EKGs
Terms
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Name this condition - Paroxysmal Supraventricular Tachycardia
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Name this condition - Atrial Flutter
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Name this condition - Multifocal Atrial Tachycardia
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Name this condition - Premature ventricular
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Name this condition - Paroxysmal Atrial Tachycardia
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Name this condition - Ventricular Tachycardia
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Name this condition - Ventricular Fibrillation
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Name this condition - Torsades de pointes
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Name this condition - Accelerated Idioventriculare Rhythm
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Name this condition - First Degree AV Block
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Name this condition - Morbitz Type II
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Name this condition - Third Degree AV Block
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Name this condition - Right Bundle Branch Block
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Name this condition - Left Bundle Branch Block
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Name this condition - Left Anterior Hemiblock
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Name this condition - Left Posterior Hemiblock
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Name this condition - Wolf-Parkinson-White Syndrome
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Name this condition - Lown-Ganong-Levine Syndrome
- What does the PR interval measure
- Start of atrial depolarization to the start of ventricular depolarization
- What does the ST segment record
- The time from the end of ventricular deploarization to the beginning of ventricular repolarization
- What does the QT interval measure
- The time from the start of ventricular deplarization to the end of ventricular repolarization
- What leads make up the "anterior leads"
- V1-V2-V3-V4
- What leads make up the "lateral leads"
- I, AVL, V5, V6
- What leads make up the "inferior leads"
- II, III, AVF
- What is the duration and amplitude of the P wave
- Duration: <.12 seconds, Amplitude: 2.5mm or less
- Where is the P wave normally biphasic
- Lead III and V1
- What is the duration of the PR interval
- .12 to .2 seconds
- What is the normal duration of the QT interval
- .44-.86 seconds. (40% of normal cardiac cycle from 1 R wave to the next)
- What is the normal duration of the QRS complex
- .06 to .12 seconds
- What does the term "R-wave progression" mean
- The R wave get progressivel larger as you proceed across the precordial leads from V1 to V5
- Deep S waves are normally seen in what precordial leads
- Leads V1 and V2
- What leads do you look at to identify the axis
- Leads I and AVF
- The QRS complexes of Lead I and AVF would appear how in left axis deviation
- Lead I - Positive and Lead AVF - Negative
- The QRS complexes of Lead I and AVF would appear how in right axis deviation
- Lead I - Negative and Lead AVF-Positive
- What leads do you look at to diagnose atrial enlargement
- Leads II and V1
- How is right atrial enlargement characterized
- P wave larger than normal in lead II and large upright first portion of biphasic P wave in lead V1 (often caused by lung disease)
- How is left atrial enlargement characterized
- Widdened P wave in lead II with the second portion being at least one small block wide and the biphasic P wave of lead V1 showing the second portion of the P wave dipping below the baseline by at least one small block.
- How is right ventricular hypertrophy recognized
- Right axis deviation and the R wave is larger than the S wave in V1, whereas the S wave is larger than the R wave in V6
- How do you recognize left ventricular hypertrophy
- The R wave in V5 or V6 plus the S wave in V1 or V2 exceeds 35 mm and the R wave in AVL exceeds 13 mm.
- What is normal sinus rhythm rate
- 60-100
- What rate do junctional pacemakers typically discharge at
- 40-60
- What rate do ventricular pacemeaker cells discharge at
- 30-45
- What rate do atrial pacemakers normally discharge at
- 60-75
- What non-disease related conditions may cause PSVT
- Alcohol, coffee or sheer excitement
- What can you manually do to slow or terminate PSVT
- Carotid massage
- True or False. Carotid massage increases block in A-flutter
- TRUE
- How can you distinguish a wandering atrial pacemaker from MAT
- MAT has varying P wave shapes and a rate of 100-200 whereas a wandering atrial pacemaker has one P wave shape and a rate less than 100
- How can MAT be distinguished from A-fib
- MAT has easily identifiable P waves occurring before each QRS complex
- When should you worry about PVCs
- Frequent PVCs, a run of 3 or more PVCs, Multiform PVCs, PVCs falling on T waves
- A run of 3 or more PVCs is called what
- Ventricular tachycardia
- A PVC falling on an elongated T wave can produce what
- Torsades de pointes
- Define bigeminy and trigeminy
- Bigminy - ratio of one normal sinus beat to one PVC. Trigeminy-two normal sinus beats for every one PVC
- What is sick sinus syndrome
- Demonstrated by alternating periods of supraventricular tachycardia and bradycardia. Often there is a long pause after the SVT of greater than 4 seconds.
- How is first-degree AV block identified
- PR interval is longer than .2 seconds
- How do you identify Mobitz Type I (Wenckebach)
- PR intervals get progressively longer until a QRS is dropped
- How do you identify Mobitz Type II
- The PR interval does not progressively lengthen but a QRS is suddenly dropped then the pattern repeats
- How do you recognize third degree AV block
- AV dissociation occurs with the P waves occurring at regular intervals and the QRS waves occurring at regular intervals
- What are the criteria for right bundle branch block
- Wide QRS complex, Rabit ears in V1 and V2 with ST segment depression and T wave inversion, reciprocal changes in V5, V6, I and AVL
- What are the criteria for left bundle branch block
- Wide QRS complex, Broad or notched R wave in V5, V6, I and AVL with ST segment depression and T wave inversion
- What axis deviation results from a left anterior hemiblock
- Left axis deviation
- What axis deviation results from a left posterior hemiblock
- Right axis deviation
- What are the criteria for WPW syndrome
- PR interval less than .12 seconds, Wide QRS, Delta waves
- What are the criteria for Lown-Ganong-Levine Syndrome (LGL)
- PR interval less than .12 seconds, QRS normal, no delta wave
- During an acute MI what 3 stages does an ECG evolve
- T wave peaking followed by T wave inversion, ST segment elevation, Appearance of Q waves
- How do the inverted T waves of an MI differ from ventricular hypertrophy
- In an MI the the inverted T wave is symmetric whereas in ventricular hypertrophy it has a gentle downslope and rapid upslope
- What does ST segment elevation represent
- Injury
- What does the appearance of Q waves indicate
- Cell death has occurred and is diagnostic of MI
- What characteristics confirm a pathologic Q wave
- A duration greater than .04 seconds, the depth of the Q wave must be at least one third the height of the R wave
- What might poor R wave progression indicate
- Anterior infarction
- What area of infarction develops with right coronary artery occlusion
- Inferior infarction
- Lateral wall infarction results from occlusion of what artery
- Left Circumflex artery
- Anterior infarctions are seen in what leads
- Precordial leads
- Tall R waves with ST segment depression in lead V1 indicate what
- Posterior infarction
- How do you distinguish rt. ventricular hypertrophy from a posterior infarction
- Rt. ventricular hypertrophy has a large R wave in V1 like a posterior infarct but it also has rt. axis deviation.
- What are the EKG signs for Angina
- ST segment depression or T wave inversion
- ST segment elevation may be seen in what two cardiac disease states
- Transmural infarction or Prinzmetal's angina
- ST segment depression may be seen in what two cardiac disease states
- Angina or non-Q wave infarction
- Peaked T waves througout all leads means what
- Hyperkalemia
- How does low calcium levels effect the QT interval
- Prolongs it
- How does high calcium levels effect the QT interval
- Shortens it
- How does digitalis effect the EKG
- ST segment depression with flattening or inversion of T wave most prominent in leads with tall R waves
- How does pericardial effusion effect the EKG reading
- Low voltage in all leads
- What is electrical alternans
- The effusion allows the heart to rotate freely in the sac varying the electrical activity with each beat.
- What are the EKG signs of pericarditis
- ST segment elevation and T wave flattening or inversion often seen in far more leads that a localized infarction
- What type of blocks are seen with myocarditis
- Bundle branch blocks and hemiblocks
- What are the EKG signs for an Acute Pulmonary Embolism
- A large S wave in lead I, a deep Q wave in lead III and an inverted T wave in lead III (S1Q3T3)
- Anterior infarctions result from blockage of what artery
- Left anterior descending artery
- Posterior infarctions result from what artery blockage
- Rt. coronary artery or left circumflex artery
- S1 heart sounds represent what and where do they fall on the EKG
- Closure of the tricuspid and mitral valves during systole and correspond with the QRS
- S2 heart sounds represent what and where do they fall on the EKG
- Closure of the aortic and pulmonic semilunar valves and fall on the T wave
- Where does the S3 heart sound occur
- Sometime after S2
- Where does the S4 heart sound occur and what does it represent
- Falls on the P wave and represents atrial kick forcing blood into a stiffened ventricle
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Name this condition - Atrial Fibrillation
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Name this condition - Wenckebach
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Name this condition - Ischemia
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Name this condition - Myocardial Infarction