Day 1 Flashcards
What is Wellen’s warning?
- Upsloping ST segment with a quick downslope at the T wave (almost looks sinusoidal)
- A sign of impending ischemia
The P wave should be less than ______ in height.
3 mm (3 boxes)
One vertical box is equal to __________.
1 mm or 1 mV
AV block can occur due to pathologies that are ____________.
at or above the bundle of His (called supra-His)
What is semaphore?
Signaling (with hands or with flags) to planes
“My grandfather worked in the Navy in WWII and did semaphore in the South Pacific.”
The P wave is normally up in which leads?
I and aVF (usually in II as well)
To get the exact degree of axis, you can ____________.
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
Give the degrees of each of the directional leads.
- I: 0º
- II: +60º
- III: +120º
- aVR: +210º or -150º
- aVL: +330º or -30º
- aVF: +90ºor -270º
Low amplitude, isoelectric lead I is indicative of _____________.
COPD; the heart is oriented vertically and compressed by the expanded lungs
What is the normal thickness of the LV?
1 cm
What is the normal thickness of the RV?
3 mm
The initial depolarization of the ventricles goes ____________.
left-to-right (hence, a small Q wave is normal in V6)
Review the “3x3” rule in the R wave progression.
It should be at least 3 boxes tall by V3.
The seven causes of a tall R wave in V1 are as follows: ________________.
- Posterior MI (i.e., reciprocal Q wave)
- RBBB
- RVH
- WPW
- …
An R wave is considered pathologically tall if ___________.
it is greater than 8 mm by itself
Delayed R progression can be a sign of _____________.
anterior MI
The “small-F flitter” sign is ____________.
inverted P in aVL, indicative of COPD with vertical heart
Schamroth sign is ____________.
isoelectric low-voltage
QRS in lead I, indicative of COPD with vertical heart
The only difference between polymorphic ventricular tachycardia and torsades is _____________.
that torsades requires an antecedent QT prolongation
How can you tell if the voltage has been modified on an EKG strip?
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).
V1 - V2 is considered an ____________ infarction.
anteroseptal
V3 - V4 is considered a _____________ infarction.
apical
The P wave should not be greater than ______.
3 mm
In medical reperfusion therapy, what are the three success markers?
- Relief of angina
- Normalization of ST segment by at least 50% of its elevation
- New accelerated idioventricular rhythm (AIVR)
Other than pericarditis, what can cause PR depression?
Tachycardia
Whenever you see ST elevation, always look for _____________.
reciprocal depression
Reciprocal depression makes ST elevation more likely to be truly ischemic.
When you see an inferior MI, you need to ______________.
do right-sided leads to look for a right-sided MI
If you see mild ST elevation in a person with COPD, remember to ____________.
lower the leads by 3 interspaces; those with COPD have displaced hearts that can skew the EKG
List some non-MI causes of ST elevation.
- Pericarditis
- Early repolarization
- Acute cor pulmonale
- Hyperkalemia
- Intracranial hemorrhage
- Prinzmetal angina
- Acute pancreatitis
- Acute cholecystitis
- Myocardial metastases
- LBBB
- LVH
- Brugada syndrome
List some non-infarction causes of Q waves.
- HOCM
- WPW
- COPD
- PE
- iLBBB
- LVH
- LAFB
- Infiltrate (sarcoid, amyloid, hemochromatosisº
- Misplaced leads
- Cardiac displacement (e.g., PTX)
Angioplasty began in which year?
1979 (Andreas Gruentzig)
Stenting began in which year?
1993
