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ECG
ECG WTCC
| Question | Answer |
|---|---|
| 7 sinus rhythms | Normal sinus rhythm , sinus bradycardia , sinus tachycardia , sinus Arrhythmia , sinus arrest , sinoatrial exit block, sick sinus syndrome |
| P-Wave duration is | Less than 0.12 sec |
| No P-Wave indicates what | Rhythm originates below the atria |
| Normal PR-Interval is | 0.12 to 0.2 sec |
| PR- Intervals indicate the time impulse travels thru what part of the conduction system | Atria, to start of ventricular depolarization |
| QRS Complexes indicate time that impulses take to travel thru where | Ventricular Myocardium, ventricular depolarization |
| Normal time for QRS | 0.06-0.10 |
| Acute posterior MI can show up as what on ECG | ST Segment depression |
| Acute MI can show up as what on ECG | Elevated ST-Segment |
| Tall T- Waves May indicate what early sign | May indicate early sign of STEMI, hyperkalemia |
| Flat T-Waves could indicate what | Are commonly seen after an Ischemic Event |
| Normal QT-Interval is | 0.39 to 0.46 sec / QT-Interval should be 1/2 the time of the R-R duration |
| Atrial Flutter rate | 250-350 bpm / normal QRS/ Regular rhythm Atrial rate to Ventricular rate can be a ratio like 2:1, 3:1, 4:1 |
| Atrial Fibrillation rate | 375 700 impulses / normal QRS / rhythm is irregularly Ventricular rate will be 90 - 100 |
| Rate of Junctional rhythm is | 40-60 |
| Rate of Junctional Tachycardia is | 101-180 |
| Junctional Rhythms have what in common | P wave will be inverted, may be buried in QRS or after QRS. PR interval is only measurable if prior to QRS. PRI will be short if measurable. May appear as PJC if pt. in sinus arrest/pause. |
| When impulse originates in ventricles or Junctional then QRS will look wide or narrow | Wide. in ventricular rhythm. Could be wide or narrow in junctional rhythm depending on region of impulse generation, lower in AV junction will produce wider QRS and higher will produce narrow. |
| Frequency of PVC | Frequent PVC = 6 or more per minute Couplet PVC’s are 2 in a row bi, tri, quad, sustained , non sustained, occasional, Interpolated, Triplett, salvo, multifocal, unifocal |
| Term for when PVC occurs and does not interrupt the underlying rhythm | Interpolated PVC |
| SAMPLE | s/s, allergies, medications, previous history, last intake, events |
| Criteria for Pathological Q wave | 1/3 or more the amplitude of the R wave and duration greater then 0.04, indicates tissue death, seem in anatomically contiguous leads |
| Criteria for Idioventricular rhythm | Rhythm- usually regular Rate- 20- 40 P wave- missing PRI- missing QRS- Wide and Bizarre looking |
| Criteria for Junctional rhythm | Rhythm- usually regular Rate- 40 - 60 P wave- inverted can be before, after or buried in QRS. PRI- measurable only if before QRS and will be shorter QRS- can be wide if impulse comes from lower av junct. and narrow from higher; may be inverted |
| Criteria for SVT - supraventricular tachycardia | Rhythm- regular Rate- 150 - 250 adult 180 child P wave- usually buried in QRS or T wave PRI- short if seen QRS- narrow and long, watch for Delta wave = WPW syndr. |
| Criteria for Accelerated Idioventricular rhythm | Rhythm- usually regular Rate- 40 - 100 P wave- missing PRI- missing QRS- wide and bizarre looking |
| PVC criteria | wide QRS with T wave deflection in the opposite direction of the QRS. produces a irregular rhythm. early beat. need to count as a beat with other beats. |
| Criteria for 3rd degree AV Block | Rhythm- atrial and ventricular have regular but are independent from each other Rate- atrial faster than vent. P wave- all blocks have P waves PRI- varies as more P waves than QRS QRS- normal with junct. and wide with Vent, |
| ECG for RBBB | Lead V1 will have RSR wave with wide QRS and V6 will have a negative deflection |
| Normal amplitude height for P wave | Less than 2.5 mm |
| Criteria for A Flutter | Rhythm- atrial and ventricular regular Rate- atrial > vent. usually a ratio P wave- no P wave , instead F waves-- 3:1, 2:1 ... PRI- missing QRS- normal 0.06 - 0.10 |
| Criteria for Classical or Mobitz 2 / 2nd degree type 2 | Rhythm- atrial regular and vent irregular Rate- atrial > vent P wave- normal , more P's then Q's PRI- constant and normal when paired with QRS. QRS- normal but will be missing QRS complexes CAN DEVELOP INTO 3RD DEGREE |
| Criteria for 1st degree AV Block | Rhythm- regular Rate- normal P wave- normal PRI- long > 0.20 QRS- normal |
| Criteria for 2nd degree type 1 or Wenckebach / Mobitz 1 | Rhythm- atrial regular and vent irregular Rate- atrial > vent P wave- normal, more P's than Q's PRI- Progressively gets longer until QRS drops QRS- normal |
| ECG for LBBB | V1 QRS or QS wave is negative deflection and V6 will be positive deflection both wide |
| Causes for left axis deviation LAD | Pregnancy, left ventricular hypertrophy, obesity, Hyperkalemia, Emphysema |
| Delay of repolarization can present how on ECG | ST elevation or depression |
| Issues that can trigger MAT | Acute exacerbation of Emphysema, CHF or Mitral value regrug. |
| Term for placing limb leads on torso | Mason - Likar attachment |
| Criteria for Preexcitation | Delta wave and wide QRS |
| Criteria for Accelerated Junctional rhythm | Rhythm- normal Rate- 60 - 100 P wave- inverted or buried in QRS, before after QRSS PRI- measurable only prior to QRS and short QRS- may be inverted, normal to wide |
| Criteria for Junctional Tachycardia | Rhythm- regular Rate- greater than 100 usually 130 - 150 P wave- usually missing PRI- usually missing QRS- normal to narrow. may be inverted |
| Types of Artifact | Interrupted, Somatic, Wandering Baseline, AC interference |
| Sustained vs. non sustained V-Tach | Sustained is 30 seconds or longer and non sustained is less than 30 sec. |
| Term for witnessing rhythm change | Paroxysmal Event |
| 3 or more PVC's in a row with HR > 100 is what | Run of Ventricular Tachycardia , AKA = Triplett or Salvo |
| R on T PVC can cause what dysrhythmia | V tach or V fib |
| Criteria for A Fib | Rhythm- Irregular Rate- atrial impulses of 375 - 700, vent. 90-100 P wave- P waves replaced with f- waves PRI- missing QRS- normal thrombus , loss of SV of 20% - 30% |
| Criteria for V Fib | Rhythm- none Rate- not measurable P wave- missing PRI- missing QRS- missing just chaotic waves, can have fine or coarse 3mm, pt. will be unresponsive, no pulse/RR |
| Difference B/w V tach and SVT | V Tach = wide QRS and HR 101 - 250 with a least 3 PVC in row SVT = narrow QRS and HR 150 - 250 and child 180 plus |
| Rhythms that can lead to V Tach | PVC's , 2nd and 3rd degree HB, R on T PVC. |
| Criteria for PAC | Rhythm- produces a Irregular rhythm Rate- usually normal P wave- PAC will have different looking P than other complexes PRI- normal QRS- normal |
| Criteria for Sinus Dysrhythmia | Rhythm- Irregular Rate- 60 - 100 P wave- normal PRI- normal QRS- normal , R to R interval follows breathing pattern |
| Criteria for WAP ; wandering atrial pacemaker | Rhythm- slightly irregular Rate- usually normal P wave- 3 different morphologies in a lead PRI- varies with P's QRS- normal |
| Criteria for MAT ; multifocal atrial tachycardia | Rhythm- Irregular Rate- 101 - 150 P wave- Changes constantly, can be inverted or hidden PRI- varies QRS- normal SAME as WAP but faster |
| 4 things to look for in T wave with ischemia | Peaked or tented T Broad wide base, symmetrical Hyperacute |
| Ischemic region of heart can cause what dysrhythmic beat | PVC, B/c area is more excitable or irritable |
| Criteria for Ventricular Tachycardia | Rhythm- Regular ; 3 or more PVC in row with HR > 100 Rate- 101 - 200 P wave- missing PRI- missing QRS- Wide and may be bizarre |
| 7 steps to ECG interpretation | Rhythm, rate, P wave, PRI, QRS, Lead groups, Morphology |
| Term for return of a blood vessel to a blocked state after being opened | Restenosis |
| Measurement for LVH ; left ventricular hypertrophy | Deepest S/QS wave in lead V1 / V2 and Tallest R wave in lead V5/ V6. Add both measurements together and if = 35mm or more then LVH, Known as Sokolov-Lyon criteria |
| 2 leads that are use to determine Axis Deviation | Lead 1 and aVF |
| Left axis Deviation QRS in leads | Positive in lead 1 and negative in aVF |
| Right axis deviation QRS in leads | Negative in lead 1 and positive in lead aVF |
| Normal axis QRS in leads | Positive in both lead 1 and aVF |
| NW axis deviation QRS in leads | Negative in both lead 1 and aVF |
| Lead 1 travels in what direction | Right arm Neg to Left arm Pos |
| Ventricular conduction in LBBB travels in what pathway to depolarize the LV | Down the RBB to depolar. the RV then current moves towards LV and causes the depolar. of the Intraventricular septum to depolar. abnormally from the R to L |
| Normal direction of septal depolarization is | From Left to Right, ;, abnormal with LBBB |
| Causes of Right Axis Deviation | Right Ventricular Hypertrophy, Anterolateral MI, ; Is considered normal for children and thin tall people. |
| Criteria for Agonal rhythm | Rhythm- Reg or Irreg Rate- Less than 20 P wave- missing PRI- missing QRS- wide and bizarre Heart is dying |
| Measurement for Hyperacute T wave | More than 1/2 the height of the QRS, should be less than 1/2 |
| Difference B/w A-Fib and Somatic artifact on tracing | A- Fib has an Irregular rhythm |
| Condition that can cause a decrease of 20% - 30% of SV | A - FIB |
| Condition that can cause a decrease of 10% - 30% of CO | A- Flutter |
| Criteria for Sinus Arrest | Rhythm- Irregular Rate- varies P wave- normal PRI- normal QRS- normal pause 6 sec= Code Blue; HR < 60 may produce escape beat Pause is not directly related to the R to R duration. |
| Criteria for Torsade de Pointes | Rhythm- Irregular Rate- 101 - 250 P wave- missing PRI- missing QRS- wide with a long QT duration; Ribbon looking ; VT |
| Reasons for Wandering Baseline / Baseline Shift | Poor lead contact, pulling on leads, GEL, dirty oily hairy skin |
| What type of dysrhythmia is Wolf-Parkinson-White syndr. | Reentrant |
| Normal height of T wave | 1/2 the height of R wave, Less than 5mm in Limb leads, Less than 10 mm in Precordial leads |
| Main difference B/w BBB and IVR is | BBB has P wave, morphology of QRS |
| Which lead can show precursor to MI | aVR shows ST elevation |
| Lead 3 travels in what direction | Left arm Neg to Left Leg Pos. |
| EECP ; enhanced external counter pulsation is | Treatment for choric Angina. helps to develop Collateral Blood Vessels by squeezing the butt and legs, performed daily for one hour each. |
| Possible cause for Sinus Tachycardia | Recent MI, Hypovolemia |
| Usual setting for Artifact Filter | 40 - 150 Hz |
| RPP ; Rate Pressure Product / double product | Take systolic pressure and multiple it to HR , estimates the amount of O2 use of heart |
| O-P-Q-R-S-T | Onset, Provoke, Quality, Radiation, Severity, Time = use to gauge pain level |
| Criteria for R on T PVC | PVC starts on the downslope of the T wave not allowing complete repolarization of the ventricles and can cause V Tach or V Fib |
| R to R duration time | 0.6 to 1 second |
| QT duration | 0.39 -0.45 |
| PRI duration | 0.12 - 0.2 |
| QRS duration | 0.06 - 0.10 |
| Triad of RVF | Distended Jugular Vein, Clear lung sounds, Hypotension, also Edema and Ascites MAIN Causes Chronic lung D and L/S HF |
| False Fine V Fib issues | Same as Interrupted artifact with bad leads ; if pt. can talk to you NO V FIB |
| 6 Blood samples that may be taken for MI | Troponin and CK, CBC, Lipid panel, PT/INR, PT/PTT, Electrolyte, |
| Difference B/w Sinus Arrest and Sinus Block | The Pause on Sinus Arrest is NOT directly related to the underlying rhythm and Sinus Block IS directly related to the underlying rhythm, it will walk out. |
| Lead 2 travels in what direction | From the Right Arm Neg to The Left Leg Pos |
| Criteria for PEA ; pulseless electrical activity | ECG shows electrical activity but no palpatory pulse is felt. not shockable B/C already have ele. |
| Leads 2, 3, and aVF look at what region | Inferior |
| Leads 1 and aVL look at what region | Lateral |
| Leads V1 and V2 look at what region | Septum |
| Lead aVR looks at what region | Right Ventricle and Basal septum |
| Leads V3 and V 4 look at what region | Anterior |
| Leads V5 and V6 look at what region | Lateral |
| measurement of ST segment elevation in any Leads | Elevation in any Lead of 1 mm except V2 and V3, Elevation of 2mm in V2 and V3 |
| Measurement of ST segment depression in any leads | Depression of 0.5mm in 2 contiguous leads |
| Biphasic T wave could indicate | Ischemia or Hyperkalemia, biphasic morphology can be neg to pos or pos to neg. |
| Reasons for Pathological Q wave to present | Old MI , New MI, LVH, LBBB, PE |
| Measurement of Q wave | Less than 1/4 distance of R wave. Duration on 0.04 or less |
| Ambulatory monitor that is placed on the chest or wrist | Symptom event monitor, no storage before activation. |
| Coronary Art. that supplies the anterior wall of the LV | Left main coronary art. and LAD, left anterior descending coronary art. |
| Ambulatory can be worn up to 30 days, locks prior 5 minute trace when activated | Loop Memory Monitor, can press button prior, during or after event. |
| Term for when Pacemaker does not sense any electrical impulse and does not turn off | Under sensing |
| Ambulatory monitor that produces complete ECG tracing and worn for 24 - 48 Hours | Holt Monitor, must keep diary |
| Ambulatory monitor that is real time and monitored by tech. | Telemetry, no need for diary |
| Issues with under sensing with pacemakers | As the pacing never turns off it can lead to R on T pacing or cardiac arrest |
| ST segment elevation can indicate what | Myocardial injury or infarct |
| Atriobiventricular pacing looks like what BBB rhythm | RBBB |
| ST Depression on stress test ECG could indicate what | Myocardial Ischemia, Infarction , Hypothermia, Hypokalemia, and Digitalis toxicity. |
| Pacing complication Malfunction is | Failure to Pace |
| Pacing complication Malsensing is | Failure to sense |
| Pacing complication Loss of Capture | No Depolarization |
| Pacing complication Oversensing is | Inhibiting Impulses, may be caused by muscle movement being picked up by pacemaker as heart |
| Pacing complication Undersensing is | Triggering impulses when not needed and never turning off. |
| Chemical stress test uses which 2 methods | Nuclear testing and Chemical Stressing Echocardiography ; No exercise |
| Ways STEMI can present on ECG | ST segment elevation or depression , T wave inversion, Development of Pathological Q wave,, Ischemia delays repolar. |
| Why NSTEMI hard to detect on ECG | Does not have classical morphology of STEMI , pt. may be asymptomatic , MUST take blood test for cardiac markers. |
| ST depression with T wave inversion can indicate what | Myocardial Ischemia |
| Atrioventricular Pacing presents like what BBB | LBBB |
| Measurement of ST elevation in 2 contiguous leads other than V2, V3 | 1mm, would suggest Myocardial Injury/Infarction |
| Measurement of ST elevation in V2 and V3 | 2mm |
| Pacemaker batteries last how long | Avg. 6 - 7 years |
| Major coronary art. that supplies Lateral Wall of LV | Left main coronary art. and Circumflex art. |
| ECG trace STEMI | ST Elevation/Depression, T wave inversion, Pathological Q wave, Tombstoning |
| Major coronary art. that supplies the Septal wall of LV | Left coronary art. and Septal branch of left coronary art. |
| Major coronary art. that supplies the Inferior wall LV and Right Atrium | Right coronary art. and Marginal art. |
| 3 Phases of exercise stress test | Resting phase , Post exercise phase, and Recovery phase. |
| Malsensing is AKA | Competition and can cause A-Fib with in the atria or V-Tach with in the vent. Can also cause R on T phenomenon |
| Way to find the end of the T wave if it does not continue down to the isoelectric line | Maximum Slope Intercept method |
| 3 Exercise stress test protocols | Bruce, Modified Bruce, Naughton ;; Time and Incline |
| Intake requirements prior to stress test. | No alcohol, tobacco, caffeine 24 hrs prior. No food intake 4 hrs prior. AFTER test no alcohol, tobacco 3 hrs after and no hot bath/shower for 2 hrs after. |
| 3 Programs of pacemakers | Fixed rate ( not really used anymore ), Demand ( sends or inhibits impulses ) and Rate Response ( adjust rate to meet metabolic demand ) |
| Ambulatory monitor that can record up to 96 hrs | MCOT mobile cardiac outpatient telemetry, sends data to monitor by radio frequency then to monitor center by cellular. |
| Main Difference for 3rd degree AV block and other BBB is | Impulses for 3rd degree are all blocked ABOVE the ventricles and other BBB some impulses get thru |
| AV delay with pacemaker is same as what with normal heart | PR Interval |
| Ambulatory monitor that implants a wire under skin | Insertable loop recorder |
| 3 types of Acute Coronary Syndromes | Unstable Angina, STEMI and NSTEMI |
| Pathological Q wave indicates what | Tissue Death |
| Population of people that WAP may be a normal finding for | Children, Older adults and Well conditioned Athletes. |
| Atrial Dysrhythmias are caused by what | Ectopic Impulses. could be damage from MI or Valvular issues. If AV node is faster than the SA node then it runs the show. |
| 6 Sinus Rhythms are | Normal sinus rhythm, sinus bradycardia, sinus tachycardia, sinus dysrhythmia, sinus arrest and sinus exit block |
| What items can erase ecg tracing | Alcohol, sunlight, plastic, x-ray film |
Created by:
scones and joe
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