1
Q
In what leads should a p-wave be positive?
A
I, II, aVF, V4-V6
2
Q
List the inherent pace makers & their rates.
A
SA node 60-100
AV node 40-60
Ventricular tissue 20-40
3
Q
What should the duration of a p-wave be?
A
< 0.12 seconds
4
Q
What should the duration of a PR interval be?
A
0.1 - 0.2 seconds
5
Q
What should the duration of a QRS complex be?
A
< 0.12 seconds
6
Q
Elevation/depression of an ST segment by __ mm is clinically relevant
A
1
7
Q
T-waves should be positive in which leads?
A
I, II, V3-V6
8
Q
What does Paroxysmal mean?
A
Intermittent
9
Q
Venticular ectopy is usually indicative of what?
A
K⁺ imbalances
10
Q
What effects do halothane/enflurane have in regards to arrhythmias?
A
They sensitize the myocardium
11
Q
What arrhythmia in infants can result from sevoflurane?
A
Bradycardia (via oculocardiac reflex)
12
Q
What can desflurane cause during induction?
A
Prolonged QT
13
Q
What two adverse events can occur from local anesthetic injection into the vasculature?
A
Severe bradycardia
Asystole
14
Q
How would excessive intravascular lidocaine be treated?
A
Lipid rescue
15
Q
What is the list of conditions that can result in perioperative dysrhythmias?
A
- General/Local anesthetics
- Abnormal ABG or electrolytes
- Endotracheal intubation (most common)
- Autonomic reflexes
- CVP cannulation
- Surgical manipulation of heart/lungs
- Location of surgery
- Hypoxemia
- Cardiac Ischemia
- Catecholamine excess
16
Q
What anatomic structure (discussed in class) causes dysrhythmias when stimulated during cardiac surgeries?
A
Pulmonary arteries
17
Q
What can prevent the oculocardiac reflex?
A
Glycopyrolate & Atropine
18
Q
What example was given of a surgical location where stimulation results in dysrhythmias?
A
Eyes (due to oculocardiac reflexes)
Heart/lungs
19
Q
Describe the P wave, QRS complex, & T waves in HYPERkalemia.
A
P waves - flat & low amplitude (slow conduction)
QRS - wide, fusion of QRS-T (causing loss of ST segment)
T - tall & tented
20
Q
Describe the T wave in HYPOkalemia.
A
Negative T-waves
U-wave may be visible in V2 & V3
21
Q
What is a delta wave? What syndrome is it commonly seen in?
A
A slurred upstroke in the QRS complex
WPW (s/t pre-excitation of the ventricles)
22
Q
Where does lead V1 go? V2?
A
V1 - 4th ICS, right of sternum
V2 - 4th ICS, left of sternum
23
Q
Where does lead V3 go? V4?
A
V3 - between V2 & V4
V4 - 5th intercostal space, left of sternum, midclavicular line
24
Q
Where does lead V5 go?
V6?
A
V5 - 5th ICS, left of sternum, anterior axillary line
V6 - 5th ICS, left of sternum, midaxillary line
25
What wave is the first positive deflection after a p-wave?
R-wave
26
Describe an s-wave.
Negative deflection below baseline after an R or Q wave.
27
What QRS is denoted by 1 in the figure below?
R
28
What QRS is denoted by 2 in the figure below?
QS
29
What QRS is denoted by 3 in the figure below?
qRs
30
What QRS is denoted by 4 in the figure below?
rS
31
What QRS is denoted by 5 in the figure below?
qR
32
What QRS is denoted by 6 in the figure below?
rSR'
33
1 small box on an EKG strip equals _____.
1mm or 0.04s
34
1 large box on an EKG strip equals ______.
5mm or 0.2s
35
If healthy, both the QRS complex and T-wave should be ______ in leads I, II, & III.
positive.
36
What is the mean electrical axis of the heart?
59°
37
A clockwise shift of the mean electrical axis shift of the heart is indicative of what?
Right-axis deviation
38
A counter-clockwise shift of the mean electrical axis shift of the heart is indicative of what?
Left-axis deviation
39
For Lead I, where is the negative terminal connected? How about the positive terminal?
Negative = RT arm
Positive = LT arm
40
For Lead II, where is the negative terminal connected? How about he positive terminal?
Negative = RT arm
Positive = LT leg
41
For Lead III, where is the negative terminal connected? How about the positive terminal?
Negative = LT arm
Positive = LT leg
42
Which lead is used to determine posterior vs anterior injury?
V2
43
In which precordial lead does the QRS complex have the most magnitude?
V4
44
What mV is denoted by a small box on an EKG strip?
0.1mV
45
What mV is denoted by a large box on an EKG strip?
0.5mV
46
What angle is viewed utilizing aVF?
90°
47
What angle is viewed utilizing aVL?
-30°
48
What angle is viewed utilizing aVR?
How does this compare to lead II?
150°
aVR is essentially opposite lead II. (not exactly though, Lead II's negative terminal is -120°)
49
For Lead aVR, where are the positive & negative terminals?
Negative = LT arm + LT leg (+30°)
Positive = RT ARM (-150°)
50
For Lead aVF, where are the positive & negative terminals?
Negative = LT arm + RT arm
Positive = LT LEG
51
For Lead aVL, where are the positive & negative terminals?
Negative = LT leg + RT arm
Positive = LT ARM
52
What cardiac EKG lead is the least useful in practice but most unique in its position? (this one has a lot of test questions about it)
aVR
53
What is the axis of Lead I?
0°
54
What is the axis of Lead III?
120°
55
What degree change would characterize an extreme axis deviation?
-90° to 180°
56
What would the mV of this QRS complex be?
+1.5mV
57
What would the mV of this QRS complex be?
- 1.0mV (approximation)
58
Determine the mV of leads I & III and subsequently the degree & axis of deviation noted by these strips.
Lead I ≈ -2.0 mV
Lead III ≈ +1.75 mV
Deviation ≈ in between +180° & +120° ≈ 170° due to greater Lead I magnitude.
**Significant right axis deviation**
59
The EKG strips below are indicative of what pathology?
Right Bundle Branch Block (RBBB)
60
A notched, wide R wave on Lead V6 would likely be indicative of what condition?
Left Bundle Branch Block (LBBB)
61
A positive current of injury on V2 would be indicative of what?
Posterior MI
62
A negative current of injury on V2 would be indicative of what?
Anterior MI
63
What axis deviation is expected with a negative QS deflection in Lead I + Lead II, and positive R deflection in Lead III?
Right Axis Deviation
64
What axis deviation would be expected with a negative QS deflection in Lead II and Lead III & a positive R deflection in Lead I?
Left Axis Deviation
65
What axis deviation would be expected with a positive V1 QRS & a negative QRS in Leads I, II, & III?
Extreme RT Axis Deviation
no mans land
66
What block would you expect to present with a RT axis deviation?
Posterior Hemiblock
67
What block would you expect to present with a LT axis deviation?
Anterior Hemiblock
68
What is an MCL1 lead?
How is it placed?
Modified V1 lead
Positive Lead 4th ICS right of sternum
(negative terminal on the LT arm)
69
What would leads I, III, and III look like with normal axis?
All + QRS
70
Differentiate physiologic left axis & pathologic left axis deviation.
Physiologic: (+ L1) (+/isoelectric L2) ( - L3)
Pathologic: (+ L1) ( - L2) ( - L3)
71
What axis deviation is pathologic in all adults?
RT axis deviation is pathological in all adults.
72
What is the most common cause of right ventricular hypertrophy?
- **Lung disease**, pulmonary embolus, and pulmonary valve disease.
73
In what situations would you find physiologic left axis deviation?
Obesity & athleticism
74
Bundle Branch Block diagnosis is dependent on ______.
Hemiblock diagnosis is based on _______________.
Time
Axis deviation
75
What anatomical features of the heart are fed via the RCA?
Inferior & Posterior wall
Right ventricle (almost entirely)
SA & AV node
Posterior fascicle of LBB
76
What sx can someone with RCA problems usually have? Why?
Bradycardia & hypotension
Because the RCA supplies blood to the SA & AV node
77
Wha anatomical features of the heart are fed via the LAD?
"Widow maker"
Anterior wall of LV
Septal wall
Bundle of His & Bundle branch
78
What severe outcome should you worry about with septal infarct?
Septal rupture
79
What anatomical features of the heart are fed via the circumflex artery?
Lateral wall of LV
SA & AV nodes (mainly RCA)
Posterior wall of LV (in 15% of people)
80
Why is morphine now avoided in MI's?
Morphine causes histamine release.
81
What percentage occlusion would be assumed with chest pain on exertion?
70 - 85% occlusion
82
What percentage occlusion would be assumed with chest pain at rest?
90% occlusion
83
What percentage occlusion would be assumed with chest pain unrelieved by nitroglycerin?
100% occlusion
84
What should be administered before nitroglycerin with an acute right-sided MI?
fluid bolus
85
Are EKGs better in regards to sensitivity or specificity?
SPECIFICITY (sensitivity is the limitation)
(If MI is shown on EKG then it's likely an MI)
Most machines only 50% sensitive to picking up MI's.
Negative EKG result DOES NOT rule out MI.
86
On an EKG, what would indicate ischemia?
Symmetrical inverted T-waves in two or more related leads.
(Inverted T-waves are normal in Lead 3 & V1)
87
On an EKG, what would indicate an injury pattern?
ST elevation of more than 1mm in two or more related leads.
*most important thing to look for*
88
On an EKG, what would indicate infarction?
Pathologic Q waves >>
> 0.4 sec wide or ⅓ the depth of r-wave height
When seen with ST elevation = AMI
89
Which leads indicate a true lateral MI?
Which would indicate a high lateral?
True lateral = V5 & V6
High lateral = I, aVL
90
What is the most commonly seen MI? What is it usually due to?
Inferior MI
Occlusion of the RCA
91
What type of sx are seen with inferior MI?
Bradycardia, hypotension, 1st degree (Mobitz 1) block, and nausea.
92
Do you use nitrates with inferior wall MI?
Use caution with nitrates due to RV's being preload dependent w/ inferior MI's
93
What is the most lethal MI? Why?
Do you use nitrates?
Anterior Wall (LAD) "widow maker"
The LAD feeds the LCA
Yes use nitrates.
94
What dysrhythmias are commonly seen with anterior wall MI?
Complete Heart Block (CHB)
VFib/Vtach
95
What would cause one to prepare defibrillation pads for a patient having an anterior MI? (other than vfib/vtach)
Presence of **BBB or hemiblock** whilst undergoing an anterior MI
96
What condition will present with ST elevation in all leads?
What sx might they have & what will make them feel better?
How is it diagnosed?
Pericarditis
Patient feels better when they lean forward & there won't be reciprocal ST depression.
Diagnosed via fever, WBCs, hx of IVDU, etc.
97
What condition looks like an MI on EKG but can be fatal if thrombolytics are administered?
Dissecting thoracic aorta aneurysm
(NO nitro or heparin!!!)
98
What four conditions mimic MI in their EKG presentation?
LBBB
LV hypertrophy
Pericarditis
Thoracic aortic dissection
99
An anterior hemiblock will be indicated by a _________ axis deviation.
LT axis
100
A posterior hemiblock will be indicated by a ________ axis deviation.
RT axis
Health Assessment
flashcards
Decks in class (14)
# Cards
-
Pre-Op (Test 1)52
-
Physical Exam (Test 1)87
-
Algorithms (Test 1)31
-
EKG practice (Test 1)30
-
Basic & Advanced EKG (Test 1)100
-
Airway Assessment (Test 2)101
-
Musculoskeletal (Test 2)92
-
Ischemic HD (Test 2)24
-
Blood Products & Transfusion (Test 2) Corndog170
-
Valvular HD (Test 2)55
-
Blood Disorders (Exam 2)38
-
Exam 3 - Hepatic/Biliary Systems69
-
Exam 3 Neurological Diseases in Anesthesia81
-
Exam 3 - Vascular Diseases78
