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38 Cards in this Set
- Front
- Back
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Steps for EKG analysis
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Rate
Rhythm Axis Hypertrophy Ichemia/infarction |
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How do you figure out HR from EKG?
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60/RR interval (in seconds)
1500/# of small boxes btw QRS |
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Sinus Arrhythmia vs. sick sinus syndrome
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Both have varying HR and RR interval
Diff dx: have pt take in deep breaths and it should cause difference in HR |
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What is supraventricular tach? Causes?
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Tachycardia originating above ventricule tissue, including sinus tach, atrial tach, juntional tach
Panic attack, stress, MVP, ANS dysfxt |
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Steps for analyzing rhythm
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Rate, RR interval - normal?
P before each QRS and QRS after each P PR int normal? QRS int normal? |
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R on T PVC
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As ventricle is repolarizing (T wave) a PVC hits and causes an R wave on top of the T wave
Can progress to Vtach of Vfib = dangerous |
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Types of premature contractions
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Premature atrial contraction
Premature junctional contraction PVC |
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What is an ectopic foci?
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Initiaton of electrical signal outside normal autorhythmic cells = abnormal pattern
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Unifocal vs. Multifocal PVC
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Unfocal = 1 area causing abnormla contraction
Multifocal = 2 dif foci causing contractions, identified by 2 different looking PVCs |
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How do you identify a PVC on EKG?
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Lack P waves, long QRS waves and unusual looking
Followed by compensatory pause |
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How often does PVCs occur?
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30-40% in healthy population
50-60% in CAD pts |
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How do you identify R vs. L ventricular PVCs?
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R - downward b/c going from pos to neg
L - upward b/c going from neg to pos |
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Non-cardiac causes of PVCs
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Pectus excavatum
Common with ischemia |
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Keys in identifying AV blocks
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PR interval (AV block exceeds .2 sec)
Ratio of P waves to QRS (missing?) |
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Second degree AV blcok
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Some P waves don't conduct impulse
Result in some P waves with no QRS after |
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3rd degree AV block
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No correlation btw P wave and QRS
QRS widened b/c impulse arising from ventricular fibers, and must go cell to cell |
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How do you identify BBB? Cause?
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Long QRS > .12, but still ahve p wave before it
Long QRS b/c must depolarize cell to cell Cause: vent hypertrophy, WPW, dru and electrolye cuases Hard to see ichemia/infarct |
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How do you identify A-fib?
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No p-wave before QRS b/c atria is just spasing out
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How do you identify atrial flutter?
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Multiple p waves/QRS
Atria is contracting at a rate of over 200x/min |
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Risks of Afib and Aflutt
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Major risk factors for stroke
Afib is the most common arrhythmia If combined with rapid Vent rate, can also get ischemia A flutter can progress to A-fib |
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How do you identify Wolf-Parkinson-White on EKG?
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PR interval < .12
Delta wave (slow upslope at beginning of R wave) |
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Precipitating factors for A-fib
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Obesity
DM HTN Prior MI Heart failure Sleep apnea Alcohol Caffeine Corticosteroids Stresss/anger |
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Long QT syndrome. What is it associated with?
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Sudden cardiac death syndrome (SCD)
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Possible symptoms of Arrhythmias
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Palpitations
Skipped beat Syncpe, dizzy, fainting SOB Chest pain |
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Can ex help arrhythmias?
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Acute ex inc's freq of arrhythmias
Chronic ex dec's likelihood of SERIOUS arrhythmias |
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How do you determine L ventricular hypertrophy from an EKG?
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Add height of QRS wave in leads 5 and 6.. if >35 mm = L vent hypertrophy
Also, deep S wave in limb I |
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What may R ventricular hypertrophy signify?
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L vent infarct
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How do you detrmine atrial hypertrophy on EKG?
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Notched or biphasic p wave
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Where is ST segment depression measured?
What's signifciant? |
0.08 sec after J point
> or equal to 1 mm downslope or horizontal = ischemia > or equal to 1.5 mm upslope = ischemia |
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T wave and ischemia?
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T wave inversion that is symmetrical when QRS is upright signals ischemia
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Signs of myocardial infarction on EKG
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Acute = elevated ST segment
Chronic = significant Q waves |
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Evolution of a Q wave MI?
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Initial ST elevation with normal Q
Followed by deepending Q waves Evenually T wave normalizes, but deep Q remains |
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What is SCD thought to be from?
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V-fib
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What arrhythmias may arise from Digitalis
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A-fib
V-tach Multiple PVCs V-fib |
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EKG changes in stroke pts
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Deep symetric inverted T waves in many leads
Non-specific ST segments, T wave changes Prolonged QT intervals Prominent U waves Supraventricular tachycardia |
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How do you find MEA?
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It is perpendicular to most isoelectric lead within the determined quadrant
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What does autonomic dysfxt predispose a pt to?
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Serious arrhythmias
Heart rate variability (HRV) can be used to evaluate autonomic dysfxt (variability in HR from beat to beat) Stroke, TBI, MS at serious risk |
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How do you identify L vent hypertrophy on ecg?
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Add S1 plus either V5 or V6 (whichever is biggest in mm)
if greater than or equal to 35 = hypertrophy |
