1. 1st negative deflection is a __________ wave
    Q wave
  2. What are the 5 criteria for NSR?
    • P for every QRS
    • Regular rythm
    • Rate between 60-100
    • Pr = .12-.20
    • QRS = .08-.12
  3. Estimate rate by....
    • Estimating R to R by big boxes..
    • 300
    • 150
    • 75
    • 60
  4. Escape Beats
    • Image Upload 2
    • Look like upside down P waves pre or post QRS
    • Junctional rates = 40-60
  5. 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.
  6. Torsades de Pointes caused by ___________
    Hypokalemia, often treated with mag.
  7. How do you know an impulse is above the ventricle?
    It is NARROW
  8. 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. 
  9. Heart Blocks 1st degree...
    • P for every QRS
    • PRI = >.20
  10. 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
  11. 3rd degree heart block
    Regular P- waves, no association between P's and QRSs
  12. 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
  13. How do you determine where a bundle branch is blocked?
    Based on were you find RR'.

    • V1&V2 = Right BBB
    • V5&V6 = Left BBB
  14. Why is a L BBB important?
    Can no longer determine ishchemic injury with an EKG with L BBB
  15. What is the vector of depolarization?
    Down and to the left.
  16. If a vector is going to a positive lead...
    the deflection will be positive.
  17. If you have a negative deflection in lead 1
    you have a right axis deviation
  18. Positive electodes on left arm and left foot
    Positive electodes on left arm and left foot
  19. What would cause L axis deviation?
    L ventricular hypertrophy
  20. Right axis deviation is normal in...
    kids, tall people and COPDers
  21. Normal axis orientation is...
    L1 and AVF pos - double thumbs up
  22. Biphasic p-waves may indicate...
    Atrial hypertrophy
  23. 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
  24. Limb leads only look at...........
    Axis deviation
  25. Flipped Ts in V5 and V6=
    LVH criteria
  26. Ischemia
    • Inverted Twaves in V2-6
    • ST elevation - Tombstone sign connected to inverted T
  27. Non-Q wave non- stemi MIs
    Necrosis didn't go through entire wall of mycardium
  28. When is a q wave pathologic?
    If it is > .04 (wide) or if 1/3 the amplitude of QRS
  29. Heart failure
    Myocardial O2 supply must meet demand
  30. the number 1 cause of R sided HF is...
    Left sided HF
  31. Frank Starlings law.....
    • The better the stretch as in filling the right atrium...atrial kick.
    • The better the contraction.
  32. Angiotensin II
    • Powerful vasoconstrictor
    • Remodels myocardium
  33. What is the function of aldosterone?
    Excrete potassium
  34. Orthopnea
    how many pillows do you use at night?
  35. HF patients MUST be on ace inhibitor because...
    blocks vasoconstriciton, slows remodeling.
  36. How do you vasodilate the viens?
    Morphine and nitrates
  37. 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
  38. 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
  39. How do you look for ischemia on an EKG?
    Ischemia is noted with inverted T waves in leads V2-6.
  40. PACs can often be caused by....
    stimulants such as caffiene and OTC meds
  41. 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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