CPR2 Exam 1 > ECG Tutorial Part 2 - Dr. Johnston > Flashcards

ECG Tutorial Part 2 - Dr. Johnston Flashcards

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1
Q

1st degree AV block is what

A

PR segment is longer then 0.2sec

= due to the AV node problem

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2
Q

1st degree AV Block is seen when

A
  1. Atherosclerosis, HTN, DM, *
  2. Fibrosis like in Congenital HD*
  3. CAD ischemia
  4. Drugs like CCB, B.B, Anti-arrhymias
  5. Thyroid problem or adrenal insufficiency
  6. Inflammation or amyloidosis, hemochromatosis, sarcoidosis
  7. Valvular calcification
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3
Q

2nd degree AV Block types

A
  1. Mobitz type 1 (Wenckbach) : progressive PR prolongation before dropped QRS
    = Grouped Beats, there is a pattern
  2. Mobitz type 2
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4
Q

Mobitz type 1 (Wenckbach) is what and associated with

A

Mobitz type 1 (Wenckbach) : progressive PR prolongation before dropped QRS, “grouped beats” = pattern
= progressive lengthening of PR (since the impulse from SA to AV comes to early during refractory period)
= associated with Inferior wall MI
= transient

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5
Q

Mobitz type 1 (Wenckbach) :causes

A
  1. Digitalis toxicity
  2. Ischemic event (inferior MI)** seen in leads 2,3, AVF
  3. Myocarditis
  4. Right coronary artery disease
  5. Edema around AV node
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6
Q

Mobitz type 1 (Wenckbach) : looks like

A

Narrow QRS , longer and longer PR before the dropping of QRS
= 40-55bpm

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7
Q

What do you see in MI inferior wall

A

ST elevation : leads 2, 3, AVF

ST depression : leads 1, AVL

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8
Q

Mobitz type 2 associated with a prognosis

A
  1. Ischemic heart disease
  2. Anterior wall MI
  3. Conductive system degeneration
  4. LAD coronary artery disease
    = worse prognosis then type 1, progressive and irreversible
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9
Q

Mobitz type 2 looks like and where is the block

A

PR stays the same in the length
Drops QRS at any point, wide QRS
20-40bpm
= anyplace distal to AV node, bundle of his, bundle branches, fascicularis branches

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10
Q

3rd degree AV Block is what and types (above and below AV node block)

A

A and V are not communicating at all and work independently

  1. Above AV block : Junctional rhythm ——> narrow QRS (40-55bpm)
  2. Below AV Block : Ventricular Pacemaker ——> Wide QRS (20-40bpm)
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11
Q

3rd degree AV Block TX

A

pacemaker if sustained

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12
Q

3rd degree AV Block causes

A
  1. Ischemic HD
  2. Infiltration disease
  3. Cardiac surgery : (Bypass, valve, myocarditis, degenerative)
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13
Q

3rd degree AV Block looks like

A

P and QRS have different HRs and not any pattern to when they show up next to each other

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14
Q

Oder of activation of wall in the ventricles

A
  1. Left ventricular septa ——> RIGTH ventricular septa
  2. To bottom RIGTH ventricular wall ——> upper RIGTH ventricular wall
  3. Bottom left V wall ——> upper left V wall
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15
Q

BBB ( Bundle Branch Block) looks like

A
  1. QRS is wider then 3 small boxes (0.12sec)

2. ST segment and T wave opposite of QRS (seen I premature ventricular contractions)

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16
Q

RBBB which leads should you look at

A

1, AVL, 6, V1, V2

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17
Q

RBBB what happens

A

After septum in activated

The left ventricle is activated first and then the right is activated

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18
Q

RBBB looks like what on EKG

A

QRS is wide and notched (R’)
ST in opposite direction
RIGHT LEAD = R, S, R’

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19
Q

Left side of heart is seen in what leads and what do you see in RBBB

A

1, V5, V6, AVL = wide R wave with and wide S wave present

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20
Q

RIGTH side of heart in what leads and looks like what in RBBB

A

V1* and V2* (can have notches), and V3
= R, S, R’
Wide fat QRS

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21
Q

LBBB what happens

A

Left septum does not activate
Right septum activates first traveling to left septum
Then RIGTH V and last Left ventricle

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22
Q

LBBB what do you see

A
  1. No Q wave in V5, V6 (left side heart) + inverted ST

2. DEEP Q and S wave in V1 and V2 (right side heart)

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23
Q

LBBB causes

A
  1. HTN
  2. Ischemia
  3. Aortic Stenosis
  4. Cardiomyopathy
  5. LAD ——> myocardial dysfunction
  6. RAD ——> Congestive cardiomyopathy
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24
Q

Leads to look at for LBBB

A

1 (wide R and R’), V6, ALV, V5, = all look the same **

V1/ V2 / V3 (very deep wide or narrow Q and S)**

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25
Hemiblocks are what
Blocks after the bifurcation of the left bundle
26
Hemiblocks directions it can happen and what does each ekg look like
1. Left Anterior (superior fascicle) = more common, upside down QRS, so its R, narrow S at inferior AVF, and normal 1 2. Left Posterior (inferior fascicle), normal QRS at AVF and upside down at 1 3. NO hemiblock, normal QRS in 1 and AVF
27
Left anterior Hemiblocks Left posterior Hemiblocks Axis
LAH : left axis (+1, -AVF), more then -60degrees | LPH : right axis (-1, +AVF), more ten 120 degrees
28
LAH : small Q and small R leads
1. Small Q : 1, AVL | 2. Small R : AVF, 2,3
29
LPH : small Q and small R leads
1. Small R : 1, AVL | 2. Small Q : AVF, 2,3
30
LAH causes
- LAD occlusion MI** | - conduction system disease
31
What can see the exact type of hypertrophy imaging
Echocardiogram
32
LAE RAE LVE = LVH RVE = RVH
Left atrial enlargement RIGTH atrial enlargement Left ventricular enlargement = LV hypertrophy RIGTH V E = Right ventricular hypertrophy
33
Atrial enlargement causes
1. Dilitation : high Blood V in chamber 2. Hypertrophy : High resistance to BF out of chamber 3. V overload
34
Atrial enlargement leads to look at and which chamber enlarges first
first the right then left | LEADS : 1, 2, 3, V1 (dont need to know)
35
P wave normal EKG characteristics
1. NOT 3mm high | 2. Pointed, notched, wide, tall is not normal (normal = rounded)
36
V1 and 2 RAE looks like P wave
Lead 2 : pointed at top then wider at base | V1 : pointed and then dips down a little before PR segment finishes
37
V1 and 2 LAE looks like P wave
Lead 2 : 2 bumps looking like an M, only both are round humps V1 : one round normal and then dips down before PR segment finishes (looks normal)
38
V1 and 2 LAE + RAE looks like P wave | *dont need to know*
Lead 2 : 2 humps at the top the first is pointed and the second one in round (M looking ) V1 : pointed iceberg and then dips down round and deeper then normal
39
RAE associated with 2 things
1. Tricuspid valve disease | 2. Lung : Pulmonary HTN, COPD, PE, asthma, mitral valve disease
40
LAE associated with what 2 things
Mitral stenosis | Mitral Regurgitation
41
Inverted P wave means
AV node junction origin P waves problem in leads 2 and 3
42
Ventricular Hypertrophy causes
Excess V during Diastole and need more P to eject blood during systole
43
LVH most common causes
HTN** | Aortic valve problems, hypertrophic cardiomyopathy, coarction or aorta
44
LVH EGK looks like and leads
Increased Voltage V5 and V6, AVL, 1 (high R) | Deep WRS in V1 and V2 (deep S)
45
Scoring system for LVH
Romhilt - Estes Scoring System (4-5 score is yes) Sokolow Lyon Criteria = R wave 2.5 boxes AVL ——> 5 boxes 1 and V6
46
ST sloping down line until it hits the T wave means
Stenosis some kind of straining
47
RVH causes
LUNG** = COPD = Tetrology of Fallot = tricuspid problem regurgitation
48
RVH axis and leads with high S and high R
RIGTH axis 1. High R : leads V1, AVF,3 2. high S : V6, 1, AVL
49
High K EGK
Rises RMP and slows conduction and widens QRS | = TALL peaked T waves, longer PR segment, can loose P wave (looks like a sine wave)
50
Low K EGK
Rises RMP = increases automaticity and more irregular firing = U wave, prolong QT interval, flat or inverted T wave
51
Low Ca EGK
Prolong QT, flatten T wave = arrhythmia (Torsades de Pointes)
52
High Ca EGK
Shortens QT interval | Short ST segment
53
Acidosis EGK
More vulnerable to re-enter arrhythmias like tachy and such
54
Hypokalemia causes
= Dietetics , metabolic alkalosis, high aldosterone (Conn’s, Cushings) = B-agonist overdose = Diarrhea = seen in hospital often
55
Hypokalemia U wave is seen in what leads
2, V3, V4
56
Hyperkalemia causes
= renal failure | = metabolic acidosis, DKA, cell breakdown
57
TX hyperkalemia
1. Dialysis 2. Insulin and glucose 3. Na HCO3 4. Albuterol 5. Renin binding agents
58
Hypercalcemia causes
= hyoerparathyroidism = malignancy = TB, sarcoidosis (granulomatous disease) = hyperthyroidism
59
Hypothermia EKG
Bradycardia = J wave (Osborne wave) ——> wave going up from S wave looking like a tall peak T wave before the actual T wave (RAISED ST SEGMENT) = looks like 2 ice bergs
60
PE EGK
``` SOB, CXR normal = Tachy = ST depression in lead 2 1. S1Q3T3**= deep S wave in lead 1, deep Q in lead 3 and inverted T in lead 3, and V1-V4**** 2. Transient RBBB**** ```
61
WPW (Wolff-Parkinson’s)is what
White syndrome = SHORT PR segment + sudden tachy = slurred P wave to QRS ——> this is a Delta wave = accessory AV conduction pathway is present ——> Bundle of Kent and this bypasses normal AV conduction ****
62
Delta wave
After p wave ends concave (J) looking line up to the R
63
WPW (Wolff-Parkinson’s) associated problems these pt have and leads to look at
Tachycardia, palpitations, near fainting spells for months | = leads V1-V6
64
Brugada Syndrome prevalence
AD, Asian male, young age Predisposed to sudden death and cardiac arrhythmias = NA+ channel opathy
65
Brugada Syndrome EKG looks like
= elevated ST segments (ski slope looking on way down) before the inverted T wave = lead V1, V2, V3 = can also see RBBB
66
Wellens syndrome EGK
T wave inversion big V2, V3 = can happen in LAD disease
67
Long QT syndrome
Normal QT is less then 1/2 R—>R interval | If longer then that = predisposed to ventricular arrhythmia
68
Pericarditis EKG
Raised ST segment in like an convex way (upside down U in some way) or concave* = in ALL leads , how you can tell its probable not an MI
CPR2 Exam 1
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