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53 Cards in this Set
- Front
- Back
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V3 and V4 are oriented where normally?
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over the interventricular septum
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3 different rates of heart?
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atria focie: 60-80
AV juntion: 40-60 Ventricular node: 20-40 |
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numbers to memorize for rate
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300/big boxes
and 300, 150, 100, 75, 60, 50 |
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multifocal atrial tachycardia occurs in what kind of patients?
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COPD patients
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atrial fibrillation
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continuous rapid firing of multiple atrial automaticity foci......no single impulse depolarizes the impulse completely
-110 -will see disorganized pattern between qrs segments |
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escape
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occurs when the SA node stops working properly and another part of the heart takes over
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causes of atrial and junctional foci becoming irritable and producing pre-mature contractions?
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-adrenaline
-increased symphathetic stimulation -caffeine -digitalis -ethanol -hyperthyroidism -low oxygen |
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premature atrial contraction
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-caused by things that create irratable foci
-will have prime p wave -124 |
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premature junctional beat
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-widened qrs because one of the bundle branches is still refractory
-prime p waves 131 |
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causes of ventricular foci being irritable
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-low oxygen
-low potasium -mitral valve prolapse, stretch, myocarditis |
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premature ventricular contraction
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-premature
-very wide qrs with great amplitude -normally opposite the polarity of normal QRSs -135 - |
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how many PVCs per minute is pathologic?
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6
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what common condition can cause PVCs?
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-mitral valve prolapse
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when is it dangerous for a PVC to fall?
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on a patient's T wave
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supraventricular tachycardia
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rate between 150-250
either atrial or junctional in origin set off by stimulus (epi,hyperthyroid, etc.) 153 |
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should you give medication for a SVT to a patient with VT?
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never!!!
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ventricular tachycardia
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-runs of PVCs
-rate of 150-250 -caused by low oxygen and hypokalemia |
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torsades de pointes
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-twisting on points
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Atrial flutter
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250-350 bpm
saw tooth pattern 159 |
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ventricular fibrillation
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-no recognizable pattern or recognizable waves
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junctional focus would produce what kind of P waves?
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-inverted prime p waves
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one more time on afib
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-irregular rate
-no identifiable p waves |
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wolf parkinson white syndrome
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-delta wave
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sick sinus syndrome
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-pts don't have normal escape mechanisms when SA node misses beats....often have bradycardia
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primary AV block
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-PR interval more than 0.2 seconds
-constantly lengthened cycle to cycle |
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Mobitz type 1 block: Wenckebach
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-progressive lengthening of the PR interval until a beat is dropped
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Mobitz type 2 block: Mobitz
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no lengthenizing of the PR interval.....beat just gets dropped
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Third degree heart block
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-p wave does not lead to qrs ever
-junctional or Ventricular focus takes over as pacemaker -186 - |
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how to know if there is a bbb?
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qrs will be greater than 120ms
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RBBB
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-194
-bunny ears or you could fall right in the cave -will see this pattern on v1 and v2 -RR' |
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LBBB
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-194
-upside down L -will see this pattern on V5 and V6 |
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what are the right chest leads?
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v1 and v2
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progression in chest leads of the amplitude of the leads
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-generally goes from negative to possitive with V3 often times equal
-deviation towards V6 indicates deviation on its axis |
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right ventricular hypertrophy
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there is a large R wave in lead V1.....remember this should normally be negative in deflection
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Left ventricular hypertrophy
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-leftward vector
-chest leads all have very large deflections -depth of S in V1 + height of V5.....if greater than 35, there is LVHypertrophy inverted T waves are a common finding |
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ischemia is characterized by what?
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T wave inversion
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Pericarditis
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-ST segment elevation
-tall t wave - -269 |
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subendocardial infarction
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ST depression
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Necrosis of heart tissue
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Q waves.....diagnostic for infarction
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insignificant Q waves
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less than 40ms in duration
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significatn q waves
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greater than 40 ms
or 1/3 of qrs |
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anterior infarction
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-Q waves in V1, V2, V3, or V4
-ST elevation if acute -anterior decending occlusion 280 |
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Lateral infarction
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Q waves in 1 and AVL
-circumflex occlusion 280 |
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Inferior infarction
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Q waves in 2, 3 and AVF
occlusion depends on which is dominant...most people are right dominant 280 |
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posterior infarction
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-looks opposite of anterior infarction
-right coronary artery occlusion -no Q wave and ST depression 280 |
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COPD on EKG
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-low amplitude in all leads
-Right axis deviation |
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Pulmonary Embolus on EKG
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-large s wave in lead 1
-ST depression in lead 2 -Large Q wave in lead 3 with T wave inversion -T wave inversion in V1 through V4 -Right bundle branch block 313 not on list, but probably useful |
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Hyperkalemia EKG
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-peaked T waves
-P wave widens and flattens and can even disappear -QRS widens because depolarization will take longer |
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Hypokalemia EKG
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-U waves
-Flat T wave |
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way to remember hyperkalemia vs. hypokalemia?
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think of the T wave as a wave housing the potassium
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How to examine an EKG
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1) rate (300/big boxes)
2) rhythm (prematurity, pauses, irrgularity, abnormal waves) -check P before each QRS -PR and QRS interval 3) AXIS 4)Hypertrophy -atrial -ventricular 5)Infarction -Q waves -Inverted T waves -ST segment elevation or depression 6)Other -hyperkalemia -Pericarditis -WPW |
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atrial hypertrophy
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-diphasic P waves
-if largest component is on EKGs right (like reading XRay) then it is right atrial enlargement. |
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with STEMI what will happen to the ST segment with time?
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it will return to baseline
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