Baker: ECG Interpretation

Question 1

What are the inferior leads?

Answer 1

II, III, AVF

Question 2

What are the septal leads?

Answer 2

V1 and V2

Question 3

What are the lateral leads?

Answer 3

V5 and V6

Question 4

What are the anterior leads?

Answer 4

V3 and V4

Question 5

List the order of things you should go through when looking at an ECG

Answer 5

Rhythm - regular sinus rhythm (look for positive p waves in the inferior leads), sinus arrhythmia (rhythm changes with inspiration and expiration), irregular or regular
Rate - count boxes (300, 150, 100, 75, 60)
Axis - look for positive R waves in leads I and II
Intervals - PR (should be ~200ms), QRS (less than 120ms), and QT (less than 450ms)
QRS complex (pathologic Q waves - Q waves normal in aVR and V1?)
ST/T wave abnormalities

Question 6

3 criteria for left ventricular hypertrophy

Answer 6

Lead I greater than 14mV
aVL greater than 11mV
S in V1 and V2 + R in V5 and V6 > 35mV

Question 7

3 supportive findings for left ventricular hypertrophy

Answer 7

ST-T wave depression
left atrial enlargement
prolonged QRS

Question 8

If a patient comes in complaining of chest pain, what does your differential look like?

Answer 8

Cardio: CAD (acute infarct, unstable or stable angina), aortic dissection, pericarditis

GI: GERD, esophageal spasm, ulcers*, cholelithiasis

Pulmonary: pneumonia, PE*, pleuritis

Musculoskeletal: costrochondritis, intercostal muscle issues, cervical spine issue

Question 9

How do you treat CAD?

Answer 9

exercise, weight management, stop smoking, control stress
take aspirin lifelong or Plavix for a year to decrease risk of thrombus,
statins lifelong for lipid management, blood pressure therapy with beta blockers or ACE inhibitors

Question 10

What are these signs specific for?

diffuse ST elevation
PR depression
PR elevation in aVR

**PR elevation in aVR diagnostic for pericarditis

Answer 10

pericarditis

Question 11

How to treat pericarditis?

Answer 11

pain relief: NSAIDs esp Indomethacin, colchicine (used for gout)

Question 12

Complications of pericarditis?

Answer 12

recurence
pericardial effusion
tamponade
constrictive pericardial disease

Question 13

These are two findings on the ECG that are normal in young adults, especially young athletes

Answer 13

left ventricular hypertrophy

J point elevation

Question 14

What does ST depression indicate?

Answer 14

coronary ischemia

• *picked up in the inferolateral leads
• *does not localize to a specific coronary distribution
• *esp worrisome if it is transient and occurs with chest pain

Question 15

What is one clinical finding you will see in an aortic dissection?

Answer 15

chest pain radiates to the back