Term
| what could a pt reporting feeling "weak and dizzy" mean clinically? what would you want to do to test this pt? |
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Definition
| hypotension, dehydration, bleeding electrolyte imbalance, hypoglycemic, beginning of stroke. tests: cat scan, EKG, vital signs. if the pt is |
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Term
| what does it mean if this pt becomes diaphoretic? |
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Definition
| diaphoretic: sympathetics are kicking in, means that TPR will go up, (MAP=CO x TPR), but if MAP is still not going up and still hypotension -> give fluids, b/c CO = HR x SV and HR must be (and is) very low |
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Term
| what is it called if there is a p wave before each QRS, but the heart rate is down? |
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Definition
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Term
| what can cause the sinus bradycardia with "weak and dizzy" and diaphoresis? |
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Definition
| beta blockers (feeling lousy - loss of perfusion to the brain) |
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Term
| if a is hypotensive due to bradycardia and fluids are given to help, rather than the primary HR issue being addressed, what is a risk? |
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Definition
| pulmonary edema is possible if the kidneys aren't working properly and don't release the extra water |
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Term
| if the QRS is upright in leads I and II, but slightly down in aVF, what does this say about the axis? |
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Definition
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Term
| if a HR is at ~ 160 bpm, (~3 beats per sec), how can this immediately affect the heart tissue? |
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Definition
| there can be some local ischemic effects, though not enough to produce tissue necrosis or infarction - you may see some ST segment changes or a prolonged repolarization period |
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Term
| how much time does the heart spend in diastole? systole? |
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Definition
| diastole: 2/3, systole: 1/3 |
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Term
| if a pt has sinus tachycardia, why would they feel "fluttering" and be SOB? |
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Definition
| the heart is going too fast to have adequate time to fill, and due to a decreased SV, you will get hypoperfusion of the tissue |
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Term
| what are things to consider with an irregular heart beat? |
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Definition
| sinus arrhythmia, PVCs, PACs, atrial fib, flutter with a variable block, fluid in the pericardium changing pulse pressure? |
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Term
| if rhythm is irregular, but axis is upright, no signs of hypertrophy, no signs of ischemia, what is a likely cause? |
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Definition
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Term
| can a significant # of pts w/a recent MI still have a normal EKG? |
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Definition
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Term
| if the the PR is longer than 5 boxes and QRS is widened in V1,2,3; what is a likely problem? |
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Definition
| first degree heart block and inter-ventricular conduction delay |
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Term
| what is is when the PR interval gets longer, longer, longer, drops? |
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Definition
| wenckebach, 2nd degree heart block |
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Term
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Definition
| noise in an EKG baseline coming from hypothermic muscle shivers, also the electrodes may not be properly attached since the pt was wet |
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Term
| if a pt has fatigue and reports "kidney problems" what needs to be taken into consideration? what might their EKG appear as? |
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Definition
| electrolyte imbalance, K levels can rise in the extracellular compartment (as well as Na, Ca, BUN, and creatinine levels also being screwed up). being overloaded w/electrolytes can lead to high volume -> LVH, pulmonary edema, LAD, and RVH. the EKG whould probably show an extreme LAD w/peaked T waves (which stretch the whole QRS out) |
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Term
| how do you treat someone with hyperkalemia? |
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Definition
| give glucose which allows K to go into cells, then breathing tx, fluids and diuretics to see if they can pee it out |
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Term
| what does it mean if aVF is isoelectric and lead 1 is upright? |
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Definition
| the impulse may be pointing directly down lead 1/axis of 0, (@ 90 degree angle = get isoelectric QRS) |
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Term
| what might be seen on a pt with hyperkalemia after aggressive tx? |
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Definition
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Term
| if all of the R wave QRS complexes are huge, what is one way you can tell where the hypertrophy is? |
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Definition
| if there was a LAD, aVF would be getting smaller, if if not the case, RVH is likely (and thus pulmonary HTN) |
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Term
| what is the quick and dirty method for determining hypertrophy? |
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Definition
| if you can distinctly see each individual lead, hypertrophy is not likely |
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Term
| if an EKG is normal, but the pt is experiencing chest pain, what is a possible reason? |
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Definition
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Term
| if the R wave progression is off, what is the first thing to check? |
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Definition
| make sure the leads are on correctly |
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Term
| what is the S1, Q3, T3, pattern? |
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Definition
| an S wave in lead I and a Q wave in lead III. T wave inversion in lead III may also be present -> possible pulm embolus |
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Term
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Definition
| the J point is where the QRS meets the ST wave |
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Term
| what would be the correct tx for a pt with chest pain upon laying down and slight ST elevation? |
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Definition
| ST elevation in II, III, and aVF, as well as some precordial leads would indicate necessity to get and echo to check what is going on in the pericardium |
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Term
| if axis is hard to determine, what should you be considering? |
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Definition
|
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Term
| what does ST elevation in II, III, and aVF tell you? |
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Definition
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Term
| if a person has a barrel chest, how will this affect the ability to determine hypertrophy? |
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Definition
| the heart will be more surrounded by insulation, making it more difficult to detect cardiomegaly |
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Term
| what would a sinus dysrhythmia look like? |
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Definition
| irregular heart beat, but the PR interval doesn't progressively get longer and drop. *can be due to anxiety attack |
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Term
| what could be a factor if there are "goofy marks" before the QRS not seen before patches of tachycardia? |
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Definition
| a pacemaker set at a slower pace |
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Term
| what can ST elevation indicate? |
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Definition
|
|
Term
| what is the trigeminal pattern? |
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Definition
| 2 beats, then ectopic (PVC) beat that causes a pause |
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Term
| what should you think when you see AV irritability or ectopy? |
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Definition
| ischemia, either global or affecting repolarization |
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Term
| what is the link between peaked T waves and diabetes? |
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Definition
| the kidneys if the glomeruli are affected by hyperglycemia, can stop filtering out excess K++, which then can lead to hyperkalemia |
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Term
| if the axis is moving away from lead I, what does this say about deviation? |
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Definition
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|
Term
| ST elevation? ST depression? |
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Definition
| elevation: MI, depression: ischemia |
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Term
| what would a biphasic P wave tell you? |
|
Definition
| L or R atrial abnormality |
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|
Term
| what is indicative of a RBBB? |
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Definition
|
|
Term
| what is indicative of a LBBB? |
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Definition
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Term
| if you suspect an MI, but the EKG is normal, what are other things to check for? |
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Definition
| cardiomegaly, lung changes, pulse ox, respiratory rate, *cardiac enzymes |
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Term
| to read an EKG, you must be able to determine: |
|
Definition
| rate, rhythm, axis, hypertrophy, ischemia, infarction |
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Term
| what is the rate determination algorithm? |
|
Definition
| 300, 150, 100, 75, 60, 50 |
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Term
| what does a completely inverted aVR tell you? |
|
Definition
| that the axis is at 30 degrees (aVR is opposite) |
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|
Term
| what is the normal axis range? |
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Definition
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|
Term
| how do you determine if there is LVH? what does this probably indicate about the heart's morphology? |
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Definition
| add the amplitude of V1 and V5 (includes R and S waves), and it is considered LVH if the sum exceeds more than 35 mm. this probably means that there is also LAD |
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Term
| if a pt has V1+ V5 > 35, but there is no apparent LVH via ultrasound/echo, what might be at fault? |
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Definition
|
|
Term
| what is an indicator for RVH? what might cause it? |
|
Definition
| a positive R wave in V1, which could be caused by pulmonary constriction/pulmonary HTN |
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|
Term
| what does a stemi look like? |
|
Definition
| ST element elevations look like "a fireman's hat" |
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|
Term
| what will an inferior MI appear as? |
|
Definition
| STEMI in leads II, III and aVF |
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|
Term
| what is a possible artery occluded in an inferior MI? |
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Definition
|
|
Term
| how will an acute septal MI appear? |
|
Definition
|
|
Term
| how will an acute lateral MI appear? |
|
Definition
|
|
Term
| what might significant Qs tell you? |
|
Definition
| that the wall may be blown out |
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|
Term
| how would an anterior and lateral MI appear on the same EKG? |
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Definition
| STEMIs in lead I, aVL, V2-6 |
|
|
Term
| how would an antero-lateral MI appear? |
|
Definition
| ST segment elevation in V3, V4, I, aVL |
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|
Term
| what is one way of detecting a posterior MI? |
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Definition
| if the ST segments are depressed in the usual anterior MI positions, if you flip them it will appear as anterior MI from the posterior |
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Term
| what is the difference between atrial fibrillation and atrial flutter? |
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Definition
| atrial fibrillation is faster |
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|
Term
| how does atrial flutter appear? |
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Definition
| a saw-tooth pattern. there can be a 2:1 block, with the atria firing 2x for every 1 ventricle firing, but one of the P waves does get buried in the R wave of the ventricular depolarization |
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Term
| what is characteristic of digitalis toxicity? what would accompany it on a test? |
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Definition
| ST depression in a curve. we would be notified the pt is in heart failure and is taking a drug to slow the heart down. |
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Term
| what does an EKG look like for a pt with a dual chamber pacer? |
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Definition
| there are large spikes in place of the P and R waves |
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|
Term
| what is indicative of atrial hypertrophy? |
|
Definition
|
|
Term
| what is global ST elevation likely to be? |
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Definition
|
|
Term
| what does a premature atrial contraction look like? |
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Definition
| a PA consists of a normal rate and then a premature beat |
|
|
Term
| what does a premature ventricular contraction look like? |
|
Definition
| a huge complex, long duration (sometimes accompanied by a biphasic p wave) |
|
|
Term
| how long should the QT interval be? |
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Definition
| less than half the distance between the 2 QRSs (the longer the cardiac cycle, the greater the vulnerable period and can trigger ventricular tachycardia) |
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|
Term
| what would right atrial enlargement look like? |
|
Definition
| an enlarged p wave in the limb leads, less prominent in the precordials |
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Term
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Definition
| wolff-parkinson-white syndrome, where there is pre-excitation of the ventricles of the heart in the form of a delta wave ramping up to the R wave |
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|
Term
| what artery is associated with a lateral MI? |
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Definition
|
|
Term
| what artery is associated with an anterior MI? |
|
Definition
|
|
Term
| what artery is associated with a posterior MI? |
|
Definition
|
|
Term
| what arteries are associated with a inferior MI? |
|
Definition
| the right or left coronaries |
|
|
Term
| how do hypo vs hypercalcemia affect EKGs? |
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Definition
| hypo: prolongs things -> longer QT, hyper: pulls things together -> shorter QT |
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|
Term
| what does ventricular fibrillation look like? |
|
Definition
| nonsense squiggles - check the leads on the pt |
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|
Term
| what is torsades de pointes? |
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Definition
| a form of ventricular tachycardia where the outline looks like a party streamer |
|
|
Term
| what doesa flatline mean? what are things to check? |
|
Definition
| asystole, make sure machine is connected to pt, defibrillators is in sensing mode, etc |
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Term
|
Definition
I. Rate, rhythm – fast/slow, regular/irregular, brady/tachy
II. Axis – normal, LAD, RAD
III. Hypertrophy
IV. 1st degree block – long PR interval
V. Interventricular conduction delay – widened QRS
VI. Pacer spikes
VII. Delta waves
VIII. Atrial fibrillation – regular or irregular
IX. Flutter waves
X. Peaked T waves – hyperkalemia (e.g. in an end stage renal pt)
XI. Prolonged QT – hypocalcemia
XII. V tach, V fib
XIII. Asystole
XIV. MIs
a. Inferior II, III, aVF
b. Lateral I, aVL, V5, V6
c. Anterior V1, V2
d. Septal (V2), V3, V4 |
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