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EKG
EKG
195
Anatomy
Graduate
05/23/2012

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Term
what do the surface electrodes of EKG measure
Definition
surface electrodes record myocyte action potentials/electrical impulses that are traveling to the heart
Term
is the skin electrode positive or negative
Definition
positive
Term
is the depolarization positive or negative
Definition
negative
Term
does the depolarization move toward or away from the electrode
Definition
negative depolarization moves toward the positive electrode
Term
with the depolarization wave moving toward the electrode, will you get a positive or negative deflection from the isoelectric line on the EKG?
Definition
positive
Term
how many different leads are examined on an EKG
Definition
12
Term
what is a lead
Definition
paired positive and negative electrodes
Term
what is the vertical axis of an EKG
Definition
voltage
Term
what are the units of voltage on the vertical line of an EKG
Definition
mV
Term
what is on the horizontal axis of an EKG
Definition
time
Term
what are the units of time on the horizontal axis of an EKG
Definition
seconds
Term
what is the isoelectric line
Definition
0mV, baseline, mechanical flatline
Term
are positive charges deflected above or below isoelectric line
Definition
above
Term
on EKG graph paper, what is the distance between each small line
Definition
1mm
Term
what is the time differentiation of each small line/1mm on the horizontal axis
Definition
.04s
Term
on the vertical axis, what is the voltage differentiation of each small box/1mm
Definition
0.1mV
Term
how much voltage is in one big box on the EKG
Definition
0.5mV
Term
how much time is in one big box on the EKG
Definition
0.2s
Term
how many mm in one big box on an EKG
Definition
5mm
Term
what does the P wave represent
Definition
atrial depolarization/contraction
Term
what does the QRS represent
Definition
ventricular depolarization/contraction
Term
what does the T wave represent
Definition
ventricular repolarization
Term
what is the normal time range for a QRS complex to occur
Definition
2-3 boxes = .08-.12s
Term
what is the normal flow of depolarization in the cardiac conduction system
Definition
SA node, atria, AV node, His bundle, R&L bundle branches, purkinje fibers, ventricles
Term
what are internodal tracts
Definition
nerve tissue that travels and carries the depolarization waves from the right atrium to the left atrium
Term
what is automaticity
Definition
cardiac myocytes have the capability of firing automatically without external impulses
Term
can each area of the heart have specific, inherent, different firing rates?
Definition
yes
Term
how does firing of myocytes usually occur
Definition
by direct electrical conduction from neighboring cells
Term
what determines which electrical impulse is the pacemaker
Definition
the faster firing impulse wins and determines firing rate
Term
what is the hierarchy of automaticity
Definition
SA node, AV node, HIS-Purkinje, ventricular foci
Term
what is the intrinsic rate of the SA node
Definition
60-100
Term
what is the intrinsic rate of the AV node
Definition
40-60
Term
what is the intrinsic rate of the HIS-Purkinje fibers
Definition
30-40
Term
what is the intrinsic rate of the ventricular foci
Definition
20-40
Term
what kinds of medications could lower heart rate to 40?
Definition
beta blockers
Term
what are the clinical symptoms of having a heart rate of 40
Definition
not alert, shortness of breath, fatigue, light headedness, early fatigue, orthostatic hypotension
Term
if a patient gets lightheaded when they stand up, what should you do
Definition
have them sit down. If it happens a second time, have them stand up slowly, exhale as they stand (not hold breath), hold on for several seconds once they stand, focus eyes on something to increase balance, monitor blood pressure
Term
what are the symptoms of heart rate <40
Definition
unconscious
Term
what should you do if patient is unconscious with HR <40
Definition
start chest compressions/CPR
Term
what kind of problem would wipe out the SA node or AV node
Definition
heart attack
Term
are SA, AV, and ventricular foci susceptible to external chemical influences that alter firing rate/heart rate?
Definition
yes
Term
what is an endogenous chemical influence of heart rate
Definition
catecholamine
Term
what is the role of the autonomic nervous system on heart rate
Definition
sympathetic effects on SA node, AV node, ventricles. Parasympathetic effects on SA node, AV node
Term
what is the PR interval
Definition
the pause at the AV node for the ventricles to fill
Term
why don't we see a wave for atrial repolarization
Definition
the wave is lost/imbedded in QRS wave
Term
what part of the EKG graph is the S
Definition
the negative deflection
Term
what is the normal time range for the PR interval
Definition
3-5 blocks = .12-.2s
Term
what is the normal time frame for the QRS complex
Definition
.04-.1s
Term
what is the most labile part of the EKG
Definition
ST segment
Term
is the shape or the time of the ST segment more important
Definition
shape
Term
is the P usually positive or negative
Definition
positive
Term
how to measure PR interval
Definition
beginning of P wave to beginning of R wave
Term
what is the positive part of the QRS wave
Definition
R
Term
which hump represents ventricular repolarization
Definition
T
Term
what are the rates of each bold line in the dubin method of determining heart rate from EKG
Definition
300, 150, 100, 75, 60, 50
Term
which wave do you count in dubin method of determining heart rate
Definition
R wave
Term
what rate is bradycardia
Definition
<60
Term
what rate is tachycardia
Definition
>100
Term
what rate is atrial flutter
Definition
250-350
Term
what type of rate would ventricular flutter be
Definition
bradycardia
Term
how does atrial fibrillation affect heart rate
Definition
could be either bradycardia or tachycardia because the ventricular response is irregular
Term
what do we call a normal rhythm
Definition
sinus
Term
what are 3 abnormal rhythms
Definition
supraventricular, heart blocks,ventricular
Term
what causes a heart block rhythm
Definition
electrical impulses occur at the junction of the atria and ventricles
Term
what causes ventricular rhythm
Definition
electrical impulses originate in the ventricles
Term
what is another term for arrhythmia
Definition
dysrhythmia
Term
what are stable, controlled rhythms
Definition
dysrhythmias that the patient is taking medication for. Known by physician and documented
Term
what are lethal dysrhythmias
Definition
those that have to be managed immediately and require immediate defibrillation
Term
what is a supraventricular dysrhythmia
Definition
anything originating above the ventricles
Term
what is a sinus dysrhythmia
Definition
impulse is still coming from the SA node, but it doesn't fall within the normal heart rate of 60-100
Term
what do we call it when a person is an athlete and has a heart rate of 55
Definition
sinus dysrhythmia, sinus bradycardia
Term
what do we call it when a person is exercising and their heart rate gets to 150
Definition
sinus tachycardia
Term
what is happening in atrial fibrillation/flutter
Definition
another pacemaker in the atria besides the SA node has taken over the rhythm of the heart
Term
what does PAC stand for
Definition
premature atrial contraction
Term
what normal thing can cause PACs
Definition
caffeine
Term
what happens in a PAC
Definition
an odd pacemaker in the atria jumped the gun and paced the heart for that beat/sequence.
Term
what is a junctional dysrhythmia
Definition
impulse comes from lower down in the atria near the division between the atria and the ventricles
Term
what is the atrial rate with atrial flutter
Definition
250-350
Term
what do P waves look like in atrial flutter
Definition
saw tooth
Term
what is the ratio of P:QRS in atrial flutter
Definition
1:1, 2:1, 3:1, 4:1
Term
what does atrial flutter rapidly change to
Definition
atrial fibrillation
Term
what is the atrial rate with atrial fibrillation
Definition
350-450
Term
what do the P waves look like in atrial fibrillation
Definition
indistinguishable, jagged baseline
Term
what does the QRS rte look like in atrial fibrillation
Definition
irregular
Term
what is the heart rate in controlled A fib
Definition
<100
Term
what is the heart rate in uncontrolled A fib
Definition
>100
Term
what are some treatments for Afib
Definition
electrical cardioversion
Term
what determins whether a patient is treated for Afib
Definition
full clinical picture/symptoms: blood pressure, decreased cardiac output
Term
what is the danger of chronic Afib
Definition
clot/emboli risk
Term
do you have irregular QRS with atrial fibrillation
Definition
yes, you can
Term
do you have irregular QRS with atrial flutter
Definition
no
Term
what causes AV heart blocks
Definition
faulty conduction through AV node
Term
what is the range of AV heart blocks
Definition
partial to complete
Term
what to look for in AV heart block
Definition
conduction rate of P:QRS to see if each P wave causes a QRS
Term
what are the 3 types of heart blocks
Definition
1st degree, 2nd degree, 3rd degree
Term
what is the ratio of P:QRS in 1st degree heart block
Definition
1 to 1
Term
describe the PR interval of a 1st degree AV block
Definition
fixed interval greater than 0.2s
Term
describe the rate of 1st degree heart block
Definition
regular
Term
do you need treatment for 1st degree heart block
Definition
no
Term
what is significant in the EKG for 1st degree AV block
Definition
long time between P and R because of extensive delay at the AV node
Term
what does elevated ST segment indicated
Definition
early MI
Term
what does depressed ST segment indicated
Definition
ischemia
Term
what are the 2 types of 2nd degree AV heart block
Definition
type I wenckebach, type II
Term
what happens in type I wenckebach 2nd degree AV block
Definition
PR interval gets progressively longer until a QRS is dropped, then the cycle repeats. It's irregularly regular.
Term
does type I 2nd degree av block require medication
Definition
no. it's stable
Term
what is the P:QRS ratio in type II 2nd degree AV block
Definition
2:1, 3:1, 4:1. not 1:1
Term
why are there more P waves than QRS waves in type II 2nd degree AV block
Definition
the P waves are not getting conducted through the AV node every time.
Term
if the P wave isn't getting through the AV node every time, how is heart rate affected
Definition
slows
Term
what is the treamtne for type 2 2nd degree AV block with P: QRS ratio of 3:1?
Definition
pacemaker because the heart rate will be too slow for sufficient cardiac output
Term
what happens in 3rd degree av block
Definition
complete dissociation of P and QRS. NONE of the atrial depolarizations penetrate to the ventricles
Term
how are ventricular rates affected in 3rd degree AV block
Definition
may be as low as 20's, 30's.
Term
what is the outlook of 3rd degree AV block
Definition
medical emergency. Insufficient cardiac output due to bradycardia.
Term
what are treatments of 3rd degree AV block
Definition
pacemaker
Term
what is causing the ventricles to contract in 3rd degree AV block
Definition
purkinje fibers
Term
what does EKG of 3rd degree AV block look like
Definition
no relationship between P and QRS. Random. Slow heart rate
Term
what is a bundle branch block
Definition
an MI wipes off the nerve tissue of a bundle branch, resulting in a notched R wave. The R wave will also be long.
Term
what is the characteristic of ventricular dysrhythmias
Definition
no p waves discernable, QRS >0.12s, PVC, compensatory pause usally follows
Term
what does ventricular dysrhythmia require for treatment
Definition
defibrillation
Term
why is there usually a pause after a PVC
Definition
compensatory pause in the heart because the heart notices that an odd depolarization occurred so it pauses to reset itself
Term
can PVC's occur randomly and be normal
Definition
yes, from caffeine
Term
are frequent PVC's a problem
Definition
yes
Term
what is bigemeny
Definition
every other QRS = PVC
Term
what is trigemeny
Definition
every third QRS = PVC
Term
what is a couplet
Definition
2 PVCs in a row
Term
what is a triplet
Definition
3 PVCs in a row
Term
what is ventricular tachycardia
Definition
series of PVCs happening continuously one after the next
Term
what is the worst type of ventricular dysrhythmia
Definition
ventricular fibrillation
Term
describe p waves in ventricular tachycardia
Definition
no discernable p waves
Term
what determines if you have VT
Definition
3 or more PVCs in a row
Term
how is QRS changed in VT
Definition
it's long. >0.12s
Term
what is the rate of VT
Definition
fast, tachycardia. 100-250
Term
what are treatments for VT
Definition
meds, cardioversion, implantable defibrillator
Term
how to tell whether to do pulse in patient with VT
Definition
do CPR if pulse is weak, thready
Term
what do T waves look like in ischemia
Definition
inverted
Term
describe p waves in ventricular fibrillation
Definition
no p waves
Term
what is happening to ventricles in Vfib
Definition
erratic quivering. No squeeze. No cardiac output
Term
what does the EKG look like in ventricular fibrillation
Definition
erratic. Sine wave to jagged scribble
Term
treatment of Vfib
Definition
CPR, defibrillation
Term
what is flat line caled
Definition
asystole
Term
how does ischemia affect EKG
Definition
depressed ST, inverted T wave
Term
how does amount of ST depression relate to amount of ischemia
Definition
proportional
Term
how to tell acute MI from EKG
Definition
elevated ST, possibly significant Q wave
Term
if there is a significant Q wave with elevated ST, what does that mean
Definition
acute MI, transmural
Term
if there is not a significant Q wave with elevated ST, what does that mean
Definition
MI, subendocardial
Term
what does it mean for Q wave to be significant
Definition
wide. >1mm. Or amplitude >1/3 QRS
Term
how long will Q wave remain significant
Definition
lifetime
Term
besides EKG, how else can you tell if someone is having an early MI
Definition
enzymes
Term
what is the Q wave normally
Definition
isoelectric
Term
what is the q wave following MI
Definition
negative
Term
what causes the weird Q waves
Definition
damaged heart muscle scars over. Electrical impulse must go around this area.
Term
which lead do we usually look at
Definition
lead 2 or V5
Term
which plane are limb leads in
Definition
frontal
Term
what are the 6 limb leads
Definition
I, II, III, aVR, aVL, aVF
Term
which plane are precordial leads in
Definition
transverse
Term
what are the 6 transverse leads
Definition
V1, V2, V3, V4, V5, V6
Term
what is Einthoven's triangle
Definition
electrodes on R wrist, L wrist, L foot
Term
what is the direction of viewing of lead 1
Definition
lead 1 will look at the heart from R wrist to L wrist
Term
what is the direction of viewing of lead 2
Definition
lead 2 looks at the heart from R wrist to L foot
Term
what is the viewing direction of lead 3
Definition
lead 3 looks at the impulse flowing from the heart from the angle of L wrist to L foot
Term
what is the view of aVR
Definition
R wrist to heart
Term
what is the view of aVL
Definition
L wrist to heart
Term
what ist he view of aVF
Definition
L foot to heart
Term
what are the inferior leads
Definition
2, 3, aVF
Term
what are the lateral leads
Definition
1, aVL
Term
what are the anterior leads
Definition
V3, V4
Term
what are the septal leads
Definition
V1, V2
Term
what are the posterior leads
Definition
reciprocal changes in V1, V2
Term
what EKG represents acuteinferior MI
Definition
ST elevation in II, III, aVF, may also be significant Q wave in these leads
Term
what EKG represents acute lateral MI
Definition
ST elevation in I, aVL, may also be significant Q wave in these leads
Term
what EKG reflects acute anterior MI
Definition
St elevation in V3, V4, may also be significant Q wave in these leads
Term
what EKG representsacute septal MI
Definition
ST elevation in V1, V2, may also be significant Q in these leads
Term
what EKG represents acute posterior MI
Definition
ST depression in V1, V2, may have significant R wave in same leads
Term
what would an anteiror infarct affect
Definition
bundle branches
Term
how can you detect ventricular hypertrophy with EKG
Definition
R wave will get more positive V1-V6. increased voltage means there is more muscle tissue that the voltage has to get through.
Term
what problems might cause the R atria to phyertrophy
Definition
icnreased preload, valve complications of the tricuspid valve.
Term
how would you see R atrial enlargement in EKG
Definition
abnormally tall p wave in lead II
Term
how would you see L atrial enlargement in EKG
Definition
abnormally wide p wave in any lead or diphasic p wave in lead V1
Term
how would you see R ventricular hypertrophy on EKG
Definition
large R in V1
Term
how would you see L ventricular hypterophy in EKG
Definition
poor R wave progression V1-V6
Term
what causes R ventricular hypertrophy
Definition
pathology to pulmonary valve, lungpathology
Term
what is the mean QRS vector
Definition
if you add up all the small vectors of ventricular depolarization, you get mean QRS vector
Term
does the mean QRS vector go to left or right
Definition
left
Term
how does heart sit in tall, think patient
Definition
more vertically
Term
how to categorize heart tilt
Definition
left axis deviation = tilted up and left, right axis deviation = tilted to the right. Can be extreme if tilted really far to the right
Term
how does infarction affect axis
Definition
axis moves away from infarction
Term
what is cor pulmonale
Definition
a condition that happens with lung disease
Term
what are normal EKG changes with exercise
Definition
increased HR
Term
what happens with exercise induced ischemia on EKG
Definition
ST segment depression
Term
what are electrophysiology studies
Definition
EKG as a diagnostic tool to localize conduction abnormalities
Term
what are possible treatments that may be recommended following EP studies
Definition
pacemaker, implantable cardiac defibrillator, catheter ablation
Term
how is wolf parkinsin white syndrome diagnosed
Definition
electrophysiology studies
Term
what is wolf parkinson white syndrome
Definition
there's a little piece of muscle that bypasses the AV node, carrying down the signal from the atria to the ventricles without pausing first to give the ventricles time to fill and decreasing the stroke volume.
Term
how is wolf parkinsin white syndrome treated
Definition
implant a defibrillator that shocks the heart into a normal rhythm when it senses that the heart is going into vfib
Term
how can you see in EKG that a person has a pacemaker
Definition
regular spike/line in the EKG
Term
review the ekg's in the ppt
Definition
ok
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