Term
| what do the surface electrodes of EKG measure |
|
Definition
| surface electrodes record myocyte action potentials/electrical impulses that are traveling to the heart |
|
|
Term
| is the skin electrode positive or negative |
|
Definition
|
|
Term
| is the depolarization positive or negative |
|
Definition
|
|
Term
| does the depolarization move toward or away from the electrode |
|
Definition
| negative depolarization moves toward the positive electrode |
|
|
Term
| with the depolarization wave moving toward the electrode, will you get a positive or negative deflection from the isoelectric line on the EKG? |
|
Definition
|
|
Term
| how many different leads are examined on an EKG |
|
Definition
|
|
Term
|
Definition
| paired positive and negative electrodes |
|
|
Term
| what is the vertical axis of an EKG |
|
Definition
|
|
Term
| what are the units of voltage on the vertical line of an EKG |
|
Definition
|
|
Term
| what is on the horizontal axis of an EKG |
|
Definition
|
|
Term
| what are the units of time on the horizontal axis of an EKG |
|
Definition
|
|
Term
| what is the isoelectric line |
|
Definition
| 0mV, baseline, mechanical flatline |
|
|
Term
| are positive charges deflected above or below isoelectric line |
|
Definition
|
|
Term
| on EKG graph paper, what is the distance between each small line |
|
Definition
|
|
Term
| what is the time differentiation of each small line/1mm on the horizontal axis |
|
Definition
|
|
Term
| on the vertical axis, what is the voltage differentiation of each small box/1mm |
|
Definition
|
|
Term
| how much voltage is in one big box on the EKG |
|
Definition
|
|
Term
| how much time is in one big box on the EKG |
|
Definition
|
|
Term
| how many mm in one big box on an EKG |
|
Definition
|
|
Term
| what does the P wave represent |
|
Definition
| atrial depolarization/contraction |
|
|
Term
| what does the QRS represent |
|
Definition
| ventricular depolarization/contraction |
|
|
Term
| what does the T wave represent |
|
Definition
| ventricular repolarization |
|
|
Term
| what is the normal time range for a QRS complex to occur |
|
Definition
|
|
Term
| what is the normal flow of depolarization in the cardiac conduction system |
|
Definition
| SA node, atria, AV node, His bundle, R&L bundle branches, purkinje fibers, ventricles |
|
|
Term
| what are internodal tracts |
|
Definition
| nerve tissue that travels and carries the depolarization waves from the right atrium to the left atrium |
|
|
Term
|
Definition
| cardiac myocytes have the capability of firing automatically without external impulses |
|
|
Term
| can each area of the heart have specific, inherent, different firing rates? |
|
Definition
|
|
Term
| how does firing of myocytes usually occur |
|
Definition
| by direct electrical conduction from neighboring cells |
|
|
Term
| what determines which electrical impulse is the pacemaker |
|
Definition
| the faster firing impulse wins and determines firing rate |
|
|
Term
| what is the hierarchy of automaticity |
|
Definition
| SA node, AV node, HIS-Purkinje, ventricular foci |
|
|
Term
| what is the intrinsic rate of the SA node |
|
Definition
|
|
Term
| what is the intrinsic rate of the AV node |
|
Definition
|
|
Term
| what is the intrinsic rate of the HIS-Purkinje fibers |
|
Definition
|
|
Term
| what is the intrinsic rate of the ventricular foci |
|
Definition
|
|
Term
| what kinds of medications could lower heart rate to 40? |
|
Definition
|
|
Term
| what are the clinical symptoms of having a heart rate of 40 |
|
Definition
| not alert, shortness of breath, fatigue, light headedness, early fatigue, orthostatic hypotension |
|
|
Term
| if a patient gets lightheaded when they stand up, what should you do |
|
Definition
| have them sit down. If it happens a second time, have them stand up slowly, exhale as they stand (not hold breath), hold on for several seconds once they stand, focus eyes on something to increase balance, monitor blood pressure |
|
|
Term
| what are the symptoms of heart rate <40 |
|
Definition
|
|
Term
| what should you do if patient is unconscious with HR <40 |
|
Definition
| start chest compressions/CPR |
|
|
Term
| what kind of problem would wipe out the SA node or AV node |
|
Definition
|
|
Term
| are SA, AV, and ventricular foci susceptible to external chemical influences that alter firing rate/heart rate? |
|
Definition
|
|
Term
| what is an endogenous chemical influence of heart rate |
|
Definition
|
|
Term
| what is the role of the autonomic nervous system on heart rate |
|
Definition
| sympathetic effects on SA node, AV node, ventricles. Parasympathetic effects on SA node, AV node |
|
|
Term
|
Definition
| the pause at the AV node for the ventricles to fill |
|
|
Term
| why don't we see a wave for atrial repolarization |
|
Definition
| the wave is lost/imbedded in QRS wave |
|
|
Term
| what part of the EKG graph is the S |
|
Definition
|
|
Term
| what is the normal time range for the PR interval |
|
Definition
|
|
Term
| what is the normal time frame for the QRS complex |
|
Definition
|
|
Term
| what is the most labile part of the EKG |
|
Definition
|
|
Term
| is the shape or the time of the ST segment more important |
|
Definition
|
|
Term
| is the P usually positive or negative |
|
Definition
|
|
Term
| how to measure PR interval |
|
Definition
| beginning of P wave to beginning of R wave |
|
|
Term
| what is the positive part of the QRS wave |
|
Definition
|
|
Term
| which hump represents ventricular repolarization |
|
Definition
|
|
Term
| what are the rates of each bold line in the dubin method of determining heart rate from EKG |
|
Definition
| 300, 150, 100, 75, 60, 50 |
|
|
Term
| which wave do you count in dubin method of determining heart rate |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what rate is atrial flutter |
|
Definition
|
|
Term
| what type of rate would ventricular flutter be |
|
Definition
|
|
Term
| how does atrial fibrillation affect heart rate |
|
Definition
| could be either bradycardia or tachycardia because the ventricular response is irregular |
|
|
Term
| what do we call a normal rhythm |
|
Definition
|
|
Term
| what are 3 abnormal rhythms |
|
Definition
| supraventricular, heart blocks,ventricular |
|
|
Term
| what causes a heart block rhythm |
|
Definition
| electrical impulses occur at the junction of the atria and ventricles |
|
|
Term
| what causes ventricular rhythm |
|
Definition
| electrical impulses originate in the ventricles |
|
|
Term
| what is another term for arrhythmia |
|
Definition
|
|
Term
| what are stable, controlled rhythms |
|
Definition
| dysrhythmias that the patient is taking medication for. Known by physician and documented |
|
|
Term
| what are lethal dysrhythmias |
|
Definition
| those that have to be managed immediately and require immediate defibrillation |
|
|
Term
| what is a supraventricular dysrhythmia |
|
Definition
| anything originating above the ventricles |
|
|
Term
| what is a sinus dysrhythmia |
|
Definition
| impulse is still coming from the SA node, but it doesn't fall within the normal heart rate of 60-100 |
|
|
Term
| what do we call it when a person is an athlete and has a heart rate of 55 |
|
Definition
| sinus dysrhythmia, sinus bradycardia |
|
|
Term
| what do we call it when a person is exercising and their heart rate gets to 150 |
|
Definition
|
|
Term
| what is happening in atrial fibrillation/flutter |
|
Definition
| another pacemaker in the atria besides the SA node has taken over the rhythm of the heart |
|
|
Term
|
Definition
| premature atrial contraction |
|
|
Term
| what normal thing can cause PACs |
|
Definition
|
|
Term
|
Definition
| an odd pacemaker in the atria jumped the gun and paced the heart for that beat/sequence. |
|
|
Term
| what is a junctional dysrhythmia |
|
Definition
| impulse comes from lower down in the atria near the division between the atria and the ventricles |
|
|
Term
| what is the atrial rate with atrial flutter |
|
Definition
|
|
Term
| what do P waves look like in atrial flutter |
|
Definition
|
|
Term
| what is the ratio of P:QRS in atrial flutter |
|
Definition
|
|
Term
| what does atrial flutter rapidly change to |
|
Definition
|
|
Term
| what is the atrial rate with atrial fibrillation |
|
Definition
|
|
Term
| what do the P waves look like in atrial fibrillation |
|
Definition
| indistinguishable, jagged baseline |
|
|
Term
| what does the QRS rte look like in atrial fibrillation |
|
Definition
|
|
Term
| what is the heart rate in controlled A fib |
|
Definition
|
|
Term
| what is the heart rate in uncontrolled A fib |
|
Definition
|
|
Term
| what are some treatments for Afib |
|
Definition
|
|
Term
| what determins whether a patient is treated for Afib |
|
Definition
| full clinical picture/symptoms: blood pressure, decreased cardiac output |
|
|
Term
| what is the danger of chronic Afib |
|
Definition
|
|
Term
| do you have irregular QRS with atrial fibrillation |
|
Definition
|
|
Term
| do you have irregular QRS with atrial flutter |
|
Definition
|
|
Term
| what causes AV heart blocks |
|
Definition
| faulty conduction through AV node |
|
|
Term
| what is the range of AV heart blocks |
|
Definition
|
|
Term
| what to look for in AV heart block |
|
Definition
| conduction rate of P:QRS to see if each P wave causes a QRS |
|
|
Term
| what are the 3 types of heart blocks |
|
Definition
| 1st degree, 2nd degree, 3rd degree |
|
|
Term
| what is the ratio of P:QRS in 1st degree heart block |
|
Definition
|
|
Term
| describe the PR interval of a 1st degree AV block |
|
Definition
| fixed interval greater than 0.2s |
|
|
Term
| describe the rate of 1st degree heart block |
|
Definition
|
|
Term
| do you need treatment for 1st degree heart block |
|
Definition
|
|
Term
| what is significant in the EKG for 1st degree AV block |
|
Definition
| long time between P and R because of extensive delay at the AV node |
|
|
Term
| what does elevated ST segment indicated |
|
Definition
|
|
Term
| what does depressed ST segment indicated |
|
Definition
|
|
Term
| what are the 2 types of 2nd degree AV heart block |
|
Definition
| type I wenckebach, type II |
|
|
Term
| what happens in type I wenckebach 2nd degree AV block |
|
Definition
| PR interval gets progressively longer until a QRS is dropped, then the cycle repeats. It's irregularly regular. |
|
|
Term
| does type I 2nd degree av block require medication |
|
Definition
|
|
Term
| what is the P:QRS ratio in type II 2nd degree AV block |
|
Definition
|
|
Term
| why are there more P waves than QRS waves in type II 2nd degree AV block |
|
Definition
| the P waves are not getting conducted through the AV node every time. |
|
|
Term
| if the P wave isn't getting through the AV node every time, how is heart rate affected |
|
Definition
|
|
Term
| what is the treamtne for type 2 2nd degree AV block with P: QRS ratio of 3:1? |
|
Definition
| pacemaker because the heart rate will be too slow for sufficient cardiac output |
|
|
Term
| what happens in 3rd degree av block |
|
Definition
| complete dissociation of P and QRS. NONE of the atrial depolarizations penetrate to the ventricles |
|
|
Term
| how are ventricular rates affected in 3rd degree AV block |
|
Definition
| may be as low as 20's, 30's. |
|
|
Term
| what is the outlook of 3rd degree AV block |
|
Definition
| medical emergency. Insufficient cardiac output due to bradycardia. |
|
|
Term
| what are treatments of 3rd degree AV block |
|
Definition
|
|
Term
| what is causing the ventricles to contract in 3rd degree AV block |
|
Definition
|
|
Term
| what does EKG of 3rd degree AV block look like |
|
Definition
| no relationship between P and QRS. Random. Slow heart rate |
|
|
Term
| what is a bundle branch block |
|
Definition
| an MI wipes off the nerve tissue of a bundle branch, resulting in a notched R wave. The R wave will also be long. |
|
|
Term
| what is the characteristic of ventricular dysrhythmias |
|
Definition
| no p waves discernable, QRS >0.12s, PVC, compensatory pause usally follows |
|
|
Term
| what does ventricular dysrhythmia require for treatment |
|
Definition
|
|
Term
| why is there usually a pause after a PVC |
|
Definition
| compensatory pause in the heart because the heart notices that an odd depolarization occurred so it pauses to reset itself |
|
|
Term
| can PVC's occur randomly and be normal |
|
Definition
|
|
Term
| are frequent PVC's a problem |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what is ventricular tachycardia |
|
Definition
| series of PVCs happening continuously one after the next |
|
|
Term
| what is the worst type of ventricular dysrhythmia |
|
Definition
|
|
Term
| describe p waves in ventricular tachycardia |
|
Definition
|
|
Term
| what determines if you have VT |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| fast, tachycardia. 100-250 |
|
|
Term
| what are treatments for VT |
|
Definition
| meds, cardioversion, implantable defibrillator |
|
|
Term
| how to tell whether to do pulse in patient with VT |
|
Definition
| do CPR if pulse is weak, thready |
|
|
Term
| what do T waves look like in ischemia |
|
Definition
|
|
Term
| describe p waves in ventricular fibrillation |
|
Definition
|
|
Term
| what is happening to ventricles in Vfib |
|
Definition
| erratic quivering. No squeeze. No cardiac output |
|
|
Term
| what does the EKG look like in ventricular fibrillation |
|
Definition
| erratic. Sine wave to jagged scribble |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| how does ischemia affect EKG |
|
Definition
| depressed ST, inverted T wave |
|
|
Term
| how does amount of ST depression relate to amount of ischemia |
|
Definition
|
|
Term
| how to tell acute MI from EKG |
|
Definition
| elevated ST, possibly significant Q wave |
|
|
Term
| if there is a significant Q wave with elevated ST, what does that mean |
|
Definition
|
|
Term
| if there is not a significant Q wave with elevated ST, what does that mean |
|
Definition
|
|
Term
| what does it mean for Q wave to be significant |
|
Definition
| wide. >1mm. Or amplitude >1/3 QRS |
|
|
Term
| how long will Q wave remain significant |
|
Definition
|
|
Term
| besides EKG, how else can you tell if someone is having an early MI |
|
Definition
|
|
Term
| what is the Q wave normally |
|
Definition
|
|
Term
| what is the q wave following MI |
|
Definition
|
|
Term
| what causes the weird Q waves |
|
Definition
| damaged heart muscle scars over. Electrical impulse must go around this area. |
|
|
Term
| which lead do we usually look at |
|
Definition
|
|
Term
| which plane are limb leads in |
|
Definition
|
|
Term
| what are the 6 limb leads |
|
Definition
| I, II, III, aVR, aVL, aVF |
|
|
Term
| which plane are precordial leads in |
|
Definition
|
|
Term
| what are the 6 transverse leads |
|
Definition
|
|
Term
| what is Einthoven's triangle |
|
Definition
| electrodes on R wrist, L wrist, L foot |
|
|
Term
| what is the direction of viewing of lead 1 |
|
Definition
| lead 1 will look at the heart from R wrist to L wrist |
|
|
Term
| what is the direction of viewing of lead 2 |
|
Definition
| lead 2 looks at the heart from R wrist to L foot |
|
|
Term
| what is the viewing direction of lead 3 |
|
Definition
| lead 3 looks at the impulse flowing from the heart from the angle of L wrist to L foot |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what are the inferior leads |
|
Definition
|
|
Term
| what are the lateral leads |
|
Definition
|
|
Term
| what are the anterior leads |
|
Definition
|
|
Term
| what are the septal leads |
|
Definition
|
|
Term
| what are the posterior leads |
|
Definition
| reciprocal changes in V1, V2 |
|
|
Term
| what EKG represents acuteinferior MI |
|
Definition
| ST elevation in II, III, aVF, may also be significant Q wave in these leads |
|
|
Term
| what EKG represents acute lateral MI |
|
Definition
| ST elevation in I, aVL, may also be significant Q wave in these leads |
|
|
Term
| what EKG reflects acute anterior MI |
|
Definition
| St elevation in V3, V4, may also be significant Q wave in these leads |
|
|
Term
| what EKG representsacute septal MI |
|
Definition
| ST elevation in V1, V2, may also be significant Q in these leads |
|
|
Term
| what EKG represents acute posterior MI |
|
Definition
| ST depression in V1, V2, may have significant R wave in same leads |
|
|
Term
| what would an anteiror infarct affect |
|
Definition
|
|
Term
| how can you detect ventricular hypertrophy with EKG |
|
Definition
| R wave will get more positive V1-V6. increased voltage means there is more muscle tissue that the voltage has to get through. |
|
|
Term
| what problems might cause the R atria to phyertrophy |
|
Definition
| icnreased preload, valve complications of the tricuspid valve. |
|
|
Term
| how would you see R atrial enlargement in EKG |
|
Definition
| abnormally tall p wave in lead II |
|
|
Term
| how would you see L atrial enlargement in EKG |
|
Definition
| abnormally wide p wave in any lead or diphasic p wave in lead V1 |
|
|
Term
| how would you see R ventricular hypertrophy on EKG |
|
Definition
|
|
Term
| how would you see L ventricular hypterophy in EKG |
|
Definition
| poor R wave progression V1-V6 |
|
|
Term
| what causes R ventricular hypertrophy |
|
Definition
| pathology to pulmonary valve, lungpathology |
|
|
Term
| what is the mean QRS vector |
|
Definition
| if you add up all the small vectors of ventricular depolarization, you get mean QRS vector |
|
|
Term
| does the mean QRS vector go to left or right |
|
Definition
|
|
Term
| how does heart sit in tall, think patient |
|
Definition
|
|
Term
| how to categorize heart tilt |
|
Definition
| left axis deviation = tilted up and left, right axis deviation = tilted to the right. Can be extreme if tilted really far to the right |
|
|
Term
| how does infarction affect axis |
|
Definition
| axis moves away from infarction |
|
|
Term
|
Definition
| a condition that happens with lung disease |
|
|
Term
| what are normal EKG changes with exercise |
|
Definition
|
|
Term
| what happens with exercise induced ischemia on EKG |
|
Definition
|
|
Term
| what are electrophysiology studies |
|
Definition
| EKG as a diagnostic tool to localize conduction abnormalities |
|
|
Term
| what are possible treatments that may be recommended following EP studies |
|
Definition
| pacemaker, implantable cardiac defibrillator, catheter ablation |
|
|
Term
| how is wolf parkinsin white syndrome diagnosed |
|
Definition
| electrophysiology studies |
|
|
Term
| what is wolf parkinson white syndrome |
|
Definition
| there's a little piece of muscle that bypasses the AV node, carrying down the signal from the atria to the ventricles without pausing first to give the ventricles time to fill and decreasing the stroke volume. |
|
|
Term
| how is wolf parkinsin white syndrome treated |
|
Definition
| implant a defibrillator that shocks the heart into a normal rhythm when it senses that the heart is going into vfib |
|
|
Term
| how can you see in EKG that a person has a pacemaker |
|
Definition
| regular spike/line in the EKG |
|
|
Term
| review the ekg's in the ppt |
|
Definition
|
|
