ACG Flashcards
P - Normal
PR - Normal
Regular
QRS - Normal
Rate 60-100
NSR
NSR
P - Normal
PR - Normal
Regular
QRS - Normal
Rate 60-100
P - No or inverted
PR - No
Regular
QRS - Normal
Rate 20-40
Junctional Escape/Brady
P - No or inverted
PR - No
Regular
QRS - Normal
Rate 40-60
Junctional
Junctional Escape/Brady
P - No or inverted
PR - No
Regular
QRS - Normal
Rate 20-40
Sinus Brady
P - Normal
PR - Normal
Regular
QRS - Normal
Rate 40-60
Sinus Tachy
P - Normal
PR - Normal
Regular
QRS - Normal
Rate 100-150
Junctional
P - No or inverted
PR - No
Regular
QRS - Normal
Rate 40-60
A Fib
P - No
PR - No
Irregular
QRS - Narrow-Normal
Rate 60-130
V Tach
P - No
PR - No
Regular
QRS - Wide
Rate above 150
How do we describe different A Flutter rhythms?
rate of flutter to QRS can range from 1:1 (fastest) to 2:1….4:1 (slower as numbers go up)
V Fib
P - No
PR - No
Irregular
QRS - Undetermined
Rate Fast and changing
P - Normal
PR - Normal
Regular
QRS - Normal
Rate 40-60
Sinus Brady
SVT
P - No
PR - No
Regular
QRS - Narrow
Rate above 150
P - Normal
PR - Normal
Regular
QRS - Normal
Rate 100-150
Sinus Tachy
A Fib RVR
P - No
PR - No
Irregular
QRS - Normal-Narrow
Rate above 130
A Flutter
P - Flutter
PR - No
Regular
QRS - Normal-Narrow
Rate above 60
Junctional Tachycardia
P - No or inverted
PR - No
Regular
QRS - Normal
Rate 60-100
Idioventricular
P - No
PR - No
Regular
QRS - Wide
Rate 20-40
P - No
PR - No
Irregular
QRS - Narrow-Normal
Rate 60-130
A Fib
P - No
PR - No
Regular
QRS - Wide
Rate above 150
V Tach
What’s the difference between V Tach and SVT
QRS difference
P - No
PR - No
Irregular
QRS - Undetermined
Rate Fast and changing
V Fib
What’s the difference between V Tach and V Fib?
Regularity difference
P - No
PR - No
Regular
QRS - Narrow
Rate above 150
SVT
What’s the difference between A Fib and A Fib RVR?
Rate difference
RVR’s rate is above 130
P - No
PR - No
Irregular
QRS - Normal-Narrow
Rate above 130
A Fib RVR
P - Flutter
PR - No
Regular
QRS - Normal-Narrow
Rate above 60
A Flutter
P - No or inverted
PR - No
Regular
QRS - Normal
Rate 60-100
Junctional Tachycardia
P - No
PR - No
Regular
QRS - Wide
Rate 20-40
Idioventricular
What’s the difference between Idioventricular and Junctional Escape
Idioventricular has a wide QRS
Junctional Escape may have an inverted P
Toxicology or metabolic signs in ECG
Regular rhythm
Wide qrs complex over 200ms
Ventricular rate 120 (still too slow to be a vtach), i.e. = super wide but not too fast
V2-V3 - Pattern of inverted or biphasic T waves (the T starts on positive, goes negative, goes back to positive)
No precordial q waves
Wellens’ syndrome
* Indicative of upcoming MI in days
- P wave with two humps
- Conduction from SA node, first impacts the right atrium than to LA via Bachmann’s bundle. If there is a delay due to ischemia it will look like double humps
P mitral “mit ral”
- P wave looks like a tall triangle.
- Suggests right heart problem
- Right heart problems are usually pulmonary related
P Pulmonale
Lateral leads
I, aVL, V5, V6
Inferior leads
II, III, aVF
Anterior & Septal leads
V1, V2 are both Septal and Anterior
V3, V4 are Anterior
First look in ACG
- Inf leads first - most common MI in the US (II, III, aVF)
- V5 and V6 - Lateral lower - deadliest
- In V3 and V4, a little V2 - anterior - widow maker
Looking at the limb leads (first six)
=>1mm STE (Leads: I, II, III, AVR, AVL, AVF) in two or more contiguous leads
Looking at leads V1-V6
- V1,V4-V6 (over 2mm), not involving V2-V3
- V2-V3 (over 2mm for men, 1.5mm women)
ST depression in greater or equal to 2 precordial leads V1-V4
Posterior wall impact
Pathological q waves
- Greater than 1mm wide
- Greater 2mm deep
- Greater than 25% of the qrs depth
Axis deviation ranges
Normal is between -30 and +90 degrees; Extreme axis deviation -90 to -180
Distinguishing RBBB & LBBB
Both will have supraventricular rhythm (mainly NSR); can be Afib/Aflutter
Wide QRS .12<
Look at V1-V3
If pronounced Q pointing negative = LBBB (most common)
If pronounced R positive (likely notched) = RBBB