18. EKG Analysis

Question 1

List the systematic steps for fully analyzing an EKG.

Answer 1

1. Check lead aVR for P & QRS pointing down
2. Rate
3. Conduction intervals (P, PR, QRS)
4. Axis
5. Rhythm (rate, QRS width, presence of P, P: QRS, QRS regularity)
6. Hypertrophy
7. Ischemia (check each lead for Q wave duration, ST changes, T wave inversion)

Question 2

What defines a complete BBB?

Answer 2

QRS width > 0.11 sec

Question 3

How is a RBBB identified on an EKG?

Answer 3

R-R configuration in V1

“Rabbit Ears on the Right”

Question 4

How is a LBBB identified on an EKG?

Answer 4

Wide shouldered appearance in V6

“LBB is Long on the Left”

Question 5

What are the 2 most common technical errors in exercise testing?

Answer 5

• Insufficient intensity (must achieve > 85% of age-predicted HRmax)
• Poor EKG quality

Question 6

What is the normal EKG response to exercise?

Answer 6

• Only drop in HR w/in first min of exercise due to anxiety relief
• Otherwise a progressive, narrow, sinus tachycardia w/o ST changes
• Progressive fusing of the T & P waves
• Coarsening of the baseline w/ increasing workloads