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97 Cards in this Set

  • Front
  • Back
SA node rate
80-100
Av node rate
40-60
Perkinje fiber rate
20-40
Absolute refractory
-period of time when the node cannot fire again
-from Q to T
Relative refractory
-period of time when the node can fire, but won't be as strong of a contraction
-T wave
R on T phenomenon
-PVC hits right on the T wave
-can make you fibrillate
-electrical problem
artifact
False waves or abnormalities of the baseline due to sources other than the patient’s bioelectrical impulses
60 cycle
A particular kind of artifact secondary to ungrounded equipment or overhead flourescent lighting
NL sinus rhythm
-Regularity: Regular
-Rate: 60-100 beats per minute
-P Wave: Normal and upright; one P wave in front of every QRS complex
-PRI: .12-.20 seconds and constant
-QRS: less than .12 seconds
Sinus bradycardia
-Regularity: regular
-Rate: less than 60 beats per minute
-P Wave: normal and upright; one P wave in front of every QRS complex
-PRI: .12-.20 seconds and constant
-QRS: less than .12 seconds
Narrow QRS tach
-sinus tach
-atrial tach (pwaves disappear)
-SVT (great than 250 bpm)
Wolff-Parkinson-White
-Malignant SVT
-No Ca+ Channel Blockers
-Structural Defect (Bundle of Kent)
-see a delta wave
Sinus arrhythmia
-Regularity: irregular
-Rate: 60-100 beats per minute
-P Wave: normal and upright; one P wave in front of every QRS complex
-PRI: .12-.20 seconds and constant
-QRS: less than .12 seconds
atrial flutter
-Rhythm: atrial rhythm is regular; ventricular rhythm is usually regular but can be irregular if there is variable block
-Rate: atrial rate 220-350 beats per minute; ventricular rate varies
-P Wave: characteristic sawtooth pattern (F waves)
-PRI: unable to determine
-QRS: less than .12 seconds
A fib
-loss of atrial kick
-high risk of CVA
-Rhythm: grossly irregular, irregularly irregular
-Rate: atrial rate greater than 350 beats per minute; ventricular rate varies greatly
-P Wave: no discernible P waves; atrial activity is referred to as fibrillatory waves (F waves)
-PRI: unable to measure
-QRS: less than .12 seconds
-tx: digitalis
Wandering pacemaker
-different cells in the atria are firing spontaneously
-different looking pwaves
-electricity will not help
Multifocal Atrial Tachycardia
-wandering pacemaker going really fast
junctional rhythm
-Regularity: regular
-Rate: 40-60 beats a minute
-P Waves: will be inverted; can fall before, during, or after the QRS complex
-PRI: can be measured only if the P wave precedes the QRS complex; if measurable, will be less than .12 seconds
-QRS: less than .12 seconds
-SA node is typically not firing
junctional tach
-Regularity: regular
-Rate:100-180 beats per minute
-P Waves: can be inverted; can fall before, during, or after the QRS complex
-PRI: can be measured only if the P wave precedes the QRS complex; if measurable, will be less than .12 seconds
-QRS: less than .12 seconds
Ventricular rhythms
-Idioventricular
-Agonal
-Asystole
-Ventricular tachycardia
-Torsades des Pointes
-Ventricular Fibrillation
Idioventricular rhythms
-impulse starts in the ventricle
-get wide QRS's
-rhythm is regular
-commonly seen in PEA
Ventricle asystole
-electrical standstill
Agonal beats
-wide QRS that comes along every once and a while
-sign of the brkdn of Na/K pump
V tach
-hallmark: slow and wide QRS
-QRS sometimes inverted
-terminal event (will go to v fib and then asystole)
What signs will denote V tach over SVT?
-AV dislocation
-Josephson's sign
-axis in extreme right quadrant
-Brugada's sign
- + or - concordance
Brugada's sign
-refers to the distance of at least 0.10 seconds from the onset of the QRS complex to the nadir of the S wave
Josephson's sign
-notch in the downstroke of the S wave
Postive or negative concordance
-all QRS's are facing either all up or all down in all leads
torsades de pointes
-polymorphic v tach
-causes of "twisting of the points" of the QRS's
-can tx w/ magnesium sulfate
V Fib
-more irregular than torsades
monophasic defibrillator
-Traditional Defibrillator
-shock from paddle A to paddle B
-short/intense pulse @ 200 - 360 joules
biphasic defibrillator
-direction of current is reversed midway through the pulse
-impedance controlled defibrillation
ectopy
-something where it doesn't belong
-PAC
-PVC
-PJC
difference between PAC and PJC
-PJC's have no P waves
Run of V tach
-more than one QRS in a row
1st degree HB
-impulse held at A/V junction longer then usual
-PR interval >0.20 secs
-no sxs
2nd degree type I HB
-aka Wenchebach
-Progressive lengthening of PR interval until a beat drops
-regularly irregular
2nd degree type II HB
-Some beats get through the junction, some don’t
-very variable
3rd degree HB
-aka CHB
-No atrial beats are conducted to the ventricles
-2 events seen: P waves at one rate, QRS complexes (idioventricular) at another rate
Three types of pacemakers
-atrial, ventricle, A/V sequential
Three letter classification of pacemakers
1st: which chamber is being paced (A,V,D)
2nd: which chamber is being 'sensed' (A,V,D)
3rd: which chamber is triggered or inhibited (I,D)
ex: VVI pacemaker
-the ventricle is being paced, sensing the ventricle beat, and is inhibited by the ventricle beat (?)
width and height of the big blocks
-0.2 s wide
-0.5 mV high
width and height of the small blocks
-0.04 s wide
-0.1 mV high
What is the distance btwn the marks at the top of the paper?
-3 s apart
How to calculate bpm
-count the number of complexes taht fall w/in two marks x this number by 10
NL PRI
-0.12-0.2 s
NL PQI
-0.12-0.2 s
NL QRS interval
-0.08- 0.12 s
NL QTI
-0.33- 0.42 s
Triplicate method of counting bpm
-count the number of big blocks btwn two similar landmarks
-300/150/100/75/60/50
another method of counting bpm (not used very often)
-count the number of small boxes btwn two consecutive R waves and divide by 1500
What EKG signs are reversible
-ischemia, injury
What EKG sign is permanent
-infarcation
What are the four walls of the heart?
-anterior
-posterior
-lateral
-inferior
What does the RCA supply?
-the inferior wall
-RA
-RV
-Intra-atrial septum
-RV Papillary Muscles
-AV Node
-SA Node
What does the LAD supply?
-anterior wall
-LV
-Intraventricular Septum
-LV anterior papillary muscles (Mitral valve)
-Bundle of His
What does the circumflex supply?
-the lateral wall
-LA
-LV
-SA Node
What are the types of leads of the 12 lead?
-Bipolar leads (I, II, III)
-Augmented leads (AVR, AVL, AVF)
-V leads (V1-6)
T/F: Some of the leads cover the posterior wall of the heart.
False: can't see what's going on back there
What denotes NL lead II complexes?
-good Ps
What denotes NL AVR complexes?
-the complexes are upside-down
What denotes NL AVF complexes?
-they are small
What denotes typical V lead complexes?
-the Rs of the complexes get larger and the Ss get smaller as you progress from V1-6
What is the AVR lead for?
-AVR is non-diagnostic
-if it's upside-down, you have the leads on correctly
What leads show complexes of the inferior wall?
-Leads II, III, and AVF
What happens with inferior wall distress?
-bradycardia, barfing, and blocks
-effects the conduction system more than the pump
What leads show complexes of the anterior wall?
-V1-V2 - Septum
-V3-V4 - Anterior Wall
-V5-V6 - AnteroLateral
What might arise from anterior wall distress?
-Pump Failure
-Ventricular Aneurysm
-Dysrhythmias
-Sinus Tachycardia
What leads show complexes of the lateral wall?
-I and AVL (refer to V5 and 6)
What is indicative of ischemia?
-alteration of repolarization
-flipped T waves
-possible ST depression
What is indicative of injury?
-alteration of NL polarization
-ST elevation
-may involve the T wave
What is indicative of infarction?
-pathological Qs
-1/3 total QRS ht
->0.04 mm (1 small block)
How do you see AMI?
-ST elevation >1 mm
-3 contiguous leads
-start at the J point
What is a reciprocal change?
-Any change in electricity on one side of the heart will cause the opposite change on the other side.
What walls are reciprocal to each other?
-anterior to posterior
-lateral to inferior
What effects does Digitalis have on EKGs?
-causes ST depression in all leads
-Q-T interval also shortens
What is a subendocardial infarction?
-Infarcted tissue that doesn’t go through the complete thickness of the myocardium
-ST depression in a specific wall and isn't a reciprocal change
What is a bundle branch block?
-A complex travels more slowly down one bundle than the other
Describe the QRS complex of a BBB
-QRS > 0.12 sec
in all leads
-“Notched” QRS in V1-V2 for Right and V5-V6 for Left
Describe the 'signal rule' when determining the side of a BBB
-look at the terminal component of V1:
-goes down: left BBB
-goes up: right BBB
What is a hemiblock of the bundle branches?
-when either the anterior or posterior fasicle of either the right or left branch is blocked
What is indicative of RAH?
-biphasic 'P'
-tall inital component
What is indicative of LAH?
-biphasic 'P'
-wide terminal component
What is indicative of LVH?
-S wave in V1 plus R wave in V5 > 35mm
-inverted T waves in V5 and 6
NL axis
-starts in the RA and goes to the LV
Axis will shift towards______
-hypertrophy
-LVH: shifts axis more to the left
-RVH: shifts axis more to the right
Axis will shift away from _____
-infarction
--lateral (left) wall infarction shifts axis to the right
-inferior (right) wall infarction shifts axis to the left
What might cause a left axis shift?
-Obesity/Pregnancy
-Right Tension Pneumothorax
-Right Infarction
-Left Hypertrophy
what might cause a right axis shift?
-Right Hypertrophy (Cor Pulmonale)
-Left Infarction
-Left Tension Pneumothorax
What might cause an extreme left axis shift into NML?
-Combination pathologies
Global Infarction (lat, ant, inf, infarction)
Which leads do you look at to determine the axis?
-lead 1 and AVF
Directions of the compleses in the leads for a NL axis
-lead 1 up
-AVR up
Directions of the complexes in the leads for a right shift of the axis.
-lead 1: down
-AVF: up
"right for each other"
Directions of the complexes in the leads for a left shift of the axis.
-lead 1: up
-AVF: down
"left each other"
Directions of the complexes in the leads for a NML shift of the axis.
-lead 1: down
-AVF: down
40% of those having a LVMI are also ______
-having a RVMI