR interval be?
Definition
0.12 - 0.2 sec
Term
How do you find the rate from an EKG?
Definition
1. Count boxes between R waves - 300/# of boxes

2. Count # of cycles in 6 secs and multiply by 10
Term
What results in a positive wave on an EKG?
Definition
A wave of depolarization moving toward an electrode or a wave of repolarization moving away from an electrode
Term
Explain Einthoven's Triangle
Definition
-/- +/-

+/+

Bipolar leads - limb leads
Term
Angles
Lead I
Lead II
Lead III
aVR
aVL
aVF
Definition
Lead I 0
Lead II 60
Lead III 120
aVR -150
aVL -30
aVF 90
Term
Q wave
Definition
I and aVL

Q waves are negative
Term
Explain R wave progression.
Definition
V1 -
V3 to V4 transition
V5 largest R wave
V6 slightly smaller
Term
J point
Definition
where QRS complex joins ST segment
Term
Assess QRS axis
Definition
Look at Lead I and aVF
Lead I + is -90 to 90
aVF + is 0 to 180
Both + is 0 to 90

Look for biphasic wave - 90 from that
Term
Right axis deviation
Definition
between 90 and 180
+ aVF
- Lead I
Term
Left axis deviation
Definition
between 0 and -90
Lead I +
aVF -
Term
extreme right axis deviation
Definition
between -90 and 180
Lead I -
aVF -
Term
Causes of right axis deviation
Definition
deep inspiration
standing
tall, lanky body habitus
right ventricular hypertrophy
- pulmonary hypertension
- congenital heart disease
myocardial infarction of left ventricle
acute pulmonary embolism
Term
Causes of left axis deviation
Definition
Left ventricular hypertrophy
expiration
laying down
obesity
Term
P wave axis
Definition
between 0 and 70
Term
Assessment of atrial enlargement
Definition
Look at Lead II and V1
increased amplitude or increased duration
Term
Causes of Right atrial enlargement
Definition
Usually associated with r. ventricular enlargement

Pulmonary disease
- asthma, pulm embolism, COPD
Congenital heart disease
- pulmonic valve stenosis, atrial septal defect, Ebstein's anomoly, tetralogy of Fallot
Term
Causes of left atrial enlargement
Definition
Valvular heart disease
- aortic stenosis, aortic regurgitation, mitral regurgitation, mitral stenosis
Hypertensive heart disease
Cardiomyopathies
Coronary artery disease
Term
Diagnostic criteria for R. ventricular hypertrophy
Definition
Right axis deviation > 100
In lead V1, the R wave > S wave
In lead V6, the S wave > R wave
Term
Causes of R. ventricular hypertrophy
Definition
Congenital heart disease
- pulmonic stenosis, atrial septal defect, tetralogy of Fallot, Eisenmenger's syndrome
Pulmonary disease
Pulmonary artery hypertension
Pulmonary embolism
Term
Diagnostic criteria for L ventricular hypertophy
Definition
Precordial leads more sensitive than limb leads

R wave in V5 or V6 + S wave in V1 or V2 exceeds 35 mm
R wave in V5 exceeds 26 mm
R wave in V6 exceeds 18 mm
R wave in V6 exceeds the R wave in V5

R wave in aVL exceeds 13 mm
R wave in aVF exceeds 21 mm (Ms. J disagrees)
R wave in Lead I exceeds 14 mm
R wave in Lead I + S wave in Lead III exceeds 25
Term
Repolarization abnormalities
Definition
Down-sloping of ST segment

V1 and V2 for right ventricle
Lead I, aVL, V5, V6 for left ventricle
Term
Arrhythmia clinical manifestations
Definition
palpitations
presyncope or syncope
angina
congestive heart failure
sudden death
Term
Causes of arrhythmias
Definition
HIS DEBS

Hypoxia
Ischemia and irritability
Sympathetic stimulation
Drugs
Electrolyte disturbances
Bradycardia
Stretch
Term
Rhythm strip
Definition
Lead II
Holter monitor
Cell phone based monitor
implanted event recorder
Term
Carotid massage
Definition
stimulates vagal input
right stimulates SA node
left stimulates AV node

used to slow arrhythmia
Term
Five basic types of arrhythmias
Definition
1. arrhythmias of sinus origin
2. ectopic rhythms
3. reentrant arrhythmias
4. conduction blocks
5. preexcitation syndromes
Term
The 4 Arrythmia Questions
Definition
1. Are normal P waves present?
2. Are the QRS complexes narrow or wide?
3. What is the relationship between the P waves and QRS complexes?
4. Is the rhythm regular or irregular?
Term
Arrythmias of Sinus Origin
Definition
sinus tachycardia
sinus bradycardia
sinus arrhythmia
sinus arrest
Term
Sinus tachycardia
Definition
rate exceeding 100 bpm
causes: anxiety, pain, drugs, fever, infections, pulmonary embolism, acute MI, hyperthyroidism, pheochromocytoma, intravascular volume loss, alcohol intoxication or withdrawal
Term
Sinus bradycardia
Definition
less than 60 cpm
Causes: normal variant, drugs, hypthyroidism, hyperkalemia, sick sinus syndrome, sleep apnea syndromes, carotid sinus hypersensitivity syndrome, vasovagal reaction
Term
Sinus arrhythmia
Definition
slight beat-to-beat variation
common in young adults
changes in vagal tone that occur during respiration
Term
sinus arrest
Definition
causes: hypoxemia, myocardial ishcemia or infarction, hyperkalemia, diitalis toxicity, vagal hyperactivity

Escape beats may come from atria, AV node, or ventricles

Asystole - prolonged electrical inactivity
Term
atrial pacemaker rate
Definition
60-75 beats
Term
junctional pacemaker rate
Definition
40-60 bpm
most common
causes retrograde P waves
Term
ventricular pacemaker rate
Definition
30-45 bpm
Term
Ectopic rhythm
Definition
sustained rhythm coming from outside SA node
causes: digitalis toxicity, beta adrenergic meds for asthma or COPD
Term
Reentrant rhythms
Definition