Which of the following BEST describes universal and standard precautions?
Standard precaution conbine universal and body substance isolation
When might you be required to perform a 'stat' ECG?
When a patient has chest pains or changes in his or her cardiac rhythm
Telemedicine monitoring is generally used to evaluate which of the following?
Artificial pacemaker functioning
Which of the following is NOT a reason for performing an ECG?
reporting the blood pressure results of a stress test incorrectly resulting in a myocardial infarction to the patient
In addition to recording the ECG and preparing the report, an ECG technician must be able to:
Determine if the tracing is accurate and recognize if interference caused abnormalities during the recording process
On the ECG waveform, what is the beginning of the atrial depolarization to the beginning of the ventricular depolarization, or the time it takes the impulse to travel from the SA node to the AV node?
P R Interval
responsible for transporting blood to the lungs.
Pulmonary Veins
What is the state of cellular stimulation in the heart that causes it to contract?
Depolarization
Trace the pathway for the transport of blood during systemic circulation, starting with oxygenated blood from the lungs.
Left atrium, mitral valve, left ventricle, aortic semilunar valve aorta, through the body, superior and inferior vena cava
The horizontal axis represent TIME
1 mm=0.04 seconds 5 mm=0.2 second
The vertical represent VOLTAGE
horizontal measured in millivolts (1/1000 part of volt . But expressed in millimeters , 0.1m V=1mm
VERTICAL AXIS 1 small square
0
VERTICAL AXIS 1 Large square
0
VERTICAL AXIS 2 large square
-1mV
HORIZONTAL AXIS 1 small square
0
HORIZONTAL AXIS 1 large square
0
HORIZONTAL AXIS 5 large square
0
P wave is for the
SA node
after the P wave is
AV node
Q wave is
bundle branches
S wave is
purkinjie
T wave is
Dupp
Between the QS waves is
Lubb
What is the J point and why is it used?
A point on the QRS complex where the depolarization is completed and repolarization starts
Which of the following BEST describes "excitability
The ability of the heart muscle cells to responded to an impulse or stimulus
regarding pulmonary circulation?
Pulmonary circulation is the transportation of blood to and from the lungs, blood is oxygenated in the lungs during pulmonary circulation
coronary circulation?
Circulation of blood to and from the heart muscle
What does the isoelectric line of the ECG tracing indicate
No electrical activity
On the waveform, what does the QRS complex represent?
Ventricular depolarization and the resulting ventricular contraction
Which of the following parts of the conduction system conducts impulses down both sides of the interventricular septum
Bundle branches
Which two types of leads are unipolar (measure electrical activity in one direction only)?
Chest and augmented leads
When calculating heart rates, which method is the only one to use for irregular rhythms?
6 second method
Which of the following is the correct label for the augmented lead that usually produces a negative deflection?
aVR
Which of the following is NOT a function of the ECG machine?
Validation of ECG interpretation
What is the main difference between single- and multi-channel ECG machines?
The multi-channel ECG machine is able to record more than one lead tracing at a time
What is the most common output for a 12-lead ECG?
Printed format
At the normal paper speed, how much time do the five heavy lines on the ECG graph paper represent?
one second
Which of the following is NOT a consideration for handling and storing printed ECG's?
They require no special handling and can be stored for up to 50 years
What is the usual setting for the artifact filter to reduce artifact due to muscle tremor?
40Hz
What part of the ECG machine serves as a receiving device for the input function?
sensors
Augmented leads are unipolar leads. Why are they called augmented leads?
The ECG machine increases the size of the tracing
Which control on the ECG regulates how fast or slow the paper runs during the procedure?
Speed control
What occurs during signal processing inside the ECG machine?
The electrical
How should you modify the ECG procedure for a pregnant patient?
Place the patient slightly on her left side and note the number of months of pregnancy on the ECG report
What is the ICD-9 code?
Diagnostic codes used to ensure reimbursement by the patient's insurance company
three sites assist in electrode placement. They are the angle of Louis, suprasternal notch, and what other site?
Intercostal space
Which of the following MOST accurately describes the placement of the V6 electrode?
On the midaxillary line in line with V4
What is the proper positioning for yourself and the patient during an ECG?
Working from the left side of the bed or exam table with the patient's on his back with the arm and legs supported
Describe the difference between a routine ECG and continuous cardiac monitoring.
Cardiac monitoring users 3 leads with different placements
An ECG is required during a Code Blue. What special considerations should you take?
You should be available but out of the way, Take only the ECG machine into the room, and leave the electrodes in place
Which of the following statements is TRUE or CORRECT regarding the room or machine used for an ECG?
The room should be away from electrical equipment and x-ray machines, electrical equipment should be turned off
You must locate the angle of Louis and the second rib that is adjustment to this landmark when placing the chest electrodes. Then count down to the 4th intercostal space. Which lead do you place on the left sternal border?
V2
The baseline for the ECG you just performed is drifting off center. This is called wandering baseline. Which of the following is NOT a cause for this type of artifact?
Adequate electrode gel
If you were performing an ECG on a patient who had his left lower leg amputated (removed), where should you put the leg electrodes?
Place both left and right electrodes on the upper legs close to the trunk
If all required information is not on the form, what should you do?
Ask the patient or obtain the information from the medical record
The ECG waveform has various components that determine the type of cardiac rhythm. What are these components?
Waves, segments, and intervals
In which condition do the P-P and R-R intervals progressively widen, then narrow, following the patient's breathing pattern?
Sinus Dysrhythmia
What rhythm originating in the sinus node is affected by the breathing pattern of the patient?
Sinus Dysrhythmia
When evaluating the QRS measurement of an ECG tracing, which of the following questions does NOT need to be answered
Does each P wave have a QRS complex following it
What method would you use to determine the heart rate for the ECG tracing
Multiply times 10 the number of P waves or QRS complex in a six second strip
When identifying the P wave configuration, why do you ask the question, "Does each P wave have a QRS complex following it?
if there is less than or more than P wave for every QRS complex, it could indicate that the atria and ventricles are not contracting together
What is the condition in which impulses over the vagus nerve cause a decrease in heart rate?
Vagal tone
On the ECG tracing, the place at which depolarization is complete and repolarization starts is known as the:
J point
What is the normal range for the PR interval, and why is measuring it a necessary step during ECG evaluation?
Range 0.12 - 0.20 second. to determine if the electrical current is being delayed or initiated from a location other than the SA node
What is the most common monitoring lead?
lead ll
What is the major health risk for patients that have atrial fibrillation?
Thrombus formation and embolism
Multifocal atrial tachycardia is usually triggered by an acute attack of emphysema, mitral valve regurgitation, or:
Congestive heart failure
What treatment is usually indicated for patients with atrial flutter?
Oxygen therapy
Atrial dysrhythmias are caused by what kind of impulse in either the right or left atrium?
Ectopic
What rhythm causes the atria to quiver, similar to a bowl of Jell-O?
Atrial fibrillation
Wandering atrial pacemaker (WAP) is a normal finding in children, older adults, and well-conditioned athletes. It may also be related to these conditions
Organic heart disease and drug toxicity
What rhythm is similar to finding a shortcut to school, bypassing the normal traffic route to get to the destination faster?
Atrial flutter
What is unique about multifocal atrial tachycardia?
MAT has clearly changing P wave and heart rate of 101 to 150 bpm
The loss of atrial kick contributes to what percent decrease in cardiac output?
10% to 30%
Atrial dysrhythmias occur from conditions that cause pressure on the atria. Some of these conditions are:
Myocardial infarction, valvcular problems, and neurological influences
Electrical impulses that originate in the atria and initiate an early impulse that interrupts the inherent regular rhythm are called
Premature atrial complexes (PAC's
What is the term that refers to the cardiac cell that functions as an ectopic beat?
Focus
Multifocal atrial tachycardia (MAT) may occasionally be confused with:
Wandering atrial pacemaker
What treatment is usually attempted for patients with atrial fibrillation?
Medication and / or electrical cardioversion
Wandering atrial pacemaker rhythm has at least how many differently shaped P waves?
Three
A PAC is a cardiac complex that occurs too soon and has a positively deflected P wave. What is unique about this dysrhythmia?
It does not posses any normal features
The ejection of blood from the atria into the ventricles immediately prior to ventricular systole is
Atrial kick
Which atrial dysrhythmia has capital "F" waves and a classic sawtooth or picket fence appearance?
Atrial flutter
How would frequent premature atrial complexes (PACs) affect a patient with coronary artery disease?
Low cardiac output
What causes the inverted P wave morphology found with junctional rhythms?
Electrical impulses are coming from the AV node instead of the SA node, causing depolarization of the atria to flow retrograde
What is the heart rate range for accelerated junctional rhythm?
60 to 100 bpm
What symptoms might occur in a patient with junctional escape rhythm?
Hypotension, confusion, and disorientation
Which of the following dysrhythmias is NOT considered part of the supraventricular tachycardia classification?
ventricular tachycardia
What is a single early electrical impulse that originates in the atrioventricular junction, occurring before the next expected sinus impulse and causing an irregularity in the rhythm?
Premature junctional complex(PJC
What is unique about junctional escape rhythm?
The P wave may occur before, during or after The QRS complex
The term "retrograde" means:
move backwards
Which dysrhythmia is NOT associated with supraventricular tachycardia?
Ventricular tachycardia
What is the difference between accelerated junctional rhythm and junctional tachycardia rhythm?
Heart Rate
The criteria needed to classify a dysrhythmia as supraventricular tachycardia is
Heart rate between 150 and 300 bpm
What is unique about premature junctional complexes (PJCs)? (
PJCs have an irregular rhythm, the P wave is wave is inverted and may appear before during or after the QRS complex
The effect of junctional tachycardia on a patient depends on:
The Heart rate of the rhythm
When do junctional escape rhythms occur?
When the SA nodes fails to initiate electrical activity causing one of the backup pacemaker sites to take over
Why is it unlikely that a patient would have symptoms of low cardiac output with accelerated junctional rhythm?
Because the heart rate is the same as normal sinus rhythm
What is the heart rate for junctional escape rhythm? (
40 to 60 bpm
When is junctional tachycardia considered to be serious and life-threatening for a patient?
After a recent myocardial infarction
What symptoms would a patient have if PJCs occur more than four to six times per minute?
Hypotension, irregular pulse
What symptom might a patient complain of when experiencing supraventricular tachycardia?
Palpitation
What is the difference between accelerated junctional rhythm and junctional escape rhythm?
Heart Rate
Which of the following heart block dysrhythmias is identified by a repetitious prolonging PR interval pattern after each blocked QRS complex? (
Heart Rate
Which heart block dysrhythmia is known as the 'classical' heart block?
Second degree heart block, typeII
Which heart block dysrhythmia is also known as 'complete heart block'?
Third degree heart block
What is the cause of a heart block dysrhythmia?
The electrical current has a difficulty traveling down the normal conduction pathway
Electrical separation of the atria and ventricles is often referred to as:
AV dissociation
In which heart block dysrhythmia are ALL electrical impulses originating above the ventricles blocked and prevented from reaching the ventricles?
Third degree heart block
What heart block rhythm is usually due to inflammation around the AV node, and is often a temporary condition that will resolve itself and return to a normal heart rhythm?
Second degree heart block, Mobitz l
Which heart block dysrhythmia has regular P-P and R-R intervals, with both having the same rate?
First degree heart block
When would you use the mnemonic 'Lengthen, Lengthen, drop equals Wenckebach'?
To determine the different between a second degree type l or type ll heart block
Which of the following heart block dysrhythmias is identified by missing QRS complexes and a consistent PR interval measurement?
Second degree heart block, type ll
Which of the following heart block dysrhythmias is identified by regular P-P and R-R intervals that are firing at two distinctly different rates?
Third degree heart block
Which heart block rhythm has a PR interval that measures greater than 0.20 second and measures the same duration each time?
First degree heart block
Which heart block dysrhythmia is highly unstable and considered a critical condition?
Second degree heart block, type ll
Which heart block dysrhythmia can quickly progress to a third degree heart block and a possible Code Blue situation?
Second degree heart block, type l
QRS complexes that measure 0.12 second or greater with a rate between 20 and 40 bpm indicate that the impulses causing ventricular depolarization are coming from the:
Purkinje fibers
What does or does not occur in heart block rhythms? (
The electrical current is delayed or blocked along normal conduction pathways at or above the AV junction
Frequent nonconducted QRS complexes are likely to cause signs of
Low cardiac output
In which heart block dysrhythmia would the patient probably be unconscious and require immediate medical intervention? (
Third degree heart block
P-P intervals are _____ in all heart block dysrhythmias.
Regular
Which ventricular dysrhythmia has a heart rate between 40 and 100 beats per minute?
Accelerated Idioventricular
Which ventricular dysrhythmia has a heart rate less than 20 beats per minute?
Agonal
What symptoms might a patient experience with PVCs?
Dizziness thumping or skipping sensation
Which of the following rhythms is likely to result in a cardiac arrest?
Ventricular fibrillation
Which of the following is a correct statement about premature ventricular complexes (PVCs)?
PVC's may be unifocal or multifocal in origin
PVCs can occur due to bradycardia or hypoxic states. What must be done to determine which is causing a patient's PVCs?
Blood sample must be drawn to evaluate a hypoxic state
How are agonal rhythm and asystole the same?
Both rhythm have an absence of P wave, The patient is unconscious, are life threatening and require basic and advanced life support
Which of the following dysrhythmias is NOT considered to be a medical emergency?
Occasional PVC's
Which ventricular dysrhythmia has a heart rate between 20 and 40 beats per minute? (
Idioventricular
Why does it take longer than normal to depolarize the ventricles during a ventricular dysrhythmia?
Because the current is initiated within the purkinje fibers, and the electrical stimulation occurs from the ventricular cell to cell condition
QRS complexes that measure 0.12 seconds or greater with a rate between 20-40 bpm indicate that the impulses causing ventricular depolarization are coming from the
Purkinje fibers
Ventricular fibrillation is typically described as:
Chaotic
Which of the following indicates that a cell-by-cell stimulation is occurring to depolarize the ventricles and that the dysrhythmia is originating in the ventricles?
A QRTS complex measurement of 0.12 second or greater
What is the difference between ventricular tachycardia and ventricular fibrillation?
Ventricular tachycardia has 3 or more PVC's and rate of greater than 100 bpm Ventricular fibrillation
Ventricular rhythms occurring within the range of the Purkinje network are occasionally referred to as ventricular escape rhythms. Ventricular escape rhythms occur because:
The higher pacemaker sites within the heart have failed
If the dysrhythmia is one that originates from above the ventricles and you notice a wide QRS complex, which rhythm could this be?
Bundle branches block
When the QRS complex measures _____, a bundle branch block must be considered.
0.12 second or greater
What occurs when the pacemaker does not send electrical impulses to the myocardium?
Malfunctioning ( failure to pace
How is a right bundle branch block (RBBB) distinguished from a left bundle branch block (LBBB)?
Leads V1 is referenced and if the QRS is positively deflected it is a RBBB, if the QRS is negative it is a LBBB
What is the advantage of atrioventricular pacing?
It mimics the normal cardiac condition system and allows for the atria to contract completely prior to the ventricles to allow for the an atrial kick
Which pacemaker rhythm has a pacing spike before P waves?
Atrial pacemaker rhythm
What portion of the heart do electronic pacemakers mimic?
SA node
When is a ventricular pacemaker used?
When conduction in the ventricles is not working properly
When is an atrial pacemaker used alone?
When the conduction system from AV node through the ventricles is intact and functioning
Which of the following best describes a lack of ventricular spike and normal QRS complex on an ECG tracing of a patient with an AV sequential pacemaker
The patient own conduction system kick in and inhibited the pacemaker
Which pacemaker rhythm has a pacing spike before the QRS complex?
Ventricular pacemaker
What happens when one or both of the ventricular pathways are not functioning properly due to damage or a delay from cardiac disease, drugs, or other conditions?
A bundle branch block occurs
Which of the following is NOT one of the components to be evaluated on a pacemaker tracing?
The QT interval
What term refers to the ability of the heart muscle to respond to electrical stimulation and depolarize the myocardial tissue?
Capture
Which term indicates the stimulation of electrical current from the pacemaker generator?
Pacing spike
Which pacemaker complication shows a pacing spike, but no waveform immediately following it?
Loss of capture
What additional patient information is needed on the ECG tracing when a bundle branch block is discovered?
Blood pressure reading
What is the target heart rate used during exercise electrocardiography?
220 minus the patients age
How do you determine how many pre-test recordings of BP and12-lead ECGs you obtain?
Check with facility policy
During exercise electrocardiography, the patient becomes very diaphoretic (sweaty) and is breathing heavily; his blood pressure is 156/102. What should you do?
Immediately report these symptoms to the licensed practitioner
Which of these patients would have a Persantine�-thallium stress test?
68 year old patient confined to his bed after cardiac surgery
You will instruct the patient when the appointment is made in preparation for an exercise electrocardiography. Which of the following is a correct statement?
Check the order and instruct the patient regarding medication she or she should or should not take prior to the procedure
What is the purpose of an exercise electrocardiography test
To evaluate how the heart and blood vessels respond to physical activity
Why might the physician request the rate pressure product (RPP)?
This estimates oxygen utilization
Prior to initiating an exercise stress test, you will have to take and record a series of blood pressures and 12-lead ECGs. What are the most common patient positions, in order, when these are obtained?
Supine sitting after hyperventilation, and standing
On the consent form for Ms. Kallir's treadmill stress test, a large X is marked on the signature line. Explain why you would or would not continue with the procedure.
Yes complete the test. Ms. kallir is unable to sing her name
Which of the following would NOT alleviate the patient's fears during exercise electrocardiography?
Explaining the location of the crash cart
What would you tell a patient who asked you how long a thallium stress test would last?
4 to 5 hours
During exercise electrocardiography, which of the following occurs in approximately 5% of healthy adults, and is it more common in men or women?
false positive results women
What is the rate pressure product (RPP)?
Systolic BP times heart rate
Which of the following conditions would prevent a patient from participating in exercise electrocardiography?
Severe anemia
If the treadmill stress test is inconclusive, what does this mean and what should be done?
Results are questionable and more test will be do
Which statement is correct regarding the patient who achieves target heart rate (THR)?
The results are more reliable when the patient nears or achieves the THR
How do you abrade the skin in preparation for electrode placement?
Rub firmly and briskly at each electrode site with a skin rasp
Which of the following is NOT a reason for ambulatory monitoring?
Evaluate for heart disease during a routine physical examination
What is the purpose of ambulatory monitoring?
Document electrical activity of the heart during normal activity
What is the advantage of continuous monitoring over intermittent monitoring?
continuous monitoring provides a complete tracing and records before, during, and after the patient activates the event marker
During ambulatory monitoring, what is a scanner used for?
To analyze results and provide a printout for interpretation
Which patient will be asked to keep a diary?
Mr. Fisher, whose is physician ordered holter monitoring for him this morning
When asked by a patient or the parent of a patient whether ambulatory monitoring is painful, what would be your BEST response
The monitoring is not painful, however there may be some discomfort while the electrodes are in place
Why would a patient use an "event marker" during ambulatory monitoring?
To mark ECG tracing when symptoms occurs
Which of the following does NOT need to be avoided during ambulatory monitoring?
Microwave oven
Which of the following is a true or correct statement regarding patient education for ambulatory monitoring?
Wear a loose fitting shirt, preferably one that buttons down, the front and you will be more comfortable during the procedure
What is the purpose of ambulatory monitoring?
Document electrical activity of the heart during normal activity
Transtelephonic monitors are mainly used to monitor patients with what device?
Permanent pacemaker
Who is responsible for interpreting the ambulatory monitoring results
Cardiologist
Which of the following dysrhythmias would not be evaluated using a post-system event monitor
Ventricular fibrillation
How are lead wires coded to ensure proper placement for ambulatory monitoring
Colors
What is the last thing you do before having the patient put on his or her shirt during ambulatory
Run a baseline ECG tracing
Which of the following are angina symptoms?
Shortness of breath, sweating, bad indigestion jaw pain, cough arm pain,sense of impending doom, anxiety,dizziness, nausea, pressure in chest
What percentage of patients having a myocardial infarction present with ST segment elevation?
75 % - 80%
Which of the following are common cardiac symptoms in women? (
Shortness of breath, weakness unusual fatigue
The right coronary artery has two branches. The posterior descending artery supplies blood to which part of the heart?
The wall of both ventricles
Besides women, what other patient groups present atypically?
Diabetics and elderly patient
The chest pain a patient experiences when the heart muscle is not receiving enough oxygen due to a partial or complete blockage of a coronary artery is referred to as:
Angina
The coronary arteries have three layers. The outermost layer is called:
Tunica adventitia
Why does sudden death occur more often with NSTEMI patient?
Classic sings and symptoms of a heart attack are not present,12 leads ECG does not display the classic morphologic change,since the patient are asymptomatic they do not receive medical care
What three symptoms are indicative of right-sided heart failure and are considered ominous when they present together?
Jugular vein distention, hypotension normal breath sounds
What percentage of women having a heart attack have never experienced chest pain?
40 %
A lack of blood supply to an area of heart tissue due to a blockage in circulation in that area is known as:
Ischemia
The left coronary artery has two branches. The left descending artery supplies blood to which part of the heart?
Both Ventricles
What is the function of the tunica adventitia, the outermost layer of a coronary artery?
to keep the vessel open
Which procedure allows visualization of the coronary arteries and placement of a stent?
Cardiac catheterization
Other than a cardiac condition, a patient may have chest pain due to
Inflammation of the lungs, Gastric or esophageal irritation, Gallbladder problems
Which layer of the coronary artery comes in direct contact with the blood and is prone to disruption when atherosclerotic plaque is ruptured and peels away?
Tunica intima
The right coronary artery has two branches. The marginal artery supplies blood to which part of the heart
The walls of the right atrium and the right ventricle
Unstable angina is a warning sign that the cardiac disease has advanced or worsened. Which of the following are signs of unstable angina?
Change i severity and frequency, change in cause and duration, change in responsiveness to treatment or medication
he coronary arteries have three layers. The innermost layer is called:
Tunica intima
STEMI refers to the classic MI, which occurs as a result of a complete occlusion of a coronary artery. What changes occur in the ECG tracing?
ST segment depression or elevation, Twave inversion , Development of a pathologic Q wave
Why are the mnemonics O-P-Q-R-S-T and S-A-M-P-L-E important in the care and management of a patient with chest pain
They create a logical flow for the patient questioning and information gathering for prompt medical care
The left coronary artery has two branches. The circumflex artery supplies blood to which part of the heart?
The left atrium and left ventricles
What is the function of the tunica media, the middle layer of a coronary artery?
To dilate and constrict to maintain normal blood pressure and homeostasis
Pathologic Q waves seen in _____ anatomically contiguous leads indicate that some of the tissue in that part of heart is dead.
Two or more
Displacement of the heart is often seen in conditions such as:
Pregnancy birth defects, left ventricular hypertrophy
Identify the heart block on this ECG tracing:
Left bundle branch block
In which group of patients is right axis deviation considered normal?
Children and thin adults
Each lead of a standard 12-lead ECG looks at different portions of the heart. What portion of the heart is viewed with leads V3 and V4?
Anterior wall of the left ventricle
When totaled, how many millimeters are the minimum necessary to clinically suspect hypertrophy?
35
Each lead of a standard 12-lead ECG looks at different portions of the heart. What portion of the heart is viewed with leads II, III, and AVF?
Inferior wall of the left ventricle
Each lead of a standard 12-lead ECG looks at different arteries of the heart. Which artery and branch are viewed with leads II, III, and aVF?
Right coronary and marginal branch
What occurs when there is a reduction or interruption in blood flow and oxygen to the myocardium for a short time?
myocardial ischemia
ST segment elevation of 1 mm or more that is seen in two or more anatomically contiguous leads is indicative of:
Myocardial ischemia
In left axis deviation, in which direction does the QRS complex point?
lead l positive aVF negative
Which of the following most accurately describes the difference between LBBB and RBBB?
The QRS complex is negative for LBBB and positive for RBBB
What two leads should you use to determine the presence of axis deviation?
Leads l and aVF
Which leads should you use when analyzing a 12-lead ECG for the presence of left ventricular hypertrophy?
V1, V2, V5, and V6
Each lead of a standard 12-lead ECG looks at different arteries of the heart. Which artery and branch is viewed with leads V3 and V4?
Left coronary and left anterior descending
If the axis is normal, in which direction does the QRS complex point?
lead l negative aVF positive
Each lead of a standard 12-lead ECG looks at different arteries of the heart. Which artery and branch are viewed with leads V1 and V2
Left coronary and septal branch
Each lead of a standard 12-lead ECG looks at different portions of the heart. What portion of the heart is viewed with I, aVL, V5, and V6?
Lateral wall of the left ventricle
Each lead of a standard 12-lead ECG looks at different portions of the heart. What portion of the heart is viewed with leads V1 and V2?
Septal wall
Each lead of a standard 12-lead ECG looks at different arteries of the heart. Which artery and branch is viewed with leads I, aVL, V5, and V6?
left coronary and left circumflex
RBBB
Right bundle branch block ,
LBBB
Left bundle branch block
On the ECG tracing, the place at which depolarization is complete and redpolarization start is known ass the
J point
What is the most common monitoring lead
Lead II
Different between a route ECG and Continuous Cardiac monitoring
Cardiac monitoring use 3 leads with different placements
12 leads
routine EKG will consist of
3 Leads
What is Einthoven's triangle?
When doing an exercise Stress Test, what is the minimum number of leads that you have to monitor?
Telemetry monitoring
Loop monitor
5 Leads
HOLTER MONITOR, STRESS TEST
mount a completed EKG for a patient's chart
Know your office policy, ensure the pt identifiers have been entered onto the EKG, some facilities require attaching stickers with bar codes to identify the pt and any test results.
anatomical landmarks for chest lead placement EKG
between the 5th and 6th midclivicular, mid point of left clavicle
Rate pressure product (RPP or Double product
multiply the systolic blood pressure by patient,s heart rate. This technique used to estimate oxygen utilization or myocardial work
Ectopicim Pulse
An electrical impulse that comes from outside of the normal pacemaker site or electrical conduction pathway
P wave (Upward small curve
Atrial depolarization with resulting atrial contraction
QRS complex (Q, R and S Waves
Ventricular depolarizastion and resulting ventricular contracting ( larger than the P wave, atrial repolarization occurs not seen
T Wave, Small upward - sloping curve
Ventricular repolarization
U Wave, Small upward curve
Repolarization of the bundle of his and Purkinje fiber ( not always seen, may be seen in instances of electrolyte imbalance
Lead I
0
Lead II
0
Waveform
refers to movement away from the isoelectric with either upward (positive deflection or downward ( negative deflection
Segment
Line between two waveforms
Interval
waveform plus a segment
Complex
several waveforms
Lead III
0
PR Interval, P wave and baseline prior to QRS complex
Beginning of atrial depolarization to the beginning of ventricular depolarization
QT interval, QRS complex, ST segment and T wave
Period of time from the start of ventricular depolarization to the end of ventricular repolarization
ST segment, End of QRS complex to the beginning of T wave
Time between ventricular depolarization and the beginning of ventricular repolarization
1st Degree heart AV block
PR interval is contant and measures greater than waves are half- inch before complex, other second 0.20 seconds P- waves are half - inch before complex,otherwise looks fairly normal
2nd degree heart AV block I&II
1. lengthens, lengthens gone line after p - wave
2. t - waves are upside down inverted
3rd degree heart block
P-P and R-R intervals are regular constant but firing at different rates, (Three mountains in the middle, P wave is closer and than it is far away
Agonal rhythm
Has a absence of P waves, A ventricular rate of less than 20 bpm all three pacmakers have died heart is dead
Atrial Fibrillation
Has CHAOTIC atrial electrical activity no P waves F waves instead with irregular R -
R intervals, Scribbles need a defibrillator, tantrum
Atrial flutter
saw tooth or a picket fence pattern, atrial pattern no P waves F waves instead that may be in a ratio 250 - 350 bpm person would be out of it
Junctional escape rhythm
Inverted or a absent P wave. The P - wave may occur before, during or after the QRS complex 40 - 60 bpm
Mat multifocal atrial tachycardia
supposed to look like mountains climbers
Premature Atrial Complex
Extra beat closer than the rest, shorten length Pac is a complex that occurs sooner than it should with a positively deflected P wave
Sinus arrest
Has regularly occurring, PQRST's both before and after the arrest period. No electrical activity during the arrest period, after 6 sec is considern life threating
Sinus Bradycardia
Wide bizarre complexes, slow heart rate less than 60 bpm, looks like 1st degree heart block can cause escape beat can be fix with medation or pacemaker
Sinus dysrhythmia
P-P and R-R intervals will progressively widen then narrow following the patients breathing pattern,change in breathing patterns different lengths, cause by breathing
Supraventricular Tachycardia
Remember for heart rates approaching 150 and higher, it will be very likely that the P wave will be buried. Be prepared to increase the paper speed for this rhythm
Ventricular fibrillation
Soldiers out of step, all scribbles, needs a defib, There are no P waves< QRS complex or T waves. The tracing has a CHAOTIC or disorganized appearance
Ventricular Tachycardia
Has wide and bizarre QRS complexes with classic saw tooth appearance, a rate in excess of 100 bpm with no P Looks like big mountains
Wandering Atrial pacemaker
WAP,has at least three different shaped P waves. The rhythm may be regular or irregular. Rate is typically between 60-100 bpm. Spike in the atrium, going going gone
Regular Rhythm
60-100 beats per minute
Torsades de pointe
What is the name of the smallest part of the lungs responsible gas exchange
Alveoli
Which of the following events is present during ventricular relaxation
Repolarization
AVR,aVL and aVF are know as the standard leads
Augmented Leads
An electrocardiogram is a recording of the
Electrical activity of the heart
Electodes are also referred to as
Sensors
The QRS complex associated with a complete(third degree Av block is always wide
False
Second degree AV block are example of incomplete AV blocks
True
During a first degree AV block, the PR intervals are completely variable because the atria and ventricles beat independently each other
False
Second degree AV block type I is likely to progress rapidly to a complete ( third degree AV block without warning
False
The lead from center of the heart to the positive left leg
AVF
The lead from right arm to the left leg
II
The lead from the left arm to the left leg
III
Murmur is an abnormal sound that may indicate
Structural heart disease
Proper electrode placement for Holter monitoring is
Anterior trunk of body
First degree AV block
PR constant, PR prolonged
Second degree AV block Mobitz
PR varies, PR progress
Third degree AV block
PR varies P waves have no constant relationship to QRS
A 60 year old male patient has history of on and off chest pain. His resting ECG is normal, is it decided to put him thru exercise stress test. Which of the following will be the target heart rate for this patient
160 beats per mintue
This part of the conduction system of the heart is located at the superior portion of the interventricular septum and has the ability to function as a pacemaker with an intrinsic firing rate 40-60 beats per mintue
AV node
Which of the following is an indication for stress testing
Evaluation of chest pain in patient with normal baseline EKG
What is the name of the smallest part of the lungs responsible for gas exchange
Villi
Which of the following is considered a negative Holter
Evaluation of chest pain a patient with normal baseline EKG
This is an arrhythmia produced by an electrical impulse originating from a site other than the sinus node
Ectopic rhythms
The vertical axis of the EKG paper measures
Voltage/Ampitude
In a properly standardized EKG machine, 1m V should produce a deflection of
10.mm
What is the significance of a PR interval measuring less than 0.12 or more than 0.20 second
The impulse followed an abnirmal pathway or was delayed in the ares of the AV node
The EKG does not provide information about
The mechanical ( contractile condition of the myocardium
What does the QRS complex represent
Ventricular depolarization
The left atrium is responsible for
Receiving oxygenated blood from pulmonary veins
How does the stylus mark the ECG paper
Heat
The normal running speed of the paper is
25mm/sec
Which of the following lists of the blood flow through the heart is arrange in the correct sequence
Superior vena cava, Right atria Right ventricle, Lungs, Left atria, left ventricle Aorta
What is the ratio of breaths to compression during performing CPR
2 to 30
Which of the following is the concept of HIPAA
Privacy
Sensors for lead II are
Right arm-left leg
The sensitivity switch controls the
Amplification
Rapid flutter waves that look like saw tooth appearance on the EKG tracing are called Atrial Flutter
True
Artifacts are not recorded on the EKG
Result when there are additional voltages on the patient
Grounding the electrocardiograph is necessary to reduce
AC artfact
In using a holter monitor, how many hours minimum does the patient wear the for
24 hours
The medical term for a blocked blood vessel by a thrombus is
Occluded
A symmetrical inverted T wave is characteristic of
Ischemia
Ischemia means
Decreased blood flow to an area
When analyzing a strip you should determine rhythm by looking at it
The P-R interval
Patient's EKG shows a regular heart rate of 58 bpm, but the rhythm is progressively getting longer over 3 cardiac cycles (PQRST complexes and then it then it repeat itself. The rhythm is referred to as
abnormal and irregular
If a patient's heart rate was 56 and the EKG did not show any P wave, where would the heart beat originate from
AV node
He body is erect with eyes forward, feet together, arms at the side, and palms forward in the
Anatomical position
Delay at the AV node
PR segment
Atrial depolarization
P wave
Ventricular depolarization
QRS complex
Ventricular repolarization
T wave
pause between ventricular depolarization and repolarization
ST segment
Several wave form
Complex
Baseline between the waves
Segment
Movement away from baseline
Wave form
A wave and segment
Interval
One large square is equal to what amount of time ( and distance on ECG
0.2 sec/5mm
What leads are considered inferior leads
II, III, aVF
In which leads would you see a positive Pwave
I, II, AVL, AVF, V4-V6
If there is a blockage between the AV node and the AV bundle, how will this affect the appearance of the ECG
There would be more P waves than QRS complexes
What electrical event of the heart is not recored on the standard 12 leads ECG trace
Atrial repolarization
In which leads would you see a positive P wave
I, II, ABL, AVF, V4-V6
In which leads would you see a BIPHASIC P wave
V1
Regarding the QRS complex, in which leads would you see a TALL R wave
V5,V6
Regarding the QRS complex, in which leads would you see a biphasic complex, reflection a transition zone
V3, V4
In what leads do you see an R wave progression
V1 to V6
What segment if elevated or depressed, reveals a sign of serious pathway
ST
Which of the following best represents the normal height of the T wave
1/3-2/3 height of corresponding R wave
What portion of the ECG represent the duration of ventricular systole
QT interval
What does the sympathetic system do to the heart and what receptors are associated with it
Constrict arteries( alpa 1 adrenergic receptors
What does the Parasympathetic system do to the heart and what recpetors are associated with it
Dilation of arteries (cholinergic receptors
Vasovagal syncope is a reflex of _____ response ( dilated systemic arteries causing hypertension ans slow SA node
Parasympathetic
Neurocardiogenic syncope paradoxical____ response to prolonged ____causing ___ and slowing of the pulse, resulting in loss of consciousness, (Tilt test that is positive confirm dx
Parasympathetic, standing vasodilation
What is the best match for the following definition a barely detectable rate change in sinus pacing related to inspiration and expiration
Sinus arrythmia
Upon inspiration your HR ___and upon expiration your HR
Increases, decreases
What disease shows a HR>100bpm and P waves of various shape
Multifocal Atrial Tachycardia
What is a another name for an automaticity focus that transientky escapes overdrive suppression to emit one beat (atrial, juctional otr ventricular
Escape beat
What would cause a interval P immediately before premature QRS
Premature junctional bear causing retograde atrial depolarization
If a PVC falls on a ___wave it could lead to serious arrhythmias.This is know as ___on ___phenomenon
T,R,T
The rate of Paroxysmal Tachycardia is typically
150-250 bpm
What is R A D
Right axis deviation
What is L A D
Left axis deviation or left anterior descending
What is the beat lead for determining RAD
LeadI
If you see a patient with a positive QRS in Lead I and negative QRS in Lead aVf what sort of axis do they have
L A D
What plane does axis rotation take place in
Horizontal
This ECG finding is pathognomic for which of the diseases below S1 Q3 T(interval 3
Pulmonary Embolism
You wouls typically see peaked, tent like T wave in what
Hyperkalemia
____is seen in ,subendocardial infarct and digitalis toxcity
ST segment depression
What would you most likely see in Left Ventricular Hypertrophy Right axis deviation
Deep S wave in V1 and large R wave in V5
Pulmonary Circulation
The transportation of blood to and from the lungs, blood is oxygenated in the lungs during pulmonary circulation
Systemic Circulation
The pathways for pumping blood throughout the body and back to the heart
Coronary Circulation
The circulation of blood to and from the heart muscle
aVL
Augmented Left Arm Lead. Lead aVL records electrical activity from the midpoint between the right arm and left leg to the left arm.
aVF
Augmented Foot Lead. Lead aVF records electrical activity form the midpoint between the right arm and left arm to the left leg.
Correct lead center of the heart to the positive pole of the left leg?
aVR
Augmented Right Arm Lead. Lead aVR records electrical activity from midway between the left arm and left leg to the right arm. Lead aVR is usually a negative deflection.
Portion of heart examined: the right side of the heart in a vertical plane
The ECG wace form is indicative of
Electrical pulse through the heart
If a current moves away from the positive electrode on a ECG the ECG wave form will have a ___ deflection
upward
Target Heart rate
200 minus age
normal stroke volume
60-100 ml/beat is a normal
Stroke volume depends on
volume of blood returning to the heart,force of the myocardium contraction, vascular resistance ( after load