Criteria

Question 1

Right atrial enlargement (P pulmonale)

Answer 1

Lead II and V1 (高>2.5格 in inferior leads)

• No change in duration
• Possible R axis dev.

Question 2

Left atrial enlargement (P mitrale)

Answer 2

Lead II and V1 (terminal/negative portion 寬>1格)

*No L axis dev due to dominance

Question 3

RVH

Answer 3

Limb leads: QRS R axis dev (>+100)

Precordial leads: R>S in V1, S>R in V6

Question 4

LVH

Answer 4

Limb leads:
       # R I + S III >25 mm (25 小格)
       # R VL > 13
       # R I > 14
       # R VF > 21
Precordail leads:
       # R V5/V6 + S V1/V2 > 35 mm
       # R V5 > 26
       # R V6 > 18
       # R V6> R V5

*Axis dev little help due to L predominance

Question 5

Secondary repolarization abnormalities of ventricular hypertrophy

Answer 5

1) Down-sloping ST
2) T wave inversion

• RVH: V1, V2
• LVH: I, aVL, V5, V6
• decompensated HTN–> CHF

Question 6

RBBB

Answer 6

1. QRS> 0.12 sec (3格)
2. RSR’ in V1 and V2 (rabbit ears) with ST-depression and T inversion
3. Reciprocal change in V5, V6, I, aVL (deep S waves)

Question 7

LBBB

Answer 7

1. QRS> 0.12 sec (3格)
2. Notched R wave with prolonged upstroke in V5, V6, I, aVL with ST-depression and T inversion
3. Reciprocal change in V1, V2 (deep S waves)
4. L axis dev may present

Question 8

Left anterior hemiblock

Answer 8

1. Normal QRS, ST, T
2. L axis dev b/t -30 to -90 degrees
3. No other cause of L axis dev is present

Question 9

Left posterior hemiblock

Answer 9

1. Normal QRS, ST, T
2. R axis dev b/t +90 to +180 degrees
3. No other cause of R axis dev is present

Question 10

Bifascicular block

Answer 10

RBBB + R or L fascicular hemiblock

Question 11

WPW syndrome

Wolff-Parkinson-White

Answer 11

1. PR less than 0.12 sec
2. Wide QRS
3. Delta wave in some leads

Question 12

LGL syndrome

Lown-Ganong-Levine

Answer 12

1. PR less than 0.12 sec
2. Normal QRS
3. No delta wave

Question 13

Significant Q wave

Answer 13

1. Wide: >0.04 sec (1格)

2. Deep: >1/3 R in the same QRS

Question 14

Posterior MI

Answer 14

STD and tall R in anterior leads (esp V1)

Question 15

Who needs emergent reperfusion?

Answer 15

1. STE≥ 1 mm in two contiguous leads (incl posterior)
2. New/resumed new LBBB
3. LBBB (new/old) with Sgarbossa criteria

Question 16

Modified Sgarbossa criteria

Answer 16

1. STE≥ 1mm concordant with QRS in ANY lead
2. STD≥ 1mm concordant with QRS in ANY of V1-V3
3. Excessive discordant STE in ANY lead by ≥ 25% of the depth of the preceding S-wave

Question 17

Does new LBBB mean AMI?

Answer 17

No

Question 18

STD in treadmill that is suggestive of CAD

Answer 18

STD> 1 mm that is horizontal or down-sloping and persists for ≥ 0.08 sec

Question 19

Corrected QT interval (QTc)

Answer 19

QT divided by square root of RR

*

Question 20

HOCM

Answer 20

1. Ventricular hypertrophy
2. L axis dev
3. Significant septal Q in lateral and inferior leads

Question 21

COPD

Answer 21

1. Low voltage (dampening from expanded RV)
2. R axis dev (expanded lungs)
3. RVH with repolarization abnormalities (poor R propagation)
4. Cor pulmonale

Question 22

EKG change suggestive of acute massive PE

Answer 22

1. Pattern of RVH with repolarization abnormalities(RV dilatation)
2. RBBB
3. S1Q3
4. Arrhythmias: sinus tachycardia, A Fib

Question 23

CNS diseases (ex. infarct, SAH)

Answer 23

1. Diffuse T inversion (wide and deep)
2. U waves
3. Possible sinus bradycardia

Question 24

EKG of Brugada syndrome

Answer 24

1. Pattern of RBBB

2. STE in V1-V3

Question 25

Most common EKG change in myocarditis

Answer 25

Conduction blocks (esp. BBB, hemiblock)

Question 26

EKG change in digitalis intoxication

Answer 26

1. Conduction blocks (SA node, AV node--> for Rx suprraventricular arrhythmia) 2. Tachyarrhythmias (enhances automatics: PAT and PVC>>junctional>A flutter and A Fib) 3. Combination (most common: PAT+second-degree AV block 2:1)

Question 27

What is digitalis effect of therapeutic blood levels? need discontinuing the drug?

Answer 27

STD (gradual down-sloping) + flat or inverted T | NO.

Question 28

EKG change in hypothermia

Answer 28

Everything slows down! 1. Sinus bradycardia 2. All segments/intervals prolong 3. Osborne wave (= J wave) 4. Slow A Fib 5. Muscle tremor artifact

Question 29

EKG change in hypo-Ca

Answer 29

Long QR --> TdP!

Question 30

EKG change in hyper-Ca

Answer 30

Short QT

Question 31

EKG change in hypo-K

Answer 31

1. STD 2. T flattens 3. U wave presents

Question 32

EKG change in hyper-K

Answer 32

1. Peak T diffusely 2. PR prolongs, then P flattens 3. Wide QRS 4. QRS merges with T = VF

Question 33

EKG changes in non-Q wave infarctions

Answer 33

1. T inversion | 2. ST depression