deck 10

Question 1

What is the main difference between T-wave peaking (TWP) morphology in hyperkalemia and infarction?

Answer 1

• infarction TWP (hyperacute TWs) : broad, asymmetric base
• hyperkalemia TWP: narrow, symmetric base

Question 2

Characteristics of ARD effect? (3)

Answer 2

1. mildly prolonged QTc
2. prominent U waves
3. slowing of A-flutter rate

Question 3

Causes of late precordial transition (leftward rotation)? (2)

Answer 3

1. anterior wall MI
2. chronic lung dz

Question 4

EKG presentation of hypocalcemia? (3)

Answer 4

1. h/o CKD
2. prolonged QTc (due to prolonged JT)
3. +/- T wave pathology (peaking, inversion, or flattening)

Question 5

Pt has diffuse concave-up STEs with PR elevation in aVR. A large pericardial effusion is tapped.

What do you expect the pericardial fluid to look like (grossly)?

Answer 5

purulent pericardial fluid (as opposed to clear or bloody fluid)

• classic EKG changes of pericarditis are most likely to occur with purulent pericardial inflammation

Question 6

Which anti-arrhythmic drugs prolong the QTc the most? (3)

Answer 6

1. class 1a ARDs (quinidine, disopyramide, procainamide)
2. sotalol
3. amiodarone

Question 7

criteria for old anterior QWMI? (2)

Answer 7

1. anterior QWMI criteria met (EITHER of the following):
   
   • rS in V1 followed by pathologic Q in ANY of V2-V4
   • Decreasing R wave amplitude from V2-V5
2. no injury pattern present

Question 8

In which leads will you find the classic “sine wave” pattern of profound hyperkalemia?

Answer 8

only in V1 and aVR

Question 9

Typical limb lead QRS changes found in acute PE? Comment on sensitivity & timing of the above findings.

Answer 9

S1Q3 or S1Q3T3 pattern

• Not very sensitive (occurs in only 30% of patients)
• Only lasts for 1-2 weeks

Question 10

Classic Rt precordial QRS findings in acute PE? (2) Comment on sensitivity & timing of the above findings.

Answer 10

1. complete/incomplete RBBB in V1 or V2 (lasts
2. TWIs in V1 or V2 (can last for months)

sensitivity: above findings occur in only ~25% of patients

Question 11

most common EKG finding in acute PE?

Answer 11

sinus tachycardia

Question 12

Causes of AT with 2:1 block?

Answer 12

1. dig poisoning (75%)
2. structural heart disease (25%)

Question 13

Question stem has pt with “red-green” color blindness.

Answer 13

think of digoxin toxicity

Question 14

Pt has syncopal event and EKG shows narrow-complex 2:1 AVB with ventricular rate 35. Type of conduction problem to code?

Answer 14

code for 2nd degree Mobitz II heart block

• history of syncope + 2:1 AVB → infranodal disease more likely → code for 2nd degree Mobitz II AVB

Question 15

Name 4 different arrhythmias that can be found in acute cor pulmonale.

Answer 15

1. sinus tachycardia (most common)
2. atrial tachycardia
3. Afib
4. Aflutter

Question 16

Which adult patient population most frequently has juvenile T waves?

Answer 16

young adult females

Question 17

Which LVH voltage criteria is the most accurate?

Answer 17

cornell criteria is most accurate (i.e. most specific)

Question 18

What is a “reciprocal echo complex?”

Answer 18

a type of nonsustained re-entry rhythm

mechanism of reciprocal echo complex:

• Impulse activates a chamber, then returns in retrograde fashion to activate the same chamber again
• e.g. APC activates ventricles, then impulse returns through slow AVN pathway→ retrograde atrial activation

Question 19

Pt has early repolarization finding on EKG. What else should be coded?

Answer 19

“borderline normal EKG or normal variant”

• “borderline ekg” should be coded on every EKG where the only findings are physiologic variant (e.g. early repolarization, juvenile T waves, etc…)

Question 20

What are the two types of sensing malfunctions and how should they be coded?

Answer 20

1. UNDERsensing - leads to OVERpacing (PPM fails to be inhibited appropriately)
2. OVERsensing - leads to UNDERpacing (PPM fails to be triggered appropriately)

• Both of the above should be coded as “PPM malfunction, failure to sense”

Question 21

Name 6 EKG findings that are considered to be “normal variant.”

Answer 21

1. juvenile T waves: small TWIs in V1-V3
2. pseudo cor-pulmonale: S waves in leads I-III
3. V2 pseudo-infarct pattern: R=S in V2
4. prominent U waves (greater than 1.5 mm)
5. incomplete right bundloid pattern (rSr’ in V1 w/ QRS
6. early repolarization pattern

Question 22

Which leads usually have j point elevation in patient with early repolarization?

Answer 22

V2-V5

Question 23

In which leads is the Osbourne wave usually positive?

Answer 23

left precordial leads (v3-v6)

Question 24

At what frequency does the tremor of parkinson’s usually occur?

Answer 24

300 cycles per minute (similar to atrial flutter cycle length)

Question 25

Which 2 other rhythms can wandering atrial pacemaker be confused with?

Answer 25

wandering atrial pacemaker can be confused with:

1. sinus rhythm with frequent APCs
2. Afib