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CV
Priniciples (Test 3)
| Question | Answer |
|---|---|
| Where is the SA node located? | junction of the superior vena cava and right atrium |
| Where is the AV node located? | conductive pathway between the atria and ventricles |
| What is the inherent rate of the SA node? | 60-100bpm |
| What is the inherent rate of the AV node? | 40-60bpm |
| What in the inherent rate of the ventricles/ purkinjie fibers? | 20-40bpm |
| Which leads are bipolar limbs? Where are the electrodes? | I, II, III (between the R and L arm and L leg) |
| Which leads are unipolar/augmented leads? Where are the electrodes? | aVR, aVL, aVF (between a limb and a reference point/AV node) |
| Which leads are unipolar/precordial leads? Where are the electrodes? | V1, V2, V3, V4, V5, V6 (between a chest lead and a reference point) |
| What is the reference point called that is used to take MCL? | Wilson's terminal |
| Where are the electrodes for Lead I? | looks from R arm (-) to L arm (+) |
| Where are the electrodes for Lead II? | looks from R arm (-) to L leg (+) |
| Where are the electrodes for Lead III? | looks from L arm (-) to L leg (+) |
| Where is the V1 lead placed? | 4th intercostal space; R sternal border |
| Where is the V2 lead placed? | 4th intercostal space; L sternal border |
| Where is the V3 lead placed? | between V2 and V4 |
| Where is the V4 lead placed? | 5th intercostal space; midclavicular line |
| Where is the V5 lead placed? | between V4 and V6 |
| Where is the V6 lead placed? | 5th intercostal space; midaxillary line |
| EKG paper runs across a stylus at ______mm/sec. | 25 |
| EKG is calibrated at _____mV or ______ big boxes. | 1mV, 2 big boxes |
| 1 small box= _____sec | 0.04 sec |
| 1 big box= _____ sec | 0.2 sec |
| 1 small box=_____mV | 0.1mV |
| 2 big boxes= _____mV | 1mV |
| True or False: Increasing the "size" of the tracing keeps the complex scaled and does not distort features of the complex | False: Increasing the size allows for easier viewing, but may distort features of the complex |
| Gain is also called _________. | sensitivity |
| Increasing the gain allows greater reception, but may increase ___________. | artifact |
| How does wandering pacemaker differ from NSR? | each P wave looks a little different d/t impulse being generated from different atrial places each beat |
| How does sinus dysrhythmia/sinus arrhythmia differ from NSR? | R-R interval is irregular |
| How does A-flutter differ from NSR? | multiple P:1QRS |
| How does A-fib differ from NSR? | no true P wave; R-R very IRREGULAR |
| How does SVT differ from V-Tach? | SVT has narrow QRS (<0.12 sec) |
| How does accelerated junction rhythm differ from NSR? | P wave is inverted or after QRS |
| What is the HR of a junctional escape rhythm? | 40-60bpm |
| What is the HR of an accelerated junctional rhythm? | 60-100bpm |
| What is the HR of a junctional tachycardia rhythm? | >100bpm |
| Is the R-R interval constant in V-Tach? | yes |
| What does ventricular escape rhythm look like? | rate=20-40bpm; wide QRS (>0.12 sec) |
| How do PAC's differ from PJC's? | PAC=normal P wave; PJC=P wave is inverted or after QRS |
| How do PAC's differ from PVC's? | PAC=narrow QRS; PVC=wide QRS |
| How does 1st deg heart block differ from NSR? | PR >0.2 sec |
| What is the P:QRS ratio for 1st deg heart block? | still 1:1 |
| What are the R-R and P-P intervals for 2nd degree Type I heart block? | R-R=irregular; P-P=regular |
| What are the R-R and P-P intervals for 2nd degree Type II heart block? | R-R=regular; P-P=regular |
| How does 3rd degree heart block differ from 2nd degree Type I heart block? | 3rd= R-R is regular; 2nd deg Type I=R-R is irregular |
| How does 3rd degree heart block differ from 2nd degree Type II hear block? | 3rd= vent. HR=20-40; 2nd deg Type II= vent. HR=60-100 |
| What is the other name for 2nd deg Type I heart block? | Wenckeback |
| What is the other name for 2nd deg Type II heart block? | Classical |
| What is the other name for 3rd deg hear block? | Complete |
| Ventricular paced beats have a (narrow or wide?) QRS? | wide |
| What EKG abnormality is associated with hyperkalemia? | tall, peaked T wave |
| True or False: As serum K rises, so does the height of the T wave. | True |
| What EKG abnormality is associated with hypokalemia? | depressed T wave; U wave |
| What does an EKG of a person with Wolfe-Parkinson-White look like? | short P-R, sloping R (delta) wave |
| How would you determine if a patient has Left Ventricular Hypertrophy? | measure depth of S wave in V1; measure height of R wave in V6; if 2 measurements when added together are >35mm then LVH is present |
| How would you determine if a patient has Left Atrial Hypertrophy? | notched P wave in V1 (biphasic or widened "humpback") |
| How would you determine if a patient has Right Atrial Hypertrophy? | tall, peaked P wave (>2.5mm tall) in V1 |
| If lead I is positive, then we know our axis is in the __________hemisphere. | Right |
| If aVF is positive, then we know our axis is in the ___________ hemisphere. | Lower |
| The axis deviates (toward or away from?) an infarct. | away from |
| The axis deviates (toward or away from?) hypertrophy. | toward |
| Right axis deviation is (clockwise or counterclockwise?) movement of the vector? | clockwise |
| Left axis deviation is (clockwise or counterclockwise?) movement of the vector? | counterclockwise |
| What types of patients would we expect to exhibit a RIGHT axis deviation? | very thin people, infarct on L side, R hypertrophy |
| What types of patients would we expect to exhibit a LEFT axis deviation? | obese, pregnant, infarct on R side, L hypertrophy |
| What does a right bundle branch block look like? | 2 R waves (bunny ears) |
| What does a left bundle branch block look like? | deep Q wave |
| Which leads look at the lateral wall of the heart? What coronary artery supplies it? | I, aVL, V5, V6 (L circ) |
| Which leads look at the inferior wall of the heart? What coronary artery supplies it? | II, III, aVF (RCA) |
| Which leads look at the septum of the heart? What coronary artery supplies it? | V1, V2 (LAD) |
| Which leads look at the anterior wall of the heart? What coronary artery supplies it? | V3, V4 (LAD) |
| What EKG changes indicate ischemia? | tall T waves (>1/3 height of QRS); peaked T waves; inverted T waves; ST depression |
| At what point(s) during anesthesia is ischemia likely to occur? | induction and emergence |
| What EKG changes indicate injury? | ST elevation |
| What EKG changes indicate infarction? | Q wave formation (>1/3 height of R wave) |
| What other abnormaility presents with the same EKG changes as infarction? | LBBB |
| True or False: Q wave formation disappears after the infarct is compete. | False: Once you have a Q wave, it never goes away |
| What does an "old infarct" look like? | Q wave w/o T wave changes |
| What do you call an infarct that is <1/2 the thickness of the endocardium? | subendocardial |
| What does an EKG of a subendocardial infarct look like? | no Q wave; only T/ST changes |
| What do you call an infarct that is >1/2 the thickness of the endocardium? | transmural/subepicardial |
| What does an EKG of a transmural/subepicardial infarct look like? | has a Q wave; w/ T/ST changes |
| When doing a right-sided EKG, where do you place the electrodes? | limb leads stay in same place; V leads are place anatomically the same place, but on the R side |
| What is the purpose of a right-sided EKG? | evaluate the R ventricle, not normally seen in 12-lead |
| What therapy might be changed if a right-sided EKG shows that the RV is infarcted? | DO NOT give nitro |
| Which lead is best for determining atrial dysrhythmias? | lead II |
| Which lead is best for determining ischemia? | V5 |
| When monitoring lead II and lead V5, ______% of events are detected. | 80% |
| When monitoring lead V5 and V4, ______% of events are detected. | 90% |
| When monitoring lead V5, V4 and II, ______% of events are detected. | 96% |
| If you notice ST elevation, check the location of the _______ lead. If this lead is placed too high on the chest, you will have false ST elevation. | red (L leg) |
| What can you do to rule out the accidental assumption of asystole when an electrode comes off? | check another lead |
| What must you do anytime an unusual rhythm appears on the monitor or there is a rhythm change? | check a pulse |
| True or False: The defibrillator resets to "defib" mode after each shock, so the "sync" button must be pressed before EACH cardioversion. | True |
Created by:
lindseymontgomery
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