Term
| Which lead(s) are used to determine left or right bundle branch block? |
|
Definition
| I, V1, and V6 (V1 is the most useful as it views the septum) |
|
|
Term
| What are two methods of determining heart rate from an EKG strip? |
|
Definition
-300 or big box method
-R waves in 6 second strip x 10 |
|
|
Term
| A vertical line on an EKG indicating a pacemaker has discharged is a... |
|
Definition
|
|
Term
| Which is more rare, wide complex tachycardia of supraventricular origin, or ventricular tachycardia? |
|
Definition
| Wide complex tachycardia of supraventricular origin |
|
|
Term
| What is the nature of the P-P and R-R intervals in 2nd Degree Type I AV Block? |
|
Definition
| P-P intervals remain regular, R-R intervals are irregular |
|
|
Term
| What is the period during the cardiac action potential where cells are in a stable, depolarized state? |
|
Definition
| Absolute Refractory Period (upslope of the T wave) |
|
|
Term
| What is the amiodarone dose for stable, wide-complex VT? |
|
Definition
|
|
Term
| What are the EKG characteristics of ventricular tachycardia? |
|
Definition
Rate > 100 BPM
QRS > 0.12 sec
Regular
No P waves |
|
|
Term
| What is the dose/route for Epi in symptomatic bradycardia? |
|
Definition
| 2-10 mcg/min IV infusion (1:10,000) |
|
|
Term
| What is the relationship of P waves to QRS complexes in 2nd Degree 2:1 AV Block? |
|
Definition
| 2 P-waves to 1 QRS complex |
|
|
Term
| Does the AV junction typically produce rhythms with a wide or a narrow QRS complex? |
|
Definition
|
|
Term
| What are the EKG characteristics of 1st Degree AV Block? |
|
Definition
Regular
PR interval > 0.20 sec
Normal QRS
Varying rates
Normal P waves (upright) |
|
|
Term
| What electrical events produce fusion beats? |
|
Definition
| Simultaneous depolarization of the atria and ventricles |
|
|
Term
| What are the EKG characteristics of 2nd Degree Type II AV Block? |
|
Definition
Consistent PR Intervals
Varying rates
Irregular
More P waves than QRS Complexes
Dropped beats |
|
|
Term
| What are the characteristics of an abnormal Q wave? |
|
Definition
Depth-deeper than 1/3 ht of R wave
Width-wider than 1 small box |
|
|
Term
| The anterior descending and circumflex are branches of which coronary artery? |
|
Definition
|
|
Term
| Where in the cardiac conduction system does a complete heart block occur? |
|
Definition
|
|
Term
| The ability of a pacing stimulus to successfully depolarize the myocardium is known as... |
|
Definition
|
|
Term
| What does that EKG from the beginning of the QRS complex to the end of the T wave represent? What is it known as? |
|
Definition
| Represents ventricular depolarization/repolarization, and is known as the QT interval |
|
|
Term
| Where does a first degree block typically occur? |
|
Definition
|
|
Term
| How does failure to capture appear on an EKG? |
|
Definition
| Pacing spike followed by no electrical activity |
|
|
Term
| What is the polarity of the electrodes placed on the chest for the V leads? |
|
Definition
|
|
Term
| Which AV Block is frequently characterized by wildly variable PR intervals? Why? |
|
Definition
| 3d Degree due to complete dissociation |
|
|
Term
| Can atrial fibrillation result in reduced CO? Why? |
|
Definition
| Yes, decreased ventricular filling (preload) |
|
|
Term
| What are the EKG characteristics of an idioventricular or "ventricular escape" rhythm? |
|
Definition
20-50 BPM
Wide complex QRS
Regular
No P waves |
|
|
Term
| Which leads view the heart in a horizontal plane? |
|
Definition
|
|
Term
| What are some potential causes of sinus bradycardia? |
|
Definition
Vagal nerve stimulation
Athlete
Electrolyte imbalance
Digi-tox
MI |
|
|
Term
| What are the ways to distinguish VT from a wide-complex SVT? |
|
Definition
| Waves in an extreme right axis correlate to VT |
|
|
Term
| How will P wave morphology manifest in a junctional rhythm? Where can they be seen? |
|
Definition
| Inverted, and before, in, or after QRS |
|
|
Term
| Where are the positive and negative electrodes placed in leads I, II, and III? |
|
Definition
I- + LA, - RA
II- + LL, - RA
III- + LL, - LA |
|
|
Term
| How do P waves appear in 2nd and 3rd Degree AV block? |
|
Definition
|
|
Term
| What is the relationship of atrial rate to ventricular rate in 2nd Degree Type I AV Block? |
|
Definition
|
|
Term
| Are the atrial and ventricular rhythms (regularity) identical in 2nd Degree Type II AV Block? |
|
Definition
Atrial-regular
Ventricular-Irregular |
|
|
Term
| Is any form of electrical intervention indicated for PEA? |
|
Definition
|
|
Term
| What is the significance of an absent or very small Q wave? |
|
Definition
|
|
Term
| What region of the heart is viewed by lead V3? |
|
Definition
|
|
Term
| What is the most critical intervention in cardiac arrest? |
|
Definition
| Minimally interrupted CPR |
|
|
Term
| What is the most significant EKG characteristic of 1st Degree AV Block? |
|
Definition
| Prolonged PR Interval (> 0.20 sec) |
|
|
Term
| How would you characterize vasopressin, in terms of class? |
|
Definition
|
|
Term
| How would you characterize atropine, in terms of class? |
|
Definition
| Anti-cholinergic (Parasympatholytic) |
|
|
Term
| Wenckebach is another term for which rhythm? |
|
Definition
| 2nd Degree Type I AV Block |
|
|
Term
What is the rate range of:
Junctional
Ventricular
Accelerated Junctional
Accelerated Ventricular |
|
Definition
Junctional 40-60 BPM
Ventricular 20-50 BPM
Acclerated Junctional 60-100 BPM
Accelerated Ventricular 50-100 BPM |
|
|
Term
| Which leads are known as the "chest" leads? |
|
Definition
|
|
Term
| The lateral aspect of the left ventricle is viewed by which leads? |
|
Definition
|
|
Term
| The inferior aspect of the heart is viewed by which leads? |
|
Definition
|
|
Term
| What causes a junctional escape rhythm to occur? |
|
Definition
| Failure of the SA node to fire |
|
|
Term
| What is an example of an incomplete AV Block? |
|
Definition
| 1st Degree and 2nd Degree |
|
|
Term
| What is an example of a complete AV Block? |
|
Definition
|
|
Term
| Which AV block may progress to a complete heart block w/o warning? |
|
Definition
|
|
Term
| What EKG characteristic differentiates 2nd Degree Type I from Type II? |
|
Definition
| Varying PR intervals in Type I (PR intervals stay the same in Type II) |
|
|
Term
| What significant function of the heart does the EKG provide no information about? |
|
Definition
|
|
Term
| False abnormalities of the baseline present on an EKG strip that are due to sources other than the patient's bioelectrical impulses (ex. patient movement). |
|
Definition
|
|
Term
| This is a complex that arrives ahead of schedule. |
|
Definition
|
|
Term
| Premature complexes can arise from... |
|
Definition
| Sinus node, atrial tissue, AV node, ventricles |
|
|
Term
| This is a recurrent premature complex that arrives every second beat. |
|
Definition
| Bigeminy (every third beat-trigeminy, every fourth beat-quadgeminy, etc.) |
|
|
Term
| These are complexes that occur later than expected on a rhythm's cadence. |
|
Definition
|
|
Term
| What causes escape complexes? |
|
Definition
| The primary pacemaker failing for a prolonged period of time. |
|
|
Term
| The morphology created when an electrical impulse hits an area of obstruction and must travel through nonestablished pathways in order to depolarize the heart. |
|
Definition
|
|
Term
| This morphology will present with an ectopic P wave (differing from a sinus P wave). |
|
Definition
|
|
Term
| This type of morphology will present with wide waves from delayed conduction of impulses |
|
Definition
| Ventricular morphology (left and right ventricle foci) |
|
|
Term
| This morphology occurs when the AV node acts as the heart's pacemaker. |
|
Definition
|
|
Term
| With this morphology, the PR interval will be shorter than expected (or buried in the QRS complex) and P wave morphology will always be inverted in leads II, III, and aVF. |
|
Definition
|
|
Term
| Why is the P wave always inverted in leads II, III, and aVF in junctional foci? |
|
Definition
| The direction of the vector of the retrograde atrial conduction stemming from the junctional complex (the vector is moving away from the leads). |
|
|
Term
| This is the merging together or melding of two or more waves and vectors occurring at the same, or nearly the same, time. |
|
Definition
|
|
Term
| What are the two types of fusion beats? |
|
Definition
| Isolated and Actual Fusion |
|
|
Term
| This type of fusion involves wave from two different complexes. |
|
Definition
|
|
Term
| In isolated fusion, are the forces of one vector affecting the actual shape of the other vector. |
|
Definition
| No, they just appear combined on the EKG. |
|
|
Term
| This is the fusion of two entire complexes occurring simultaneously. |
|
Definition
|
|
Term
| This type of fusion actually occurs in the heart, and is not just represented on the EKG. |
|
Definition
|
|
Term
| Leads V3 and V4 represent what region of the heart? |
|
Definition
|
|
Term
| Leads II, III, and aVF represent what region of the heart? |
|
Definition
|
|
Term
| Leads I, aVL, V5 and V6 represent what region of the heart? |
|
Definition
|
|
Term
| Leads V1 and V2 represent what region of the heart? |
|
Definition
|
|
Term
| How do we determine the electrical axis of the hexaxial system? |
|
Definition
| By determining the positivity or negativity of I and aVF. |
|
|
Term
| How many regions is the hexaxial system divided into to determine electrical axis? |
|
Definition
| Four (Normal, Left, Extreme Right, Right) |
|
|
Term
| If both I and aVF show negative impulses, what quadrant does this represent? |
|
Definition
|
|
Term
| If I is positive, and aVF is negative, what quadrant does this represent? |
|
Definition
|
|
Term
| If I is negative and aVF is positive, what quadrant does this represent? |
|
Definition
|
|
Term
| If I and aVF are both positive, what quadrant does this represent? |
|
Definition
|
|
Term
| Any axis that falls outside the normal quadrant should be considered... |
|
Definition
|
|
Term
| This describes any axis falling in the left quadrant, or between -30 and -90 degrees. |
|
Definition
|
|
Term
| This describes any axis falling in either right quadrant. |
|
Definition
|
|
Term
| Which fascicle innervates the superior and anterior aspects of the left ventricle? |
|
Definition
|
|
Term
| Which fascicle innervates the inferior and posterior aspects of the left ventricle? |
|
Definition
|
|
Term
| This innervates part of the septum and the right ventricle. |
|
Definition
|
|
Term
| Signs of Right Bundle Branch Block (RBBB). |
|
Definition
| Complexes greater than or equal to 0.12 sec, slurred S wave in I and V6, and positive complexes in V1. |
|
|
Term
| Signs of Left Bundle Branch Block |
|
Definition
| Duration greater than or equal to 0.12 sec; broad, monomorphic R waves in I and V6, with no Q waves; broad, monomorphic S waves in V1, may have a small R wave. |
|
|
Term
| Applying to waves, what does monomorphic mean? |
|
Definition
| Complexes are all positive, or all negative. |
|
|
Term
| What is a discordant T wave? |
|
Definition
| The last part of the QRS complex and the T wave electrically oppose each other. |
|
|
Term
| When approaching arrhythmias, what do you generally consider? |
|
Definition
| Fast or slow rhythm, regular or irregular rhythm (regularly irregular, irregularly irregular) |
|
|
Term
| An irregularly irregular rhythm has... |
|
Definition
| No pattern at all. A regular irregular pattern has some form of regularity to the pattern or irregular complex. |
|
|
Term
| What are the major P wave things to consider when interpreting arrhythmias? |
|
Definition
Are there any?
Are they all the same?
Does each QRS complex have one?
Is the PR interval constant? |
|
|
Term
| What are the major QRS complex things to consider when interpreting arrhythmias? |
|
Definition
Are the P waves and QRS complexes associated?
Are the QRS complexes narrow or wide?
Are the QRS complexes grouped or not grouped?
Are there any dropped beats? |
|
|
Term
| This arrhythmia is marked by a regularly irregular rhythm, a x:x-1 variable P:QRS wave, a variable PR interval, variable grouping and dropped beats. |
|
Definition
| Morbitz I Second-Degree Heart Block |
|
|
Term
| This arrhythmia is also known as Wenckebach. |
|
Definition
| Second-Degree Heart Block (Morbitz I) |
|
|
Term
| This arrhythmia is caused by a diseased AV node with a long refractory period, resulting in PR interval lengthening between successive beats until a beat drops. |
|
Definition
| Morbitz 1 Second-Degree Heart Block |
|
|
Term
| What happens to the R-R interval with each beat during Morbitz I Second-Degree Heart Block? |
|
Definition
|
|
Term
| What's the difference between Morbitz I and Morbitz II Second-Degree Heart Block? |
|
Definition
| Morbitz II has grouped beats with one beat dropped between each group, and a normal P wave and PR interval. |
|
|
Term
|
Definition
| A diseased AV node, it is a harbinger of bad things to come (i.e. complete heart block). |
|
|
Term
| This arrhythmia has separate rates for the underlying and escape rhythm; is regular, but with P and QRS rate differences; a variable P:QRS ratio; a variable, no pattern PR interval; and normal to wide QRS width. |
|
Definition
|
|
Term
| This arrhythmia is characterized by no P wave (chaotic atrial activity), variable rate, and is irregularly irregular. |
|
Definition
|
|
Term
| This arrhythmia results from the chaotic firing of numerous atrial pacemaker cells in a totally haphazard fashion. |
|
Definition
|
|
Term
| What is the electrical axis of the heart? |
|
Definition
| The sum of all the ventricular vectors. |
|
|
Term
| This is a system of analyzing vectors that cuts the center of the heart along a coronal plane. |
|
Definition
|
|
Term
| The hexaxial system consists of what leads? |
|
Definition
| The six limb leads: I, II, III, aVR, aVL and aVF |
|
|
Term
| When an electrical impulse moves away form an electrode, it makes a(n) _________ wave. |
|
Definition
|
|
Term
| When an electrical impulse moves towards an electrode, it makes a(n) __________ wave. |
|
Definition
|
|
Term
| What this wave represents is unknown, but its presence could signal hypokalemia? |
|
Definition
|
|
Term
| What is Intrinsicoid Deflection? |
|
Definition
| Represents the amt of time it takes the electrical impulse to travel from the purkinje system in the endocardium, to the surface of the epicardium immediately under an electrode. |
|
|
Term
| Where is the intrinsicoid deflection measured? |
|
Definition
| From the beginning of the QRS complex to the beginning of the negative downslope of the R wave (in leads that begin with an R wave and don't have a Q wave). |
|
|
Term
| In the right precordial leads, intrinsicoid deflection should measure... |
|
Definition
| Less than or equal to 0.035 sec |
|
|
Term
| In the left precordial leads, intrinsicoid deflection should measure... |
|
Definition
| Less than or equal to 0.045 sec |
|
|
Term
| This wave represents atrial contraction. |
|
Definition
|
|
Term
| The normal measurement of a P wave. |
|
Definition
|
|
Term
| What would cause the P wave to appear as a downward wave? |
|
Definition
| If the impulse didn't originate from the SA, but other cells. |
|
|
Term
| This wave represents atrial repolarization. |
|
Definition
|
|
Term
| The TP wave is often confused with... |
|
Definition
| PR depression or ST depression in tachycardia. |
|
|
Term
| This wave is normally buried in the QRS Complex. |
|
Definition
|
|
Term
| This segment extends from the end of the P wave to the beginning of the QRS complex. |
|
Definition
|
|
Term
| Normal measurement of the PR Segment. |
|
Definition
| May be depressed by less than or equal to 0.8mm in normal circumstances. |
|
|
Term
| This represents impulse travel from the atria to the ventricles, and travel through the AV node (where the impulse slows to prevent simultaneous contraction of the atria/ventricles). |
|
Definition
|
|
Term
| How long is the normal PR interval? |
|
Definition
|
|
Term
| This represents ventricular contraction. |
|
Definition
|
|
Term
| Normal measurement of the QRS Complex. |
|
Definition
|
|
Term
| With regards to the QRS Complex, this is a sign of a pathological condition (previous infar/scar tissue). |
|
Definition
| Q wave greater than 1/3 the ht of the R wave. |
|
|
Term
| Additional waves in the QRS Complex are known as... |
|
Definition
| Prime waves (ex. two R waves, RR, R and R prime waves) |
|
|
Term
| Additional waves in the QRS Complex are important indications of... |
|
Definition
|
|
Term
| This segment extends from the QRS complex to the beginning of the T wave. |
|
Definition
|
|
Term
| The ST segment should be at baseline, if not, it could mean... |
|
Definition
Elevation=STEMI
Depression=Ischemia |
|
|
Term
| This wave represents ventricular repolarization. |
|
Definition
|
|
Term
| The T wave should have a(n) (asymmetrical/symmetrical) appearance. |
|
Definition
| Should be asymmetrical, with slow upstroke and fast downstroke. |
|
|
Term
| This interval lays between the beginning of the QRS complex to the end of the T wave. |
|
Definition
|
|
Term
| Normal rate of QT Interval. |
|
Definition
|
|
Term
| Normal measurement of QT interval. |
|
Definition
| Should not be more than 1/2 RR interval. |
|
|
Term
| A QT interval measurement greater than 1/2 the R to R interval measurement may signify... |
|
Definition
| Hypercalcemia, some meds may cause this reading as well |
|
|
Term
| Why is an extended QT interval dangerous. |
|
Definition
| Risks starting right on top of the T, which can result in deadly rhythms. |
|
|
Term
| This wave represents electrical depolarization of both atria. |
|
Definition
|
|
Term
| This wave represents atrial repolarization. |
|
Definition
|
|
Term
| This interval covers all the events from SA node firing up to ventricular depolarization. |
|
Definition
|
|
Term
| This represents ventricular depolarization. |
|
Definition
|
|
Term
| This segment represents an electrically neutral time for the heart, a time when ventricles are maintaining contraction to push blood out of the heart. |
|
Definition
|
|
Term
| This wave represents ventricular repolarization. |
|
Definition
|
|
Term
| This interval represents all of the events of ventricular systole. |
|
Definition
|
|
Term
| False abnormalilities of the baseline present on an EKG strip that are due to sources other than the patient's bioelectrical impulses (ex. patient movement). |
|
Definition
|
|
Term
| This coronary artery bifurcates into the anterior descending artery (aka interventricular artery) and the circumflex artery. |
|
Definition
|
|
Term
| This coronary artery bifurcates into the acute marginal artery and the posterior descending artery. |
|
Definition
|
|
Term
| The mitral valve is located between the... |
|
Definition
| Left atrium and ventricle |
|
|
Term
| The main function of the cardiac conduction system. |
|
Definition
| To create an electrical impulse and transmit it in an organized manner to the rest of the myocardium. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| The Bundle of His fires at... |
|
Definition
|
|
Term
| The Bundle Branches fire at... |
|
Definition
|
|
Term
| Purkinje Cells fire at... |
|
Definition
|
|
Term
| Myocardial Cells fire at... |
|
Definition
|
|
Term
| The AV Bundle consists of the... |
|
Definition
| AV Node and Bundle of His |
|
|
Term
| These conduct electrical impulses from the SA Node to the AV Node. |
|
Definition
| Internodal Pathways (anterior, middle, and posterior) |
|
|
Term
| This prevents communication between the atria and ventricles, except via the AV Node. |
|
Definition
|
|
Term
| The process that occurs when the AV Node slows the electrical impulse to prevent simultaneous atrium/ventricle contraction is called... |
|
Definition
|
|
Term
| This Bundle Branch bifurcates into fascicles. |
|
Definition
|
|
Term
| These cells lie just beneath the endocardium and innervate myocardial cells initiating ventricular depolarization. |
|
Definition
|
|
Term
| The body's critical electrolytes. |
|
Definition
| Na+ (sodium), K+ (potassium), Ca++ (calcium), and Cl- (chloride) |
|
|
Term
| This maintains the RMP by moving ions against their concentration gradient. |
|
Definition
|
|
Term
| How much energy does the Na+/K+ pump utilize? |
|
Definition
|
|
Term
| This is the rapid depolarization phase of a myocyte AP. Rapid Na+ channels open, and Na+ rushes in. |
|
Definition
|
|
Term
| During this phase of a myocyte AP, Cl- enters the cell causing Na+ fast channels to slow, and Na+ slow channels and Ca++ channels to open. Contraction occurs. |
|
Definition
| Phase 1 (partial repolarization) |
|
|
Term
| During this phase of a myocyte AP, the depolarized state of a cell is prolonged (hence, so is contraction). |
|
Definition
|
|
Term
| During phase 3, the repolarization phase of mycocyte APs, these channels open and these ions exit the cell, causing rapid repolarization. |
|
Definition
|
|
Term
| The resting membrane potential of a cell is maintained during what phase? |
|
Definition
|
|
Term
| Do all myocytes reach threshold at the same time? |
|
Definition
| No, different myocytes fire at different thresholds (this is why the SA node fires quickest). |
|
|
Term
| The heart is primarily affected by what division of the PNS? |
|
Definition
| The Autonomic Nervous System |
|
|
Term
| The two divisions of the ANS. |
|
Definition
| Sympathetic and Parasympathetic |
|
|
Term
| This is the "fight or flight" division of the ANS. |
|
Definition
|
|
Term
| This is the "rest and digest" division of the ANS. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Relating to contractility |
|
|
Term
|
Definition
|
|
Term
| The ____________ NS increases the rate, contractility, and conduction of the heart. |
|
Definition
|
|
Term
| The ___________ NS decreases the rate, contractility, and conduction of the heart. |
|
Definition
|
|
Term
| Main chemical messenger of the Parasympathetic NS. |
|
Definition
|
|
Term
| Main chemical messenger of the Sympathetic NS. |
|
Definition
| Epinephrine/Norepinephrine |
|
|
Term
| What are the primary receptors of the Sympathetic Nervous System? |
|
Definition
| Alpha, Beta 1, and Beta 2 |
|
|
Term
|
Definition
|
|
Term
| Beta 1 receptors cause... |
|
Definition
| Increased heart rate, contractility, and conduction |
|
|
Term
| Beta 2 receptors cause... |
|
Definition
|
|
Term
| T or F, visually the right ventricle dominates the anterior view of the heart. |
|
Definition
|
|
Term
| T or F, the right ventricle pumps blood through the peripheral circulation. |
|
Definition
|
|
Term
| Intrinsic rate of SA node |
|
Definition
|
|
Term
| Intrinsic rate of atrial cells |
|
Definition
|
|
Term
| Intrinsic rate of the AV node |
|
Definition
|
|
Term
| Intrinsic rate of the His Bundle |
|
Definition
|
|
Term
| Intrinsic rate of Purkinje cells |
|
Definition
|
|
Term
| Intrinsic rate of myocardial cells |
|
Definition
|
|
Term
| The AV node is always supplied by the... |
|
Definition
|
|
Term
| The electrical potential of resting myocytes is... |
|
Definition
|
|
Term
| T or F, the sodium-potassium ATPase pumps use ATP to push two sodium ions out and bring one potassium ion into the cell. This creates a net negative charge inside the cell. |
|
Definition
|
|
Term
| T or F, the cell fires when the action potential is reached. The cell is polarized during this process. |
|
Definition
|
|
Term
| T or F, the electrochemical activity of polarization-depolarization is measurable by the EKG. |
|
Definition
|
|
Term
| T or F, a vector is a diagrammatic way to show the strength and direction of an electrical impulse. |
|
Definition
|
|
Term
| The Autonomic Nervous System is further subdivided into the _______ and ______ nervous system. |
|
Definition
| Parsympathetic and Sympathetic |
|
|
Term
| The _______________ of the heart is a vector representing the summation of all the individual vectors that make ventricular depolarization. |
|
Definition
|
|
Term
| The baseline is a straight line drawn between the _______ of one complex to the ________ of the succeeding complex. |
|
Definition
|
|
Term
| T or F, the P wave represents atrial repolarization and the innervation of the atrial myocytes. |
|
Definition
|
|
Term
| The normal duration for the PR interval is... |
|
Definition
|
|
Term
| The normal duration for the QRS interval is... |
|
Definition
|
|
Term
| Q waves are significant if... |
|
Definition
-Greater than or equal to 0.03 sec wide
-Deeper than 1/3 the ht of the R wave |
|
|
Term
| T or F, T waves represent ventricular repolarization. |
|
Definition
|
|
Term
| T or F, the QT should always be more than 1/2 preceding R-R interval. |
|
Definition
| False (should not be greater than 1/2) |
|
|
Term
| T or F, the U wave is a small, flat wave seen after the T wave and before the next P wave. |
|
Definition
|
|
Term
| The paper on an EKG normally moves at... |
|
Definition
|
|
Term
| The width of each small box on and EKG printout represents... |
|
Definition
|
|
Term
| The small boxes on an EKG paper measure... |
|
Definition
|
|
Term
| The big boxes on an EKG paper measure |
|
Definition
|
|
Term
| A wave that is 10 small boxes high and three small boxes wide is described as... |
|
Definition
|
|
Term
| a distance of 2 big boxes and 2 little boxes wide on an EKG printout is described as being how wide? |
|
Definition
|
|
Term
| When calculating heart rates on an EKG printout using the box method, the numbers to remember are... |
|
Definition
|
|
Term
| If there are 3.5 beats in a 6-second strip, what's the HR? |
|
Definition
|
|
Term
| What is the rate is there are 3.5 beats in a 12-second strip? |
|
Definition
|
|
Term
| What is the rate if there are five beats in a 6-second strip? |
|
Definition
|
|
Term
| T or F, artifacts relate to complexes that arise at odd times or intervals from the underlying rhythm. |
|
Definition
|
|
Term
| T or F, moving lead wires, muscle tremors, and interference from an external electrical apparatus can all lead to artifact. |
|
Definition
|
|
Term
| A ___________ complex is a complex that arrives before the expected time according to the cadence of the underlying rhythm. |
|
Definition
|
|
Term
| An __________ complex occurs late in the cadence of the underlying rhythm momentarily. It occurs hwen the principal pacemaker fails and is replaced by the next available pacemaker in the pacemaker hierarchy of the heart and the electrical conduction system. |
|
Definition
|
|
Term
| T or F, an escape rhythm occurs whne the failure of the primary pacemaker lasts for an extended period of time, causing the next available pacemaker in the hierarchy to take over the entire pacing function for as long as needed. This is a protective mechanism to assure survival. |
|
Definition
|
|
Term
| Two of the main factors that determine the morphology of complexes include the... |
|
Definition
-Location of the initiating focus/pacemaker
-Route of the conduction that the impulse travels through the heart |
|
|
Term
| Are all ectopic P waves morphologically different from sinus P waves? |
|
Definition
|
|
Term
| An ectopic atrial pacemaker firing near the AV node will cause the P wave morphology to appear... |
|
Definition
| Inverted in lead II, III, aVF |
|
|
Term
| T or F, an ectopic complex originating in the AV node may be transmitted retrogradely to the atria or may actually never cause atrial depolarization by blocking retrograde conduction. |
|
Definition
|
|
Term
| T or F, the morphology of ectopic ventricular complexes should always be narrow, and slightly different from the appearance of the normal sinus complex. |
|
Definition
|
|
Term
| T or F, an electrical impulse can travel normally down the electrical conduction system and then hit an area that is refractory to impulse propagation. The subsequent impulse propagation would then continue aberrantly via direct cell-to-cell transmission from the point of obstruction. The result can be an aberrantly conducted complex that has a normal morphological appearance at the onset but then changes abruptly. |
|
Definition
|
|
Term
| The entire EKG is _____ sec long. |
|
Definition
|
|
Term
| In the normal quadrant, lead I is _____ and lead aVF is _______. |
|
Definition
|
|
Term
| In the left quadrant, lead I is ______ and lead aVF is _______. |
|
Definition
|
|
Term
| In the right quadrant, lead I is _____ and lead aVF is _______. |
|
Definition
|
|
Term
| In the extreme right quandrant, lead I is ______ and lead aVF is ________. |
|
Definition
|
|
Term
| Because all RSR' complexes are close in appearance, all you need to diagnose RBBB is to identify their presence in V1. T or F. |
|
Definition
|
|
Term
| What are the three major criteria for diagnosing RBBB? |
|
Definition
-QRS greater than or equal to 0.12 sec
-Slurred S wave in leads I and V6
-RSR' pattern in V1 |
|
|
Term
| T or F, in RBBB there can be negative complexes in V1 or V2. |
|
Definition
|
|
Term
| What are the criteria for diagnosing LBBB? |
|
Definition
-QRS greater than or equal to 0.12 sec
-Broad, monomorphic R waves in I and V6, with nor Q waves
-Broad, monomorphic S waves in V1 |
|
|
Term
| What are the criteria for diagnosing V-Tach? |
|
Definition
-Wide-complex (greater than 0.16 sec)
-AV dissociation
-Fusion/capture beats
-Complexes in all of the precordial leads are negative
-Josephson's and Brugada's signs |
|
|
Term
| Sinus arrhythmia is a normal respiratory variant. T or F |
|
Definition
|
|
Term
| Regular rhythm with a HR of 125 BPM with identical P waves occurring before each QRS complex. |
|
Definition
|
|
Term
| If an entire complex is missing from a rhythm strip, but the underlying rhythm is unchanged and maintains the same RR interval, it is known as... |
|
Definition
|
|
Term
| T or F, in atrial flutter, the flutter wave usually occurs at a rate of 250-350 BPM. |
|
Definition
|
|
Term
| T or F, A-fib is an irregularly irregular rhythm with no discernible P waves in any lead. |
|
Definition
|
|
Term
| An irregularly irregular rhythm at 195 BPM with no discernible P waves is known as... |
|
Definition
| A-fib with a rapid ventricular response |
|
|
Term
| An irregularly irregular rhythm of 65 BPM with at least 3 varying P wave morphologies and PR intervals is known as... |
|
Definition
| Wandering Atrial Pacemaker |
|
|
Term
| T or F, an accelerated junctional rhythm is a junctional rhythm over 100 BPM. |
|
Definition
|
|
Term
| T or F, an idioventricular rhythm is caused by a ventricular focus acting as the primary pacemaker. The usual rate is in the range of 20-40 BPM. |
|
Definition
|
|
Term
| What two beats are associated with V-Tach? |
|
Definition
|
|
Term
| T or F, a wide-complex tachycardia should always be considered and treated as V-Tach until proven otherwise. |
|
Definition
|
|
Term
| T or F, V-fib has discernible complexes on close examination of the strip. |
|
Definition
|
|
Term
| A grouped rhythm with PR intervals that prolong until a beat is dropped is known as... |
|
Definition
| Morbitz I second-degree heart block (aka Wenckbach) |
|
|
Term
| In this rhythm, there are grouped beats with one beat dropped between groups. It is caused by a diseased AV node and is a harbinger of bad things to come (namely complete heart block). |
|
Definition
|
|
Term
| What is the key point to remember about Morbitz II? |
|
Definition
| The PR interval is the same in all of the conducted beats |
|
|
Term
| This rhythm is caused by a diseased AV node w/ a long refractory period, resulting in a PR interval that lengthens between successive beats until a beat is dropped (the RR interval, on the other hand, shortens with each beat). |
|
Definition
| Morbitz I second-degree heart block (aka Wenckbach) |
|
|
Term
| A rhythm with dissociated atrial and ventricular pacemakers, in which the atrial beat is faster than the ventricular rate, is known as... |
|
Definition
|
|
Term
| If there are just as many P waves as there are QRSs, but they are dissociated, it is known as ___________ rather than 3rd-degree heart block. |
|
Definition
|
|
Term
| T or F, the P wave is caused by the depolarization of the atria. The depolarization of the SA node, by itself, is electrocardiographically not visible. |
|
Definition
|
|
Term
| The combined atrial vector points in NSR should point in which major direction? |
|
Definition
|
|
Term
| In NSR, the P waves should always be upright in leads... |
|
Definition
|
|
Term
| The length of the PR interval should be... |
|
Definition
|
|
Term
| T or F, during the PR interval, the atria , AV node, bundle of His, the bundle branches, and the purkinje system all fire. |
|
Definition
|
|
Term
| In NSR, the width of the QRS complex should be... |
|
Definition
|
|
Term
| T or F, sometimes, circus pathways may form during the relative refractory period that can lead to complex arrhythmia formation. |
|
Definition
|
|
Term
| In NSR, the PP interval should not be longer than...(on the EKG paper) |
|
Definition
|
|
Term
| T or F, slight variations in P wave morphology and PR interval are considered acceptable in NSR. |
|
Definition
| True (very slight variations) |
|
|
Term
| T or F, in sinus bradycardia the entire complex is broader, leading to a slower rate. |
|
Definition
|
|
Term
| What phase of the action potential is lengthened in sinus bradycardia? |
|
Definition
|
|
Term
| T or F, a slightly prolonged QT interval and QTc are considered normal in sinus brady. |
|
Definition
|
|
Term
| This is the main electrocardiographic segment that is lengthened in sinus brady. |
|
Definition
|
|
Term
| T or F, MI can lead to sinus brady. |
|
Definition
|
|
Term
| The HR in sinus tachy is usually between _____ and _____, but may be as high as _____, and in rare cases _____. |
|
Definition
|
|
Term
| Maximum HR is =[ ____ BPM - age (in yrs)] |
|
Definition
|
|
Term
| T or F, wide complexes are acceptable in sinus tachy. |
|
Definition
|
|
Term
| Electrical alternans is represented electrocardiographically as a varying ______ of the QRS complex. |
|
Definition
|
|
Term
Which of the following may lead to electrical alternans:
-Tachycardias
-MIs
-Pericardial effusions
-Pericarditis |
|
Definition
| Tachycardias and Pericardial effusions |
|
|
Term
| Sinus tachy has a much shorter Phase 4 of the action potential, this is electrocardiographically represented by a short _____ segment. |
|
Definition
|
|
Term
| T or F, Sinus tachy should not be considered a pathological rhythm, but merely a physiological response to autonomic stress. |
|
Definition
|
|
Term
| T or F, it is common for the TP segment to be completely missing on a strip showing sinus tach. |
|
Definition
|
|
Term
| In an acute MI, would beta-blocking agents be indicated to slow tachy? |
|
Definition
| Yes (hence reducing O2 demand of the heart) |
|
|
Term
| What are the two kinds of sinus arrhythmias? |
|
Definition
| Respiratory (phasic) and Nonrespiratory (nonphasic) sinus arrhythmias |
|
|
Term
| Respiratory sinus arrhythmia is caused by transient_______ stimulation. |
|
Definition
|
|
Term
| Is respiratory sinus arrhythmia a variant of normal? |
|
Definition
|
|
Term
| HR normally increases with (inspiration/expiration). |
|
Definition
|
|
Term
| This type of sinus arrhythmia occurs in the elderly and in Pts with serious ischemic heart disease or structural abnormalities. |
|
Definition
|
|
Term
| What is the basic pacemaking rate of atrial tissue? |
|
Definition
|
|
Term
| T or F, after a PAC, the sinus node takes over as the pacemaker. However, the rhythm may be reset at a different rate. |
|
Definition
|
|
Term
| T or F, whenever you see inverted P waves in lead II, it should make you think of ectopic pacemakers in either the atria, AV node, or the ventricles. |
|
Definition
|
|
Term
| The pacemaking function of any cardiac tissue is dependent on the rate of ______ depolarization that it intrinsically possesses. |
|
Definition
|
|
Term
| A pause that is an exact multiple of the PP interval and is associated with premature complexes is known as... |
|
Definition
| Compensatory pause (if it is not an exact multiple, it is known as noncompensatory) |
|
|
Term
| T or F, PACs are usually associated with noncompensatory pauses b/c the SA node is rese4t by the premature atrial depolarization wave. |
|
Definition
|
|
Term
| Aberrantly conducted PACs generally have QRS complexes that show... |
|
Definition
|
|
Term
| Sometimes the conduction to the ventricles from a PAC may actually be blocked, this makes the P wave of the PAC visible, but the QRS and T waves are not. When this occurs it is known as... |
|
Definition
|
|
Term
| For simplicity, the PR interval in an ectopic atrial rhythm is... |
|
Definition
|
|
Term
| What are useful in determining ectopic atrial rhythm? |
|
Definition
| P wave morphology and PR interval |
|
|
Term
| Inverted P wave, with PR interval of 0.20 sec (ectopic atrial or junctional rhythm) |
|
Definition
|
|
Term
| Inverted P wave, with PR interval of 0.10 sec (ectopic atrial or junctional) |
|
Definition
|
|
Term
| Ectopic atrial tach is maintained by the ectopic atrial focus and... |
|
Definition
|
|
Term
| EAT are usually triggered by... |
|
Definition
|
|
Term
| This is the other name for EAT. |
|
Definition
| Paroxysmal Atrial Tachycardia |
|
|
Term
|
Definition
| 100-180 BPM, up to 250 possible |
|
|
Term
|
Definition
| Atrial 150-250 BPM, with variable ventricular rate |
|
|
Term
| Can AV block serve a protective purpose for the heart? |
|
Definition
|
|
Term
| What are the three irregularly irregular atrial rhythms? |
|
Definition
|
|
Term
| What pathological condition is commonly associated with WAP? |
|
Definition
|
|
Term
| What components of complexes are variable in WAP? |
|
Definition
| P waves and PR intervals (there will be at least 3 ectopic atrial pacemakers) |
|
|
Term
| The average atrial rate in WAP is... |
|
Definition
|
|
Term
|
Definition
| 100-150 BPM (can be as high as 250) |
|
|
Term
| T or F, aberrantly conducted complexes are rarely seen in MAT. |
|
Definition
|
|
Term
| MAT is usually found in Pts with COPD or _____________. |
|
Definition
|
|
Term
| T or F, MAT usually resolves when the underlying condition is corrected. |
|
Definition
|
|
Term
| The HR of atrial flutter. |
|
Definition
| Atrial 200-400 BPM with a ventricular response of 100-300 BPM |
|
|
Term
| The atrial complexes in A-flutter are known as... |
|
Definition
|
|
Term
| Will the baseline between F waves be ever be electric for short periods of time? |
|
Definition
|
|
Term
| Atrial flutter involves the formation of a ___________ circuit in the _______ atrium. |
|
Definition
|
|
Term
| What mnemonic can be used to remember the differential diagnosis of atrial flutter? |
|
Definition
|
|
Term
| In A-fib, electrical activity in the atria is referred to as... |
|
Definition
| f waves or Fibrillatory waves |
|
|
Term
| Rates for f waves in A-fib. |
|
Definition
|
|
Term
| T or F, in atrial fib, the atrial tissue has many ectopic foci firing at the same time. The result is the formation of small depolarization areas of wavelets that each give rise to their own small vector. These vectors form the pattern of the f waves on the EKG strip. |
|
Definition
|
|
Term
| The ventricular rate of A-fib is usually... |
|
Definition
|
|
Term
| Can complete AV block occur in Pts with Afib? |
|
Definition
|
|
Term
| Refers to a pattern where a premature complex is transmitted aberrantly if it occurs after a long cycle. (so short complex after a long complex will be aberrant) |
|
Definition
|
|
Term
| Will P waves in a junctional rhythm always be inverted? |
|
Definition
|
|
Term
| Where can the P wave of a junctional rhythm be found? |
|
Definition
| Immediately before, buried in, or immediately after the QRS complex |
|
|
Term
| If the P wave is found after the QRS complex, it creates a ___ interval. |
|
Definition
|
|
Term
| If there is an inverted P wave in front of a QRS complex, look at the PR interval. If it is prolonged it is a _____ complex, if it is short, it is probably a _______ complex. |
|
Definition
|
|
Term
| Junctional rhythms usually occur at rates of... |
|
Definition
|
|
Term
| Accelerated junctional rhythm rate. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Junctional escape complexes and junctional rhythms are usually a result of what? |
|
Definition
| The SA failing it function as the primary pacemaker |
|
|
Term
| Junctional rhythms are critical for maintaining what two things during failure of SA nodal or atrial pacemakers? |
|
Definition
| Ventricular response and hemodynamic stability |
|
|
Term
| Junctional rhythms are normally formed as... |
|
Definition
|
|
Term
| Premature junctional contractions are ______ supraventricular complexes. |
|
Definition
|
|
Term
| When deciding between the possibility that a complex is either a PAC or a PJC, the presence of a compensatory pause favors which type of premature complex? |
|
Definition
|
|
Term
| At rates greater than 130 BPM, it is difficult to make a diagnosis of junctional tach b/c it closely resembles... |
|
Definition
|
|
Term
| What three things must a reentry circuit have? |
|
Definition
-A circuit with at least two different pathways
-Pathways with different intrinsic properties of conduction
-One pathway that conducts slower than the other |
|
|
Term
| This is an indirect sign that a Pt possesses a dual pathway system. |
|
Definition
| Two different PR intervals, with morphologically identical P waves in a normal sinus rhythm. |
|
|
Term
|
Definition
|
|
Term
| AV reentry tach is caused by a macroreentry circuit involving the ______ and an __________. |
|
Definition
| AV node / accessory pathway |
|
|
Term
| This is indicative of atrial waves traveling unimpeded thru accessory pathways, causing slow cell-to-cell ventricular depolarization |
|
Definition
|
|
Term
| In the macroreentry circuit formed in AVRT, what is the slow pathway? |
|
Definition
|
|
Term
| The Wolff-Parkinson-White (WPW) pattern consists of... |
|
Definition
-Delta wave
-Short PR interval
-Wide QRS complex
-ST-T wave changes |
|
|
Term
| WPW pattern and syndrome are synonymous, T or F. |
|
Definition
| False (the syndrome means there is also a tach rhythm present) |
|
|
Term
| A reentrant tachy that's formed when an impulse travels down the accessory pathway and reenters the atria through the AV node is called an _______ AVRT. |
|
Definition
|
|
Term
| A reentrant tachy that is formed whne an impulse travels down the accessory pathway and reenters the atria through the AV node is called an _______ AVRT. |
|
Definition
|
|
Term
| Antidromic is a _______ complex tachy, b/c the rate is not under the control of the AV node. |
|
Definition
|
|
Term
| If the ventricular rate of a tach is above 250 BPM, then it is very likely it involves an... |
|
Definition
|
|
Term
| The three irregularly irregular supraventricular tachycardias include... |
|
Definition
| Afib, MAT, Aflut with variable block |
|
|
Term
| The presence of a pseudo-S or pseudo-R' wave in a Pt with a narrow-complex tach above 140 BPM favors the diagnosis of... |
|
Definition
|
|
Term
| A rhythm is considered to be of ventricular origin if the ectopic pacemaker is found below the bifurcation of the... |
|
Definition
|
|
Term
| What are the characteristics of a ventricular complex? |
|
Definition
-Wide, bizarre looking complexes
-Width greater than 0.12 sec
-May or may not have inverted P waves
-ST and T wave abnormalities |
|
|
Term
| In general, ectopic foci starting in the left ventricle will have a _______ bundle branch block morphology. |
|
Definition
|
|
Term
| Ventricular rhythms are frequently associated with... |
|
Definition
| 3rd Degree (Complete) Heart Block |
|
|
Term
| This phenomenon refers to a PVC that falls within the relative refractory period of the previous complex. |
|
Definition
|
|
Term
| An end-diastolic PVC is one that falls immediately after the normally occurring... |
|
Definition
|
|
Term
| When a PVC occurs every other beat, it is called a ventricular... |
|
Definition
|
|
Term
| When two PVCs occur one right after the other, it is called a... |
|
Definition
|
|
Term
| This term describes when three or more PVCs occur sequentially. |
|
Definition
|
|
Term
| When there are at least 3 ventricular escape complexes in a row, that is known as... |
|
Definition
|
|
Term
| These are the last failsafe pacemakers of the heart. |
|
Definition
|
|
Term
| Rates for idioventricular rhythms. |
|
Definition
|
|
Term
| Rates for accelerated idioventricular rhythms. |
|
Definition
|
|
Term
| T or F, repefusion arrhythmias refer to arrhythmia disturbances that occur during the reperfusion phase of thrombolytic therapy for an acute MI (accelerate idioventricular rhythm is an example). |
|
Definition
|
|
Term
| T or F, reperfusion arrhythmias require immediate intervention. |
|
Definition
|
|
Term
| If you ever see a wide complex rhythm with a normal looking QRS complex smack in the middle of it, it is either... |
|
Definition
| Accelerated Idioventricular or VTach |
|
|
Term
| Refers to a rhythm composed of 3 or more ectopic ventricular complexes in a row, with a rate above 100 BPM. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| If the rate of VTach is above 200 BPM, nad the morphology of the complexes blend to form a sinusoidal pattern, the more accurate term is... |
|
Definition
|
|
Term
| If all the VTach ventricular complexes are nearly identical, the rhythm is known as ________ Vtach. |
|
Definition
|
|
Term
| If a run of monomorphic VTach lasts less than 30 sec, it is known as... |
|
Definition
|
|
Term
| If a run of monomorphic VTach lasts greater than 30 sec, or if the rhythm requires an intervention to break it, it is known as... |
|
Definition
|
|
Term
| A notch in the downstroke of the S wave in an ectopic ventricular complex is known as... |
|
Definition
|
|
Term
| A length of greater than or equal to 0.10 sec between the onset of the QRS complex to the very bottom of the S wave is known as ... |
|
Definition
|
|
Term
| Many runs of VTach are triggered by... |
|
Definition
|
|
Term
| Indirect evidence of AV dissociation includes.... |
|
Definition
|
|
Term
| T or F, Torsade de Pointes is a variation of Polymorphic VTach. |
|
Definition
|
|
Term
| The difference between Polymorphic VTach and Torsade de Pointes is... |
|
Definition
| When the Pt is in sinus rhythm, the QRS complexes have a prolonged QT interval in Torsades (normal QT in poly VTach). |
|
|
Term
| T or F, Both torsade and Poly Vtach have groups of ventricular complexes (5-20) that seem to form groups, caused by a twisting of the polarity of the QRS complexes. |
|
Definition
|
|
Term
| Rates for torsade/poly VTach |
|
Definition
| 150-300 BPM (typically present around 200-250) |
|
|
Term
| Are torsade and Poly Vtach self limiting? |
|
Definition
| Yes, usually (but can break down into VFib) |
|
|
