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CV

Priniciples (Test 3)

QuestionAnswer
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