Term
| When an impulse is moving toward an electrode, it is seen as a(n) ___?___ line. |
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Definition
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Term
| Lead 1 goes from ___?___ to ___?___. |
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Definition
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Term
| Lead 2 goes from ___?___ to ___?___. |
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Definition
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Term
| Lead 3 goes from ___?___ to ___?___. |
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Definition
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Term
| What is the Einthoven Triangle? |
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Definition
| imaginary inverted equilateral triangle centered on the chest with points on the arm and leg leads |
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Term
| What degrees are assigned to Lead I? |
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Definition
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Term
| What degrees are assigned to Lead II? |
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Definition
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Term
| What degrees are assigned to Lead III? |
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Definition
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Term
| Which leads are used to estimate axis deviation? |
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Definition
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Term
| What deflections are seen in a right axis deviation? |
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Definition
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Term
| What deflections are seen in a normal deviation? |
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Definition
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Term
| What deflections are seen in a left axis deviation? |
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Definition
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Term
| What deflections are seen in an extreme right deviation? |
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Definition
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Term
| What are the components of the electrical conduction system? |
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Definition
-sinoatrial (SA) node
-intraatrial pathway
-internodal pathways
-atrioventricular (AV) junction
-Bundle of His
-right bundle branch
-left bundle branch
-Purkinje fibers |
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Term
| Each small box on EKG paper represents ___?___ seconds |
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Definition
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Term
| What is the normal range for the PR interval? |
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Definition
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Term
| What is the normal range for the QRS interval? |
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Definition
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Term
| The P wave corresponds to the event of ___?___ when the impulse is in the ___?___ |
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Definition
atrial depolarization
internodal pathways |
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Term
| The QRS complex corresponds to the event of ___?___ |
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Definition
| ventricular depolarization |
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Term
| The T wave corresponds to the event of ___?___ |
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Definition
| ventricular repolarization |
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Term
| The P wave is upright in Lead ___?___ |
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Definition
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Term
| The PR interval isoelectric line following the P wave corresponds to the event of ___?___ |
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Definition
| impulse delay at the AV junction |
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Term
| A wave repolarizes in the same direction that it depolarized. T/F |
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Definition
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Term
| What is the inherent rate of the SA node? |
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Definition
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Term
| What is the inherent rate of the AV junction? |
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Definition
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Term
| What is the inherent rate of the ventricle? |
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Definition
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Term
| 1st way to determine ECG rate: Count number of QRS complexes in 6 seconds (___?___ large boxes) and multiply by ___?___ |
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Definition
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Term
| 2nd way to determine ECG rate: Choose R wave at the beginning of large box and count large boxes until next R wave using the scale ___?___ |
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Definition
| 300 > 150 > 100 > 75 > 60 > 50 > 43 bpm |
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Term
| 3rd way to determine ECG rate: Count number of small squares between 2 R waves and divide into ___?___ or large squares into ___?___ |
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Definition
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Term
| In normal sinus rhythm, R-R is variable. T/F |
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Definition
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Term
| What is the difference between sinus rhythm and sinus arrhythmia? |
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Definition
| in sinus arrhythmia, P-P is variable which also causes R-R variability |
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Term
| What are causes of sinus arrhythmia? |
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Definition
-normal
-children
-r/t respirations |
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Term
| What is the difference between sinus rhythm and sinus bradycardia? |
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Definition
| in sinus bradycardia, rate is < 60 bpm |
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Term
| What are causes of sinus bradycardia? |
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Definition
-excellent physical conditioning
-high vagal tone (nausea, inferior MI, occasional fright)
-sinoatrial dz
-beta-receptor blocking drugs
-other medications |
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Term
| What are features of sinus tachycardia? |
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Definition
-rate > 100 bpm
-gradual onset and termination |
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Term
| What are causes of sinus tachycardia? |
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Definition
-external stress
-meds
-hyperthyroid
-PE
-anemia
-CHF
-AV fistula
-myocarditis
-pheochromocytoma |
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Term
| Where do PACs (premature atrial contractions/complexes) originate? |
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Definition
| irritable focus in atrium |
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Term
| How does the PR interval in PACs differ from sinus complexes? |
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Definition
| prolonged or different in PACs |
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Term
|
Definition
-common incidental finding
-anxiety
-exhaustion
-hypoxia
-caffeine
-smoking
-PE
-hyperthyroidisim
-heart dz |
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Term
| What are features of atrial fibrillation? |
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Definition
-variable R-R (irregularly irregular)
-no PR intervatl
-multiple irritable foci within atria |
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Term
| Why is a rapid ventricular response of > 100 bpm desirable in afib? |
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Definition
| trying to grab onto impulses received |
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Term
|
Definition
-CAD
-valvular dz
-atrial fibrosis from aging inflammation of atria
-increased sympathetic and parasympathetic activity
-toxins
-hyperthyroid
-cardiac trauma
-pericarditis
-increased atrial pressure
-idiopathic |
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Term
| What are features of atrial flutter? |
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Definition
-single irritable focus in atrium
-atrial rate 250-300 bpm |
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Term
| What is the cause of the sawtooth appearance of atrial flutter? |
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Definition
| looping of energy in atria |
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Term
| What is 2:1 conduction in atrial flutter? |
|
Definition
-1 ventricular contraction for every 2 atrial contractions
-1 hump between QRS complexes |
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Term
| What are causes of atrial flutter? |
|
Definition
-CAD
-valvular dz
-atrial fibrosis from aging inflammation of atria
-increased sympathetic and parasympathetic activity
-toxins
-hyperthyroid
-cardiac trauma
-pericarditis
-increased atrial pressure
-idiopathic |
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Term
| What are features of supraventricular tachycardia? |
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Definition
-indistinguishable P waves
-rate 150-250 bpm |
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Term
|
Definition
| -AV nodal re-entry or bypass |
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Term
| What is the difference between sinus rhythm and 1st degree AV block? |
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Definition
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Term
| What are causes of 1st degree AV block? |
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Definition
-increased vagal tone
-medications |
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Term
| What are features of 2nd degree Type I AV block (Wenckebach)? |
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Definition
-at level of AV node
-progressive lengthening of PR interval followed by dropped QRS complex, so more P waves than QRS complexes
-R-R irregular (grouped beats, regularly irregular)
-generally slow rate |
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Term
| What are causes of 2nd degree Type I AV block (Wenckebach)? |
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Definition
-increased vagal tone
-highly trained athletes
-responses to rapid atrial pacing during EPS
-acute inferior MI |
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Term
| What is the difference between Type I (Wenckebach) and Type II (Classic) 2nd degree AV block? |
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Definition
| II (Classic) at level of Bundle of His or lower |
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Term
| What are causes of 2nd degree Type II AV block (Classic)? |
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Definition
-anterior MI (reflect trifasicular block)
-significant dz to conduction system |
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|
Term
| What is the difference between 2nd degree Type I (Wenckebach) and 3rd degree (Complete) AV block? |
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Definition
|
|
Term
| What are causes of 3rd degree AV block (Complete)? |
|
Definition
-ischemic heart dz
-inferior MI
-myocarditis
-trauma
-extreme hyperkalemia
-infections (e.g. Lyme)
-infiltrative processes (e.g. sarcoidosis, amyloidosis, neoplasm)
-idiopathic fibrosis
-medications (e.g. Dig, beta blockers, CCB, antiarrhythmics)
-ablation |
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Term
| Higher degree of AV block corresponds to ___?___ location in heart and ___?___ severity. |
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Definition
lower location in heart
increased severity |
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Term
| What are features of junctional rhythm? |
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Definition
-initiated at AV junction
-P wave inverted, close to QRS, or buried in QRS
-rate 40-60 bpm |
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Term
| What are causes of junctional rhythm? |
|
Definition
-excessive vagal tone
-highly trained athletes
-sick sinus syndrome
-drugs that slow sinus rate
-ischemia |
|
|
Term
| What is the difference between junctional rhythm and accelerated junctional? |
|
Definition
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|
Term
| What are causes of accelerated junctional? |
|
Definition
-increased automaticity
-enhanced phase 4 depolarization (e.g. ischemia, MI, dig toxicity, hypokalemia and other electrolyte disturbances, hypoxemia) |
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Term
| What is the difference between junctional rhythm and junctional tachycardia? |
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Definition
| junctional tach: rate > 100 bpm |
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Term
| What are causes of junctional tachycardia? |
|
Definition
-increased automaticity
-enhanced phase 4 depolarization (e.g. ischemia, MI, dig toxicity, hypokalemia and other electrolyte disturbances, hypoxemia)
-high degree AV block |
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Term
| What are features of PJCs? |
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Definition
-irritable focus within the AV junction
-P wave inverted or after QRS, PRI < 0.12 |
|
|
Term
|
Definition
-incidental finding in normal heart
-anxiety
-exhaustion
-hypoxia
-caffeine
-smoking
-PE
-hyperthyroidism
-heart dz |
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|
Term
|
Definition
| right ventricle receives impulse before left |
|
|
Term
|
Definition
| underlying cardiac pathology |
|
|
Term
| A wide QRS in leads ___?___ indicates LBBB. |
|
Definition
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|
Term
| A wide QRS in leads ___?___ indicates RBBB. |
|
Definition
|
|
Term
|
Definition
| left ventricle receives impulse before right |
|
|
Term
|
Definition
-healthy
-CAD
-lung dz
-PE
-cardiomyopathy
-atrial and ventricular septal defects |
|
|
Term
| What are features of idioventricular rhythm? |
|
Definition
-impulse initiated in ventricle
-P waves disassociated
-QRS wide, bizarre, > .12
-rate 20-40 bpm |
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Term
| What are causes of idioventricular rhythm? |
|
Definition
| escaped rhythm d/t failure of other pacemaker sites |
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|
Term
| What is the difference between idioventricular and accelerated idioventricular rhythm? |
|
Definition
|
|
Term
| What are causes of accelerated idioventricular rhythm? |
|
Definition
-increased automaticity
-enhanced phase 4 depolarization (e.g. ischemia, MI, dig toxicity, hypokalemia, other electrolyte imbalances, hypoxiemia) |
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|
Term
| What are features of PVCs? |
|
Definition
-single irritable focus within ventricles
-wide QRS complex |
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|
Term
|
Definition
-heart dz
-drug toxicity
-hypoxia
-electrolyte imbalance
-stimulants (coffee, tea, tobacco, anxiety) |
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Term
| What are features of vtach? |
|
Definition
-irritable focus within ventricles firing irregularly (reentry)
-QRS wide, bizarre
-no P wave for every QRS, maybe disassociated P waves
-rate 150-250 (< 150 slow VT, > 250 v-flutter) |
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|
Term
| What are causes of vtach? |
|
Definition
-organic heart dz
-drugs
-ischemia
-dilated cardiomyopathy |
|
|
Term
| What are features of Torsades de Pointes? |
|
Definition
-polymorphic vtach (QRS morphology changes)
-no baseline |
|
|
Term
| What are causes of Torsades de Pointes? |
|
Definition
-congenital or acquired prolongation of QT interval
-medications (quinidine, sotolol, amiodarone, ibutilide, tikosyn, etc.) |
|
|
Term
| What are features of vfib? |
|
Definition
-multiple irritable foci in ventricles
-completely chaotic |
|
|
Term
|
Definition
-organic heart dz
-drugs
-ischemia |
|
|
Term
| What are features of asystole? |
|
Definition
|
|
Term
| What are causes of asystole? |
|
Definition
-sinus arrest
-vagally mediated |
|
|
Term
| What are features of paced rhythm? |
|
Definition
-pacemaker spikes immediately followed by P wave or QRS complex
-wide QRS complex |
|
|
Term
| What are features of wandering atrial pacemaker? |
|
Definition
-pacemaker wanders bw SA node, atria, and AV junction
-P waves differ in morphology
-PR interval and R-R vary
-rate < 100 bpm |
|
|
Term
| What are features of multifocal atrial tachycardia? |
|
Definition
-multiple foci firing in atria
-P waves differ in morphology
-PR interval and R-R vary
-rate > 100 bpm |
|
|
Term
| What are features of atrial tachycardia? |
|
Definition
-irritable focus within atrium
-rate 150-250 bpm |
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|
