deck 15

Question 1

For the following EKG, evaluate the rate, rhythm, and axis (RRA) and code appropriately.

Answer 1

code for SVT

• axis is normal
• short RP tachycardia (note retrograde P inferiorally and in Rt precordium)
• likely AVNRT (because RP interval < 70 ms)

Question 2

EKG presentation of HYPOkalemia? (3)

Answer 2

1. AVN dz: 1st deg AVB, Wenckebach, AV dissociation
2. repolarization anomalies: ST depression, T wave flattening, prominent U waves
3. ventricular arrhythmia 2/2 dispersion of repolarization: prolonged QTc →VT/VF

Question 3

EKG presentation of chronic lung disease? (5)

Answer 3

• axis deviation: RAD and lateral rotation (poor R wave progression)
• hypertrophied Rt heart: RVH and RAE
• attenuation of voltage due to î inflated lungs: low limb-lead voltage

Question 4

For the following EKG, evaluate the rate, rhythm, and axis (RRA) and code appropriately.

Answer 4

AV junctional rhythm with APCs

• note that axis is normal but there is limb lead reversal

Question 5

What feature of LAFB is usually present, but not necessary to make the EKG diagnosis?

Answer 5

dominant LPF activation pattern, signified by:

• qR in high lateral leads (early septal, late lateral activation)
• rS inferiorally (early inferior, late anterior activation)

Question 6

Fill in the blank:

You cannot code ________ in a patient who has had LAD on EKG since infancy.

Answer 6

LAFB

• axis deviation on EKG in an infant is usually due to congenital defect → do not code hemiblocks in these patients

Question 7

What feature of LPFB is usually present, but not necessary to make the EKG diagnosis?

Answer 7

dominant LAF activation pattern, signified by:

• rS in high lateral leads (early lateral, late septal activation)
• qR inferiorally (early anterior, late inferior activation)

Question 8

Which items from the board-standard EKG coding sheet (BSEC) will you fill in after assessing the RRA? (5)

Answer 8

eval of RRA (rate, rhythm, axis) will give you the following BSEC information:

1. atrial rhythms
2. AVJ rhythms*
3. ventricular rhythms*
4. AV conduction*
5. QRS axis abnormalities

*only code if dysrhythmia present

Question 9

What are the typical characteristics of “cerebral T waves.” (3)

Answer 9

1. wide
2. high amplitude
3. upright vs. inverted

Question 10

Differential diagnosis of electrical alternans? (4)

Answer 10

1. acute LV failure (decompensated HF)
2. pericardial effusion
3. ACS (DOE may be anginal equivalent)
4. deep respirations (physiologic alternans)