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74 Cards in this Set

  • Front
  • Back
Name the types of sinus rhythms.
sinus rhythm
sinus bradycardia
sinus tachycardia
sinus arrhythmia
SA block
sinus arrest
List EKG leads and whether they are frontal or horizontal and bipolar or unipolar.
frontal
-bipolar → lead I, II, III
-unipolar → aVL, aVR, aVF

horizontal + unipolar → V1, V2, V3, V4, V5, V6
List the 3 functional activities of the heart.
1. automaticity
2. conductivity
3. contraction
List frontal and horizontal leads and whether they are bipolar or unipolar.
FRONTAL:
bipolar → leads I, II, III
unipolar → aVR, aVL, aVR

HORIZONTAL:
unipolar → V1, V2, V3, V4, V5, V6
List the limb leads.
standard → leads I, II, III
augmented → aVR, aVL, aVF
List the precordial chest leads.
V1, V2, V3, V4, V5, V6
List the steps for interpreting an EKG.
1. rate
2. rhythm → regular or irregular (regularly irregular or irregularly irregular)?
3. p wave → present or absent, upright or inverted, followed by QRS complex?
4. pr interval → 3-5 small boxes, fixed or variable?
5. QRS complex → <3 small boxes?
6. ST segment → isoelectric, elevated or depressed?
7. T wave → upright or inverted?
Describe the characteristics of normal sinus rhythm.
1. rate → 60-100 bpm
2. rhythm → regular
3. p wave → present, upright, followed by QRS complex
4. pr interval → 3-5 small boxes, fixed
5. QRS complex → <3 small boxes
6. ST segment → isoelectric
7. T wave → upright
Torsades des Pointes
What are the EKG changes seen with hyponatremia?
no significant changes
What are the EKG changes seen with hypernatremia?
no signficant changes
What are the EKG changes seen with hypokalemia?
flattened R wave
widened QRS complex
peaked T wave
What are the EKG changes seen with hypokalemia?
flattened or inverted T wave
prominent U wave
What are the EKG changes seen with hypocalcemia?
prolonged QT interval
What are the EKG changes seen with hypercalcemia?
shortened QT interval
What are the EKG changes seen with hypomagnesemia?
diminished p wave
diminished and slightly widened QRS complex
flattened T wave
prominent U wave
What are the EKG changes seen with hypermagnesemia?
prolonged pr interval and QRS complex
elevated T wave
What are the EKG changes seen with digitalis?
downsloping ST segment (think Salvador Dali's mustache)
What does this EKG indicate?
digitalis effect
What leads indicate a bundle branch block?
V1, V2
If a right bundle branch block is present, you cannot diagnose hypertrophy, axis, or MI, true or false?
false
you can't diagnose hypertrophy or axis
but you can diagnose MI
If a left bundle branch block is present, you cannot diagnose hypertrophy, axis, or MI, true or false?
true
What is the intrinsic heart rate of the SA node, atria, AV node, bundle of his, purkinje fibers, and ventricles?
SA node → 60-100
atria → 55-60
AV node → 50-55
bundle of his → 45-50
purkinje fibers → 40-45
ventricles → 35-40
What is overdrive suppression?
Suppression of the automaticity and independent
depolarization of cells with pacemaker potential by
tissues firing at a higher intrinsic rate of automaticity.

This is why the SA node normally functions as the
pacemaker of the heart, despite the presence of
other tissues that possess automaticity.
What is the only route of conduction from the SA node to the left atria?
Bachman's bundle
What is the only route of conduction from atria to ventricles?
bundle of His
Describe Einthoven's Triangle.
artifact
List common causes of artifact.
AC interference
loose electrode or broken wire
muscle tremor
What are the 4 ways to calculate rate?
1. 6 second method → count number of QRS complexes in 30 boxes → multiply by 10
2. large box method → count number of large boxes between 2 QRS complexes → divide by 300
3. small box method → count number of small boxes between 2 QRS complexs → divide by 1500
4. sequence method → count down 300-150-100-75-60-50-43 (each number falls on a big box starting at a QRS complex and ending at the next one)
What is the only method you can use to calculate rate if the rhythm is irregular?
6 second method
Describe the characteristics of sinus bradycardia.
1. rate → <60 bpm
2. otherwise normal

*can be clinically normal in athletes or during sleep
Describe the characteristics of sinus tachycardia.
1. rate → 101-180
2. otherwise normal
What are the characteristics of sinus arrhythmia?
irregular discharge of SA node
sinus bradycardia
sinus tachycardia
sinus arrhythmia
Is sinoatrial block an automaticity or conductivity problem?
conductivity → impulse generated by SA node but not conducted to atria
Is sinus arrest an automaticity or conductivity problem?
automaticity → impulse failed to generate
What are the characteristics of sinoatrial block?
appears as missed beat
underlying rhythm not reset
What are the characteristics of sinus arrest?
does not correspond with missed beat
underlying rhythm may be reset with ectopic pacemaker
sinoatrial block
sinus arrest
What are the rates of idioatrial, idiojunctional, and idioventricular rhythms?
idioatrial → 60-80
idiojunctional → 40-60
idioventricular → 20-40

*can be accelerated above inherent rate
How do you differentiate between PJCs and PVCs?
both have no p wave
PJCs → QRS complex <3 small boxes
PVCs → QRS complex >3 small boxes
Which atrial dysrhythmias are due to altered automaticity and which are due to reentry?
altered automaticity → PACs, wandering pacemaker, MAT, A-fib
reentry → SVT → AVNRT, AVRT, WPW, A-flutter
What are the characteristics of PAC?
atrial ectopic focus
premature beat
p wave present but morphology different than other p waves
resets underlying rhythm
PAC
What are the causes of PAC?
often innocuous
may be caused by stress, fatigue, atrial enlargement, ischemia, CHF, hyperthyroidism, electrolyte disturbance, drug use, digitalis toxicity
Palpitations may indicate what type of rhythm?
PAC
What are the characteristics of wandering pacemaker?
SA node alternating with ectopic atrial foci
rate <100
p wave morphology varies
What are the characteristics of multifocal atrial tachycardia?
same as wandering pacemaker except rate >100
requires 3 different p wave morphologies
Multifocal atrial tachycardia is commonly seen in what patient population?
COPD
MAT
wandering atrial pacemaker
Wolf-Parkison-White is a type of what type of dysrhythmia?
AVRT
What are the characteristics of WPW?
no pr interval
wide QRS complex and delta wave
atrial flutter
What are the characteristics of atrial flutter?
reentrant circuit in atria
regular rhythm
sawtooth pattern of p waves
Is atrial flutter characterized by a regular or irregular rhythm?
regular
How is atrial fibrillation managemed?
B-blockers, CCB, digoxin, warfarin
What are the characteristics of atrial fibrillation?
irregularly irregular
no distinct p waves
atrial fibrillation
The AV node contains pacemakers cells, true or false?
false!
What are the EKG characteristics of PJC?
p wave absent, inverted, or after QRS complex due to retrograde conduction
pr interval shortened
junctional rhythm
What are the rates of junctional escape rhythm, accelerated junctional rhythm, junctional tachycardia?
junctional escape rhythm → 40-60
accelerated junctional rhythm → 61-100
junctional tachycardia → >100
What are the characteristics of junctional rhythms?
rhythm regular
p waves inverted, absent, or after QRS complex
What is sick sinus syndrome?
tachy-brady syndrome
alternating sinus bradycardia or junctional rhythm with atrial fibrillation
What are the characteristics of PVCs?
rhythm irregular
inverted T wave
What is an R-on-T PVC?
PVC that occurs during T wave
can cause V-tach or V-fib
What are the causes of pulseless electrical activity?
use the mnemonic MATCHED

M - MI
A - acidosis
T - tension pneumothorax
C - pericardial tamponade
H - hypoxia, hypthermia, hypokalemia, hypovolemia (most common)
E - PE
D - OD
What is the double-thumbs up sign?
refers to axis deviation
both lead I and aVF QRS complexes are positive
so no axis deviation
ventricular tachycardia