Cardiovascular, Everything Ecg

Front 1

how many millimeters is each small box on the ECG?

Back 1

1 mm

Front 2

how many seconds is each little box on the ECG?

Back 2

.04 s

Front 3

each big box is how many seconds?

Back 3

.2 s

Front 4

how many big boxes is 1 second?

Back 4

5

Front 5

what does the P-wave represent?

Back 5

atrial depolarization

Front 6

what is the normal amplitude for the P-wave?

Back 6

less than or equal to 2.5 mm (or boxes)

Front 7

what is the normal duration of the p-wave?

Back 7

.12 seconds (or 3 boxes wide)

Front 8

in which lead is the p-wave usually biphasic?

Back 8

V1

Front 9

which leads will the p-wave be upright or positive?

Back 9

I, II, aVL, aVF, V4-6

Front 10

describe the 3 phases of the p-wave?

Back 10

phase 1: is right atrial depolarization
phase 2: right and left atrial depolarization
phase 3: left atrial depolarization

Front 11

what does the PR-interval describe?

Back 11

the conduction time from the SA node to the ventricles

Front 12

how long does a normal PR-interval last?

Back 12

.12 - .21 seconds (3-5 boxes wide)

Front 13

if PR-interval is longer than .21 seconds what is the cause?

Back 13

1st degree AV block

Front 14

if a PR-interval is less than .12 seconds what is the cause?

Back 14

accessory pathway which bypasses the AV node, such as that found in Wolff-Parkinson-White syndrome

Front 15

what is the the PR-segment?

Back 15

the distance from the end of the P-wave to the beginning of the Q-wave

Front 16

what does the QRS complex represent?

Back 16

ventricular contraction

Front 17

what is the duration of a normal QRS complex?

Back 17

.08 - .10 seconds (2-2.5 boxes wide)

Front 18

what is the length of an abnormal Q-wave?

Back 18

greater than or equal to .04 sec (1 box wide)

Front 19

leads V1 and V2 represent signals from which ventricle?

Back 19

right

Front 20

leads V5 and V6 represent signals from which ventricle?

Back 20

left

Front 21

what is the J-point?

Back 21

the point at which the S and T segments meet

Front 22

what amplitude does the J-point normally lie?

Back 22

0, a.k.a. the isoelectric line

Front 23

what does the st-segment indicate?

Back 23

early repolarization pericarditis

Front 24

what does the st-segment indicate?

Back 24

infarction ventricular aneurysm

Front 25

what does the st-segment indicate?

Back 25

injury pattern

Front 26

what does the st-segment indicate?

Back 26

strain pattern

Front 27

what does the st-segment indicate?

Back 27

strain pattern

Front 28

what does the st-segment indicate?

Back 28

subendocardial ischemia

Front 29

what does the T-wave represent?

Back 29

ventricular repolarization

Front 30

the T-wave should be upright or positive in which leads?

Back 30

I, II, V3-6

Front 31

In limb leads the T-wave should be less than or equal to how many mm?

Back 31

5

Front 32

in precordial leads the T-wave should be less than or equal to how many mm?

Back 32

10

Front 33

would you rather see a symmetrical or asymmetric T-wave?

Back 33

asymmetric with 2/3 of the width during the rising phase

Front 34

what does the QT-interval describe?

Back 34

the entire depolarization and repolarization of the ventricles

Front 35

how do you find the corrected QT-interval (QTc) by taking into account the HR?

Back 35

QTc = QT + 1.75(ventricular rate-60)

Front 36

what is the range for a normal QTc interval?

Back 36

.42 + or - .02 seconds

Front 37

where is the U-wave found?

Back 37

in leads V3 and V4 between the T-wave and the P-wave

Front 38

a abnormally large U-wave represents what?

Back 38

hypokalemia

Front 39

how do you determine HR by looking at a ECG?

Back 39

divide 300 by the number of big boxes between two similar points such as the peak of the QRS complex

Front 40

the mean P-wave vector (the combined input of both atria depolarizing) will be in what direction?

Back 40

down and to the left

Front 41

where is the P-wave usually seen best?

Back 41

lead II

Front 42

leads V3 and V4 are good for measuring what?

Back 42

the depolarization of the interventricular septum

Front 43

the negative or positive sign in front of the degree for the hearts depolarization vector is determined in relation to which lead?

Back 43

lead I with the negative pole being the top of the heart and the positive pole being the bottom of the heart

Front 44

what ECG finding indicates right atrial enlargement?

Back 44

P-wave greater than 2.5 mm, look in limb leads first

Front 45

what ECG finding indicates left atrial enlargement?

Back 45

P-wave with negative deflection in V1 and a amplitude greater than or equal to 1 mm

Front 46

how do you know when biatrial enlargement has occurred?

Back 46

the signs of left and right atrial enlargement will be present

Right = P-wave greater than 2.5 mm, look in limb leads first

Left = P-wave with negative deflection in V1 and a amplitude greater than or equal to 1 mm

Front 47

what ECG finding is indicative of right ventricular hypertrophy?

Back 47

R-wave is greater than or equal to S-wave in V1

Front 48

what ECG finding is indicative of left ventricular hypertrophy?

Back 48

S-wave in V1 plus the R-wave in V5 or V6 is greater than or equal to 35mm

Front 49

what does this ECG show?

Back 49

left atrial enlargement

Front 50

what does this ECG show?

Back 50

right atrial enlargement

Front 51

what does this ECG show?

Back 51

right ventricular hypertrophy

Front 52

what does this ECG show?

Back 52

left ventricular hypertrophy - defined as V1 s-wave + V6 R-wave is > 35mm, which in this case is true

Front 53

a qrs complex greater than .12 seconds usually means?

Back 53

RBBB or LBBB

Front 54

rSR' in V1 with a wide S-wave in I and V6 indicates?

Back 54

RBBB

Front 55

what does the ECG show?

Back 55

RBBB,

notice
- the rSR' in V1
- the wide S-wave in V6
- the wide S-wave in I

Front 56

the patterns shown below are indicative of what?

Back 56

LBBB

Front 57

the patterns shown are indicative of what?

Back 57

RBBB

Front 58

what is shown on this ECG strip?

Back 58

LBBB

Notice
- wide S-wave in V1
- QRS > or equal to .12 seconds
- large R-wave in I and V6 is not obvious but does not exclude diagnosis of LBBB
- There is not rSR' in V1 so this is not RBBB

Front 59

left axis deviation > or equal to -40 degrees, small q-waves in lead I, and rS complex in lead III on and ECG indicate what?

Back 59

Left Anterior Hemiblock

Front 60

anytime you see a left axis deviation greater than or equal to -40 degrees you know it must be?

Back 60

Left anterior hemiblock

Front 61

what does this ECG strip indicate?

Back 61

Left anterior hemiblock

Notice
- positive QRS in lead I and negative QRS in lead aVF indicates left axis deviation
- aVR closest to equiphasic

Front 62

if QRS axis is > or equal to 120 degrees and/or there are small Q-waves in lead III on ECG, what is indicated?

Back 62

Left posterior hemiblock

Front 63

what does this ECG strip indicate?

Back 63

left posterior hemiblock

- notice lower right axis deviation with the most equiphasic lead being lead aVR indicating a greater than 120 degree deviation
- also there is a small Q-wave in lead III

Front 64

a prolonged PR-interval is indicative of?

Back 64

1st degree AV block

Front 65

what are the abnormal rhythms as seen in 2nd degree heart block called?

Back 65

Mobitz 1 (Wenckebach) and Mobitz 2

Front 66

what causes the missed beats in Mobitz 1?

Back 66

progressive AV-block leads to longer and longer PR-interval which eventually the block is so long that the ventricle doesn't contract because the P-wave happens during the T-wave (refractory period)

Front 67

describe the PR-interval in Mobitz 2?

Back 67

normal and nonvariable

Front 68

what causes Mobitz 2?

Back 68

intermittent complete heart block

Front 69

what is shown?

Back 69

2md degree heart block - Mobitz 1

Front 70

what is shown?

Back 70

2md degree heart block: Mobitz 2

Front 71

what is shown?

Back 71

2nd degree heart block: Mobitz 2

Front 72

what is shown?

Back 72

3rd degree heart block: complete heart block

Front 73

what will be seen with complete heart block (3rd degree heart block)?

Back 73

atria contracting at a regular rate/rhythm and ventricles contracting at a regular rate/rhythm that is different than the atrial rhythm and usually slower = result of no AV conduction

Front 74

during 3rd degree heart block if the QRS appears normal looking where is the pacemaker for the ventricles likely found?

Back 74

in the Perkinje fibers close to the AV node

Front 75

what is shown?

Back 75

3rd degree heart block: complete heart block with pacemaker in ventricular tissue rather than the normal conducting system (ex perkinje fibers) - evidenced by abnormal QRS complex

Front 76

what are the 3 premature systolic complexes?

Back 76

1. premature atrial complexes
2. premature junctional complexes
3. premature ventricular complexes

Front 77

what causes premature atrial contractions?

Back 77

pacemaker tissue in the atria acting independently of AV node

Front 78

describe the rhythm of APC's (atrial premature contractions)

Back 78

irregular

Front 79

describe the PR-interval in APC's

Back 79

variable

Front 80

what is shown?

Back 80

premature atrial contraction

notice
- variable P-P interval
- irregular rhythm

Front 81

what is shown?

Back 81

premature atrial contraction

Front 82

what is shown?

Back 82

premature atrial contraction

notice
- the P-wave is so premature it happens during the refractory period thus no ventricular contraction happens and there is a pause in cardiac activity

Front 83

what is shown?

Back 83

atrial bigeminy

Front 84

what is the cause of ectopic atrial tachycardia and how does it present?

Back 84

caused by intermittent ectopic pacemaker activity resulting in fast increases in atrial rhythm accompanied by slower rate increase in ventricular rhythm

Front 85

what is show?

Back 85

ectopic atrial tachycardia

notice
- ventricular tachycardia is at maximum rate

Front 86

if you see a HR lower than 100 with an irregular irregular rhythm and at least three different looking P-waves, what might be wrong?

Back 86

wondering atrial pacemaker (WAP)

Front 87

what is shown?

Back 87

wondering atrial pacemaker

notice
- BPM = less than 100
- irregular irregular rhythm
- 3 different looking P-waves

Front 88

ECG showing greater than 100 BPM, irregular irregular rhythm, and at least three different P-waves is likely to be what?

Back 88

multifocal atrial tachycardia

Front 89

what is shown?

Back 89

multifocal tachycardia

notice
- >100 BPM
- irregular irregular rhythm
- at least 3 different looking P-waves

Front 90

what is shown?

Back 90

multifocal tachycardia

notice
- >100 BPM
- irregular irregular rhythm
- at least 3 different looking P-waves

Front 91

what is shown?

Back 91

atrial flutter = 2:1 block, notice that one of the P-waves falls on top of the T-wave so it is not distinguishable

Front 92

what is shown?

Back 92

atrial flutter - 4:1 block

Front 93

what is shown?

Back 93

atrial fibrillation

notice
- irregular irregular rhythm
- chaotic/indistinguishable P-waves
- QRS normal

Front 94

if you see an ECG strip where the rate and rhythm are irregular and there are many small (rate around 300 per minute) or possibly no distinguishable P-waves, what would you consider?

Back 94

atrial fibrillation

Front 95

when considering lead II, if you see a negative P-wave, no P-wave, or a P-wave which adds to the S-phase of the QRS, you would think of?

Back 95

Premature Junctional Contraction

Front 96

what is the most common finding with a premature junctional contraction on ECG?

Back 96

P-wave is missing because it is buried in the QRS complex

Front 97

what is shown?

Back 97

premature junctional contraction

notice
- inverted P-wave

Front 98

what is shown?

Back 98

premature junctional contraction

notice
- missing P-wave (most common finding)

Front 99

what is the name of the rhythm in which atrial depolarization does not happen and after a pause the AV node initiates a ventricular contraction?

Back 99

junctional escape beat

Front 100

what is shown?

Back 100

junctional escape beat

Front 101

what is shown?

Back 101

junctional rhythm

notice
- missing P-wave
- rate 40-60 BPM

Front 102

if ECG shows a rate of 40-60 BPM, variable P-waves (absent, retrograde, or anterograde), and regular rythm, what do you have?

Back 102

junctional rhythm

Front 103

if ECG shows a rate of 60-100 BPM, variable P-waves (absent, retrograde, or anterograde), and regular rythm, what do you have?

Back 103

accelerated junctional rhythm

Front 104

what is shown?

Back 104

accelerated junctional rhythm

Notice
- distinguished from junctional rhythm by the 60-100 BPM rate

Front 105

if ECG shows an irregular rhythm, periodic wide and abnormal appearing QRS (>.12 seconds), and compensatory pauses between ventricular contractions, what do you have

Back 105

ventricular premature contraction (PVC)

Front 106

what is shown?

Back 106

premature ventricular contraction

Front 107

what is shown?

Back 107

premature ventricular contraction

Front 108

what is shown?

Back 108

ventricular tachycardia

Front 109

what is shown?

Back 109

accelerated idioventricular rhythm

notice
- 40 to 100 BPM
- Wide (> or equal to .12 seconds) QRS with bizarre appearance

Front 110

what looks like v-tach but is slower, usually around 40-100 BPM as compared to 100-200 BPM for V-tach?

Back 110

Accelerated idioventricular rhythm

Front 111

what is the name of the irregular rhythm without P-waves, and has diamond shaped variation in amplitude?

Back 111

Torsade de Pointes

Front 112

describe the P-waves in accelerated idioventricular rhythm?

Back 112

there are none

Front 113

what is shown?

Back 113

Torsade de Pointes

Front 114

what is shown?

Back 114

ventricular fibrillation