question

There are ____ standard ECG leads

answer

12

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3 of the 12 leads are

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standard limb leads, I,II,III

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Where are standard limb leads placed?

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I right arm, III left arm, II left leg, there an electrode placed on the right leg to act as a ground.

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The placement of the standard limb leads forms what triangle?

answer

Einthoven Triangle

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The standard limb leads, I, II, III are called ___ ____ because they conduct between to designated electrodes

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bipolar leads

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Standard Lead I records electrical activity from the ___ ___ to the ____ ____

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right arm- to the left arm+

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Standard Lead II records electrical activity from the ___ ___ to the ___ ____

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Right arm - to the left leg+

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The Left Arm,Standard lead can be either ____ charged or ____ charged depending on the direction of the picture being taken

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Left are lead can be either + or _

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Standard Lead III records electrical activity from the ___ ____ to the ____ ____

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Left arm - to the Left Leg +

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Augmented leads are the 3 leads known as

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aVR, aVL and aVF

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aVR stands for

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augmented voltage right arm

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aVL stands for

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augmented voltage left arm

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aVF stands for

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augmented voltage foot

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Augmented limb leads are ____ because each lead uses only 1 electrode to record electrical activity generated from the heart

answer

unipolar

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aVR records activity from the Rarm and the electrical current generated from the heart flows ____ the positive right arm

answer

away

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aVL records activity form the left arm and the electrical current generated from the heart flows ___ the positive left arm

answer

toward

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ECG Graph paper moves at a standard speed of

answer

25 mm/sec

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Each small square on the ECG paper is equal to ____ seconds and is ___ in height and ___ wide

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0.04 seconds and is 0.1 mv in height, and is 1 mm high and 1mm wide

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there are ______ small squares /min

answer

1500 small squares per minute

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1500 small squares per minute is equal to

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.04 x 1500 = 60 seconds

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Every 5th line there is a bold line both horizontally and vertically forming a large square with is equal to how many seconds?

answer

0.2 seconds

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Each large square is 0.5 mv in height and is 5mm high by 5mmwide, there are howmany large squares per minute?

answer

300 large squares /min

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there are 300 large squares/min on ECG paper, this is figured by

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0.2 seconds x 300 large squares= 60 seconds

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There are vertical hash marks at the top of the paper to represent 1,2, or 3 seconds, but most commonly

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3 seconds

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if the hash marks are 3 seconds apart, there are how many large squares in that 3 second interval?

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0.2 seconds x 15 large squares = 3 second interval

question

If the vertical hash marks are 3 seconds apart how many small squares are in each?

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3seconds x 0.04 seconds per small square = 75 small squares per each 3 second interval

question

ECG paper - Voltage (Gain) is defined how?

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ECG recordings are standardized with a special signal inscribed into the recording to give an accurate voltage measurement.

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The most common voltage (Gain) on ECG paper is

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Standard I which is 1 mv = 10 mm high

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Standard II voltage ( Gain ) is used when

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the QRS complexes are small

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StandarII voltage(Gain) is equal to

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1 mv= 20 mm high

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Standard 1/2 Voltage (Gain) is used when the patient has?

answer

extreme ventricular hypertrophy

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Standard 1/2 Voltage(Gain) is measured

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1mv=5mm high

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To Calculate Rate most accurately, you should

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count the number of small squares between two consecutive R waves and divide that number into 1500

question

you can count the large squares between two consecutive R waves to calculate rate and

answer

then divide into 300

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The easiest way to calculate the rate on an ECG strip is to

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count the number of QRS complexes in a 6 second strip and multiply by 10

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Normal Sinus Rhythm has a normal atrial and ventricular rate which is

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60-100

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The pace maker site for sinus tachycardia is

answer

the SA node

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in Sinus Tachycardia, the rhythm is normal but the

answer

rate is greater than 100 beats per minute

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What causes Sinus Tachycardia?

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Pain, Anxiety, Fever, Hypoxia, Shock,Medications, and stimulants such as caffeine and tobacco

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How do we treat Sinus Tachycardia?

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We treat the underlying cause, if it is symptomatic, we use beta blockerssuch as metoprolol & esmolol or calcium channel blockers such as Diltiazem or Verapamil

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Sinus Bradycardia is a normal rhythm but the rate is

answer

less than 60

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Sinus Bradycardia is caused by

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vagal stimulation, occurs normally in athletes and during sleep, hypothermia, and electrolyte imbalances

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We treat Sinus Bradycardia only if

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symptomatic with atropine and if severe, a pacemaker

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Sinus Arrhythmias are associated with what breathing pattern?

answer

Cheyne stokes respiration, where the heart rate is up while during inspiration and decreases during expiration

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A sinus arrhythmia can be identified because the

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rate is between 45-100 bpm with normal Pwave,normal PR interval and a normal QRS complex but the \"beats\" are not spaced evenly apart

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Atrial Fibrillation is caused by

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heart failure , CHF

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Atrial Fibrillation is treated by (medications aimed at)

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controlling the rate by use of calcium channel blockers such as Dilitiazem or Verapamil or the use of Beta Blockers such as Metoprolol or Esmolol IF UNSTABLE,SYCHRONIZED CARDIOVERTION

question

What is Sychronized Cardiovertion?

answer

Where a patient with an unstable heart rhythm recieves electrical therapy at the top of each R wave. There MUST BE A RATE to use Sych Cardiovert

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Atrial Fibrillation occurrs when the atrial rate(pace maker sites are) is determined by

answer

350-600 ectopic foci, which leads to a PR interval that cannot be measured and a QRS complex that is Narrow to normal in duration

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Normal QRS duration is

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.06 -.12 seconds

question

A normal PR interval should have a duration of

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.12-.2 seconds

question

the normal P wave should precede each

answer

QRS complex

question

Atrial Flutter is caused by

answer

heart failure and CHF

question

How do we treat Atrial Flutter?

answer

Treatment is aimed at controlling the rate through calcium channel blockers such as Diltiazem or Verapamil or through Beta Blockers such as Metoprolol or Esmolol if the patient is UNSTABLE, SYCHRONIZED CARDIOVERTION

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Atrial Flutter is accompanied by a rapid ventricular response and a reduced cardiac output,this causes the Pwave to have a

answer

sawtooth wave known as Flutter Waves and a PR INTERVAL that includes a usually constant R wave. The QRS is narrow to normal

question

Atrial Flutter has an atrail rate of

answer

250-350 beats per minute with a regular ventricular rate

question

Unifocal Premature Ventricular Contractions are also known as

answer

Unifocal PVC

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Unifocal PVC's are caused by

answer

( OCCUR NORMALLY) ,stress, exercise, stimulants, electrolyte imbalances, CAD, heart disease, hypoxemia, and digitalis toxicity

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We treat unifocal PVC's only if symptomatic with

answer

IV antiarrhythmics such as amiodarone and lidocaine

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Unifocal PVC's originate from what pace maker site?

answer

the same ectopic focus, so the each look similiar in appearance. They are a regular irregular ventricular beat.

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During the premature beat of a Unifocal PVC, the Pwave is ____,the PR interval ____

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P wave is missing , the PR interval is not measurable, the QRS complex is wide, bizarre, distorted but is in the same shape, because each originates from the same ectopic focus

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Just as with a Unifocal PVC there is no visible P wave in the premature beats of a Multifocal PVC, but the QRS complexes, although still wide, bizarre and distored, they

answer

have a different shape because they originate is different places.

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Just like Unifocal PVC's, Multifocal PVC's are caused by

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Stress exercise, simulants, electrolyte imbalances, CAD, heart disease, hypoxemia and idopathic (OCCUR NORMALLY)

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Ventricular Bigeminy is noticed by a PVC that occurs rhythmically every

answer

every other beat, due to one ventricular ectopic focus

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Just like unifocal and multifocal PVC's , Ventricular Bigeminy is caused by

answer

Stress, exercise,stimulants, electrolyte imbalances, CAD, Heart disease, hypoxemia and idiopathic (OCCUR NORMALLY)

question

We treat Ventricular Bigeminy only if symptomatic with

answer

IV antiarrhythmic medications such as amiodarone and lidocaine.

question

We treat Multifocal PVC's only if symptomatic with IV

answer

Antiarrhythmic medications such as amiodarone and lidocaine

question

Ventricular Trigeminy like Unifocal PVC's, Multifocal PVC's, Ventricular Bigeminy occurs normall but is also caused by

answer

stress , exercise, stimulants, electrolyte imbalances, CAD, heart disease, hypoxemia and idiopathic

question

We treat Ventricular Trigeminy ( like all of the other PVC's) only if symptomatic, when symptomatic we administer IV Antiarrhytmics such as

answer

amiodarone and lidocaine

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We can identify Ventricular Trigeminy when we see that every

answer

third beat is a wide bizarre distorted QRS complex ( signifying a PVC)

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The PVC site for Ventricular Trigeminy is

answer

ectopic ventricular focus

question

Ventricular Tachycardia is caused by

answer

acute myocardial ischemia/infarction , electrolyte abnormalities and advanced cardiomyopathy.

question

Ventricular Fibrillation is caused by

answer

acute myocardial ischemia/infarction, electrolyte abnormalities, advanced cardiomyopathy, severe acidosis, electrical shock

question

with Ventricular Fibrillation, the waveform is identified by the

answer

absence of both atrial rate and ventricular rate, the absence of an atrial rhythm and ventricular rhythm, and the absence of identifiable P wave, PR interval and QRS complexes.

question

Ventricular Fibrillation is basically just

answer

impulses from many ectopic foci resulting a chaotic twitching of the ventricles

question

Ventricular Fibrillation is treated IMMEDIATELY with

answer

HIGH QUALITY CPR, DEFIBRILLATION, and medications such as epinephrine or vasopression, amiodarone or lidocaine

question

We treat Ventricular Tachycardia

answer

WHEN NO PULSE, WE TREAT V-TACH THE SAME AS V-FIB! if there IS A PULSE PRESENT, we use antiarrhythmics such as amiodarone or lidocaine or IF UNSTABLE, WE SYNCH CARDIO VERT .

question

During V-Tach, there is no measurable atrial rate, but the ventricular rate

answer

100-250 bpm, AND A VENTRICULAR RHYTHM WITH A REGULAR R to R, there is NO P WAVE with wide QRS complexes

question

ASYSTOLE is caused by

answer

H's and T's, and is treated with HIGH QUALITY CPR, epinephrine or vasopressin, we search for a reversible cause NEVER DEFIBRILLATE THIS RHYTHM!

question

during Asystole, there is a cardiac standstill, where there is

answer

NO ELECTRICAL IMPULSE

question

PULSELESS ELECTRICAL ACTIVITY can be any electrical conduction pattern except

answer

V-Fib and Pulseless V-tach that exists without a pulse

question

Pulseless Electrical Activity is caused by

answer

the H's and T's, is treated with High Quality CPR , medications such as epinephrine and vasopressin, atropine, and searching for a reversible cause DO NOT DEFIBRILLATE THIS RHYTHM

question

DISORDERS OF CONDUCTION INCLUDE

answer

First - degree AV Block, Second-degree AV Block, Mobitz 1, Second-degree AV Block, Mobitz II, and Third degree AV block

question

We can identify the First Degree AV Block by

answer

noticing the constant prolonged P-R interval, the block is present at the AV node

question

We treat a first degree heart block with

answer

atropine only if symptomatic.

question

a First Degree Heart Block is caused by

answer

Drug effects or toxicity , increase of vagal tone, hyperkalemia, MI and myocarditis

question

We can identify a Second - degree MOBITZ I

answer

by the progressive prolongation of the P-R interval until the QRS complex is absent (dropped)

question

We treat a second degree heart block Mobitz I only if symptomatic, with

answer

atropine, TCP/TVP ( trancutaneous pacing, transvenous pacing)

question

A SECOND DEGREE MOBITZ I is caused by

answer

drug effect/toxicity, excessive vagal tone, ischemic heart disease, myocarditis

question

A Second Degree heart block MOBITZ II is identified by the normal or prolonged BUT CONSTANT PR INTERVAL until

answer

the QRS complex is dropped

question

a Second Degree heart block MOBITZ II is caused by

answer

AMI, drug effect/toxicity, valvular disease

question

A Second Degree heart block Mobitz II can progress easily to

answer

a complete heart block

question

IF SYMPTOMATIC, treat a Second Degree heart block Mobitz II with

answer

atropine, TCP/TVP

question

A third- degree heart block can be identified due to its complete Atrial and Ventricular Disassociation, in other words,

answer

the atrial and ventricular contractions occur independantly, therefore, they march out evenly to their own rhythms,There is no relationship between the P waves and QRS complexes

question

Circulatory Volume is equal to

answer

Venous Return

question

Contractile force is the same as

answer

Stroke Volume

question

Stroke Volume x Rate =

answer

Cardiac output

question

Cardiac output +Systemic Vascular Resistance =

answer

Mean Arterial Pressure

question

Venous Return ( circulatory volume) has a direct affect on

answer

cardiac output

question

Mean Arterial Pressure directly affects

answer

tissue perfusion

question

What 3 factors affect cardiac output?

answer

Circulatory Blood Volume(venous return), Heart rate,and Contractile force of the heart ( stroke volume)

question

HR x SV=

answer

Cardiac output

question

What 2 factors affect Systemic Vascular Resistance?

answer

The RADIUS of the VESSEL (vascular tone) and the VISCOSITY OF THE BLOOD

question

What regulates vascular tone? or in other words What controls the radius of the vessel?

answer

The sympathetic nervous system and circulating hormones such as epinephrine, angiotensin and vasopressin

question

What is Mean Arterial Pressure?

answer

The typical measure of Blood Pressure as it is RELATES to PERFUSION

question

What affects Mean Arterial Pressure?

answer

Cardiac Output and Systemic Vascular Resistance

question

CO x SVR = MAP or

answer

HR x SV X SVR= MAP

question

MAP is also figured by

answer

[systolic + diastolic(2)] / 3

question

What maintains Tissue Perfusion?

answer

adequate blood pressure

question

Chronotropic is defined as

answer

Agent affecting the rate of cardiac contraction * very low rates and very high rates lowre cardiac output and can cause arrhythmias

question

Inotropic

answer

agents affecting the force of cardiac contraction

question

Preload

answer

load or tension on the cardiac muscle as it begins to contract

question

Afterload

answer

amount of resistance against which the heart must pump

question

Cardiac Glycosides

answer

increase the force of cardiac contraction = are cardiotonic(inotropic) agents

question

Digoxin and Digitoxin are

answer

cardiac glycosides= are cardiotonic agents ;Inotropic

question

Beta-Adrenergbic Cardiac Stimulants are

answer

Catecholamines such as dobutamine, dopamine(dose specific), Isoproterenol, Epinephrine

question

Dopamine is a dose specific inotropic agent, a low dose=

answer

renal perfusion (dopamenergic receptors)

question

a moderate dose of Dopamine =

answer

increase HR and contractility targeting the beta 1 receptors

question

a High dose of dopamine targets alpha receptors and

answer

causes peripheral vasoconstriction

question

Do NOT USE Isoproterenol in

answer

heart failure because of the increased myocardial oxygen consumption

question

Do NOT use Epinephrine in heart failure because

answer

of the increased myocardial oxygen consumption

question

Dobutamine increases the force of contraction without

answer

increasing blood pressure (beta 1)

question

Phosphodiesterase inhibitors are cardiotonic ( Inotropic) agents

answer

such as Amrinone and milrinone and work by increasing levels of cAMP and increases intracellular calcium

ECG Graph paper, ECG waveforms,Cardiac Drugs

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