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82 Cards in this Set

  • Front
  • Back
Horizontal axis (time)
1 small box = ____ seconds
5 small boxes = _____seconds
Scores on top of graph = _____ seconds
Paper speed = _____mm/sec
1. 0.04 seconds
2. 0.20 seconds
3. 3 seconds
4. 25 mm/sec
Verticle axis (aplitude)
1 small box = ____mm = _____mV
10 small boxes = ___ large boxes = ______mV
1. 1 mm = 0.1mV
2. 2 large boxes = 1.0mV
P wave (atrial depolarization)
Upright (positive) in which leads?
I, II, AVF, and V4-6
P wave is normally negative in which lead?
QRS represents?
ventriular depolarization
The first downward, or negative, wave before an R wave is a _____ wave
Q wave
Any upward, or positive, was is an _______ wave
R wave
A downward, or negative, wave after an R was is an _____ wave
S wave
A "QS" wave in V1 or V2 couple represent a?
The amplitude of each wave in the QRS complex is indicated by ______case letters when it is _<______ the amplitude of the entire complex
lower case when it is <1/3 the amplitude (qRS)
If the amplitude of the QRS complex is >_____ it is indicated by a ______case letter?
>1/3 the amplitude, upper case letter (qRS)
As the QRS complex progresses from V1-6, you should see what with the S wave?
Decreased amplitude
As the QRS complex progresses from V1-6, you should see what with the R wave?
Increased amplitude
List some conditions associated with poor R wave progression
Ant. MI
misplaced precordial leads
Normal transition (R-S=same height) of the R-S complex usually occurs?
early - V1-V2
late - V5-V6
What is the normal QRS duration?
0.05-0.10 seconds
A prolonged QRS interval usually indicates?
intraventricular conduction delay
What might the appearance of the QRS look like with intraventicular conduction delays?
Causes the QRS to widen Slurring following the peak of the QRS
Notch at the peak of the QRS
Name the type of wave and what it could represent
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)
What are 3 classic signs of WPW?
Short PR
Wide QRS
Delta wave
Low amplitude of the QRS complex is <_____mm in all leads
<10mm in all leads (<1.0mV)
What are medical conditions associated with low amplitude of the QRS?
pericardial effusion
Extreme obesity
High amplitude of QRS complex is indicative of?
What is the calculation to measure LVH?
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)
What are some conditions that cause LVH?
Aortic stenosis or insufficiency
What would indicate RVH on the 12 lead?
Tall R wave in V1 with progressive decrase in amplitude thru V4
What conditions would cause RVH?
Pulmonary stenosis
Tricuspid insufficiency
Posterior MI
1. RVH
2. LVH

a. complex looks the same, just bigger
b. Complex not normal, Big R wave, small S wave
1. B
2. A
What constitutes a significant Q wave? What could that mean?
duration is >0.04 se3c and/or >1/3 the height of the QRS complex
Indicative of old MI
In which leads do you look at the inferior part of the heart?
Leads II, III, aVF
What does the T wave represent?
repolarization of the ventricles
T waves are normally upright in which leads?
I, II, V3-6
T wave is normally inverted in which lead(s)?
What are tall T waves associated with?
K+ excess (tented T_
myocardial ischemia
ventricular overload
antypsychotic drugs
CVA's or CNS ischemia
Primary T wave inversion is frequently caused by?
myocardial ischemia and inflammation
Secondary T wave abnormalities can be caused by?
conduction disturbances, and LVH. Don't misdiagnose as ischemia, look at amplitude of QRS to diagnose LVH (>35mm)
U waves are best seen in which leads?
V3-4, more prominent in bradycardia and hypokalemia
What is a U wave?
a low voltage deflection of uncertain origin
How do you measure the PR interval?
What is normal PR interval?
- beginning of the P to beginning of the QRS
-0.12 - 0.20 sec
What does the PR interval measure?
AV node conduction
How do you measure the ST segment?
From the end of the QRS to the start of the T wave
An elevation of the ST segment of <____mm or a depression of <0.5mm may be considered normal
1. <1mm
2. <0.5mm
What is the J point? Why is it important?
The junction of the S wave and the ST segment
Important in determining myocardial ischemia
To evaluate ST segment elevation or depression you will measure where in relation to the J point?
0.06mm or 1 1/2 blocks after J point.
Elevation of the ST segment at the J point may be a normal variant in which types of patients?
children, young adults and black men due to early repolarization
Where do you measure the QT interval from? What does it represent?
The beginning of the Q to the end of the T
Total time of systole
The QT interval shouild not be < or > half the preceding R-R interval if the HR is between 60-90?
>half - may predispose the the patient to R and T (Torsades de Points)
The QT duration is normally correct for the HR to = QTc. What is the normal QTc?
0.44 +/- 0.02 seconds
What is the normal ECG deflection?
Down and to the left
Vectors are used to represent the hearts?
Hearts electrical activity
Has a force that has both magnitude and direction
Vectors are caused by?
The spread of the wave of depolarization throughout the myocardium
What is a lead?
an electrode used to sense the hearts electrical activity
What are the 3 basic laws of electrocardiography?
-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.
What are the frontal plane hexaxial leads of the 12 lead?
Bipolar Limb Leads I, II, III
Augmented Limb Leads aVR, aVL, aVF
The Bipolar limb leads form?
Einthovens triangle with the heart located in the center
Einthovens Law is the sum of?
Any complex in leads I and III equals that of Lead II (this is why P waves are best viewed in Lead II)
What does the aVR look at?
Nothing all - complexes
The frontal plane is divided into ______segments each _____degrees each?
12 segments, 30 degrees each
In the Hexaxial lead system, label the frontal leads
Augmented leads are unipolar with the + pole at? - pole?
Einthoven's triangle
- pole is the theoretical electrically neutral center of the heart
What are the augmented limb leads?
What are the 6 horizontal plane precordial leads and which part of the heart to they look at?
V1 - septum, or R heart
V2 - septum, or R heart
V3- anterior wall
V4 - anterior wall
V5 - lateral wall
V6 - lateral wall
What are the lead locations for the precordial leads?
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
Why does the R wave normally enlarge as you go from V1-V6?
Left ventricle is biggest, thickest so you get more eletrical current
Which area of the heart of you looking at with the Brown lead?
The "Brown" lead is the "V" lead so you place it at the part of the heart you want to look at
Whaqt is the numerical degree designation of each of the 6 limb leads?
I = 0 degrees
II = +60 degrees
III = +120
aVL = -30 degrees
aVF = +90
aVR = -150
What are the locations of the
1. Normal axis
2. Right axis deviation
3. Left axis deviation
4. Indeterminate axis deviation
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)
What is the Quick Quadrant method for determining the axis of the QRS complex?
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
What is the Precise Method for determining axis deviation, what are the 3 essential questions?
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?
List some causes of right axis deviation?
Normal in tall, slender people, infants and children
Conduction disturbances (WPW, RBBB)
Myocardial infarction (anterior, anterolateral)
Valvular disease (right sided)
Pulmonary Htn
Congenital heart disease
Pulmonary conditions
List some causes of left axis deviation?
Normal variant in obese, pregnant or elderly
Conduction -WPW, LBBB
MI - inferior
Valvular disease L side
Systemic HTN
Congenital heart disease
Abdominal tumor
1. limb leads
2. augmented limb leads
3. precordial leads

a. unipolar
b. bipolar
1. b -bipolar
2. a - unipolar
3. a - unipolar
Name the complexes
1. R
2. qRS
3. QS
4. RSR'
5. QR
Determine axis
Normal axis
Determine axis
Left axis
Determine axis
Right axis
Determine axis
Indeterminate axis
What is the isoelectric line?
-The baseline of the ECG tracing
-No electrical activity occuring
-associated with the PR interval
-Deflections above +
- Deflections below -
What is considered high amplitude in the following leads
1. aVL
2. aVF
3. V1-6
1. >11 mm in aVL
2. >20 mm in aVF
3. > 30 mm in V1-6
In progression from V1-V6 describe the normal progression of amplitude in the following waves

1. R
2. S
3. T
1. Bigger
2. Smaller
3. Bigger
What waves does the 3 basic laws of ECG apply to?
P wave (artial depolarization)
QRS complex (ventricular depolarization) (p 13 of handout)
The intersection of what leads divide the precordium into 4 quadrants?
Leads I and aVF