Adv Principles Week 4 - Ekg

Front 1

Horizontal axis (time)
1 small box = ____ seconds
5 small boxes = _____seconds
Scores on top of graph = _____ seconds
Paper speed = _____mm/sec

Back 1

1. 0.04 seconds
2. 0.20 seconds
3. 3 seconds
4. 25 mm/sec

Front 2

Verticle axis (aplitude)
1 small box = ____mm = _____mV
10 small boxes = ___ large boxes = ______mV

Back 2

1. 1 mm = 0.1mV
2. 2 large boxes = 1.0mV

Front 3

P wave (atrial depolarization)
Upright (positive) in which leads?

Back 3

I, II, AVF, and V4-6

Front 4

P wave is normally negative in which lead?

Back 4

AVR

Front 5

QRS represents?

Back 5

ventriular depolarization

Front 6

The first downward, or negative, wave before an R wave is a _____ wave

Back 6

Q wave

Front 7

Any upward, or positive, was is an _______ wave

Back 7

R wave

Front 8

A downward, or negative, wave after an R was is an _____ wave

Back 8

S wave

Front 9

A "QS" wave in V1 or V2 couple represent a?

Back 9

MI

Front 10

The amplitude of each wave in the QRS complex is indicated by ______case letters when it is _<______ the amplitude of the entire complex

Back 10

lower case when it is <1/3 the amplitude (qRS)

Front 11

If the amplitude of the QRS complex is >_____ it is indicated by a ______case letter?

Back 11

>1/3 the amplitude, upper case letter (qRS)

Front 12

As the QRS complex progresses from V1-6, you should see what with the S wave?

Back 12

Decreased amplitude

Front 13

As the QRS complex progresses from V1-6, you should see what with the R wave?

Back 13

Increased amplitude

Front 14

List some conditions associated with poor R wave progression

Back 14

LVH, RVH
Ant. MI
Emphysema
(L) BBB
misplaced precordial leads

Front 15

Normal transition (R-S=same height) of the R-S complex usually occurs?

Back 15

V3-V4
early - V1-V2
late - V5-V6

Front 16

What is the normal QRS duration?

Back 16

0.05-0.10 seconds

Front 17

A prolonged QRS interval usually indicates?

Back 17

intraventricular conduction delay

Front 18

What might the appearance of the QRS look like with intraventicular conduction delays?

Back 18

Causes the QRS to widen Slurring following the peak of the QRS
Notch at the peak of the QRS

Front 19

Name the type of wave and what it could represent

Back 19

Delta wave, these occur in several pre-excitation syndromes and produce a characteristic deformity (hump or slurring) at the beginning of the QRS (ex. WPW)

Front 20

What are 3 classic signs of WPW?

Back 20

Short PR
Wide QRS
Delta wave

Front 21

Low amplitude of the QRS complex is <_____mm in all leads

Back 21

<10mm in all leads (<1.0mV)

Front 22

What are medical conditions associated with low amplitude of the QRS?

Back 22

emphysema
pericardial effusion
CHF
MI
Amyloidosis
Hypothyroidism
Extreme obesity

Front 23

High amplitude of QRS complex is indicative of?

Back 23

Hypertrophy

Front 24

What is the calculation to measure LVH?

Back 24

Amplitude (mm) of S in V1 + mm of R in V5 is >35 mm= LVH
(also ST depression and T wave inversion in V5 and V6)

Front 25

What are some conditions that cause LVH?

Back 25

HTN
Aortic stenosis or insufficiency
Obesity

Front 26

What would indicate RVH on the 12 lead?

Back 26

Tall R wave in V1 with progressive decrase in amplitude thru V4

Front 27

What conditions would cause RVH?

Back 27

COPD
Pulmonary stenosis
Tricuspid insufficiency
Posterior MI

Front 28

Matching
1. RVH
2. LVH

a. complex looks the same, just bigger
b. Complex not normal, Big R wave, small S wave

Back 28

1. B
2. A

Front 29

What constitutes a significant Q wave? What could that mean?

Back 29

duration is >0.04 se3c and/or >1/3 the height of the QRS complex
Indicative of old MI

Front 30

In which leads do you look at the inferior part of the heart?

Back 30

Leads II, III, aVF

Front 31

What does the T wave represent?

Back 31

repolarization of the ventricles

Front 32

T waves are normally upright in which leads?

Back 32

I, II, V3-6

Front 33

T wave is normally inverted in which lead(s)?

Back 33

aVR

Front 34

What are tall T waves associated with?

Back 34

K+ excess (tented T_
myocardial ischemia
ventricular overload
antypsychotic drugs
CVA's or CNS ischemia

Front 35

Primary T wave inversion is frequently caused by?

Back 35

myocardial ischemia and inflammation

Front 36

Secondary T wave abnormalities can be caused by?

Back 36

conduction disturbances, and LVH. Don't misdiagnose as ischemia, look at amplitude of QRS to diagnose LVH (>35mm)

Front 37

U waves are best seen in which leads?

Back 37

V3-4, more prominent in bradycardia and hypokalemia

Front 38

What is a U wave?

Back 38

a low voltage deflection of uncertain origin

Front 39

How do you measure the PR interval?
What is normal PR interval?

Back 39

- beginning of the P to beginning of the QRS
-0.12 - 0.20 sec

Front 40

What does the PR interval measure?

Back 40

AV node conduction

Front 41

How do you measure the ST segment?

Back 41

From the end of the QRS to the start of the T wave

Front 42

An elevation of the ST segment of <____mm or a depression of <0.5mm may be considered normal

Back 42

1. <1mm
2. <0.5mm

Front 43

What is the J point? Why is it important?

Back 43

The junction of the S wave and the ST segment
Important in determining myocardial ischemia

Front 44

To evaluate ST segment elevation or depression you will measure where in relation to the J point?

Back 44

0.06mm or 1 1/2 blocks after J point.

Front 45

Elevation of the ST segment at the J point may be a normal variant in which types of patients?

Back 45

children, young adults and black men due to early repolarization

Front 46

Where do you measure the QT interval from? What does it represent?

Back 46

The beginning of the Q to the end of the T
Total time of systole

Front 47

The QT interval shouild not be < or > half the preceding R-R interval if the HR is between 60-90?

Back 47

>half - may predispose the the patient to R and T (Torsades de Points)

Front 48

The QT duration is normally correct for the HR to = QTc. What is the normal QTc?

Back 48

0.44 +/- 0.02 seconds

Front 49

What is the normal ECG deflection?

Back 49

Down and to the left

Front 50

Vectors are used to represent the hearts?

Back 50

Hearts electrical activity
Has a force that has both magnitude and direction

Front 51

Vectors are caused by?

Back 51

The spread of the wave of depolarization throughout the myocardium

Front 52

What is a lead?

Back 52

an electrode used to sense the hearts electrical activity

Front 53

What are the 3 basic laws of electrocardiography?

Back 53

-Positive - when depolarization is directed toward the + electrode
-Negative - when depolarization is directed away from the + electrode
-Biphasic deflection - when depolarization is directed perpendicular to the + electrode.

Front 54

What are the frontal plane hexaxial leads of the 12 lead?

Back 54

Bipolar Limb Leads I, II, III
Augmented Limb Leads aVR, aVL, aVF

Front 55

The Bipolar limb leads form?

Back 55

Einthovens triangle with the heart located in the center

Front 56

Einthovens Law is the sum of?

Back 56

Any complex in leads I and III equals that of Lead II (this is why P waves are best viewed in Lead II)

Front 57

What does the aVR look at?

Back 57

Nothing all - complexes

Front 58

The frontal plane is divided into ______segments each _____degrees each?

Back 58

12 segments, 30 degrees each

Front 59

In the Hexaxial lead system, label the frontal leads

Back 59

Front 60

Augmented leads are unipolar with the + pole at? - pole?

Back 60

Einthoven's triangle
- pole is the theoretical electrically neutral center of the heart

Front 61

What are the augmented limb leads?

Back 61

aVR
aVL
aVF

Front 62

What are the 6 horizontal plane precordial leads and which part of the heart to they look at?

Back 62

V1 - septum, or R heart
V2 - septum, or R heart
V3- anterior wall
V4 - anterior wall
V5 - lateral wall
V6 - lateral wall

Front 63

What are the lead locations for the precordial leads?

Back 63

V1 - 4th ICS, RSB
V2 - 4th ICS, LSB
V3 - midway between V2 and V4
V4 - 5th ICS midclavicular line
V5 - 5th ICS anterior axillary line
V6 - 5th ICS mid axillary line

Front 64

Why does the R wave normally enlarge as you go from V1-V6?

Back 64

Left ventricle is biggest, thickest so you get more eletrical current

Front 65

Which area of the heart of you looking at with the Brown lead?

Back 65

The "Brown" lead is the "V" lead so you place it at the part of the heart you want to look at

Front 66

Whaqt is the numerical degree designation of each of the 6 limb leads?

Back 66

I = 0 degrees
II = +60 degrees
III = +120
aVL = -30 degrees
aVF = +90
aVR = -150

Front 67

What are the locations of the
1. Normal axis
2. Right axis deviation
3. Left axis deviation
4. Indeterminate axis deviation

Back 67

Normal axis = 0 to +90degrees
RAD = +90 to +180 degrees
LAD = 0 to -90 degrees
Intererminate axis = -90 to -180 (represents extreme R axis deviation)

Front 68

What is the Quick Quadrant method for determining the axis of the QRS complex?

Back 68

Lead I: indicates if depolarization is moving to the R or L of the heart
Lead aVF: indicates if depolarization is moving predominately upward or downward

Front 69

What is the Precise Method for determining axis deviation, what are the 3 essential questions?

Back 69

1. which lead records the tallest most + QRS
2. Which lead records the most - QRS complex
3. Which lead records the smallest or most biphasic (RS) QRS complex?

Front 70

List some causes of right axis deviation?

Back 70

Normal in tall, slender people, infants and children
RVH
Conduction disturbances (WPW, RBBB)
Myocardial infarction (anterior, anterolateral)
Valvular disease (right sided)
Pulmonary Htn
Congenital heart disease
Pulmonary conditions

Front 71

List some causes of left axis deviation?

Back 71

Normal variant in obese, pregnant or elderly
LVH
Conduction -WPW, LBBB
MI - inferior
Valvular disease L side
Systemic HTN
Congenital heart disease
Abdominal tumor
Ascites

Front 72

Matching:
1. limb leads
2. augmented limb leads
3. precordial leads

a. unipolar
b. bipolar

Back 72

1. b -bipolar
2. a - unipolar
3. a - unipolar

Front 73

Name the complexes

Back 73

1. R
2. qRS
3. QS
4. RSR'
5. QR

Front 74

Determine axis

Back 74

Normal axis

Front 75

Determine axis

Back 75

Left axis

Front 76

Determine axis

Back 76

Right axis

Front 77

Determine axis

Back 77

Indeterminate axis

Front 78

What is the isoelectric line?

Back 78

-The baseline of the ECG tracing
-No electrical activity occuring
-associated with the PR interval
-Deflections above +
- Deflections below -

Front 79

What is considered high amplitude in the following leads
1. aVL
2. aVF
3. V1-6

Back 79

1. >11 mm in aVL
2. >20 mm in aVF
3. > 30 mm in V1-6

Front 80

In progression from V1-V6 describe the normal progression of amplitude in the following waves

1. R
2. S
3. T

Back 80

1. Bigger
2. Smaller
3. Bigger

Front 81

What waves does the 3 basic laws of ECG apply to?

Back 81

P wave (artial depolarization)
QRS complex (ventricular depolarization) (p 13 of handout)

Front 82

The intersection of what leads divide the precordium into 4 quadrants?

Back 82

Leads I and aVF