Cardio Examination ECG

Classification of Heart Blocks

1st: delay in conduction 2nd: partially blocked 3rd fully blocked conduction

Atrial Flutter

250-350 bpm saw-tooth not emergency situation

atrial fibrillation

400-600 bpm not emergency situation

Normal Ventricle ejection fraction

55-70%

A 68 yo is performing a Bruce protocol on an inclined treadmill in the cardiac unit. The PT is monitoring the pt using ECG leads. During the exercise, the PT sees the ECG pattern shown. The PT's best response should be: A. Stop the treadmill session immediately and call the cardiologist B. Continue without any modifications and monitor ECG C. Reduce the treadmill speed and monitor ECG D. Stop the treadmill, have the pt rest, and then resume at a lower intensity

B. Continue without any modifications and monitor ECG

The increased metabolic demand placed on the heart during exercise can be best estimated by examining the: A. Systolic BP B. Double Product C. Diastolic BP D. HR

B. Double Product -HR and SBP

PT examinesthe output from a ECG of a pt and observes a prolong QT interval. Which is the most likely condition associated with this findings? A. hypercalcemia B. Hypocalcemia C. Hyperkalemia D. Hypokalemia

B. Hypocalcemia

A pt's ECG shows a new ST segment displacement from baseline and sinus rhythm of 68 bpm. What is the most likely diagnosis? A. bradycardia B. Low BP C. Acute MI D. Congestive HF

C. Acute MI

A pt 1 month post-MI is being seen in a clinic. when increasing the pt to 5 METs of workload, the therapist notes that the ECG reads 1 unifocal PVC. The PTs immediate action should be: A. Continue to exercise and increase the intensity B. Stop exercise because pt is undergoing ischemia C. Keep exercising at a low intensity, consultation with physician is not required here D. Stop exercise and consult with physician before starting any exercises

C. Keep exercising at a low intensity, consultation with physician is not required here

A 58 yo male is performing a Bruce protocol in your clinic with ECG leads attached. During the protocol, the PT sees the picture above. What does it mean and what should the PT do? A. 2nd degrees Type I AND Continue the protocol because this block type is not an emergency B. 1st degree AV block and the PT should cont the protocol because this block type is begin C. Myocardial Ischemia that has a depression of ST segment more than 1 mm and the PT should stop the protocol and call 911. D. Myocardial infarction that has an elevation of the ST segment greater than 1 mm and the PT should stop the protocol and call 911

C. Myocardial Ischemia that has a depression of ST segment more than 1 mm and the PT should stop the protocol and call 911

A PT is performing joint mobs on a pt in the outpatient clinic. The PT notes the ECG in the photograph. The PT's initial response should be: A. Continue with joint mobs at same intensity B. Continue with joint mobs at a lower intensity C. Stop the treatment and monitor ECG for 10 minutes D. Activate the emergency system or call 911

D. Activate the emergency system or call 911

Which of the following findings are associated with the highest risk for a subsequent cardiac event? A. exercise-induced ST segment elevation of less than 1 mm and left ventricle ejection fraction of 45% B. exercise-induced ST segment elevation of greater than 1 mm and left ventricle ejection fraction of 55% C.Exercise-induced ST segment depression of less than 2 mm and left ventricle ejection fraction of 65% D. Exercise-induced ST segment depression of greater than 2 mm and left ventricular ejection fraction of 45%

D. Exercise-induced ST segment depression of greater than 2 mm and left ventricular ejection fraction of 45%

A 50 yo male pt with second degree heart block typ II has presented his ECG to clinic. What would a PT expect to find on his ECG? A. An increase PR interval lengths with no dropped beats B. No relationship between p waves and QRS complexes C. A gradual increase in PR interval length in all the beats preceding a dropped beat D. Normal PR intervals in all the beats preceding a dropped beat

D. Normal PR intervals in all the beats preceding a dropped beat

Premature Atrial Contraction (PAC)

Does not affect the rate, it affects the rhythm stripe The P and T waves become one or have little space between them

Hypercalcemia vs Hypocakcemia S/S

Hypercalcemia: increase contraction, increase contraction rate Hypocakcemia: sluggishness, decrease contraction

Quick summary for Heart blocks Presentation and PT response

I: Increase PR interval, cont exercise II type I: progressive increase in PR interval until drop, monitor ex II type II: normal PR interval until sudden drop; stop exercise III: no relationship, stop immediately and refer

Hyperkalemia S/S

Increases repolarization of ventricles

ST segment elevation is form

MI -needs to be greater than 1 mm

2nd degree heart block type II

Mobitz PR intervals are constant and QRS are dropped intermittently student always shows up on time, but skips randomly -concerning

Hypocalcemia ECG Changes

QT interval prolong primarily by lengthening the ST segment

Hypercalcemia ECG changes

QT interval shortening

Conduction system of the heart

SA node , AV node, Bundle of His, Purkinje fibers

Hypokalemia ECG changes

ST segment depression, decrease in t wave amplitude, prominent U waves

S2 sound correlates with what ECG change

T wave

Hyperkalemia ECG Changes

Tall ,peaked T waves, QRS duration increases as K levels increases, p waves decrease in amplitude as K level increases

2nd degrees block type I

Wernchback increase PR interval until a drop QRS Regularly regular pattern *Student gets later and later to class until they skip, but they only skip every 5th class

P wave

atrial contraction (depolarization)

S1 sounds correlate with what ECG change

end QRS segment

ST segment depression is from

ischemia -needs to be greater than 1 mm

premature ventricular contraction (PVC)

no p waves, wide bizarre QRS Problem occur 3 times in a row: call Dr and refer ventricles contract before the atria

SA node

pacemaker, initiates depolarization (contraction ventricles)

AV node

passes depolarization to ventricles allows for brief delay for ventricles to fill

Atrial Tachycardia

rate 100-250 not emergency situation

1st degree heart block

slight delay in contraction from artia to ventricle PR interval increased -p is followed by QRS -generally won't progress *student is 5 minutes late to class everyday

3rd degree heart block

the atrial rate is independent of the ventricle rate (P waves and QRS march out separately) no relationship between the P-R interval is constantly changing, the QRS is usually wide and bizarre because it is ventricle origin emergency *student no shows, shows up whenever he wants , never does homework, won't pass

Purkinje fibers

throughout the ventricles

PR interval

time the atrials contracts to the ventricles contracts

QT interval

time the ventricles contract to ventricle repolarization

Bundle Branches

to left to right ventricles

QRS complex

ventricular depolarization and atrial repolarization

T wave

ventricular repolarization