EKG Test 2
Popular in Exercise Electrocardiograph
Popular in Kinesiology
This 14 page Study Guide was uploaded by Jessica Cox on Monday March 28, 2016. The Study Guide belongs to EP 3613 at Mississippi State University taught by Ben Abadie in Spring 2016. Since its upload, it has received 49 views. For similar materials see Exercise Electrocardiograph in Kinesiology at Mississippi State University.
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Date Created: 03/28/16
EKG T est #2 03/25/2016 ▯ 2/18/2016 ▯ Electrical Conduction ▯ ▯ 1. AV Blocks 1st nd 2rd 3 o degrees of severity o av node through bundle branches and bundle of his ▯ 2. Bundle Branch Block Left and Right Bundle Branch Block 1 Degree AV Block Partial, fairly benign, no symptoms, no dysfunction and wont progress o Delay in electrical stimulation (PR Interval greater than .2 seconds) o No need to treat ▯ 2 ndDegree AV Block partial block, eventually impulse comes through o 2 Versions: Wenckebach: Type 1 or Mobitz 1 Mobitz: Type 2 of Mobitz 2 All of these are considered 2 ndDegree AV Blocks o Does have symptoms mild/ severe Wenckebach: mild Mobitz: more severe Can progress to 3 Degree rd ▯ 3 Degree AV Block Mobitz progresses to 3 Degree AV Block faster than Wenckebach ▯ ▯ Wenckebach Progressive lengthening of the PR Interval ALWAYS drop in the QRS Wave Pattern starts all over Mild symptoms: o Hypoperfusion- insufficient amount of blood to be the bodies demand for O2 o 1 or More of these Symptoms: light headedness dizzy confusion loss of consciousness tachycardia arrhythmia pale/bluish skin ataxia ▯ Mobitz Drop QRS Wave, no warning of the drop Some people are bedridden with this Lots of variation o (normal,normal, drop) (normal, drop,normal) o more drops mean more severe ▯ rd ▯ 3 Degree only complete block impulses never go beyond AV NODE o there is nothing telling the ventricles to contract ▯ Etopics If SA NODE fails to fire “backs up” o Nodal Lower 1/3 AV Node through the bundle of his o Ventricular Any where in ventricular myocardium Nodal: Normal QRS Ventricular: Wide QRS o Ventricular-muscle cell to muscle cell o Wide QRS- .12 seconds to greater ▯ 3 Degree PR Interval, inconsistency ▯ ▯ Inherent/ Average Rates Atrial 60-80 bpm Nodal 40-60 bpm Ventricular 20-40 bpm ▯ ▯ 2/23/2016 ▯ ▯ Complete Bundle Branch Blocks ▯ ▯ Duel R Waves 1.R 2.R^- o written like this to separate the deflections o wide QRS wave Where you see the duel R Waves that will tell you where the block is o You will usually see them in V1,V2( right bundle branch block) o If you see them in V5,V6 (left bundle branch block) *notching by its doesn’t always mean it’s a BBB *wide QRS doesn’t mean it either ventricular etopics don’t have P waves *P wave prior to notching (QRS wave) you are looking at a bundle branch block o rabbit ears= Duel R Waves (L and R Bundle Branch Block) o notching isn’t restricted to these leads alone notching=wide QRS At least 3 Boxes = Wide Left and Right BBB o More of a observation wont have any clinical problem, you would never know it Left has more problems it makes the interpretation of other (ST segment) parts hard to see/ see @ rest Right doesn’t do that but Left is more common 70 to 75% ▯ ▯ Hyper Acceleration Opposite of conduction blocks o Impulses go through conduction to quickly o AV Node gets bypassed o Two Types 1. WPW Syndrome accessory pathway ( you shouldn’t have this in the body) located between myocardium of Right Atrium an Right Ventricle myocardium Bundle of Kent- impulses goes directly to ventricles o **only to Right Ventricle** ▯ Hypoperfusion Wont see symptoms till mid/late teens Lightheadedness, dizzy, etc (6 symptoms) How to diagnose on a EKG P Wave goes right into QRS ** Delta Wave** o slowly rises right before it shoots up o only condition that causes a Delta Wave Wide QRS Slight notching Not absolute the T Wave was inverted, will be negative o 2. LGL Syndrome you will also be born with this accessory pathway James Fibers Short, shouldn’t have it, anterior wall connects to Bundle of His bypassing the AV Node Short PR Interval (normal .12 to .2 seconds) .11 seconds or less Tight QRS wave looking @ LGL Duration of QRS tells you what you have No Delta Wave T Wave unaffected More severe symptoms- same as other Not easy to treat, you have to go inside the heart ▯ ▯ 3/1/2016 ▯ ▯ Hypertrophy A lot of causes Enlargement of the myocardial tissue from myocardial cells Enlargement: NOT a increase in tissue but a STRETCHING, makes the chamber larger o In the Atrium its called: Enlargement o In the Ventricles its called: Hypertrophy ▯ ▯ Atrial ENLARGEMENT Configuration of P Wave, depolarization o Two main Leads: V1 and V2 and II Most important is V1 o P Wave can be BIPHASIC Atrial enlargement can cause this Doesn’t always mean its abnormal (biphasic) o If 1 or 2 nd– ½ is 1 mm, isoelectric line o Greater than > 1mm it is a significant biphasic abnormal 1 half (+) is > 1mm, peak appearance o Right Atrial Enlargement (V1 and V2) 2nd half (-) o Left Atrial Enlargement deep and wide biphasic and diphasic are the same ** lead II- Atrial Enlargement MAY ALSO not always o Left Atrial Enlargement in II Can be notched Very flat P Wave (< .5 mm) barely above isoelectric line Wide P Wave (> .1 sec) Normal : .06 to .1 ▯ Right Ventricular Hypertrophy Horizontal Axis Deviation- V1(+) normally its (-) o Two Conditions: (-) QRS in Lead I (+) QRS in V1 RVH Wide QRST angle Repolarization abnormalities ▯ Left Ventricular Hypertrophy Short Cut o If QRS in one direction and the T Wave is in another direction Both left and right o Axis more skewed than normal o Look at amplitude of the S Wave in V2 o Amplitude of the R Wave in V5 GREATER THAN > 35 mm Its obvious ▯ Possible to have bi- atrial enlargement Meet both criteria? W/ in one tracing You cant have bi- ventricular ▯ ▯ Strain Pattern Ventricular strains to pump blood o ST Segment Depression o T Wave Inversion V5 and V6 ▯ ▯ Causes of Right Atrial Enlargement 1. Pulmonary Hypertension ▯ Causes of Left Atrial Enlargement 2.mitral stenosis, mitral valve prolapse ▯ Causes of Right Ventricle Hypertrophy 1. Pulmonary Hypertension ▯ Causes of Left Ventricle Hypertrophy 2.systemic hypertension, congestive heart failure, long term aerobic conditioning 3/8/2016 Infarctions most infarctions take place on the left side of the heart o pressure is the greatest o most stress atherosclerosis o fibrous cap ruptures secondary clot forms o 1:1 ratio of vessels Widowmaker=Death Sudden Death= 24 hours Silent Infarction- found in autopsy’s o Sometimes you can have an infarction and not even know it o Higher in the chain less likely to survive location, location ▯ ▯ 3 Techniques 1. ST Segment Elevation o 2mm or above o read @ J point: where S ends and ST begins o Injury nor death to myocardium: recent infarction Due to no oxygen 2. Unpredictable o T Wave Inversion: a lot of other stuff causes this 3. Significant Q Wave o usually low in amplitude and small o most common: 1. Q Wave > 1 mm in duration gap in increase and decrease in stroke 2. Amplitude of Q Wave is > 1/3 the amplitude of R Wave normal is will be less ▯ Death of Myocardium Tissue Age of the Infarction o If there is only ST Segment Elevation RECENT INFARCTION 1 STDAY o ST Segment Increase + a Significant Q Wave INTERMEDIATE 3 WEEKS OLD o Once it goes it never goes back to normal T Wave doesn’t help w/ this increase ▯ ▯ Identify the Location of the Infarction LEADS THAT HAVE A DIRECT VIEW ACUTERECENT ▯ st ▯ 1 anterior wall infarction o Left Ventricle (V1-V4) nd ▯ 2 posterior wall infarction o V1 and V2 o No leads that have a direct view o ST Segment Depression o No ischemia @ rest rd o Reciprocal ▯ 3 lateral wall o limb leads I and AVL, V5 and V6 ▯ To have an Infarction you need to see it in @ least 2 LEADS ▯ th ▯ 4 inferior wall infarction o II, III and AVL ▯ Apical Infarction- The Tip I, II, II Leads ▯ * hardly ever see an infarction on the right side of the heart ▯ ▯ Check Blood Enzymes: SGO2- peaks 2 days after Lactate dehydrogenases- peaks @ 2x the normal level, 11 day ▯ ▯ Drugs that can stop Infarction 1. Myokinase 2.streptokinase 3.urokinase 3/10/2016 AV Block and 12 Lead Block 1 three in folder? ▯ ▯ Rhythm Strip Looks at ½ dozen EKG Good for determining AV Blocks ▯ ▯ Duel Rate Ventricular Rate o Distance between two consecutive R Waves Atrial Rate o Distance between two consecutive P Waves Parasystole o When you have ventricular and atrial in the same rhythm ▯ 1st check the PR Interval for consistency o 4 Different Types of AV Blocks *inconsistent PR Interval: 3 Degree AV Block o the impulse can not get from the atrium down to the ventricles o ETOPIC FIRING: nodle or ventricular Duel Systole o Fusion beat (P Wave on top of T Wave) rd o Not dangerous (when you have 3 degree AV Block ) o When a QRS and a T Wave fall on each other- DANGEROUS 3, 5,7 –read EKG (AV BLOCK 1) ▯ ▯
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