8. Electrocardiography Flashcards

1
Q

what defines normal sinus rhythm

A

a P wave for every QRS, rate 60-100, P waves with normal configuration: upright in II, negative or biphasic in V1.

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2
Q

if PR interval is < 5 mm, what is the cause?

A

1st degree AV block, usually due to slow conduction in the AV node

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3
Q

if QRS is < 3 mm, what is the cause?

A

consider a bundle branch block

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4
Q

what should the Q-T interval be like?

A

should be less than half the R to R length. if not, prolonged QT.

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5
Q

what would define LAD?

A

positive in I, negative in aVF

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6
Q

what would define RAD?

A

negative in I

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7
Q

normal axis looks like what, in what leads?

A

positive in I, positive in aVF

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8
Q

with hypertrophy, how will the axis vector change?

A

will point more towards the point of hypertrophy

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9
Q

with infarct, how will the axis vector change?

A

will point away from point of ischemia

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10
Q

best leads for analysis of P wave?

A

II and V1

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11
Q

what will we see in lead II if there is RAE?

A

in lead II, RAE increases the height of the P wave.

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12
Q

what will we see in lead II if there is LAE?

A

in lead II, LAE will increase the duration of the P wave

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13
Q

what will we see in lead V1 if there is RAE?

A

tall initial positive deflection

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14
Q

what will we see in lead V1 if there is LAE?

A

wide and deep negative deflection (1mm by 1mm)

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15
Q

a QRS interval of > 3 mm –> what?

A

His bundle delay, bundle branch block

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16
Q

in terms of the functioning of the heart, what does LBBB create?

A

delay in activation of the L side of the heart.

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17
Q

in terms of the functioning of the heart, what does RBBB create?

A

delay in activation of the R side of the heart

18
Q

key points for LBBB

A
  • wide QRS

- predominantly + complex in V6, neg in V1

19
Q

key points for RBBB

A
  • wide QRS
  • RSR’ complex in V1 (rabbit ears)
  • ST-T depression in leads with late QRS positivity
20
Q

what does lead I look like with left anterior hemiblock?

A

predominantly positive QRS, left axis deviation

21
Q

what does lead I look like with left posterior hemiblock?

A

predominantly negative QRS, right axis deviation

22
Q

why does hypertrophy lead to higher voltage?

A

the mass of muscle being depol is increased

23
Q

LVH increases QRS voltage in what leads?

A

I, aVL, V5, V6

24
Q

RVH increases QRS voltage in what leads?

A

V1, V2, aVF, III

25
Q

what is a strain pattern?

A

ST segment depression in the leads over the affected ventricle. prob result of subendocardial hypoxia in hypertrophied ventricle.

26
Q

formula for LVH, and other criteria?

A
  • SV1 and RV5 >35
  • lateral ST segment depression/strain
  • LAD
  • LAE
27
Q

criteria for RVH?

A
  • RAD (QRS in Lead 1 is neg)
  • incr voltage in right-sided leads
  • R ventricular strain pattern (ST segment in R sided leads)
28
Q

define a pathological Q wave

A

at least 1/4 the magnitude of the remaining R wave

29
Q

infarction: ECG appearance?

A

QRS abnormality, relatively large Q wave

30
Q

ischemia: ECG appearance?

A

ST deviation

31
Q

subendocardial ischemia (mild): ST segment will look like what?

A

down-sloping. like a strain pattern

32
Q

downsloping ST depr is also associated with what?

A

ventricular hypertrophy, prob reflects sustained subendocardial hypoxia in the thickened myocardium.

33
Q

transmural ischemia (mild): ST segment will look like what?

A

upsloping and elevated - tombstone sign

34
Q

transmural ischemia of the anterior wall is almost due to what?

A

obstruction of the LAD artery

35
Q

what does a peaked T-wave indicate?

A

earliest sign of acute transmural ischemia in STEMI, likely due to potassium leaking into myocardial interstitium

36
Q

what is the most observed sigh of acute transmural ischemia? what timeframe does it present at?

A

ST elevation. appears at min to hours. still potentially reversible at this point.

37
Q

what does a T wave inversion indicate?

A

likely due to subendocardial infarction. occurs after more prolonged ischemia. usually seen with tombstone sign.

38
Q

what is the earliest evidence of actual infarction?

A

within hours-days, Q wave will appear. not reversible

39
Q

what happens as the transient ischemia resolves?

A

the ST seg returns to baseline. still have a Q wave, T seg inversion.

40
Q

years after a STEMI, what will the EKG look like?

A

only the pathological Q waves. T wave inversion will correct, and ST elev will return to baseline.