27. Introduction to the 12-lead ECG Interpretation Flashcards by Lindsey Herrera

What does an ST elevation indicate?

an MI in progress (acute)

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In ____, a large Q wave means an MI (necrosis, infarct).

lead III

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How will a right bundle branch block (RBBB) look on V1?

widened QRS that is upright/positive

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LVH will have highly positive R waves and a negative T wave in leads _____.

V4, V5, and V6

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Lead II is a bipolar lead that is _____ in the L leg and _____ in the R arm.

positive; negative

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In lead III, the Q wave should be _____ in a normal ECG.

very small if not absent

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If an acute infarct shows up on leads V1 or V2, it’s located in the ____ of the heart.

anteroseptal wall

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In lead III, a large Q wave means _____.

an MI (necrosis, infarct)

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The site of an acute MI is where the ____ shows up on ECG.

ST elevation

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Everything is _____ in aVr.

negative

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Each mm of the read paper is equal to ____ mV.

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Lead 1 is a bipolar lead that is _____ in the right arm and ____ in the left arm.

negative; positive

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A very positive and wide QRS that may have bunny ears, and a large negative T wave on V6 indicates what?

a LBBB

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_____ will have highly positive R waves and a negative T wave in leads V4, V5, and V6.

LVH

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What is aVf?

the unipolar lead headed straight down the body

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Lead III is a bipolar positive in the _____ and negative in the _____.

right leg; left arm

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If an acute infarct shows up on leads _____, it’s located in the anterior wall of the heart.

V3 or V4

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What is “large” for a Q wave? Where do you need to see it for it to be diagnostic?

greater than 25% of the R wave and 1 box wide; in 2 contiguous leads

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If an acute infarct shows up on leads V3 or V4, it’s located in the ____ of the heart.

anterior wall

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What does RA enlargement look like on lead II?

it has an early positive spike that’s taller than normal and dips slightly when the LA depolarizes

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A widened QRS that is downwards/negative in V1 is indicative of?

a left bundle branch block (LBBB)

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What does LA enlargement look like on lead II?

it has a late positive spike that’s taller than normal after growing slightly taller post RA-depolarization

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If there are positive ST elevations in every lead but aVr, it’s not a bunch of MIs, it’s _____.

acute pericarditis

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What lead should you check the P wave with?

lead II

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Which are the L sided leads?

V4, 5, and 6

A _____ means the infarct is acute but a _____ means it is an old MI.

ST elevation; Q wave

What is aVL?

the unipolar lead on the L arm

Lead I is a bipolar lead that is negative in the _____ and positive in the \_\_\_\_\_\_.

right arm; left arm

How will a left bundle branch block (RBBB) look on V1?

a widened QRS that is downwards/negative

Hemiblocks cause ______ without \_\_\_\_\_.

axis shifts; widening the QRS

Which is the unipolar lead on the L arm?

aVL

What is aVr?

the lead on the R arm

What does a bundle branch block do to the ventricular depolarization?

whichever branch is blocked, that side of the heart has to wait for the depol to go all the way around the other side of the heart first, so there will be a delay of depol on the affected side

If the P wave goes in the opposite direction of the R wave, this is abnormal and means ____ or \_\_\_\_.

hypertrophy; ischemia

To remember R vs L BBB QRS direction: - when you drive a car, to turn RIGHT you flick the turn signal UPWARDS. To turn LEFT, you hit the turn signal DOWNWARDS.

for your learning pleasure only!

Lead III is a bipolar lead that is _____ in the R leg and ______ in the left arm.

positive; negative

If an acute infarct shows up on leads \_\_\_\_\_, it's located in the anterolateral wall of the heart.

V5 or V6

Hypertrophy causes increased mass which causes ____ on the ECG.

increased voltage

LVH will have highly positive ____ waves and a negative ___ wave in leads V4, V5, and V6.

R; T

Each large box = \_\_\_\_\_.

0.2 sec

The PR interval starts at _____ and ends at \_\_\_\_\_.

the beginning of the p-wave; the beginning of the QRS

LVH will have very high voltage R waves in the _____ leads.

left sided

If an acute infarct shows up on leads V5 or V6, it's located in the ____ of the heart.

anterolateral wall

When will the QRS's be opposite in lead I versus lead II on the same ECG?

in hemiblocks

A widened QRS that is upright/positive in V1 is indicative of?

a right bundle branch block (RBBB)

What pathology masks an infarct?

a LBBB

If an acute infarct shows up on leads \_\_\_\_\_, it's located in the inferior wall of the heart.

II, III, or aVf

The QT interval starts at ______ and ends at \_\_\_\_.

the beginning of the QRS; the end of the T wave

If you start at V1 and move towards V6, you are moving from the _____ to the \_\_\_\_\_.

R ventricle; apex of the heart

V1 and V2 will show a very tall, narrow QRS in \_\_\_\_.

RVH

Which is the unipolar lead on the R arm?

aVr

In which leads will the R wave be very highly positive in RVH?

V1 and V2

Each small box = \_\_\_\_.

0.04 sec

In lead III, the ____ should be very small if not absent in a normal ECG.

Q wave

If an acute infarct shows up on leads II, III, or aVf, it's located in the ____ of the heart.

inferior wall

If an acute infarct shows up on leads \_\_\_\_\_, it's located in the anteroseptal wall of the heart.

V1 or V2

In lead \_\_\_, the Q wave should be very small if not absent in a normal ECG.

III

What is the standard for wide QRS (time and # of boxes)?

more than 0.12 sec or 3 small boxes

On V6 in a LBBB, you will see \_\_\_\_\_.

a very positive and wide QRS that may have bunny ears, and a large negative T wave

Everything is _____ in aVf.

positive

Lead II is a bipolar lead that is positive in the _____ and negative in the \_\_\_\_\_.

left leg; right arm

Normal, V5 and V6 should have ____ T waves with ____ S-T segments.

upright; flat

In lead III, a large ____ means an MI (necrosis, infarct).

Q wave

Which hemiblock is most common?

If you start at lead ____ and move towards lead \_\_\_\_, you are moving from the R ventricle to the apex of the heart.

V1; V6

If there are _____ in every lead but aVr, it's not a bunch of MIs, it's acute pericarditis.

positive ST elevations

The PR interval should be less than \_\_\_\_\_.

0.2 seconds

aVr look at which part of the heart?

the right side

A LBBB can mask an \_\_\_\_\_.

infarct

Which is the unipolar lead headed straight down the body?

aVf