ECG Flashcards
ASD
Partial RBBB (rsr)
Superior axis (if primum)
Superior axis
AVSD
Noonans
ASD (primum)
Ebsteins anomaly
Tricuspid atresia
Dextrocardia (or RAD)
Dextrocardia
RAD or superior axis
Poor R wave progression (dominant S waves in all leads)
Right ventricular hypertrophy
Right axis deviation
Dominant R wave in V1 (or narrow rSR’- incomplete RBBB)
Dominant S wave in V5-V6
May have upright T waves V1 (usually negative 7 days to 7 years)
“Rules” for RVH by age
R waves in V1:
0-6mo V1 > 5 big squares
6mo-1 year > 4 big squares
>1 year > 3 big squares
S waves in V6 :
0-6mo V1 > 3 big squares
6mo-1 year >2 big squares
>1 year > 1 big squares
Left ventricular hypertrophy
Deep dominant S wave in V1, tall dominant R wave in V5-V6
S wave depth in V1 + tallest R wave height in V5-V6 > 35 mm
May have LAD for age
May have deep q waves in lateral/inferior leads
LVH “Rules” by age
S waves in V1:
0-6 mo >3 big square
6mo-12 mo >4 big square
>1 year >5 big square
R waves in V6:
0-6 mo >3 big square
6-12 mo >4 big square
>12 mo >5 big square
May have ST depression and T wave inversion in left sided leads AKA LV strain pattern
Causes of Dominant R wave in V1
Normal in children and young adults
Right Ventricular Hypertrophy (RVH)
Left to right shunt
Right Bundle Branch Block (RBBB)
Wolff-Parkinson-White (WPW) Type A
Incorrect lead placement (e.g. V1 and V3 reversed)
Dextrocardia
Hypertrophic cardiomyopathy
Myotonic dystrophy
Duchenne Muscular dystrophy
Right bundle branch block
QRS duration > 120ms
RSR’ pattern in V1-3 (“M-shaped” QRS complex)
Wide, slurred S wave in lateral leads (I, aVL, V5-6)
Causes of Right Bundle Branch Block:
Pulmunary HTN / cor pulmonale
ASD
Ebsteins anomaly
Post VSD or TOF repair
Pulmonary embolus
Rheumatic heart disease
Myocarditis
Cardiomyopathy
If post op and rbbb always say vsd repair!
Also can’t comment on hypertrophy with Rbbb
Dextrocardia
Positive QRS complexes (with upright P and T waves) in aVR
Negative QRS complexes (with inverted P and T waves) in lead I
Marked right axis deviation
Absent R-wave progression in the chest leads (dominant S waves throughout)
HOCM
LVH (dominant S waves in V1, dominant R waves V6)
Deep narrow Q waves in inferior/lateral leads
Left atrial enlargement
Broad bifid P wave in lead II (p mitrale)
In isolation: mitral stenosis
With LVH: aortic stenosi, HOCM, HTN
Right atrial enlargement
Peaked P wave (p pulmunale)
Caused by: pulmunary HTN –> PS, ToF, primary pulmunary hypertension
Tricuspid atresia ECG
LAD
LVH
RA + LA enlargement (tall wide p waves )
CXR: reduced pulmunary markings
Rx: univentricular pathway
Partial RBBB
w LAD: primum ASD
w RAD: secundum ASD
w RAH + delta waves: Ebsteins anomaly
Complete RBBB- post VSD repair
Ebsteins ECG
RAH
RBBB
WPW
