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_MS2 Cardio > 8/5- Electrocardiography at the Bedside 2 > Flashcards

8/5- Electrocardiography at the Bedside 2 Flashcards

1
Q

Recap- Normal intervals:

  • Normal PR interval:
  • Normal QRS interval:
  • Normal QTc interval:
A
  • Normal PR interval: 3-5 small boxes = 120-200 ms
  • Normal QRS interval: 2-3 small boxes = 80-120 ms
  • Normal QTc interval: 9-11 small boxes = 360-440 ms
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2
Q

What may cause long PR?

A

Drugs

  • Digoxin
  • BB
  • CCB

Ischemia or infarction;

Degeneration or calcification of AVN or His bundle

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3
Q

What may cause long QT?

A
  • Drugs
  • Electrolytes (low K, low Ca, or low Mg)
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4
Q

What are the ECG criteria for LVH? RVH? (Left/right ventricular hypertrophy)

Are these concentric or eccentric hypertrophy?

A

LVH:

  • Left axis deviation
  • R (V5/V6) + S (V1/V2) > 35 mm

RVH:

  • Right axis deviation
  • Tall R in V1/V2 (> 5 mm or R > S)

This is for concentric hypertrophy

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5
Q

What is this showing?

A

Left Ventricular Hypertrophy

  • Deep S waves in V1 and V2
  • Tall R waves in V5 and V6
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6
Q

What is this showing?

A

Right ventricular hypertrophy

  • Right axis deviation “RAD” (from looking at leads 1 and aVF)
  • Tall R in V1, V2: R>S or R > 5mm

(QRS are positive in V1 and V2!)

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7
Q

ECG signs of pressure vs. volume overload?

A

Pressure Overload:

  • Concentric hypertrophy
  • LVH or RVH

Volume Overload:

  • Eccentric hypertrophy
  • LBBB or RBBB
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8
Q

What are pathologic Q wave characteristics?

What are they indicative of?

A
  • Small Q waves are normal in I, aVL, V5, and V6

Two features of pathologic Q waves

  1. Wider than 0.04 sec in duration
  2. Deeper than 1/3 of the R wave in same lead

Pathologic Q waves are indicative of old MI

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9
Q

Analyze this?

A

Pathologic Q waves

  • Pathologic Q waves
  • ST elevation
  • Inverted T waves
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10
Q

What are some ST segment abnormalities (broadly)? What are these indicative of?

A

- ST depression: indicates sub-endocardial ischemia

- ST elevation: indicates acute myocardial infarction

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11
Q

What is the pathophysiologic difference between ST depression and ST elevation? on EKG?

A
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12
Q

What are the different types of ST segment depression?

A
  • Downsloping
  • Horizontal
  • Upsloping
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13
Q

What is this showing?

A

Classical downsloping ST segment depression

  • Lower than isoelectric line and keeps going down (Sub-endocardial ischemia)
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14
Q

ST depression most specific for sub-endocardial ischemia is:

A. Downsloping

B. Horizontal

C. Upsloping

A

ST depression most specific for sub-endocardial ischemia is:

A. Downsloping

B. Horizontal

C. Upsloping

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15
Q

What are some possible causes of ST segment elevation?

A

- Acute myocardial infarction

- Coronary vasospasm (Prinzmetal angina): artery only becomes smaller transiently as muscle of artery contracts

- Acute pericarditis

- Early repolarization

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16
Q

Differentiation of Acute MI and Pericarditis by ECG?

A

Acute MI:

  • LOCALIZED ST elevation (only a few leads)
  • Pathologic Q waves
  • NO PR depression

Acute Pericarditis (inflammation throughout pericardium):

  • DIFFUSE ST elevation
  • NO pathologic Q waves
  • PR depression
17
Q

What is shown here?

A

Acute Anterolateral Myocardial Infraction

  • ST segment elevations in leads I, aVL, and V2-V6
  • Very marked elevation
18
Q

What is shown here?

A

Acute Pericarditis

  • Diffuse ST segment elevation in all ECG leads
  • More subtle elevation
19
Q

What is shown here?

A

PR segment depression in acute pericarditis

  • Depressed PR segments between P and QRS
20
Q

3 characteristics of Evolving Infarction?

A
  • Pathologic Q waves
  • ST elevation
  • Inverted T waves
21
Q

Evolution of Myocardial Infarction (EKG)

A
22
Q

Characteristics that determine which phase of evolution the myocardial infarction is in?

  • Acute MI:
  • Evolving MI:
  • Old MI:
A

- Acute MI: ST elevation ONLY

- Evolving MI: ST elevation AND T wave inversion or pathologic Q waves

- Old MI: pathologic Q waves only (never goes away)

(ST elevation typically subsides in 2-3 days; if it persists more than 14 days, should suspect ventricular aneurysm –)

(T wave normalization is variable… days or never)

23
Q

Steps in evolution of myocardial infarction? Recovery?

A
  • ST segment is elevated immediately
  • Pathologic Q waves and T wave inversions appear at 8-12 hours
  • ST segments normalize in 2-14 days
  • Pathologic Q waves stay usually indefinitely
  • T wave inversions are highly variable
24
Q

In what conditions do we see T wave inversions?

A
  • Myocardial ischemia
  • LVH or RVH (called strain changes)
  • LBBB or RBBB
  • Digoxin (called digoxin effect)

*NOT specific for sub-endocardial ischemia

25
Q

What characterizes “tall” T waves?

In what conditions do we see tall T waves?

A

T waves > 10mm in at least 2 chest leads

  • Myocardial ischemia
  • Acute myocardial infarction
  • Hyperkalemia!!
26
Q

What is this showing?

A

Progression of R waves in precordial leads

27
Q

Steps in abnormal R wave progression?

  • Early R/S transition:
  • Late R/S transition:
A

Early R/S transition: bigger R waves in V1 and V2

Later R/S transition: smaller R waves in V5 and V6

(resulting in overall negative QRS complex)

28
Q

Tall R waves in V1 and/or V2 may be present in which conditions/diseases?

A
  • Old posterior myocardial infarction
  • Right ventricular hypertrophy (RVH)
  • Right bundle branch block (RBBB)
  • Wolf-Parkinson-White (WPW)
  • Duchenne muscular dystrophy
29
Q

LVH ECG Criteria?

A

R (V5/V6) + S (V1/V2) > 35

and

LAD

30
Q

RVH ECG Criteria?

A

R > 5 or R/S > 1 in V1/2

and

RAD

31
Q

Pathologic Q waves are characterized how?

Indicative of?

A

Q > 0.04 ms or > 1/3 of R wave

  • Indicative of OLD myocardial infarction
32
Q

ST elevation seen in what conditions?

A

AMI, pericarditis or spasm

  • Acute pericarditis if diffuse ST elevation, no pathologic Q waves, depressed PR
33
Q

ST depression seen in what conditions?

A

ischemia (horizontal or downsloping ST); otherwise nonspecific

34
Q

Peaked T is caused by what?

A

High K, AMI, or ischemia

35
Q

Tall R in V1 is caused by what?

A

Post MI, RVH, RBBB, and WPW

36
Q

Pathologic Q waves are characterized by all of the following except?

A.

A

-

_MS2 Cardio (35 decks)

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