Day 1

Question 1

What is Wellen’s warning?

Answer 1

• Upsloping ST segment with a quick downslope at the T wave (almost looks sinusoidal)
• A sign of impending ischemia

Question 2

The P wave should be less than ______ in height.

Answer 2

3 mm (3 boxes)

Question 3

One vertical box is equal to __________.

Answer 3

1 mm or 1 mV

Question 4

AV block can occur due to pathologies that are ____________.

Answer 4

at or above the bundle of His (called supra-His)

Question 5

What is semaphore?

Answer 5

Signaling (with hands or with flags) to planes

“My grandfather worked in the Navy in WWII and did semaphore in the South Pacific.”

Question 6

The P wave is normally up in which leads?

Answer 6

I and aVF (usually in II as well)

Question 7

To get the exact degree of axis, you can ____________.

Answer 7

add or subtract 90º to the lead that is isoelectric; it is either of these options, and you look for confirming leads to figure out which it is

Question 8

Give the degrees of each of the directional leads.

Answer 8

• I: 0º
• II: +60º
• III: +120º
• aVR: +210º or -150º
• aVL: +330º or -30º
• aVF: +90ºor -270º

Question 9

Low amplitude, isoelectric lead I is indicative of _____________.

Answer 9

COPD; the heart is oriented vertically and compressed by the expanded lungs

Question 10

What is the normal thickness of the LV?

Answer 10

1 cm

Question 11

What is the normal thickness of the RV?

Answer 11

3 mm

Question 12

The initial depolarization of the ventricles goes ____________.

Answer 12

left-to-right (hence, a small Q wave is normal in V6)

Question 13

Review the “3x3” rule in the R wave progression.

Answer 13

It should be at least 3 boxes tall by V3.

Question 14

The seven causes of a tall R wave in V1 are as follows: ________________.

Answer 14

• Posterior MI (i.e., reciprocal Q wave)
• RBBB
• RVH
• WPW
• …

Question 15

An R wave is considered pathologically tall if ___________.

Answer 15

it is greater than 8 mm by itself

Question 16

Delayed R progression can be a sign of _____________.

Answer 16

anterior MI

Question 17

The “small-F flitter” sign is ____________.

Answer 17

inverted P in aVL, indicative of COPD with vertical heart

Question 18

Schamroth sign is ____________.

Answer 18

isoelectric low-voltage

QRS in lead I, indicative of COPD with vertical heart

Question 19

The only difference between polymorphic ventricular tachycardia and torsades is _____________.

Answer 19

that torsades requires an antecedent QT prolongation

Question 20

How can you tell if the voltage has been modified on an EKG strip?

Answer 20

Look to the upright rectangular box on the left side of the strip. If it is notched with the right side greater than the left side, then the voltage has been increased (it looks like a staircase walking up to the right). If it is notched the other way, with the right lower than the left, then the voltage has been decreased (it looks like a staircase walking down).

Question 21

V1 - V2 is considered an ____________ infarction.

Answer 21

anteroseptal

Question 22

V3 - V4 is considered a _____________ infarction.

Answer 22

apical

Question 23

The P wave should not be greater than ______.

Answer 23

3 mm

Question 24

In medical reperfusion therapy, what are the three success markers?

Answer 24

• Relief of angina
• Normalization of ST segment by at least 50% of its elevation
• New accelerated idioventricular rhythm (AIVR)

Question 25

Other than pericarditis, what can cause PR depression?

Answer 25

Tachycardia

Question 26

Whenever you see ST elevation, always look for _____________.

Answer 26

reciprocal depression

Reciprocal depression makes ST elevation more likely to be truly ischemic.

Question 27

When you see an inferior MI, you need to ______________.

Answer 27

do right-sided leads to look for a right-sided MI

Question 28

If you see mild ST elevation in a person with COPD, remember to ____________.

Answer 28

lower the leads by 3 interspaces; those with COPD have displaced hearts that can skew the EKG

Question 29

List some non-MI causes of ST elevation.

Answer 29

• Pericarditis
• Early repolarization
• Acute cor pulmonale
• Hyperkalemia
• Intracranial hemorrhage
• Prinzmetal angina
• Acute pancreatitis
• Acute cholecystitis
• Myocardial metastases
• LBBB
• LVH
• Brugada syndrome

Question 30

List some non-infarction causes of Q waves.

Answer 30

• HOCM
• WPW
• COPD
• PE
• iLBBB
• LVH
• LAFB
• Infiltrate (sarcoid, amyloid, hemochromatosisº
• Misplaced leads
• Cardiac displacement (e.g., PTX)

Question 31

Angioplasty began in which year?

Answer 31

1979 (Andreas Gruentzig)

Question 32

Stenting began in which year?

Answer 32

1993