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EKG
Midterm Review
93
Medical
Graduate
07/13/2010

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Term
Muscular organ the size of a man’s closed fist
Definition
Size of the Heart
Term
base
apex
Definition
Top of the heart is the ___, bottom is the ___
Term
Epicardium: Outermost layer, contains coronary arteries.
Myocardium: Middle, thickest layer
-Made of pure muscle and does the contracting
-Area of damage when someone has heart attack
Endocardium: Thin, innermost layer, forms the heart valves
-Is watertight to prevent leakage of blood out into the other layers
-The cardiac conduction system is found here
Definition
List/describe 3 layers of the heart
Term
Double-walled sac that encloses the heart
Serves as support and protection
Pericardial fluid is found between the layers of the pericardium—it minimizes friction of the layers as they rub together with each heartbeat
Anchors the heart to the diaphragm and great vessels
Definition
describe the pericardium
Term
R/L atrium
R/L ventricle
Definition
List the 4 chambers of the heart
Term
Right Atrium
Definition
 Receives deoxygenated blood from the body.
 SVC/IVC
 Blood here has an O2 sat of only 60-75% and is colored blue/black
 CO2 concentration is high
Term
Right ventricle
Definition
 Pumps blood to the lungs to get oxygenated
Term
Left Atrium
Definition
 Receives oxygenated blood from the lungs
 O2 sat of about 100%; CO2 concentration is very low
 Bright red
Term
Left Ventricle
Definition
 Pumps blood throughout the body
Term
S1—closure of mitral and tricuspid valve—1st heart sound
 Systole between S1 and S2
S2—closure of semi-lunar valves—2nd heart sound
 Diastole between S2 and the next S1
Definition
Describe S1 and S2
Term
Pulmonic valve: Between right ventricle and pulmonary artery.
Aortic valve: Between left ventricle and aorta
-Aortic stenosis– usually in older people with bicuspid or calcification of the valve
Definition
Describe semi-lunar valves
Term
Tricuspid valve: Between right atrium and ventricle.
Mitral valve: Between left atrium and ventricle
Definition
Describe AV valves
Term
o Atria contract, squeezing remainder of blood into ventricles
o last 30% being pushed out… lose it—A fib
Definition
what is atrial kick?
Term
atrial depolarization

... might wanna know this one... just sayin... =)
Definition
P wave
Term
ventricular depolarization
Definition
QRS wave
Term
ventricular repolarization
Definition
T wave
Term
Sympathetic NS
Definition
o Mediated by NE from the adrenal gland
o Speeds up the heart rate, increases BP, dilates pupils, slows digestion
o Fight or flight
Term
Parasympathetic NS
Definition
o Mediated by Ach secreted as a result of stimulation of the vagus nerve
o Slows the HR, decreases BP, enhances digestion
o Rest & digest
o Holding your breath and doing the valsalva maneuver can cause the HR to slow by vagal stimulation
Term
o Phase 4: Cardiac cell at rest.
o Phase 0: Rapid Depolarization. (QRS Complex)
o Phases 1 & 2: Early repolarization. (ST segment)
o Phase 2: Plateau phase.
o Phase 3: Rapid repolarization. (T wave)
Definition
Describe phase 0-4
Term
U wave
Definition
Late ventricular repolarization. Not usually seen; you’ll see some but usually its some type of arrhythmia
Term
Flat line between P wave and QRS complex
Definition
PR segment
Term
Flat line between QRS complex and T wave
Definition
ST segment
Term
Q wave
Definition
Downward wave preceding an upward wave.
 negative deflection that occurs before a positive deflection
 There can be only one
Term
R wave
Definition
Any upward wave.
 Can be more than 1
Term
QS wave
Definition
Downward wave with no upward wave at all.
Term
R-R segments
Definition
Measure rhythm regularity
Term
P wave
Definition
measure atrial rate
Term
SA node
Definition
Pacemaker of the heart
Term
Sinus node
Definition
 Heart’s normal pacemaker. Inherent rate 60–100 beats per minute.
 Normal sinus rhythm
Term
AV junction
Definition
 Backup pacemaker
 Inherent rate 40–60 beats per minute
Term
Ventricle
Definition
 A lower backup pacemaker
 Inherent rate 20–40 beats per minute
Term
Escape
Definition
 Predominant pacemaker slows, lower pacemaker takes over at slower rate
 Someone has bradycardia, 50 bpm, AV takes over
Term
usurpation
Definition
 Irritable lower pacemaker takes control and becomes new pacemaker at a faster rate
Term
Lead I: Right arm to left arm
-Left arm is positive electrode
Lead II: Right arm to left foot
-Left foot is positive electrode
Lead III: Left arm to left foot
-Left foot is positive electrode
Definition
Describe leads I, II, and III
Term
Triaxial diagram
Definition
formed by joining the lines representing Leads I, II, and III at the middle
Term
Hexiaxial diagram
Definition
 Formed by joining the lines representing leads I, II, III, AVR, AVL, and AVF at the middle
Term
o Formed by joining the lines representing leads I, II, and III at their ends
o Lead I + Lead III = Lead II.
o Lead II should have the tallest QRS complex of the bipolar leads.
o I is big, II and III are small– leads/machine messed up…
o Right arm usually negative!
Definition
Describe Einthoven's triangle
Term
 AVR: On right arm.
 AVL: On left arm.
 AVF: On left foot
Definition
3 augmented unipolar leads
Term
V1: 4th intercostals space (ICS), Right Sternal Border (RSB)
V2: 4th ICS, LSB
V3: B/T V2 & V3
V4: 5th ICS, midclavicular line (MCL)
V5: 5th ICS, anterior axillary line (AAL)
V6: 5th ICS, midaxillary line (MAL)
Definition
Where do leads for V1-V6 go?
Term
positive
Definition
Lead 1 QRS should be
Term
positive
Definition
Lead II QRS should be
Term
positive
Definition
LEAD III QRS should be
Term
negative
Definition
AVR QRS should be
Term
positive
Definition
AVL and AVF qrs should be
Term
negative
Definition
V1 QRS should be
Term
Macroshock
Definition
High-voltage shock that alows 110 volts to travel through skin.
Caused by: Inadequate grounding of electrical equipment (frayed/broken wires or cords, electrical outlet damage, or other).
Results in: Burns, neurologic damage, fatality.
Term
Microshock
Definition
Smaller shock that travels up a conduit into the heart (pacemaker, etc.)
Caused by: Frayed grounding wire or other.
Results in: Burns, neurologic damage, fatality
Term
o Leads 1 and 2 are on limbs—show a lot
o V1 is on chest—not as much
Definition
Which leads show least and most artifact
Term
count for 1 minute
Definition
Most accurate way of calculating HR
Term
If there are QRS complexes
The type of regularity
The heart rate
If there are P waves
The PR and QRS intervals
Definition
5 steps to rhythm interpretation
Term
o Narrow QRS complexes of uniform shape.
o Regularly spaced QRS complexes.
o Heart rate between 60–100.
o Upright rounded matching P waves “married to” the QRS.
o PR interval 0.12–0.20 secs (3-5 boxes), constant from beat to beat.
o QRS interval <0.12 secs. (less than 3 boxes)
Definition
Characteristics of normal QRS, PR intervals
Term
o QRS complexes absent or abnormally shaped.
o P waves absent, multiple in number, or abnormally shaped.
o Abnormally shortened or prolonged PR intervals.
o Abnormally prolonged QRS intervals.
o Heart rate abnormally slow or fast.
o Irregular rhythm or a rhythm interrupted by premature beats or pauses
Definition
Dysrhythmia characteristics
Term
Rate: 60–100.
Regularity: Regular.
P waves: Upright, matching, married to QRS.
PR: 0.12–0.20 secs, constant.
QRS: <0.12 secs.
Cause: Normal.
Adverse effects: None.
Treatment: None
Definition
Describe Sinus Rhythm
Term
Rate: <60.
Regularity: Regular.
P waves: Upright, matching, married to QRS.
PR: 0.12–0.20 secs, constant.
QRS: <0.12 secs
Cause: Vagal stimulation, MI, hypoxia, digitalis toxicity, well-trained athlete.
Adverse effects: Dizziness, pallor, weakness, syncope, diaphoresis, hypotension.
Treatment: Atropine if symptoms, oxygen, pacemaker, hold bradycardia-inducing medications
Definition
Sinus Bradycardia
Term
Rate: 101–160.
Regularity: Regular.
P waves: Upright, matching, married to QRS.
PR: 0.12–0.20 secs, constant.
QRS: <0.12 secs.
Cause: Atropine, emotions, pulmonary embolus, MI, CHF, fever, vagus nerve inhibition, thyrotoxicosis.
Adverse effects: Decreased cardiac output.
Treatment: Treat cause. Consider beta-blockers
Definition
Sinus tachycardia
Term
Rate: Varies with respiratory pattern.
Regularity: Irregular.
P waves: Upright, matching, married to QRS.
PR: 0.12–0.20 secs, constant
QRS: <0.12 secs.
Cause: Heart disease, breathing pattern.
Adverse effects: Usually none.
Treatment: Usually none required
Sinus arrhythmia is the only irregular rhythm from the sinus node and it has a pattern that is cyclic and usually corresponds w/ the breathing patternfaster w/ inspiration & slower w/ expiration
Definition
Sinus Arrhythmias
Term
Sinus Arrest
Definition
-Rate: Can occur at any rate.
-Regularity: Regular but interrupted by a pause.
-P waves: Normal before pause, may be different after.
-PR: 0.12–0.20 secs before pause, same or different after
-QRS: <0.12 secs on sinus beats; may be different if ventricular pacemaker takes over after pause.
-Cause: Sinus node ischemia, hypoxia, digitalis toxicity, medications.
-Adverse effects: Decreased cardiac output.
-Treatment: Atropine, oxygen if symptoms, hold bradycardia-inducing medications
Term
Sinus arrest
Definition
pause that occurs when the regularly firing sinus node suddenly stops firing for a brief period
Term
Sinus Block
Definition
-Rate: Can occur at any rate.
-Regularity: Regular but interrupted by a pause.
-P waves: Upright, matching, married to QRS.
-PR: 0.12–0.20 secs, constant.
-QRS: <0.12 secs.
-Cause: Meds, hypoxia, vagal stimulation.
-Adverse effects: Decreased cardiac output.
-Treatment: Atropine, oxygen if symptoms, hold bradycardia-inducing medications
Term
Sinus Block
Definition
pause that occurs when the sinus node fires its impulse on time, but the impulse’s exit from the sinus node to the atrial tissue is blocked (the beat that the sinus node propagated is not conducted anywhere)
Term
BBB
Definition
If any rhythm from the sinus node has a QRS of 0.12 or wider, there is a
Term
Atrium rhythms
Definition
Usually are rapid rhythms that usurp the sinus.
Occasionally will be slow.
Treatment aimed at returning to sinus rhythm
Term
2-3
Definition
INR for warfarin
Term
SVT
Definition
NO P WAVES!!!! and regular
Term
Wandering Atrial Pacemaker
Definition
Rate: <100 (usually 50-60’s)
Regularity: Irregular.
P waves: At least three different shapes.
PR: Varies.
QRS: <0.12 secs.
Cause: Medications, hypoxia, MI, vagal stimulation.
Adverse effects: Usually none ill effect.
Treatment: Usually none needed.
Term
WAP
Definition
These occur when the pace-making impulse has originated from at least 3 different foci in the atria that will make their own unique P wave
Term
Premature atrial complexes
Definition
 Rate: Can occur at any rate.
 Regularity: Regular but interrupted by premature beats.
 P waves: Shaped differently from sinus Ps.
 PR: 0.12–0.20 secs.
 QRS: <0.12 secs.
 Cause: Stimulants, hypoxia, heart disease.
 Adverse effects: Can lead to other dysrhythmias, can be a sign of early CHF.
 Treatment: Digitalis, quinidine, oxygen; omit stimulants.
Term
PAC
Definition
These are premature beats that are fired out early by irritable atrial tissue before the next sinus beat is due.
(Early firing d/t stimulants, caffeine, tobacco, etc.)
They may or may not be followed by a QRS
Term
Paroxysmal Atrial Tachycardia (PAT)
Definition
Is a sudden burst of 3 or more PAC’s in a row
In order to be dx the 1st PAC that started it must be seen
Rate: 160–250.
Regularity: Regular (but it interrupts a slower rhythm).
P waves: Different from sinus Ps.
PR: 0.12–0.20 secs.
QRS: <0.12 secs.
Cause: Same as PAC.
Adverse effects: Decreased cardiac output.
Treatment: Digitalis, calcium channel blockers, beta-blockers, sedation, amiodarone, adenosine, oxygen.
Term
PAT
Definition
It is simply a sudden burst of 3 or more PAC’s in a row that usurps the underlying rhythm and then becomes its own rhythm for just a period of time
Term
Atrial flutter
Definition
Rate: Atrial—250–350, ventricular—varies depending on conduction.
Regularity: Regular or irregular.
P waves: None. Flutter waves instead. 2 or more “flutters” to each QRS
PR: Not applicable.
QRS: <0.12 secs.
Cause: Pulmonary embolus, valvular heart disease, lung disease, thyrotoxicosis.
Adverse effects: Decreased cardiac output.
Treatment: Digitalis, calcium channel blockers, beta-blockers, adenosine, cardioversion.
Term
Atrial flutter
Definition
results when 1 irritable atrial focus fires out regular impulses at a rate so rapid that a flutter pattern is produced instead of P waves
Term
Atrial fibrillation
Definition
Rate: Atrial—350–700, ventricular—varies depending on conduction.
Regularity: Irregularly irregular. UNPREDICTABLE
P waves: None. Wavy baseline between QRSs instead.
PR: Not applicable.
QRS: <0.12 secs.
Cause: MI, lung disease, valvular heart disease, hyperthyroidism.
Adverse effects: Decreased cardiac output, blood clots causing stroke or pulmonary embolus
Term
If duration <48 hours:
--Digitalis, calcium channel blockers, beta-blockers, amiodarone, cardioversion.
If duration >48 hours:
--Non-emergent: Anticoagulation for 2–3 weeks, then cardioversion.
In emergencies: Heparin, transesophageal echo to rule out atrial clots, then cardioversion.
Definition
Tx and time frames for A-fib
Term
A Fib
Definition
when there are hundreds of atrial impulses from different locations all firing off AT THE SAME TIME
Term
Supraventricular tachycardia
Definition
 Rate: 130 or higher.
 Regularity: Regular.
 P waves: Not seen.
 PR: Not measurable
 QRS: <0.12 secs.
 Cause: Stimulants, hypoxia, heart disease.
 Adverse effects: Decreased cardiac output.
 Treatment: Digitalis, ibutilide, calcium channel blockers, beta-blockers, oxygen.
Term
<0.12 sec

wide QRS >0.12
Definition
You know that the impulse originated in the atria because the following QRS is ___. (Impulses that originate in the ventricle will have a ___)
Term
DIG!

... this might be a test question... ;)
Definition
drug related with junctional tachycardia
Term
Premature junctional complex
Definition
Premature beats that originate in the AV junction before the next sinus beat is due. Caused by irritable tissue in the AV junction usurping the sinus node for that beat.
-Rate: Can occur at any rate.
-Regularity: Regular but interrupted by premature beat.
-P waves: Inverted or absent.
-PR: 0.12 secs if P wave precedes QRS.
-QRS: <0.12 secs.
-Cause: Stimulants, hypoxia, heart disease, nicotine.
-Adverse effects: Usually none.
-Treatment: Treat the cause.
Term
Junctional Bradycardia
Definition
HR slower than normal. A higher pacemaker has failed & the AV junction has to escape to save the pts life
-Rate: <40.
-Regularity: Regular.
-P waves: Inverted or absent.
-PR: <0.12 secs if P wave precedes QRS.
-QRS: <0.12 secs.
-Cause: Vagal stimulation, hypoxia,
sinus node ischemia, heart disease.
-Adverse effects: Decreased cardiac output.
-Treatment: Atropine, pacemaker, oxygen.
Hold bradycardia-inducing medications.
Term
Junctional Rhythm
Definition
originates in the AV junction at its inherent rate of 40-60. It is usually an Escape rhythm.
-Rate: 40–60.
-Regularity: Regular.
-P waves: Inverted or absent.
-PR: <0.12 secs if P wave precedes QRS.
-QRS: <0.12 secs.
-Cause: Vagal stimulation, hypoxia,
sinus node ischemia, heart disease.
-Adverse effects: Potential for decreased
cardiac output at slower heart rates.
-Treatment: Atropine; consider oxygen; hold bradycardia-inducing medications
Term
Accelerated junctional rhythm
Definition
THIS IS AS FAST AS THE SINUS NODE
-Rate: 60–100.
-Regularity: Regular.
-P waves: Inverted or absent.
-PR: <0.12 secs if P wave precedes QRS.
-QRS: <0.12 secs.
-Cause: Heart disease, stimulants, caffeine.
-Adverse effects: Usually none.
-Treatment: Usually none needed
(remove the cause).
Term
Junctional Tachycardia
Definition
***know that a cause of this is DIGITALIS TOXICITY!!!
-Rate: >100.
-Regularity: Regular.
-P waves: Inverted or absent.
-PR: <0.12 secs if P wave precedes QRS.
-QRS: <0.12 secs.
-Cause: Digitalis toxicity, heart disease,
stimulants.
-Adverse effects: Decreased cardiac
output at faster heart rates.
-Treatment: Beta-blockers, calcium channel blockers, adenosine; consider oxygen
Term
Ventricular Rhythms
Definition
o Heart rate ranges from zero to >250.
o The most lethal of all rhythms.
o Most will cause symptoms of decreased cardiac output, if not frank cardiac standstill
Term
PVC
Definition
regular but interrupted by premature beat
Rate: Can occur at any rate.
Regularity: Regular but interrupted by premature beat.
P waves: Usually not seen.
PR: Not applicable.
QRS: Wide and bizarre in shape; >0.12 secs wide.
T wave: Opposite QRS.
Cause: Heart disease, hypokalemia, hypoxia, hypomagnesemia, stimulants, caffeine, stress.
Adverse effects: Can progress to lethal rhythms.
Treatment: Supplemental potassium, oxygen, amiodarone, procainamide
Term
Procainamide
Definition
causes prolongation of QT—can cause TDP
Term
PVC
Definition
Premature beats that originate in Irritable ventricular tissue before the next sinus beat is due
-Rate: Can occur at any rate.
-Regularity: Regular but interrupted by premature beat.
-P waves: Usually not seen.
-PR: Not applicable.
-QRS: Wide and bizarre in shape; >0.12 secs wide.
-T wave: Opposite QRS.
-Cause: Heart disease, hypokalemia, hypoxia,
hypomagnesemia, stimulants, caffeine, stress.
-Adverse effects: Can progress to lethal rhythms.
-Treatment: Supplemental potassium, oxygen, amiodarone, procainamide.
Term
Agonal Rhythm
Definition
A very irregular rhythm in which the severely impaired heart is only able to “cough out” an occasional beat from its only remaining pacemaker, the ventricle (will be doing CPR here)
-Rate: <20.
-Regularity: Irregular.
-P waves: None.
-PR: Not applicable.
-QRS: Wide and bizarre; >0.12 secs wide.
-T wave: Opposite QRS.
-Cause: Profound cardiac or other damage.
-Adverse effects: Profound shock, unconsciousness, death.
Treatment: Atropine, epinephrine, dopamine, pacemaker, oxygen, CPR
Term
Idioventricular rhythm (IVR)
Definition
rhythm originating in the ventricle at its inherent rate: Higher Pacemakers have failed, so the ventricle escapes to save the pt’s life
-Rate: 20–40.
-Regularity: Regular.
-P waves: None.
-PR: Not applicable.
-QRS: Wide and bizarre; >0.12 secs wide.
-T wave: Opposite QRS.
-Cause: Hypoxia, massive cardiac or other damage.
-Adverse effects: Decreased cardiac output, cardiovascular collapse.
-Treatment: Atropine, epinephrine, pacemaker, oxygen, dopamine, CPR if pulseless
Term
Accelerate idioventricular rhythm
Definition
rhythm originating in the ventricle, w/ a HR faster than the Ventricle’s normal. It can result from Escape OR Usurption (The common cause here is reperfusion after thrombolytics…meaning that the heart is once again getting blood flow after a period of no flow)
-Rate: 40–100.
-Regularity: Usually regular, but can be a bit irregular.
-P waves: Usually not seen.
-PR: Not applicable.
-QRS: Wide and bizarre; >0.12 secs
-T wave: Opposite QRS.
-Cause: MI, reperfusion after thrombolytics. -Adverse effects: Usually none as rhythm usually self-limiting.
-Treatment: Oxygen; atropine if rate slow and symptoms.
Term
Ventricular tachycardia
Definition
An irritable focus in the ventricle has usurped the sinus node to become the pacemaker & is firing very rapidly. *** may be tolerated for short bursts, but prolonged runs can cause profound shock, unconsciousness, and death ***
-Rate: >100.
-Regularity: Usually regular but can be a bit irregular.
-P waves: Usually none; dissociated if present.
-PR: Variable if Ps present.
-QRS: Wide and bizarre; >0,12 secs wide.
-T wave: Opposite QRS.
-Cause: Heart disease, hypoxia, hypokalemia, hypomagnesemia, stimulants.
-Adverse effects: Shock, unconsciousness, death.
-Treatment: Amiodarone, lidocaine, procainamide, cardioversion or defibrillation, supplemental potassium, oxygen.
Term
Torsades de pointes
Definition
form of V-Tach recognized by its classic shape of oscillations around an axis w/ the QRS complexes pointing up, then becoming smaller, then rotating around until they point down. It often deteriorates into ventricular fibrillation
-Rate: >200.
-Regularity: Regular or irregular.
-P waves: None.
-PR: Not applicable.
-QRS: Wide and bizarre; >0,12 secs wide
-T wave: Usually not seen due to rapidity of rhythm.
-Cause: Antiarrhythmic medications, hypokalemia, hypoxia, hypomagnesemia, heart disease.
-Adverse effects: Shock, unconsciusness, death.
-Treatment: Supplemental magnesium, cardioversion, oxygen
Term
V Fib
Definition
Hundreds of impulses in the ventricle are firing off, each depolarizing its own little piece of territory. As a result, the ventricles wiggle instead of contract. The heart’s electricle system is in chaos, and the resultant rhythm looks like static. (The pt. is functionally dead here)
-Rate: Cannot be counted.
-Regularity: Not applicable.
-P waves: None
-PR: Not applicable.
-QRS: None; wavy or spiked baseline.
-T wave: None.
-Cause: MI, hypoxia, hypokalemia, hyperkalemia, drowning, drug overdose, accidental electric shock.
-Adverse effects: Death if untreated.
-Treatment: Defibrillation, amiodarone, lidocaine, procainamide, oxygen, CPR, epinephrine
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