ECG Basics
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| In lead 1, the left arm electrode is... | positive
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| In lead II, the right arm electrode is... | negative
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| In lead III, the left leg electrode is... | positive
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| In the AVF lead, where is the + charge located? The ground? | Left foot electrode is +. Right and Left arm electrodes are ground.
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| What are the two ground electrodes in lead AVR? The positive electrode? | Ground = Left arm and left foot. Positive=Right arm
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| What are the ground electrodes in lead AVL? And the positive? | Positive = Left arm.
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| What are the 6 limb leads? | I, II, III, AVR, AVL, AVF
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| The limb leads lie in what plane? | Frontal plane, on pt's chest
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| Which leads are the "lateral" leads? | I and AVL
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| Which leads are the "inferior" leads? | II, III, and AVF
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| Which leads lie in the horizontal plane? | Chest leads (V1-V6)
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| A wave of depolarization within myocytes flows towards which electrodrode? | Positive electrode
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| How is depolarization moving towards a positve electrode manifested on the ECG? | By positive deflection
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| Amount of time represented b/n two heavy black lines | 0.2 second
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| Amount of time represented b/n two fine lines | .04 second
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| How many fine squares b/n two heavy black lines? | 5
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| P wave: define and normal duration | Atrial depolarization; no more than 2.5 mm in height & no more than .11 sec in length
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| QRS: define and normal duration | Ventricular depolarization; 0.06 - 0.12 sec
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| QT interval: define and normal duration | Duration of ventricular depolarization and repolarization; QTc < .45 sec (should be less than half the RR)
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| P-R interval: define and normal duration | time from onset of atrial depolarization to onset of ventricular depolarization; 0.12 - 0.20 sec
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| Normal axis: | -30 to -90
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| Inherent rate of SA node | 60-100 bpm
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| Inherent rate of an atrial foci | 60-80 bpm
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| Inherent rate of Junctional foci | 40-60 bpm
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| Inherent rate of ventricular voci | 20-40 bpm
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| Charictaristics of NSR | Rate: 60-100 bpm;
Rhythm: Regular;
P waves: uniform, + in lead II, one precedes each QRS;
PR interval: 0.12-0.20 sec and constant from beat to beat;
QRS duration: 0.06 - 0.12 sec
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| Rate and rhythm of Sinus Arrhythmia | Rate: Usually 60 - 100 bpm;
Rhythm: irregular, phasic w/respiration, increase w/inspiration (sympathetic), decr w/expiration (parasymp)
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| Sinus Arrhythmia: char. of P, PR, QRS intervals | P waves: uniform, + in lead II, one preceds each QRS, at very fast rates it may be diff to distinguish a P from T waves;
PR: 0.12 - 0.20 sec and constant;
QRS: 0.06 - 0.12 sec
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| Charictaristics of Sinus Bradycardia | Rate: <60 bpm;
Rhythm: Regular;
P: uniform, + in lead II, one preceding each QRS; PR: 0.12 - 0.20 sec and constant;
QRS: 0.06 < 0.12 sec
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| Characteristics of Sinus Tach | Rate: 101-180 bpm; Rhythm: reg;
P: uniform, + in lead II, one preceding each QRS;
@ very fast rates it may be diff to distinguish P from T waves;
PR: 0.12 - 0.20 and constant;
QRS: 0.06 - 0.12 sec
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| What is an axis of depolarization | the mean vector located by degrees in the frontal plane.
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| What is the axis if lead I is positive and aVF is negative | Left axis deviation
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| What is the axis if lead I is negative and and aVF is positive | Right axis deviation
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| What is the axis if lead I is negative and aVF is negative | extreme right axis deviation
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| Dipole theory | A wave of depolarization towards + electrode inscribes a + deflection; A wave of depolarization toward a - electrode inscribes a - deflection.
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| General characteristics of supraventricular dysrhythmias | Disturbances in rhythm occurring above the ventricles; can be regular or irregular
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| QRS duration of supraventricular dysrhythmias | the impulse will conduct down the normal ventricular conducting system -> QRS will be of normal duration
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| Rate and rhythm of a Wandering Atrial Pacemaker | Rate: usually 60 - 100 bpm, but may be slower; Rhythm: may be irregular as the pacemaker site changes from teh SA node to ectopic foci
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| What do you call a wandering atrail pacemaker with a rate > than 100 bpm? | Multifocal atrial tachycardia
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| P, PR, and QRS of a Wandering Atrial Pacemaker | P: size, shape and direction may change from beat to beat, at least 3 different P morphologies needed to Dx; PR: variable; QRS: 0.06 - 0.12 sec
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| What rhythm am I? Rate: 400-600, ventricular rate varies; Ventricular rhythm: irregularly irregular; P waves: none identifiable, fibrillatory waves present, erratic & wavy baseline; PR: not measurable; QRS: usually <0.12 | Atrial fibrillation
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| Rate and rhythm of SA Block | Rate: usually normal but varies due to pause; Rhythm: irreg b/c of the pause - each pause is the same as (or exact multiple of) the distance b/n two other P-P intervals
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| P, PR, and QRS characteristics in SA block | P: uniform, + in lead II, one precedes each QRS, at very fast rates it may be diff to distinguish P from T; PR: 0.12 - 0.20 and constant from beat to beat; GRS: 0.06 - 0.12 sec
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| Charictaristics of Sinus Arrest | Rate: usually normal; Rhythm: irreg b/c or undetermined length of puase (doesn't march out); P: uniform, may be diff to distinguish P from T; PR: 0.12 - 0.20 and constant; QRS: 0.06 - 0.12
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| Origin of escape beat during sinus arrest | An escape beat can emerge to pace the heart from another foci in the atria, junction, or ventricles.
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| Atrial escape | P prime wave present but is not from the sinus. PR interval will be wider than a junction escape.
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| P prime wave | Represents atrial depolarization by an automaticity focus, as opposed to normal sinus-paced P waves
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| Charictaristic of Junctional Escape Beats | Rate: usually w/in normal range but depends on underlying rhythm; Rhythm: regular and late beats; P waves: may occur before, during, or after QRS, inverted in leads II, III, aVF; PR: if P occurs before QRS, it will usually be < or= 0.12; QRS: usully<0.12
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| Rate and rhythm of Junctional Escape Rhythm | Rate: 40-60 bpm; Rhythm: regular
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| P, PR, and QRS characteristics in junctional escape rhythm | P: may occur before, during, after QRS, inverted in II, III, & aVF; PR: if a P occurs before QRS it's usually < or = 0.12, if there's no P there's no PR; QRS: usually < 0.12 sec
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| Charictaristics of Ventricular Escape | Rate: usually too slow to adequately perfuse (15-40 bpm); No P wave or atrial foci; no junctional escape mechanism; will likely see ischemic changes
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