524: cardioresp > ECG > Flashcards

ECG Flashcards

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1
Q

what is an ECG?

A

a graphical representation of the heart’s electrical activity (on specially ruled paper) recorded from electrodes placed on the surface of the body

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2
Q

when do PTs encounter ECGs?

A

ICU, cardiac surgery patients, sports (exercise testing), cardiac rehab settings, and pulmonary rehab settings

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3
Q

what information do ECGs provide to PTs?

A

readiness for PA and physiological responses to exercise

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4
Q

dysrhythmias during exercise

A

may emerge or worsen with activity

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5
Q

what can PTs who can identify abnormal ECGs changes do?

A

identify lethal dysrhythmias early, stop exercise immediately, and alert the medical team for timely treatment

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6
Q

what is the clinical decision triad?

A

lower intensity, stop exercise, and call for emergency

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7
Q
A
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8
Q

what is the SA node?

A

the primary pacemaker of the heart that generates regular, spontaneous APs

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9
Q

where is the SA node located?

A

superior right atrium

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10
Q

role of the AV node

A

it receives impulses from the atria and delays conduction to allow complete atrial contraction and optimal ventricular filling

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11
Q

what is the path of conduction in the heart?

A

SA node > AV node > bundle of His > right and left bundle branches > purkinje fibres

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12
Q

what causes ventricle contraction?

A

the depolarization signal carried via the purkinje fibres

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13
Q

bpm of the SA node

A

60-100 bpm

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14
Q

bpm of the AV node

A

40-60 bpm

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15
Q

bpm of the purkinje fibres

A

20-40 bpm

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16
Q

what does a regular rhythm at 40-60 bpm indicate?

A

AV/junctional rhythm

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17
Q

what does a slow rhythm of 20-40 bpm indicate?

A

ventricular rhythm

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18
Q

what does P wave signify?

A

atrial depolarization

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19
Q

what is the PR interval?

A

the time from the start of atrial depolarization to the start of ventricular depolarization

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20
Q

what is the PR segment?

A

represents the physiologic pause at the AV node and allows for complete atrial emptying before ventricular contraction

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21
Q

what influences the P wave?

A

atrial pathologies

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22
Q

what influences the PR interval?

A

AV conduction blocks

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23
Q

what is the QRS complex?

A

represents ventricular depolarization (contraction) and represents rapid ventricular pathologies

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24
Q

what would a problem with the QRS complex indicate?

A

ventricular pathologies

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25
what is the ST segment and T wave?
represents ventricular repolarization; ST segment is early ventricular repolarization and T wave is the end of repolarization/ventricular relaxation
26
what affects ST segment and T wave?
myocardial ischemia and infarction
27
why does correct ECG electrode placement matter?
this ensures accurate rhythm interpretation, especially during activity and misplaced electrodes can mimic ischemia, change QRS morphology, or hide serious arrhythmias
28
what is the 3-lead ECG used for?
provides one view of the heart and detects HR, rhythm, and arrhythmias
29
where does the black electrode go?
in the 2nd intercostal space and in the midclavicular line on the left side
30
where does the black electrode go?
in the 2nd intercostal space and in the midclavicular line on the right side
31
where does the red electrode go?
somewhere between iliac crest and the xiphoid process in the anterior axillary line
32
what is the 5-lead ECG used for?
2 views of the heart and detects HR, rhythm, and arrhythmias
33
when is 3-lead ECG common?
in acute care and sports
34
what is the gold standard ECG?
12-lead ECG
35
what is a 12-lead ECG?
the gold standard in cardiopulmonary testing and provides a multi-view assessment through using 10 electrodes
36
three Rs of rhythm strip analysis
rate analysis, rhythm analysis, and resemblance analysis
37
rate analysis
is the HR normal, fast (tachycardia), or slow. (bradycardia)?
38
rhythm analysis
is the rhythm regular or irregular?
39
resemblance analysis
does the strip look like a normal ECG pattern or does is resemble a known arrhythmia
40
how much time does a small (1mm) box represent?
0.04 mm
41
how much time does a big box (5mm) represent?
0.2 seconds
42
how much time does 30 big boxes represent?
6 seconds (this makes up a 6-second rhythm strip)
43
3 common methods of HR analysis
6-second method, cardiac ruler method, or 300 method
44
how to do the 6-second method?
count the number of QRS complexes in a 6 second strip and multiply by 10 and this gives you HR in bpm
45
how to do the cardiac ruler method?
find an R wave on the ECG strip and count the 5mm blocks after the R wave and use the cardiac ruler values for each 5mm block to estimate HR
46
how are cardiac ruler values found?
they are derived from 300 / # of 5mm blocks, ex. if it was the 3rd block than 300/3 and so on
47
how to do the 300 method?
count the # of big boxes between the two R-R interval and use this to divide by 300 (HR = 300 / (# of big boxes)
48
how to examine intervals in ECG?
look at the R-R interval (most common) or you can also check P-P interval (useful for atrial rhythms)
49
what on an ECG indicates an irregular pattern?
R-R intervals vary
50
normal small boxes for P wave
1.5-2.5
51
normal small boxes for PR interval
3-5
52
normal small boxes for QRS complex
1.5-3
53
normal small boxes for QT interval
8-10
54
4 parts of ECG you want to assess during resemblance
is there a P wave, is the PR interval long, is the QRS wide, and assess the ST segment and T waves
55
bradycardia HR
<60 bpm
56
where does bradycardia usually originate from?
the sinus node (called sinus bradycardia)
57
what does asymptomatic bradycardia mean to PT?
it is usually safe
58
what does symptomatic bradycardia mean to PT?
stop activity, assess vitals, and notify medial team
59
where does tachycardia originate from?
areas above the ventricles, including the atria or AV node
60
PT action for tachycardia
assess if there is physiological or pathological pain and if rate if >150-180 bpm or they are symptomatic, then stop activity, rest, and notify medical team
61
what is ventricular tachycardia?
a fast rhythm originating from the ventricles
62
PT action when noticing ventricular tachycardia
stop activity immediately and call a code/rapid response and/or start CPR and AED
63
what is an atrial flutter?
a rapid, regular rhythm from the atira, with p-waves on the ECG showing a saw tooth pattern
64
PT action for atrial flutter
continue if HR is controlled and BP is stable and stop if signs of decreased CO
65
what is a ventricular flutter?
a rapid and regular rhythm from the ventricles and P waves are usually not seen; is often a transient pattern from V-tachycardia to V-fibrillation and usually no pulse
66
PT action with ventricular flutter
could be CA with no pause so start CPR, AED, and call code
67
bpm for ventricular flutter
250-300
68
what is atrial fibrillation?
an irregular and rapid rhythm from the atria, causing ineffective atrial contractions with indiscernible p-waves and ventricular response could vary
69
what is ventricular fibrillation?
a chaotic and irregular rhythm from the ventricles, leading to ineffective contractions and sudden CA - no recognizable ECG component and the heart is quivering with no effective pumping or pulse
70
complications of ventricular fibrillation
cardiac arrest so call code, do CPR, and AED
71
PT action with atrial fibrillation
monitor ventricular response and stop if signs of decreased CO
72
what is a delay or block?
an interruption of the communication system between the atria and ventricles - this is a delay in the AV node for longer than expected
73
what is a first degree heart block?
a uniform increase in the delay at the AV node, resulting in abnormally slow conduction and PR interval prolongation (>.2 seconds) but every P wave if followed by QRS
74
what is a second degree heart block (mobitz type I)?
intermittent and progressive dealy of each stimulus until a beat is missed (no QRS) and the AV node recovery after each drop and the cycle repeats - P-P interval is regular and PR interval is constant
75
what is a second degree heart block (mobitz type II)?
sudden appearance of a single, non-conducted sinus P wave without type I feature; PR interval is constant and P-P interval is regular
76
what is a third degree heart block?
complete blockage of AV conduction, resulting in independent atrial and ventricular activity and atrial rate > ventricular rate
77
how does a third degree heart block appear on an ECG?
variable P-R intervals and QRS complex could be narrow or wide depending on the foci generating the rhythm
78
PT action for third degree heart block
stop all activity and activate emergency protocol and call 911
79
what are premature contractions?
early beats that interrupt the normal rhythm and can originate from the atria, ventricles, or the AV junction; premature beats are usually followed by a small pause
80
premature atrial complexes
includes an early P wave, a shorter P-P or R-R interval and a normal QRS
81
premature ventricular contraction
includes an ectopic beat from the ventricle and a bizarre appearing QRS
82
premature junctional contraction
is a short PR interval (<.10 second) which indicates an ectopic beat (from the AV junction); P waves could occur before, within, or after the QRS complex and QRS is normal
83
3 life threatening features on an ECG
ST segment depression, ST segment elevation, and peaked T waves
84
what does ST segment depression indicate?
MI due to the ST segment being below the baseline
85
what does a ST segment elevation indicate?
acute myocardial injury due to the ST segment being above the baseline
86
what does a peaked T wave indicate?
hyperkalemia or acute myocardial injury; waves appear as tall, narrow and pointed
87
red flag ECG pathologies to stop exercise and seek medical help
atrial flutter, atrial fibrillation, second degree AV block, third degree AV block, ventricular tachycardia, ventricular flutter, or signs of ischemia or infarct
524: cardioresp
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