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1st negative deflection is a __________ wave
Q wave
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What are the 5 criteria for NSR?
- P for every QRS
- Regular rythm
- Rate between 60-100
- Pr = .12-.20
- QRS = .08-.12
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Estimate rate by....
- Estimating R to R by big boxes..
- 300
- 150
- 75
- 60
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Escape Beats
 - Look like upside down P waves pre or post QRS
- Junctional rates = 40-60
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Premature beats
Atrial - PACs - benign - Has P waves
Juntional - more serious - no p waves
PVC - Frequent PVC may go into VTACH - Early Wide and bizare, T - wave opp of QRS, full compensatory pause.
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Torsades de Pointes caused by ___________
Hypokalemia, often treated with mag.
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How do you know an impulse is above the ventricle?
It is NARROW
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What is Wolf Parkinson White syndrome?
Young person with what looks like v-tach.
Short PR interval due to accessory pathway travels quickly by passing the delay in the AV node.
Sail like QRS (Delta wave) WIDE QRS due to pre-excitation from the quick travel by passing the delay in the AV node.
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Heart Blocks 1st degree...
- P for every QRS
- PRI = >.20
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Describe 2nd Degree Heartblock...
- Mobitz Type I or Wienkeback
- P for SOME of QRS but not all
- QRS usually narrow
- P waves march out regular
- PR interval gets progressively longer until QRS complex is dropped.
- Mobitz Type II
- P Waves march out on time
- PR interval constant
- Some Ps dont have QRS
- QRS usually wide
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3rd degree heart block
Regular P- waves, no association between P's and QRSs
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Where do the leads corrolate to the anatomy of the heart?
- V1 & V2 looks at right side of heart
- V5 & V6 looks at the left side of heart
V3 & V4 transitional
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How do you determine where a bundle branch is blocked?
Based on were you find RR'.
- V1&V2 = Right BBB
- V5&V6 = Left BBB
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Why is a L BBB important?
Can no longer determine ishchemic injury with an EKG with L BBB
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What is the vector of depolarization?
Down and to the left.
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If a vector is going to a positive lead...
the deflection will be positive.
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If you have a negative deflection in lead 1
you have a right axis deviation
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Positive electodes on left arm and left foot
Positive electodes on left arm and left foot
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What would cause L axis deviation?
L ventricular hypertrophy
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Right axis deviation is normal in...
kids, tall people and COPDers
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Normal axis orientation is...
L1 and AVF pos - double thumbs up
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Biphasic p-waves may indicate...
Atrial hypertrophy
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In ventricular hypertrophy
- - usually L axis deviation
- -Larger waves due to thicker muscle
- -if the height of S wave in V1 + the R wave in V5 > than 35 then that equals LVH
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Limb leads only look at...........
Axis deviation
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Flipped Ts in V5 and V6=
LVH criteria
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Ischemia
- Inverted Twaves in V2-6
- ST elevation - Tombstone sign connected to inverted T
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Non-Q wave non- stemi MIs
Necrosis didn't go through entire wall of mycardium
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When is a q wave pathologic?
If it is > .04 (wide) or if 1/3 the amplitude of QRS
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Heart failure
Myocardial O2 supply must meet demand
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the number 1 cause of R sided HF is...
Left sided HF
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Frank Starlings law.....
- The better the stretch as in filling the right atrium...atrial kick.
- The better the contraction.
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Angiotensin II
- Powerful vasoconstrictor
- Remodels myocardium
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What is the function of aldosterone?
Excrete potassium
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Orthopnea
how many pillows do you use at night?
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HF patients MUST be on ace inhibitor because...
blocks vasoconstriciton, slows remodeling.
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How do you vasodilate the viens?
Morphine and nitrates
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Describe axis deviation in terms of Limb lead 1 and AVF?
- Normal = L1 (+) QRS / AVF (+) QRS
- L Axis Dev = L1 (+) QRS / AVF (-) QRS
- R Axis Dev= L1 (-) QRS / AVF (+) QRS
- Extreme R Axis Dev = L1 (-) QRS / AVF (-) QRS
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How do you determine LVH from an EKG?
If the height of the S wave in V1 + the R wave in V5 is > 35 mm, there is LVH
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How do you look for ischemia on an EKG?
Ischemia is noted with inverted T waves in leads V2-6.
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PACs can often be caused by....
stimulants such as caffiene and OTC meds
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What is SVT?
Catch all phrase describing rapid arrythmias that occur above the ventricles. We know it is above the ventricles because the QRS is narrow.
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