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44 Cards in this Set
- Front
- Back
P normally pos in
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I,II, V4-6
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P normally neg
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AVR
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p wave duration
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.08-.11
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` do PACs look different than normal p waves
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yes
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WAP and MAT must have at least how many different pacemakers?
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3
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do PACs change the rate?
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yes
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T waves should always appear the same in any give lead; if you have a T wave that looks different, it is probably because
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a p wave is buried inside
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are PACs usually compensatory?
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no
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What causes inverted p waves?
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low atrial or AV nodal (retrograde conduction of the atria)
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P mitrale
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P> .12 and notched, left atrial enlargement
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P pulmonale
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P is peaked more than 2.5mm, right atrial enlargement
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When the first half of the P wave in V1 is taller than the first half of the P wave in V6, think
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right atrial enlargment
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When the second half of the P wave is wider and deeper than 1 small block, think
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left atrial enlargement
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length of pr interval
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.11 to .2
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what does the pr interval include
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atrial depolarization, atrial repolarization, AV node stim, his stim, BBB stim and purkinje stim
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where should the pr interval be measured
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widest p to the beginning of the widest qrs
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if pr interval is long in all leads, think
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meatabolic problem (maybe hyperkalemia)
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causes of short pr intervals
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1. junctional p waves
2. PACs 3. LGL or WGW |
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Wolff-Parkinson White syndrome
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young individuals, atria to ventricles through the Kent bundle without AV node, could pass out, circus rhythm
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Lown Ganong Levine Syndrome
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short pr, no tachy, benign bypass around AV, no signs of WPW
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signs of WPW**
know this slide |
1. short ps interval
2. wide qrs 3. delta wave 4. St-t wave changes 5.associated with paroxysmal tachy (Syndrome) first 4=pattern |
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delta wave
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two impulses meet each other, WPW, initial slurring of the qrs, 3 types with A most common; negative delta wave is a pseudoinfarct
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AV node that has a long refractory period until it drops a beat
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Wenkebach
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more dangerous mobitz II blocks
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infranodal or infrahisian
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Accrochage
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p waves and qrs go marching along together but independent; third degree heart block
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significant Qs
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.03 s or wider and depth equal to or greater than 1/3 of the R wave
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A negative wave after an R wave must be a
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S wave
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ST-T help diagnose a
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acute MI
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Q waves are more indicative of
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previous MI damage
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MI Q signs
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significant size and in a minimum of 2 continuous leads
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length of normal qrs**
Know this |
.06 to .11
axis -30 to 105, downward and to the left |
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qrs deflection transition zone
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between V3 and V4
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increase in muscle mass does what to the size of qrs
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larger
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qrs size after MI and decrease in ventricular muscle mass and effusions
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smaller
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why dose qrs voltage look smaller if you have COPD or are over weight
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leads further away from the heart
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pericardial effusions
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limb leads less than 5 mm (QRS)
precordial leads less than 10 mm |
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left ventricular hypertrophy
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increased muscle mass causes increased action potential, increased vector with resultant increased EKG amplitude
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EKG criteria for LVH
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S in V1 or V2 added to R of V5 or V6> 34mm *
Any precordial lead > 45mm R wave in aVL is >10mm R wave in lead I is > 11mm R in AVF > than 19mm |
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cant call LVH if what is present?
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LBBB present
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RVH
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look at V1 and V2: R waves >S wave; cant make diagnosis with RBBB; could be due to WPW or posterior wall myocardial infarction
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if tachy >100 with wide qrs, think
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v tach until proven otherwise
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3 possibilities for >.11 QRS
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RBBB, LBBB or hyperkalemia
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significant Q waves
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dead muscle, must be in more than 1 lead, >1/3 of height and >.03 sec
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osborn wave
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aka J wave, hypothermia, elevated notch after qrs, often associated with bradycardia
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