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58 Cards in this Set

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  • Back
normal ecg parameters (10 points)?
1. 12 leads present
2. rhythmic
3. heart rate= 60-100bpm
4. source is sinus node
5. PRint= .12-.2s
6. QRS= .08-.12s, R increases from V1-V6 (smaller than S in V1 and V2 but bigger in V5 and V6), R is less than 25mm, S is less than 25mm
7. STseg= neither elevated nor depressed
8. T wave= not greater than 1/2 of QRS, inverted in avR and V1, III (with small Q and goes away if breath is held), V2 (young people), and V3 (blacks)
9. QTint= .35-.43s (inversely proportional to heart rate)
10. MEA= 0-90 degrees (-values L shift, +values R shift)
possible problems if abnormal QRS?
incorrect calibration, LVH/RVH, posterior MI, WPW, dextrocardia, BBB
possible problems if elevated or depressed STseg?
elevated: AMI, prinzmetal's angina, pericarditis, LV aneurysm, high take-off
depressed: ischemia, posterior AMI, digitoxin/quinidine, LVH/RVH + strain
possible problems if T is too tall, too small, or inverted?
tall: hyperkalemia, AMI (posterior in ant.leads V1-V3, anterior in ant.leads V1-V3)
small: hypokalemia, pericardial effusion, hypothyroidism
possible problems if QTint is shorter or longer?
shorter: hypercalcemia, digoxin
longer: hypocalcemia and acute myocarditis (maybe also, AMI, cerebral injury, LVH/RVH, hypothermia)
describe how the leads look at the heart.
4 limb electrodes to create 6 limb leads: coronal plane
I - straight L
II - R foot
III - L foot
avR - R shoulder
avL - L shoulder
avF - inferior surface
6 chest leads: transverse plane
V1 - big L angle
V2 - small L angle
V3 - anterior surface
V4 - LV anterior surface
V5 - small R angle
V6 - big R angle
______________________________
positive deflection= electrical impulse flowing towards the lead
describe how the impulses are generated from the sinus node, atrioventricular node, and from various ecotopic sites.
sinus node= 60-100bpm; you're seeing the atrial depolarization as the P wave
atrioventricular node= 40-60bpm; you're seeing the PRint as the time it delays the electrical impulse in case of rapid beats + depolarization traveling from SA, through the atria, and through the AV
bundle of His= down the septum with the left side first, seen as Q wave, R wave (bigger because LV depolarization is bigger than RV), and S wave (bigger in R sided leads because LV depolarization moves away from them) as seen as a transition in the chest leads
ectopic sites= irregular QRS morphology
describe the repolarization.
STseg= transient period where no impulses are passed
T wave= repolarization of ventricles
QTint= total time for reactivating the ventricles and recovery to resting state
U wave= septum repolarization or slow repolarization of ventricles, seen in V2-V4
3. heart rate
which conditions present with bradycardia?
(less than 6 QRSs in 6s)
1. sinus bradycardia
2. sick sinus syndrome
3. 2nd/3rd degree AV block
4. escapes: AVj(x), ventricular, asystole
5. beta blockers, calcium antagonists, digoxin, adenosine
3. heart rate
which conditions present with tachycardia?
(more than 10 QRSs in 6s)
NARROW: supraventricular
1. sinus tachycardia
2. atrial tachycardia
3. atrial flutter
4. atrial fibrillation
5. AV re-entry tachycardia
BROAD: ventricular
1. supraventricular causes if abberent conduction is also present
2. ventricular tachycardia
3. accelerated idioventricular rhythm
4. torsades de pointes
CHAOTIC:
1. ventricular fibrillation
4. sinus rhythm
sinus bradycardia
1.
2.
3. less than 60bpm
4.
5.
6.
7.
8.
9.
10.
causes? digoxin, beta blockers, ischemia, MI, hypothyroidism, hypothermia, obstructive jaundice, uraemia, high intracranial pressure, SSS, K+/Ca2+ abnormalities
4. sinus rhythm
sinus tachycardia
1.
2.
3. more than 100bpm
4.
5.
6.
7.
8.
9.
10.
causes? anxiety, pain, fear, fever, exercise, adrenaline, alcohol, ischemia, AMI, heart failure, pulmonary embolism, fluid loss, anaemia, hyperthyroidism
4. sinus rhythm
sinus arrhythmia
1.
2. arrhythmic
3. 75bpm and 90bpm
4.
5.
6.
7.
8.
9.
10.
causes? under the age of 40, inspiration/expiration and harmless
4. sinus rhythm
sick sinus syndrome (SSS)
1.
2. arrhythmic
3. sinus bradycardia, then sinus tachycardia as an escape, atrial escape if sinus arrest, sinoatrial block with gaps may occur, +/- atrial tachycardia, atrial flutter, atrial fibrillation, AV node blocks
4.
5.
6.
7.
8.
9.
10.
causes? fibrosis of sinus node and conducting system, ischemia, digoxin, quinidine, beta blockers, cardiomyopathy, amyloidosis, myocarditis
4. non-sinus rhythm
atrial tachycardia
1.
2.
3. more than 100bpm (120-250bpm but above 200bpm AV block occurs to delay this)
4. atrial ectopic= abnormally shaped P waves
5.
6.
7.
8.
9.
10.
causes? digoxin, ischemia, rheumatic heart disease, cardiomyopathy, SSS, COPD
4. non-sinus rhythm
atrial flutter
1.
2. rhythmic
3. 300 F waves/m with 150/100/75bpm (so 5 flutter waves/s and 2:1, 3:1, or 4:1 QRS rate respectively because of an AV block to delay this)
4. re-entry circuit within the atria every .2s (1 node with extra conduction fiber)
5.
6.
7.
8.
9.
10.
causes? (same as fibrillation) hypertension, ischemia, hyperthyroidism, SSS, alcohol, rheumatic mitral valve disease, cardiomyopathy, atrial septal defect, pericarditis, myocarditis, pulmonary embolism, cardiac surgery, idiopathic waves
measuring? carotid sinus massage or adenosine will highlight this change by increasing the degree of AV block and making the sawtooth baseline easier to see; also, converted to sinus rhythm with DC cardioversion and overdrive atrial pacing
4. non-sinus rhythm
atrial fibrillation
1.
2. arrhythmic
3. 350-600 f waves/m with 120-180bpm
4. no P waves because multiple atrial ectopics cause only low-amplitude oscillations
5.
6.
7.
8.
9.
10.
causes? (same as flutter) hypertension, ischemia, hyperthyroidism, SSS, alcohol, rheumatic mitral valve disease, cardiomyopathy, atrial septal defect, pericarditis, myocarditis, pulmonary embolism, cardiac surgery, idiopathic waves
variations? paroxysmal, permanent, or persistent
4. sinus rhythm
AV re-entry tachycardia (WPW)
1.
2. rhythmic
3. episodes 188bpm (lose delta wave)
4. P wave is after the RS
5. narrow RS complexes
6.
7.
8.
9.
10.
causes? second pathway inside AV node (dual) or outside of AV node (accessory) leading to re-activation of AV node= WPW
4. non-sinus rhythm
AV nodal re-entry tachycardia
1.
2.
3. 130-250bpm
4. sinus but inverted P not always seen (maybe after the QRS)
5.
6. narrow QRS complexes (broad if existing with BBB, looking similar to VT)
7.
8.
9.
10.
causes?
4. non-sinus rhythm
ventricular tachycardia
1.
2.
3.
4. more than 120bpm
5.
6. broad QRS
7.
8.
9.
10.
causes? re-entry circuit, increased automaticity of ventricular focus, AMI, ischemia, hypertrophy, dilation, mitral valve prolapse, myocarditis, congenital heart disease, electrolyte disturbance, pro-arrhythmic drugs, idiopathic
4. non-sinus rhythm
accelerated idioventricular rhythm
1.
2.
3. 60bpm (slow form of VT)
4. ventricular focus
5.
6.
7.
8.
9.
10.
causes? infarcted area acts as ventricular focus, AMI
4. non-sinus rhythm
torsades de pointes
1.
2.
3. 270bpm (polymorphic form of VT that can lead to V fibrillation)
4.
5.
6. broad QRS
7.
8.
9.
10.
causes? anti-arrhythmic drugs, electrolyte abnormality, hereditary syndromes, +/- long QT interval
4. non-sinus rhythm
ventricular fibrillation
1.
2. arrhythmic
3.
4. ventricular foci (medical emergency)
5.
6. chaotic QRS complexes
7.
8.
9.
10.
causes? AMI, electrolyte and acid-base abnormalities usually follow
5. PRint conduction disturbance
sinoatrial block: 1st,2nd,3rd
1.
2. irregularly regular
3.
4. occassional missing P waves but still sinus otherwise
5. failure of P wave, followed by gap, then next P as expected
6.
7.
8.
9.
10.
causes? problem with the sinus node
5. PRint conduction disturbance
atrioventricular block: 1st, 2nd:mobitz 1,2,2:1, 3rd, high grade
1.
2.
3.
4.
5. longer PRint (varies with each type)
6. some QRS fail to be conducted
7.
8.
9.
10.
causes? problem with the bundle of his
6. QRS conduction disturbance
bundle branch block or left sided hemiblock
1.
2.
3.
4.
5.
6. 2 R peaks in one complex (the mirror of 2 S is seen in the opposite chest leads)
7.
8.
9.
10.
causes?
2. rhythmic
escape rhythms
1.
2.
3. 40-60bpm AV, less than 40bpm ventricular
4. if no P wave because sinus fails, then atrioventricular junction or ventricles create the impulse rhythm
5. none
6. AV is identical, V is broad QRS
7. scooped if ventricular
8.
9.
10.
causes?
2. arrhythmic
ectopic beats
1.
2.
3.
4. if sinus, then P, but otherwise AV or ventricular, both of which may travel retrograde and create inverted P waves
5.
6. earlier than expected; narrow if AV and broad if ventricular
7.
8.
9.
10.
causes?
10. mea
quick method of determining?
if QRS in lead I=positive, then axis is between +/-90 (perpindicular) and if in lead II=positive, then axis is between -30/+150. combined, it only leaves the area between -30 and +90, which is normal.
I+,II- = left axis deviation
I-,II+ = right axis deviation
10. mea
which diseases associated with left axis deviation?
1. LAHB
2. WPW
3. inferior MI
4. ventricular tachycardia
10. mea
which diseases associated with right axis deviation?
1. RVH
2. WPW
3. anterolateral MI
4. dextracardia
5. LPHB
4. sinus impulse
what can cause the P wave to be absent?
1. no coordinated atrial activity= atrial fibrillation, sinus arrest, SA block, hyperkalemia
2. they're hidden by= AV or ventricular tachycardia (escape rhythm); VT also produces post-QRS P waves via retrograde conduction; atrial flutter
*** if intermittently absent= sinus arrest or SA block
4. sinus impulse
what can cause the P wave to be inverted?
1. abnormal atrial depolarization= atrial ectopics, AV junctional rhythms, VT, V ectopics
2. dextrocardia
4. sinus impulse
what can cause the P wave to be too tall?
right atrial enlargement.

causes? pulmonary hypertension, pulmonary stenosis, tricuspid stenosis
4. sinus impulse
what can cause the P wave to be too wide?
left atrial enlargement.

causes? mitral valve disease, LVH (from hypertension, aortic valve disease, hypertrophic
5. PRint
what can cause this to decrease?
1. AV junctional rhythm, AV ectopic beats, AV re-entry tachycardia
2. WPW
3. LGL
6. abnormal QRS morphology
what can cause pathological Q waves?
= deeper than 2 squares, more than 1/4 the height of R wave, or more than 1 square wide
1. MI (necrosis)
2. LVH (septal hypertrophy)
3. BBB
4. pulmonary embolism (if in lead III)
6. abnormal QRS morphology
what can cause the QRS to be too big?
= less than 25mm high, bigger than S in V5 and V6, smaller tha S in V1 and V2
1. VH
2. posterior MI (tall R in V1)
3. WPW (tall R in V1)
4. dextrocardia
5. BBB (if wide as well)
6. abnormal QRS
left ventricular hypertrophy
1.
2.
3.
4.
5.
6. deep S in R sided leads and tall R in L sided leads
7. depression (strain)
8. inverted (strain)
9.
10. L deviation
causes?
6. abnormal QRS
right ventricular hypertrophy
1.
2.
3.
4.
5.
6. deep S in L sided leads and tall R in R sided leads
7. depression (strain)
8. inverted (strain)
9.
10. R deviation
causes? may occur with RBBB; pulmonary hypertension, pulmonary sclerosis
6. abnormal QRS
WPW
= bundle of Kent accessory pathway in the left side that bypasses AV node/bundle of his, to directly connect the atria and ventricles
1.
2.
3.
4.
5. shorter
6. tall R in R sided leads or deep S in L sided leads (depends on where is access. pathway - it's the opposite side)
7.
8.
9.
10. R deviation
causes?
6. abnormal QRS morphology
what can cause the QRS to be too small?
1. obesity
2. emphysema
3. pericadial effusion
6. abnormal QRS morphology
what can cause the QRS to be too wide?
= conduction through the ventricles is slower than usual, depolarization may take an abnormal route
1. BBB
2. ventricular rhythms
3. hyperkalemia
6. abnormal QRS morphology
what can cause either RBBB or LBBB, and what's the clinical significance of each?
1. ischemia
2. cardiomyopathy
3. atrial septal defect
4. massive pulmonary embolism
= very common in normal hearts, during SVT
1. ischemia
2. cardiomyopathy
3. LVH (from hypertension or aortic stenosis)
4. fibrosis of the conduction system
= more disastrous, with AMI or thrombolysis and renders the ECG unable to be analyzed further
6. abnormal QRS morphology
what can cause the QRS to be abnormal?
1. incomplete BBB
2. fascicular block (slurred or notched QRS)
3. WPW (additional delta wave along with short PRint)
7. abnormal STseg
what can cause it be elevated?
1. AMI (acute and subacute)
2. LV aneurysm
3. prinzmetal's angina
4. pericarditis
5. high take-off (normal variant)
6. aortic dissection
what markers and clinical modifications should be present with myocardial infarctions?
risk factors= smoking, hypertension, DM, hyperlipidemia, age, males, family history
measurable markers=
1. troponin I/T and CK-MB at 24h (troponin decreases until 6 days after; CK-MB decreases until 3rd day)
2. AST at 30h (decreases until 5 days after)
3. LDH at 48h (decreases until 6 days after)
how can you localize myocardial infarctions within the left ventricle?
= find the leads with STseg elevation or the mirror of it

1. anterior: V1-4
2. lateral: I, avL, V5-6
3. anterolat.: I, avL, V1-6
4. inferior: II, III, avF
*5. posterior: V1-4 depression
7. abnormal STseg
what can cause its depression?
1. ischemia (most common change)
2. posterior AMI
3. digoxin, quinidine
4. VH with strain
what is digoxin and what are it's effects?
= anti-arrhythmic drug
1. STseg depression "reverse tick" into negative T wave, especially if tall R
2. reduced T wave
3. QTint shortening
8. abnormal T wave
what causes it to be too tall?
1. hyperkalemia
2. AMI (also, hyperacute)
3. normal varient, best to compare readings at different times
8. abnormal T wave
what causes it to be too small?
1. hypokalemia
2. pericardial effusion
3. hypothyroidism
8. abnormal T wave
what causes it to be inverted?
1. ischemia
2. MI
3. VH with strain
4. digoxin
5. normal variant (avR, V1, V2 (kids), V3 (blacks))
6. with BBB
7. with pericarditis
non-diagnostic ecg appearance:
8. hyperventilation
9. mitral valve prolapse
10. pulmonary embolism
11. subarachnoid hemorrhage
9. abnormal QTint
what can cause it to be shorter than .35s?
1. hypercalcemia
2. digoxin
3. hyperthermia
9. abnormal QTint
hypercalcemia
1.
2.
3.
4.
5.
6.
7.
8. early ventricular repolarization; maybe prominent U wave
9. shortened
10.
causes? hyper PTH, malignancy, excessive vit.D, sarcoidosis, thyrotoxicosis
9. abnormal QTint
what causes it to be longer than .43s?
1. hypocalcemia
2. anti-arrhythmic drugs: quinidine, procainamide ** also seen with torsades de pointes
3. acute myocarditis
4. hereditary syndromes
* maybe: AMI, cerebral injury, hypertrophic cardiomyopathy, hypothermia
8. abnormal T wave
when will a U wave be present?
1. hypercalcemia
2. hypokalemia
3. hyperthyroidism
** is isn't diagnostic, instead, just a clue.
8. abnormal T wave (with U wave)
hypokalemia
1.
2.
3.
4.
5. 1st degree AV block
6.
7. depression
8. small T, with U
9.
10.
causes?