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