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89 Cards in this Set
- Front
- Back
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Inferior Leads
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Lead II
Lead II Lead AVF |
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Left Lateral Leads
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Lead I
Lead AVL |
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I small box is ___ sec
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0.04
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I large box is ___ sec
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.2
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True or False
P wave includes the AV node and the atrium |
FALSE
- P wave does NOT include the AV node JUST the atrium |
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what represents after depolarization and before repolarization (dysfunction is myocardium of the heart will change it)..will tell you if there is acute injury or ischemia
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ST segment
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QT interval
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time it takes to conduct and repolarize the heart
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What is the rate of the large boxes ..count them off
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300
150 100 75 60 50 43 |
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SA node BPM
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60-100
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AV Node BPM
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40-60
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Ventricle BPM
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40 or less
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BPM- sinus bradycardia
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<60 BPM
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BPM normal sinus rhythm
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60-100
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BPM sinus tachycardia
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>100 BPM
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Normal” Junctional Rhythm
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< 60
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Accelerated JR
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60-100
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Junctional Tachycardia
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> 100
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Ectopic Atrial Rhythm
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45-55
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Accelerated Atrial Rhythm
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55-100
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Atrial Tachycardia
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100-250
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Atrial Flutter BPM
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250-350
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Atrial Fib.
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>350
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Idioventricular Rhythm
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20-40
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AIVR
(acclereated Idioventricular rhythm) |
40-100
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V-Tachycardia
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100-250
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V-Flutter
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250-350
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V-Fibrillation
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>350
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polymorphic ventricular tachycardia associated with a prolonged QT interval
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Torsades Des Pointes
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ECG of Atrial Flutter
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QRS is slow but the P wave is fast
P wave btwn 250-350 |
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ECG of Atrial Fibrillation
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P wave faster than 350
no pattern to QRS - irregular no discrete P waves |
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ECG ventricular tachycardia
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Upside down QRS and they are very wide
- regular rhythm |
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ECG accelereated junctional rhythm
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- dont see P waves
- regular rhythm - rate >60 |
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SVT ECG
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AV node re-entry tachy
normal sinus QRS looks the same and suddenly burst into rapid firing and lose P waves (only rhythm distrubance at the AV node) |
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PVC ECG
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sinus rhythm but ectopic beats get thrown in and dysrupt sinus rhythm
- ventricular beats have a wider complex (if from atrium you have a narrow complex) |
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Multifocal Atrial Tachycardia
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QRS - very irregular
P waves look like A fib but you actually have a P wave for each QRS but they are all different |
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1st degree AV Node Block
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most common and least pathologic..sometimes can be normal
- the length of time to get through AV node is longer that it should be BUT every P wave gets through the AV node and no dropped beats .. PR less than 200milliseconds |
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2nd Degree AV Node Block
- Mobitz Type I (Wenckebach) |
progressive prolongation of the PR interval that gets so long that the P wave gets dropped
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2nd Degree AV node block
- Mobitz Type II (2:1 heart block) |
fixed PR interval and all of a sudden get a dropped P wave (Worse than type I)
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3rd Degree AV block
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-No association between atrium and ventricle
-Independent atrial and ventricular rhythms -Ventricular rate is usually SLOWER than atrial rate |
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AV dissociation
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-No association between atrium and ventricle
-Independent atrial and ventricular rhythms -Ventricular rate is usually FASTER, than atrial rate |
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1st degree AV block
PR > ___ sec |
0.20 seconds
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Mobitz I
- PP interval : - PR interval : - RR interval: |
PP - same
PR- increase RR - decrease Drop beat |
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Mobitz II
- PP interval: - PR interval: - RR interval: |
PP- same
PR- same RR - same Drop Beat (ex: 3 P waves for every QRS) |
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Primary Changes to the T-wave
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A. Due to an abnormality primarily in repolarization
B. T axis is similar to QRS axis C. T wave inversion is symmetrical EX: Ischemia and Injury |
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The only part of an ECG that enables you to ID ischemia
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ST segment
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Secondary Changes to the T-wave
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A. An abnormality in depolarization causes an abnormality in repolarization
B. T axis is OPPOSITE to the QRS axis (180 degrees) C. T wave inversion is asymmetrical Examples: LVH, RVH, LBBB, RBBB, WPW, PVC |
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PR interval ___ to ___ sec
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0.12 to .20 sec
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PR >.20 =
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1st degree AVB
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PR <.20 =
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Preexcitation
WPW, Lown-Ganong-Levine |
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QRS interval is between ___ and __ sec
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0.08 to 0.10 sec
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QRS >.12 =
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RBBB
LBBB PVC |
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QTc interval ___ to __ sec
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0.36 to 0.45 sec
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QTc <0.36
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Hypercalcemia
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QTc > 0.45
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- decrease Ca, K , Mg
- congenital prolonged QT - MVP |
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R on T
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PVC landing on a T wave can result in ventricular tachycardia and/or torsades
- the vulnerable period gets stimulated again (2nd 1/2 of the T wave) |
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P waves - LAA
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lead V1- bi-phasic Pwave (Nadir; >1 box deep and >1 box wide)
lead II- Notched P >0.12 |
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P waves - RAA
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Lead V1- mostly upright
Lead II - peaked >2.5 boxes tall |
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Definition of an abnormal Q wave
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> 0.03 Seconds (1 box wide)
> 1/4 to 1/3 height of R wave in the same lead seen in more than a single lead - has to be neighboring leads |
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location of abnormal Q wave correlates with
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area of infarction
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Loss of R wave progression (V1-V6) in frontal leads is a
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Q wave equivalent
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What is a Q wave equivalent for a posterior wall myocardial infarction
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R wave in V1 and V2
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Main cause of abnormal Q waves
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Infarction
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Infarct
- 1st change is |
ST segment elevation
( acute 3-5 days) |
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Do you see a Q wave less than 6 hours old infarction?
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NO
- there has not been enough tissue damage to create the Q wave and this means you can still save a lot more of the muscle than if you saw a Q wave |
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A recent infarct what do you see?
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T wave inversion
(weeks to months average 2-6) |
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Old infarct what do you see
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Just significant Q waves (no longer have ST changes)
(months - years average>6 months) |
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An acute MI seen in leads V2-V6 where in the heart is the MI?
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Anterior wall of the LV
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T wave inversion =
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ischemia
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ST depression =
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ischemia
(the worse the ST depression indicates more cell death but 1st ischemia) |
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Infarct=
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ST elevation and Q wave
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Acute infarct seen in V1-V3 ..what part of the heart is injured?
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Anterioseptal zone
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Acute infarct seen in II, III and AVF represents injury to what part of the heart?
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Inferior Wall of LV
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Increase QRS voltage
Delayed intrinsicoid reflection (wider QRS) ST-T changes (delay in completion of depolarization) |
Left Ventricular Hypertrophy
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LHV criteria
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1. QRS 100-120ms
2. Left Axis deviation 3. left atrial abnormality 4. R or S in limb lead > 20 mm 5. (S in V1 or V2) + (R in V5 or V6) > 35mm 6. R in AVL > 11mm 7. S in AVR > 14mm |
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LHV criteria is associated with what features
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LAD
ST and T changes LAA |
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Lead 1 +
Lead AVF- (axis is ?) |
Left Axis
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Criteria for Right Ventricular
Hypertrophy |
1. Right Axis Deviation
2. Tall R over right precordium (V1,V2) 3. Deep S over left precordium (V5,V6) |
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Tall R waves in V1
- wide complex = |
RBBB
WPW |
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Tall R waves in V1
- Narrow complex = |
RVH
Posterior MI |
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LBBB criteria
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1. QRS > 0.12
2. V1 - ; V6 + |
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RBBB criteria
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1. QRS > 0.12
2. V1 + ; V6 - |
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LAFB criteria
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-LAD ( > -30) with no other explanation (eg LVH, LBBB, IWMI)
- normal or slightly prolonged QRD |
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LPFB criteria
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- Normal or slightly prolonged QRS
- RAD (>100) with no other explanation (eg AWMI, RVH) - often associated with RBBB |
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ECG of Digoxin Toxicity
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Scooping of ST segments
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Hyperkalemia
- Early: ____ |
Peaked T waves
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Hypokalemia
- ___ |
Flat T waves (key)
(prolonged QT, U waves) |
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Wolff - parkinson- white
ECG |
Short or no PR interval
prolong QRS Delta wave |
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Pericarditis
- ECG |
- Diffuse ST segment elevation (look like an MI injury but have ST elevation in all leads) - phase I
- PR segment depression - Diffuse T inversion (phase III) |
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Low Voltage
ECG- cause- |
QRS height <5mm
cause- Air, Fat or Fluid |
