Advanced CRNA ECG Interpretation: Essential Concepts & Diagnostic

1. Delta waves occur in several pre-excitation syndromes and produce a characteristic hump or slurring at the beginning of the ____.

Delta waves are abnormal electrical waves that occur in the heart during certain pre-excitation syndromes, such as Wolff-Parkinson-White syndrome. These waves cause a characteristic hump or slurring at the beginning of the QRS complex on an electrocardiogram (ECG). The QRS complex represents the depolarization of the ventricles, so the presence of delta waves at the beginning of the QRS complex indicates an abnormal electrical pathway in the heart, which can lead to arrhythmias and other cardiac complications.

Explanation

Delta waves are abnormal electrical waves that occur in the heart during certain pre-excitation syndromes, such as Wolff-Parkinson-White syndrome. These waves cause a characteristic hump or slurring at the beginning of the QRS complex on an electrocardiogram (ECG). The QRS complex represents the depolarization of the ventricles, so the presence of delta waves at the beginning of the QRS complex indicates an abnormal electrical pathway in the heart, which can lead to arrhythmias and other cardiac complications.

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2. Diagnosing LVH consists of adding the amplitude of the S wave in V1 with the ___ wave in V5, if the sum is >35, as well as ST depression and T wave inversion in V5 and V6.

The correct answer is R. In diagnosing LVH, the amplitude of the S wave in V1 is added to the R wave in V5. If the sum is greater than 35, along with ST depression and T wave inversion in V5 and V6, it suggests the presence of left ventricular hypertrophy.

Explanation

The correct answer is R. In diagnosing LVH, the amplitude of the S wave in V1 is added to the R wave in V5. If the sum is greater than 35, along with ST depression and T wave inversion in V5 and V6, it suggests the presence of left ventricular hypertrophy.

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3. Match the following

LA-; F+

RA -; LA +

RA-; F+

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4. The ___ interval is used to measure AV node conduction.

The PR interval is used to measure AV node conduction. The PR interval represents the time it takes for the electrical signal to travel from the atria to the ventricles through the AV node. It is measured on an electrocardiogram (ECG) and is an important parameter in assessing the conduction system of the heart. A prolonged PR interval may indicate a delay in AV node conduction, while a shortened PR interval may suggest an accelerated conduction through the AV node.

Explanation

The PR interval is used to measure AV node conduction. The PR interval represents the time it takes for the electrical signal to travel from the atria to the ventricles through the AV node. It is measured on an electrocardiogram (ECG) and is an important parameter in assessing the conduction system of the heart. A prolonged PR interval may indicate a delay in AV node conduction, while a shortened PR interval may suggest an accelerated conduction through the AV node.

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5. Limb leads determine the axis of the frontal plane while precordial leads determine the axis of the _________ plane in the mediolateral direction.

Limb leads determine the axis of the frontal plane, which is the plane that divides the body into front and back halves. On the other hand, precordial leads determine the axis of the horizontal plane in the mediolateral direction. The horizontal plane divides the body into upper and lower halves. Therefore, the correct answer is "Horizontal."

Explanation

Limb leads determine the axis of the frontal plane, which is the plane that divides the body into front and back halves. On the other hand, precordial leads determine the axis of the horizontal plane in the mediolateral direction. The horizontal plane divides the body into upper and lower halves. Therefore, the correct answer is "Horizontal."

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6. A tall R wave in V1 that progessively decreases through V4 is indicative of _____ ventricular hyptertrophy.

A tall R wave in V1 that progressively decreases through V4 is indicative of right ventricular hypertrophy. This pattern is commonly seen in conditions such as pulmonary hypertension or chronic lung disease, where the right ventricle becomes enlarged and the electrical activity changes in the corresponding leads.

Explanation

A tall R wave in V1 that progressively decreases through V4 is indicative of right ventricular hypertrophy. This pattern is commonly seen in conditions such as pulmonary hypertension or chronic lung disease, where the right ventricle becomes enlarged and the electrical activity changes in the corresponding leads.

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8. Which of the following are not part of the hexaxial lead system?

Bipolar limb leads

Augmented limb leads

Precordial leads

The hexaxial lead system consists of six leads that are used to measure the electrical activity of the heart from different angles. The bipolar limb leads and augmented limb leads are both part of the hexaxial lead system. However, the precordial leads, also known as chest leads, are not part of the hexaxial lead system. Precordial leads are placed on the chest to provide a different perspective of the heart's electrical activity.

Explanation

The hexaxial lead system consists of six leads that are used to measure the electrical activity of the heart from different angles. The bipolar limb leads and augmented limb leads are both part of the hexaxial lead system. However, the precordial leads, also known as chest leads, are not part of the hexaxial lead system. Precordial leads are placed on the chest to provide a different perspective of the heart's electrical activity.

9. As the QRS complex progresses from V1-V6, S wave amplitude _________ and R wave amplitude ___________.

Decreases, increases

Increases, decreases

Decreases, decreases

Increases, increases

Poor R wave progression noted in: LVH, RVH, anterior MI, emphysema, L BBB, misplaced leads

Explanation

Poor R wave progression noted in: LVH, RVH, anterior MI, emphysema, L BBB, misplaced leads

10. Match the following

V 5-6

V 1-2

V 3-4