12 Leads 3.2 LVH, BER,

Question 1

Left ventricular hypertrophy can hide but also produce…

Answer 1

• ST elevation
• ST depression
• T wave inversion
• Tall T waves

Question 2

What is sokolov lions criteria for LVH?

Answer 2

Measuring the S wave in V1 and the R wave in V5 or V6.
- when adding them together and there combined measurement is over 35mm it indicates LVH

Question 3

What is another way to identify strain patterns in LVH?

Answer 3

Looking for T wave inversion and ST depression in leads V5 or V6

Question 4

What are the steps for identify LVH?

Answer 4

1. Look at V1 or V2 ( whichever is larger) and count the boxes for the negative deflection
2. Look at V5 and V6 ( which ever is larger) and count the boxes of the positive deflection
3. Add them together. If the sum is greater than 35 it confirms LVH

Question 5

What is Benign early repolarization (BER)

Answer 5

A region of the myocardium repolarizing earlier than it should

Question 6

Which demographic of patients is BER usually seen in?

Answer 6

Patients under the age of 50
- young athletic individuals
- African American males 20 - 40 yoa

Question 7

Which leads is BER usually seen in?

Answer 7

The anterior and lateral chest leads (v2-v5) w/ no reciprocal depression

Question 8

ECG characteristics of BER

Answer 8

• concave ST elevation in leads V3-V5
• J point notch which creates a fish hook appearance
• tall asymmetric T waves

Question 9

What are the causes of pericarditis?

Answer 9

• infectious diseases
• metabolic diseases
• systemic diseases
• cancer
• injury/trauma to the chest
• idiopathic

Question 10

What are the pain characteristics of pericarditis?

Answer 10

-sharp stabbing chest pain
- can be localized
- radiates to base of neck and between shoulder blades
- pain improves leaning forward and worsens when supine

Question 11

What are the characteristics of Pericarditis on the ECG?

Answer 11

• wide spread concave (upsloping) ST elevation and PR depression
• reciprocal ST depression and PR elevation in lead aVR

Question 12

What are the causes of Hyperkalemia?

Answer 12

-renal failure
- impairments of transport of potassium from circulation to the cells

Question 13

What are symptoms of hyperkalemia?

Answer 13

-malaise
- palpations
-muscle weakness
- SOP
-diarrhea
- N/V
- Chest pain

Question 14

Why is shortness of breath particularly concerning for a hyperkalemia case?

Answer 14

It can indicate metabolic acidosis

Question 15

What are the characteristic of Hyperkalemia on an ECG?

Answer 15

• ST elevation
• Wide QRS
• Broad S waves in chest leads
• Tall narrow T waves
• flattening of P waves and increase PRI
• as T waves grow P waves go

Question 16

Why are beta agonoist like salbutamol helpful w/ hyperkalemia?

Answer 16

They enhance the function of the sodium potassium pump which facilitates potassium transport back into cells