1
Q
How should an animal be positioned for an ECG
A
Right lateral recumbency
2
Q
Why should there be a blanket or towel underneath the patient when getting an ECG on a metal table
A
To prevent electric currents from being shared
3
Q
What is an electrode
A
What is attached to the patient at a certain point
4
Q
What is a lead
A
A line or a vector pointing in a certain direction between those certain points
5
Q
What is lead 1
A
Left arm to right arm
6
Q
What is lead 2
A
Right arm to left leg
7
Q
What is lead 3
A
Left arm to left leg
8
Q
What lead is commonly see on one lead forms
A
Lead 2
9
Q
Where should electrodes go on patients
A
Around the elbow and stifle
10
Q
What are electrocardiograms
A
The picture that is produced by the machine
11
Q
What is the electrocardiograph
A
Machine that makes the image
12
Q
What is automaticity
A
Cells in an area have automatic electrical change causing muscle to contract
13
Q
What ions are leaking out of cardiac cells while at rest and what stays in
A
K+ and large proteins and phosphates are netagively charge stay inside due to size
14
Q
What is a polarized cell
A
Cells that have more negatively charged ions inside than outside
15
Q
What is phase 0 of cardiac action potential
A
Depolarization w/ voltage gated Na+ channels open
16
Q
What is phase 1 of cardiac action potentials
A
Initial repolarization w/ voltage gated Na+ channels close and voltage gated K+ channels begin to open
17
Q
What is phase 2 of cardiac action potentials
A
Voltage gated Ca2+ channels open, K+ efflux continues, and myocytes contraction occurs
18
Q
What is phase 3 of cardiac action potentials
A
Rapid repolarization w/ voltage gated Ca2+ channels close and slow voltage gated K+ channels open
19
Q
What is phase 4 of cardiac action potentials
A
Resting potential w/ high K+ permeability
20
Q
What ions are cardiac myocytes reliant upon
A
Na+, K+, and Ca2+
21
Q
Why cant myocytes depolarize again before completing muscle contraction
A
Because the plateau in phase 2 caused by Ca2+ coming into the cell
22
Q
What is diastole
A
Atria fills w/ blood beginning to flow into the ventricles as soon as the atria walls relax
23
Q
What is atrial systole
A
Contraction of atria pumps blood into the ventricles
24
Q
What is ventricular systole
A
Contraction of ventricles pumps blood into the aorta and pulmonary arteries
25
Where is the SA node located
Near where the superior vena cava and the right atrial muscle fibers
26
Where is the AV node located
Near the septum between the atria
27
What is the function of the AV node
Slows impulses to allow time between the atrial and ventricular depolarization
28
What is the path of electrical conduction in the heart
SA node, AV node, bundle of HIS, right and left bundle branch, and purkinje fibers
29
What is the P wave
Depolarization of atria in reponse to SA node triggering
30
What PR interval
Delay of AV node to allow filling of ventricle
31
What is the QRS complex
Depolarization of ventricles triggers main pumping contractions
32
What is the ST segment
Beginning of ventricle repolarization should be flat
33
What is the T wave
Ventricular repolarization or electrical recovery of the ventricles
34
What do electrocardiogaph detect and record
The differeince in electrical signal between two electrodes that can be positive or negative voltage
35
What are holter monitors used for
24 hr ECG recording
36
What is Einthoven's triangle
The direction of electricity that is measured on ECGs using 3 different leads
37
What is the electrical current that is measured w/ lead one of Einthoven's triangle
Right arm (right atria) is a negative pull to the positive pull on the left arm (left atria)
38
What is the electrical current that is measured w/ lead 2 of Einthoven's triangle
Right arm (right atria) is a negative pull to the positive pull on the left leg (left ventricle)
39
What is the electrical current that is measured w/ lead 3 of Einthoven's triangle
Left arm (left atria) is a negative pull to the positive pull on the left leg (left ventricle)
40
In an ECG what does the stuff below the ioselectric line headed to
The direction of the negative pull
41
In an ECG what does the stuff above the ioselectric line headed to
The positive pull
42
Which lead has the tallest most positive QRS complex or wave and why
Lead 2 beacause of the layout of the heart in the chest
43
What are the names of augmented leads
aVR (R = right arm), aVL (L = left arm), and aVF (F= foot)
44
What is an augmented lead
When we compare one electrode to the average of the other two or the midpoint of the lead that the electrode isn't involved w/
45
What is the electrical current that is measured of aVR
Midway of the lead of lead 3 is the negative pull and RA is the positive pull
46
What is the electrical current that is measured of aVL
Midway of lead 2 is the negative pull and the LA is the positive pull
47
What is the electrical current that is measured of aVF
Midway of lead 1 is the negative pull and the LL is the positive pull
48
What is the x axis assocaited w/ on an ECG
Time
49
What is the y axis associated w/ on an ECG
Milovolts
50
How big are the little squares on an ECG
A millimeter wide and tall
51
How much is each large box worth on an ECG
A millivolt
52
How many millivolts is a small square worth, how many is a large square worth, and how are ECG callibrated because of these measurements
Each small square is 0.1 mV and a large square 0.5 mV making the callibration 10mm/mV
53
What will the quantity of the x axis based on and what does it mean
Paper speed which is how fast is the ECG being recorded
54
How many seconds pass w/ a paper speed of 25mm/s and 50mm/s w/ 1 small squre (1mm)
0.04 s and 0.02 s
55
How many seconds are passed w/ a paper speed of 25mm/s and 50mm/s w/ 1 large square (5mm)
0.1 s and 0.2 s
56
What are the 3 ways to calculate HR w/ an ECG
R-R interval, Bic Pen method, and 30 large boxes
57
What do you multiply the count of the # R peaks in 30 boxes by to get the hear rate for 25mm/s and 50mm/s
10 and 20
58
What is the mean electrical axis
Net direction of all potentials involved in ventricular depolarization this can only be used w/ 6 or more leak ECG
59
What is the normal MEA in dogs and cats
40-100 degrees in dogs and 0-160 degrees in cats
60
What is another trick to finding the MEA
By finding the tallest QRS complex
61
What are classifications of evaluate the rhythm of ECGs
Regular, regularly irregular, and irregularly irregular
62
How do we evaluate the wave forms on ECGs
P for every QRS, QRS for every P, PR interval and consistency, QRS supraventricular vs ventricular, and presency of premature beats
63
How should p waves be evaluated
By measuring the height from baseline to the top of the P wave
64
What does a tall p wave indicate
P pulmonale could indicate right atrial enlargement
65
What does a wide P wave indicate
P mitrale could indicate left atrial enlargement
66
What can lead to absent P waves
Hyperkalemia
67
What does a wandering pacemaker ECG look like
Tall and spiked p wave during inspiration and flat during expiration
68
What is the PR interval and how is it affected
Beginning of P to beginning of QRS this can be affected by conduction time through the AV node
69
What abnormalities can cause inconsistent PR intervals
Multiple types of AV blocks
70
How is the QRS complex evaluated
Measuing the width from the beginning of the Q to the end of the S and the height from baseline to top of R wave
71
What does a wide QRS indicate
Ventricular enlargement, bundle branch block, or a ventricular ectopic beat that can be diagnosed on other ECG findings
72
What do tall R waves indicate
Left ventricular enlargement
73
What does a deep S wave indicate
Right ventricular enlargement
74
How is the ST segment evaluated
Time from ventricular depolarization to repolarization should be at baseline
75
What can elevation or depression ST segment indicate
Regional myocardial ischemia
76
What causes tall tented T waves
Hyperkalemia
77
How is the QT interval evaluated
It is measured from beginning of the QRS to the end of the T wave this can vary inversely w/ HR
78
What can a prolonged QT cause or be associated w/
It can predispose arrhythmia formation and can be associated w/ medication, electrolyte abnormalities, and genetic abnormalities
79
What are common technical abnormalities on an ECG
Loose electrode connection, 60 cycle intergerence (sawtooth), broken cable, movement, muscle tremors, and misplaced electrodes
80
What is overshooting on an ECG
A wave form is cut off the graph
81
What do loose electrode connection look like on an ECG
Sudden baseline shift and sawtooth lines
82
What is 60 cycle interference on an ECG and how can it be addressed
Alternating current picked up from air or from touching the electrode can be addressed by applying more conducting medium, check for corrosion, turn off fluorscent lighting, try a different room, or find new machines
83
What does a broken cable look like on an ECG
Erratic deflections
84
What does movement look like on an ECG and what can cause it
Wandering baseline can be caused by coughing or heavy breathing
85
What do muscle tremors look like on an ECG and when can it happen
Wavy baseline, irregular height, and frequency can occur due to cat purring or the patient being anxious or cold
86
What can misplaced electrodes look like
Leads are reversed
87
What are sinus arrhythmias in the dog associated w/
High vagal tone and breathing
88
What kind of type of regularity does sinus arrhythmia full in
Regularly irregular
89
How are arrhythmias diffientriated
By the origination from a disturbance to the supraventricular impluse formation, ventricular impulse formation, impulse conduction, and impulse formation and contraction
90
What arrhythmias come from a disturbance to the supraventricular impulse formation
Sinus arrhythmia, supraventricular premature complexes, supraventricular tachycardia, sinus bradycardia, atrial fibrillation, and atrial flutter
91
What arrhythmias come from a disturbance to the ventricular impulse formation
Ventricular premature complexes, ventricular tachycardia, ventricular fibrillation, and ventricular asystole
92
What arrhythmias come from a disturbance in the impulse conduction
Atrial standstill, 1st-3rd degree AV block, and bundle branch block
93
What arrhythmias come from a disturbance in the impulse formation and conduction
Sick sinus rhythm and escape beats
94
What does sinus arrhythmia indicate and how can it be caused
Indicates increased vagal tone w/ CNS disease, respiratory disease, GI disease, and intraocular disease
95
What test is used to determine if a sinus arrhythmia is present and how is it done
An atropine response test requires giving a dose of atropine then recheck 20-30 mins later to look for supraventricular tachycardia
96
What are supraventricular premature contractions and what does the ECG look like
A ventricular contraction occurs prematurly, the premature P wave may be present or may be hidden under the previous T wave w/ a narrow QRS complex, however this does not affect ventricular conduction
97
What is supraventricular tachycardia and what can cause it
Run of 3+ SPCs in a row that can be caused by heart failure, meds, or high sympathetic tone from pain, fever, excitement, stress, or anxiety
98
How are supraventricular tachycardia treated
Treat underlying disease if possible if not beta blocker, calcium channel blocker, and digoxin
99
What is atrial flutter and what kind of regularity does it fall under
Saw toothed flutter waves w/ supraventricular QRS and absent P waves this can be regular or irregular
100
How can atrial flutter be treated
Electrical or chemical cardioversion
101
What is atrial fibrillation and what kind of rhythm is it
Fibrillatory waves w/ supraventricular QRS and absent p waves this is an irregularly irregular rhythm
102
What is atrial fibrillation correlated w/ and how is it treated
Opiods in dogs and GI disease in cattle this can be treated w/ electrical or chemical cardioversion to reduce ventricular response rate to allow for improved cardiac output
103
What is lone afib
Giant breed dogs w/ normal hearts or high vagal tone
104
What is acute treatment of afib
Calcium channel blocker or cardioversion w/ lidocaine if anesthesia/opioid related
105
What is chronic afib treatment
Calcium channel blockers, beta blockers, and digoxin
106
What causes sinus bradycardia
High vagal tone, drugs (anesthetics, Ca2+ channel blockers, or beta blockers), or systemic disease (hypothyroidism or hypothermia)
107
What is a ventricular premature contraction, what does it look like on an ECG, and when can they be normal
Early beat w/o P wave that looks like a wide/bizarre QR complex that can be positive or negative isolated ones in anesthetized patients can be normal
108
What are non normal causes to ventricular premature contractions
Epinephrine in fearful animals, heart disease, drugs, hypoxia, acid-base, electrolyte disorders, and pain
109
What is ventricular tachycardia, what breeds is this common in, and why is it life threatening
A run of 4+ VPCs in a row at a rapid rate/all beats are premature, this is common in boxers, dobermans, or any animal w/ primary heart disease this is life threatening because it doesn’t effectively send blood to the body compromising cardiac output
110
What is ventricular fibrillation
Life threatening progression from v tach w/ no organized ventricular activity producing chaotic irregular waves w/ no cardiac output
111
How is ventricular fibrillation treated
Electrical defibrillation, precordial thump, amiodarone, or lidocain if unsuccessful
112
What is ventricular aystole and how can it be treated
Absence of ventricular electrical activity that can be treated w/ epinephrine and or vasopressin w/ recovery guidelines
113
What is pulseless electrical activity
Any wave form w/ no heartbeat or the electrical signal is too weak to cause contraction this is treated the same as asystole
114
What is atrial standstill
Atrial depolarization does not occur when the SA nodes discharges lacking p waves, flate baseline, narrow QRS, and bradycardia
115
What are causes of atrial standstill
Hyperkalemia and fibrosis of the atria needing a pacemaker
116
What is a 1st degree AV block
Delayed conduction (blocked signal) through the AV node prolonging the PR interval
117
What are causes of a 1st degree AV block and should it be treated
High vagal tone, AV nodal fibrosis, and idiopathic and treatment is not indicated w/ this
118
What is a 2nd degree AV block
Intermitten disruption of AV nodal conduction w/ some P waves and there are 2 types
119
What is Mobitz type 1 2nd degree AV block
Occurs w/ high vagal tone is a progressive prolongation of PR interval until the AV node is blocked then it restarts
120
What is mobitz type 2 2nd degree AV block
More serious that has a consistent PR interval w/ some waves are not conducted through the AV node to ventricles this needs a pacemaker
121
What is a 3rd degree AV block
Complete heart block w/ dissociated of P and QRS waves, very low HR that is maintained by escape rhythm from the ventricles, does not respond to atropine, risk of sudden death, and need a pacemaker
122
What can cause 3rd degree AV blocks
Degeneration/fibrosis of AV node, myocardial disease, and drug toxicity
123
What is a bundle branch block
Impulse blocked at the left or right bundle branch, sinus rhythm, and widened QRS complexes
124
What is sick sinus rhythm
Areas of bradycardia and areas of tachycardia w/ potential to have sinus, arrest, sinus bradycardia, atrial tachycardia, and AV nodal conduction block this requires a pacemaker
125
What are escape beats
Sinus impulse not created or conducted so other tissue steps in as pacemaker as a life saving measure
126
What is the rate of escape beats through the AV node
40-60 bpm
127
What is the rate of escape beats coming from the Bundle of His and purkinje fibers
30-40 bpm
128
How do escape beats differ from PVC
Escape beats are late beats and the HRs are significantly slower
129
What are class 1 antiarrhythmics
Na+ channel blockers that affect stage 0 such as lidocaine
130
What are class 4 antiarrhythmics
Ca+2 channel blockers on stage 2 prolonging the refractory period
131
What are class 3 antiarrhythmics
K+ channel blockers that can be used on stage 3
132
What are class 2 antiarrhythmics
Beta blockers that affect stage 4
133
What arrhythmias is lidocaine used for
V-tach and can be used for Afib
134
What arrhythmias are class 2 beta blockers used for
SVT and potentially Afib
135
What arrhythmias are class 3 beta blockers be used for
Sotalol is used for V tach and refractory SVT and Afib
136
What are side affects of class 2 beta blockers
Reduces HR, cardiac output, BP, and conduction
137
What is a good at home medication to give to patients w/ chronic v tach
Sotalol and mexiletine
138
How does mexiletine affect the body
Blocks influx of Na+ preventing depolarization and decreass automaticity
139
What is epinephrine used for
Adrenaline is used for V fib and asystole (vasopressin and atropine as well)
140
What special charcterisitics of epinephrine and vasopressin (ADH)
It can return spontaneous circulation during cardiac arrest
141
What other effects does epinephrine have on the body
Increase HR/contractility/conduction across AV node, increase RR, bronchodilation, peripheral vasoconstriction, and coronary arterial dilation
Vet Tech 3
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