WilliamWallace Adv DX chapt 10 ECG's
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| What is an ECG | show 🗑
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| What do ECG's not measure | show 🗑
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| show | chest pain, exert ional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, pedal edema, fainting, palpations, nausea and indigestion in high risk pts
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| show | hx of heart disease, hx of cardiac surgery
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| physical exam suggestive of ECG | show 🗑
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| show | normally is pacemaker, has greatest automaticity, causes depolarization (60-100bpm)
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| show | normally acts as back up pacemaker (40-60 bpm)
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| show | SA node to the 3 internodal atrial conduction tracts leading to AV node and 1 intranodal conduction tract to left atrium (Bachman’s bundle)
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| show | AV Node and bundle of His (.05 second delay)
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| electrical conduction of the ventricles | show 🗑
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| Systole | show 🗑
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| show | ventrical relax
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| show | contraction of the atria (at latter end of systole) just before ventrical contraction-aids in ventrical filling and accounts for 10-20% of CO in healthy person
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| AV Node delay | show 🗑
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| show | cells that have the ability to generate electrical activity spontaneously
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| pacemaker cells | show 🗑
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| myocardial cells | show 🗑
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| ectopic impulse | show 🗑
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| SA Node is stimulated by the sympathetic nervous system, what kinds of things can increase SA Node rate | show 🗑
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| what can slow the SA node rate (or stop it) | show 🗑
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| show | supply 02 and nutrients to heart, arise from descending aorta and branches to coronary vessels
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| show | blockage of one or more coronary vessels leading to regionalized tissue ischemia and tissue death
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| show | dysrrhythmias and <CO
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| Hypoxia and ischemia of myocardium causes | show 🗑
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| show | >workload w/o concurrent blood flow (blocked coronary arteries)
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| show | potassium, magnesium and calcium are most common
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| poor cardiac output and HR | show 🗑
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| show | hypoxia, ischemia, sympathetic stimulation, drugs, electrolyte imbalance
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| acetycholine | show 🗑
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| norepinephrine | show 🗑
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| alpha and beta adrenergic receptor sites | show 🗑
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| show | alpha constrict-beta dilate
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| heart receptor | show 🗑
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| show | B2
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| blood vessel receptor | show 🗑
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| *4 major characteristics of cardiac cells | show 🗑
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| action potential | show 🗑
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| polarized | show 🗑
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| show | muscle contraction(loss of negative charge)
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| re-polarization | show 🗑
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| show | (.11 seconds) depolarization of the atria, impulse spreads across atria and triggers atrial contractions
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| *QRS complex | show 🗑
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| show | ventricals returning to resting state
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| show | PR interval, .12-.20, measures time from onset of atrial contraction to onset of vent contraction, aka time for elec impulse to spread through and AV node (3-5 small squares)
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| show | progression of elec impulse is outside normal path
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| show | delay in conduction or AV block
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| show | <.12
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| wide QRS indicates | show 🗑
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| show | normal, supraventricular
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| ST Segment | show 🗑
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| show | depressed ischemia, elevated MI
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| show | follows Twave, may be seen or unseen, final phase of ventrical re-polarization
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| show | from beginning of Q to end of T, should be ½ of R-R
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| long QT interval | show 🗑
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| show | a QRS complex that has a second positive deflection, the first is the R, the second is R-prime
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| S-prime | show 🗑
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| show | between 0 and 90 degrees
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| show | right vent is enlarged
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| show | left vent is enlarged
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| show | chest pain, dyspnea, fine crackles, palpations, pale cool skin, dizziness/syncope, sense of impending doom, low BP-<90systolic, <LOC
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| interpreting dysrrhythmias can be accomplished in 3 levels | show 🗑
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| show | QRS complexes and pulse strength (to fast/slow, irritability, lethal, absent)
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| show | atrial, junctional, ventricular
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| show | ectopic beat/rhythm, escape beats/rhythms, AV block, bundle branch block
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| *bradycardia rate | show 🗑
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| *tachycardia rate | show 🗑
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| irregular rhythms | show 🗑
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| show | positive, round, <.10, <2.5 mm tall, all should look alike
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| show | atrial enlargement
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| *more than one Pwave may indicative of | show 🗑
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| show | norm .12-.20 seconds, >.20 is possible heart block (delayed AV node)
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| *evaluating QRS | show 🗑
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| *evaluating ST segment | show 🗑
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| show | left vent infarction, rt vent hypertrophy, COPD, pulm emboli, normal in infants,
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| show | rt vent infarction, left vent hypertrophy, abdominal obesity, ascites, or ab tumor, pregnancy
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| *evaluating the Qwave | show 🗑
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| *Right atrium enlargement is seen in pts | show 🗑
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| show | rt deviation of Pwave, tall Pwave or prominent or negative Pwave
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| show | to the right
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| show | <60 bpm w/no problems to pt (athlete)
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| *relative bradycardia | show 🗑
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| transient bradycardia may be caused by | show 🗑
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| show | damage to SA node by MI
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| show | hypothyroidism, hypothermia, hyperkalemia, meds
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| show | 100-150 BPM with SA node as pacemaker, most often caused by fever, pain, hypoxemia, hypovelemia, hypotension, sepsis, heart failure and suctioning
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| *respiratory meds that cause sinus tachycardia | show 🗑
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| show | usually benign, everything is normal except rhythm, rhythm will be off (space between the R-R)
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| show | 160-240 bpm, ectopic foci in the atrium takes over as pacemaker, sudden onset and ending, may cause hypotension, CHF, or ischemic episode, or recent/pre existing MI
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| danger of PAT (paroxysmal atrial tachycardia) | show 🗑
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| show | light headed, palpations, possible fainting
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| causes of PAT | show 🗑
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| evaluating PAT | show 🗑
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| show | rapid firing of ectopic foci, sawtooth Pwave with normal QRS
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| show | flutter waves, caused by rapid contractions of atria upon stimulation by re-entry or accelerated automaticity
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| atrial flutter reduces CO how | show 🗑
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| mural thrombi | show 🗑
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| show | deteriorates to atrial Fib or spontaneously returns to normal
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| caused of atrial flutter | show 🗑
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| evaluating atrial flutter | show 🗑
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| Atrial Fibrillation | show 🗑
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| show | same as a-flutter plus hyperthyroidism, pulm diseases and congenital heart diseases
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| show | rate can be as high as 400bpm, rhythm is irregular irregular, Pwave is chaotic and irregular, PRI is unmeasurable, QRS <.12
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| PVC | show 🗑
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| common causes of PVC's | show 🗑
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| show | multiple PVC's in less than 1 minute (indicates irritable vent area), couplets (2in a row), salvos (3 in a row), or R on T phenomenon
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| Salvos | show 🗑
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| show | PVC's occur during Twave of preceding beat, can cause PVC's to turn into Vtach (when it happens Vtach QRS wave looks more rounded)
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| show | rate is underlying, rhythm is regular, Pwave is not associated with PVC (others are normal), PRI not measurable (others are norm), QRS norm except with PVC>.12 abnormal look and premature, Twave is opposite direction of PVC (PVC up Twave down)
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| show | compensatory pause (because they are premature)
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| Ventricular Tachycardia | show 🗑
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| show | hypoxic heart, as with severe myocardial ischemia
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| show | rate 140-300 bpm, rhythm is regular, no Pwave with PVC, no PTI with PVC, wide QRS
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| Ventricular Fibrillation | show 🗑
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| show | cardiac standstill-flatline-no pulse, dead
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| PEA | show 🗑
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| show | any rhythm that does not produce a pulse except Vtach, Vfib and asystole
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| most common AV Heart block causes | show 🗑
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| show | (mildest) prolonged PRI >.20 second delay at AV node
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| 1st degree AV heart block causes | show 🗑
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| show | rate normal, rhythm regular, Pwave normal, PRI prolonged (>.20), QRS norm at <.12
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| show | (intermediate block) PRI gets long each beat until QRS is dropped, same causes as type 1
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| 2nd degree AV Block type 2 aka Mobitz type 2 | show 🗑
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| evaluating 2nd degree mobitz 2 | show 🗑
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| causes of 2nd degree heart block type 2 | show 🗑
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| show | most extreme and dangerous heart block. Conduction problem is in bundle of his (narrow QRS) or in bundled branches (wide QRS), complete block, no conduction atria and ventricals
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| causes of 3rd degree heart blocks | show 🗑
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| evaluating 3rd degree heart block | show 🗑
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| idoventricular rhythm | show 🗑
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| accelerated idoventricular rhythm | show 🗑
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| evaluating idioventricular rhythm | show 🗑
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| Junctional rhythm | show 🗑
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| show | AV node damage, electrolyte disturbance, digitalis toxicity, heart failure, valve disease, rheumatic fever
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| show | rate 40-60, accelerated 60-100, junctional tachycardia >100, rhythm is reg, Pwave is absent, inverted or short, can be befor or after QRS, PRI if present is short, QRS <.12
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| Pwave following QRS is what | show 🗑
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| If Pwave appears befor QRS in junctional rythm | show 🗑
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| deviation of the ST segment up or down suggests what | show 🗑
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| COPD causes what kind of axis deviation | show 🗑
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| show | R axis deviation
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| show | Tachycardia, Multifocal atrial tachycardia, ventricle ectopic beats are most common (from hypoxemia & meds) & worsen at night due to hypoxemia.
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| show | Between R-R, add lg boxes at .20 each and sm boxes at .04 then divide into 60. 2lg + 3sm is 60/.2+.2+.04+.04+.04 equals 60/.52 is a HR of 115
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| Prolonged QRS .12-.10 causes | show 🗑
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| show | Complete RBBB or LBBB (3rd degree block), IVCD, or PVC’S (v-tach & pacemakers)
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| IVCD | show 🗑
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| Sick sinus syndrome | show 🗑
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| Atrial tachy | show 🗑
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| Atrial flutter rate according to Karol’s handout | show 🗑
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| show | Uncoordinated atrial depolarization’s
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| Junctional escape Rhythms | show 🗑
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| AV block | show 🗑
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| 1st degree block | show 🗑
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| 2nd degree AV block | show 🗑
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| 2nd degree Type 1 (wenkebach) | show 🗑
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| 3rd degree | show 🗑
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| show | reentry currents in atria or from vent to atria. Rate 140-250
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| show | Wide QRS, caused by eptopic foci in ventricle.
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| show | Caused by aberrant vent automatically or intra-ventricular reentry, can be sustained or paroxysmal (short run) wide QRS 100-200 bpm.
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| V Flutter | show 🗑
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| V Fib | show 🗑
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| The 3 types of heart cells are | show 🗑
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| show | SA node-thus the pacemaker
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| show | AV junction
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| show | ischemia and infarction leads to dysrrhythmias and <QT
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| what does the QRS reflect on ECG | show 🗑
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| show | K- moves out and NA+ and CA+ moves in
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| show | K- moves back inside and NA+ and CA+ move to the outside
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| isoelectric | show 🗑
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| show | 12, 6 limb (vertical plane) and 6 chest (horizontal plane)
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| what are the 6 limb leads | show 🗑
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| bipolar leads | show 🗑
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| show | leads aVR, aVL, aVF are augmented by the machine because they are unipolar
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| frontal plane | show 🗑
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| show | V1-V6
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| where are V1 and V2 located | show 🗑
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| where is V6 located | show 🗑
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| depressed ST | show 🗑
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| elevated ST | show 🗑
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| show | ischemia (usually seen with depressed ST
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| show | infarction
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| show | impact of lung disease on heart, severity of infarction, heart rhythm, never pick pumping ability or QT
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| show | orthopnea and syncope
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| what is the normal intrinsic rate of primary pacemaker | show 🗑
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| show | 60-80
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| show | atrial depolarization
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| show | ventrical depolarization
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| what does T wave represent | show 🗑
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| show | .20
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| normal QRS | show 🗑
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| QRS is equally spaced with 3 large boxes between, whats the rate | show 🗑
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| QRS is equally spaced with 4 large boxes between, whats the rate | show 🗑
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| show | AV block
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| show | elevated ST segment
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| show | flutter you can count and fibrillation is a quiver-chaotic, Ventrical fib and flutter originate low in the heart, so no QRS as with atrial fib and flutter (they have a QRS)
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| show | brady, sinus tach, PVC, fine and course VFib, asystol, depressed ST and elevated ST
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| 1 small box on strip | show 🗑
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| 1 large box on strip | show 🗑
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| calculating bpm | show 🗑
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