EKG STATE BOARD EXAM

STUDY FOR FINALS

The right atrium receives

Deoxygenated blood from the superior and inferior vena cava ->

The right ventricles receives

The deoxygenated blood from the right atrium via the tricuspid (right atrioventricular valve) and pumps it out of the heart via the pulmonary artery (semilunar valve) to the right and left lung ->

The left atrium receives

Oxygenated blood from both the right and left lungs via the pulmonary vein.

The left ventricle receives

Oxygenated blood from the left atrium via the bicuspid valve (mitral valve) (left atrioventricular valve) and pumps it out of the heart to the rest of the body via the aorta

Arteries Carry

Oxygenated Blood

Veins carry

Deoxygenated Blood

Pulmonary Artery

Pulmonary artery carries deoxygenated blood

Pulmonary Vein

Pulmonary veins carries oxygenated blood

Outer-Pericardium

Outermost layer of the heart covering the heart externally. (Thin Double Layer Sac)

Middle-Myocardium

Main muscular layer forming the atria and ventricles. This layer also contains blood vessels and nerves.

Inner-Endocardium

Innermost layer of the heart

Septum

Divides the right and left atrium

The main function of the valve 

Is to prevent back-flow, valves found in the heart is to prevent the back-flow of blood within the chamber.

First heart sound

LUBB

LUBB

Closure of the atrioventricular valve

Second heart sound

DUBB

DUBB

Closure of the semilunar valve

Coronary Artery

Provides blood directly to the myocardium

Angina

Chest pain or Discomfort

Frank-starling law:

Deeper the stretcher, the stronger the contraction. Intensity of ventricular contraction depends on the initial stretching of the cardiac tissues,

frank-starling law explains

That the increased volume of blood within the ventricle during the diastole phase of the cardiac cycle will cause an increase in the intensity of the stretches within the ventricular wall of the heart, causing the cardiac muscles of the ventricle to contact more forcefully.

Filling heart repolarization

Relaxation; Diastole

Pumping heart depolarization

Contraction; Systole

Normal =

60-100

Tachycardia =

above 100

Bradycardia

Below 60

Stoke Volume- Per Heartbeat

amount of blood that is pumped or ejected from the left ventricle of the heart during each heartbeat.

Cardiac Output

• amount of blood pumped by each ventricle per minute

• refers to left ventricular output through the aorta

• most important factor in cardiovascular system because the rate of blood flow through

FORMULA

CO = STROKE VOLUME x HEART RATE

Maximum Heart Rate

220 - individuals age = max heart rate

SA Node:

60-100 bpm

AV Node:

40-60 bpm

BOH (bundle of his)

20-40 bpm

PF ( Purkinje Fibers)

10-20 bpm

B B B stands for

Bundle Branch Block

L B B B stands for

Left bundle branch block

R B B B stands for

Right Bundle Branch Block

How many Nodes are there 

4

STEMI

ST segment elevation myocardial infarction

STEMI

Occurs due to complete occlusion of a major coronary artery.

STEMI

Full Thickness Damage

NSTEMI

non ST segment elevation myocardial infarction

NSTEMI

Incomplete occlusion of a major coronary artery

NSTEMI

Complete occlusion of a minor coronary artery

NSTEMI

Partial Thickness Damage

How many cardiac muscle properties are there

4

Excitability

the ability of the tissue to respond to a stimulus

Autorhythmicity

Produce its own impulses

Contractility

Contracts in response to a stimulus received

Conductivity

conducts impulses from SA to AV node, followed by BOH to PF node.

Assault

threatening or causing bodily injury to another person, it may be a crime or tort

Battery

touching a patient without his/her consent, can be either civil or criminal offense

Defamation

written or oral statement which causes harm to the reputation of a person or third party

Slander

defamatory statement presented in an oral or spoken format.

Libel

defamatory statement presented in a published or written format

Fraud

intentionally hiding the truth for unlawful gains

Invasion of privacy

HIPAA applies to any/or all patients potentially personal identifiable information

Respondeat superior:

Let the master answer

Health Care Proxy

Is an advance directive

Artifacts

EKG abnormalities that are recorded on the EKG graph, these EKG abnormalities are not related to the electrical activity of the heart, they are generated due to internal or external factors or both

the factors that can cause an artifact are;

patient movements, shivering, deep breathing, interference from other devices, improper application procedure, faulty device and more.

EKG LEADS

Is recorded by placing series of electrodes on the surface of the body. These electrodes connect the surface of the human body to the EKG machine

How many Leads are placed on the body?

There are several leads that are placed on the surface of the body to get the different views of the heart

What are LEADS?

These electrodes when graphically represented on an EKG graph are known as LEADS

What does each LEAD show?

Each lead on an EKG graph displays a specific view of the heart.

EKG is recorded in 12 leads; these are generally classified into 2 categories:

• I. Bipolar leads -Standard limb leads

• II. Unipolar leads Unipolar limb leads aka augmented limb leads -Unipolar chest leads aka precordial leads/chest leads

Einthoven Law/ Triangle 

Einthoven triangle is defined as an equilateral triangle that is used as model of standard limb leads used to record electrocardiogram

Einthoven Triangle

The heart is presumed to lie in the center of Einthoven’s triangle

12 LEAD EKG 

• Bipolar Limb Leads 

• Standard Limb Leads 

LEAD I

LA+ RA-

LEAD II

LL+ RA-

LEAD III

LL+ LA-

UNIPOLAR LEADS

• Unipolar Limb Leads

• Augmented Limb Leads

aVR+

Augumented Right Arm

aVL+

Augmented Left Arm

aVF+

Agumented Left Leg

UNIPOLAR CHEST LEADS

• Precordial Leads

• Vectors

Vectors

V1, V2, V3, V4, V5, V6

Over 4th intercostal space near right sternal margin (on the right side)

V1- LEFT SIDED HEART(CHEST PLACEMENT)

over 4th intercostal space near left sternal margin (on the left side)

V2- LEFT SIDED HEART(CHEST PLACEMENT)

In between V2 and V4 (on the left side)

V3 - LEFT SIDED HEART(CHEST PLACEMENT)

over left 5th intercostal space on the left mid-clavicular line (on the left side)

V4- LEFT SIDED HEART(CHEST PLACEMENT)

over left 5th intercostal space on the left anterior axillary line (on the left side)

V5- LEFT SIDED HEART(CHEST PLACEMENT)

over left 5th intercostal space on the left mid-axillary line (on the left side)

V6- LEFT SIDED HEART(CHEST PLACEMENT)

over 4th intercostal space near left sternal margin (on the left side)

V1- RIGHT SIDE OF HEART (CHEST PLACEMENT)

over 4th intercostal space near right sternal margin (on the right side)

V2- RIGHT SIDE OF HEART (CHEST PLACEMENT)

in between v2 and v4 (on the right side)

V3- RIGHT SIDE OF HEART (CHEST PLACEMENT)

over right 5th intercostal space on the right mid-clavicular line (on the right side)

V4-RIGHT SIDE OF HEART(CHEST PLACEMENT)

over right 5th intercostal space on the right anterior axillary line (on the right side)

V5- RIGHT SIDE OF HEART (CHEST PLACEMENT)

over right 5th intercostal space on the right mid-axillary line (on the right side)

V6- RIGHT SIDE OF HEART (CHEST PLACEMENT)

Dextrocardiac

A congenital positional anomaly. In dextrocardiac, the apex of the heart is situated on the right side of the thoracic region of the human body. For dextrocardiac patient, the electrode placement will be opposite in orientation from the normal electrode placement

ST segment elevation are two forms

• Concave upward (like an inverted “U”)

• Convex upward (like a regular alphabet “U”)

ST segment depression

Horizontal ST segment that falls below the isoelectric line

ST Segment depression are two forms

• A downsloping ST segment (like a regular alphabet “U”)

• An upscoping ST segment

What does Ischemia mean?

Reduction of blood flow to myocardium

What does Injury mean?

b/c of reduction of blood flow, it causes damage to the myocardium

What does Infarction mean?

Death of myocardium

How many Electrodes are on a 12 lead EKG

There are 10 electrodes in a 12 lead EKG