ECG

Question 0

Depressed ST interval with inverted T wave

Answer 0

• indicator of ischemia

- may see reciprocal changes

Question 1

ECG interpretation process

Answer 1

• rate
• rhythm
• P waves: I,II,aVL,aVF, V1-3: less than 2.5 boxes
• T waves: Limb leads 3; Q wave ~1 box

Question 2

ST elevation with significant Q wave and again, inverted T wave

Answer 2

• indicator of infarction/injury

- clinically significant Q wave = at least 1 box (most reliable)

Question 3

Prematurity of beats: 3 options

Answer 3

• atrial (if p waves present atria is at fault)
• junctional (no p waves normal QRS complex)
• ventricular (abnormally wide QRS complexes)

Question 4

Irregularly irregular

Answer 4

• either Multifocal atrial tachycardia

Or - Afib (Afib atrial beats of 350+ BPM: looks like junk)

Question 5

Epicardial vs endocaridal ischemia

Answer 5

• epicardial ischemia -> ST elevation

- endocaridal -> ST depression (possible becuase it happens inside out so epi ischemia is more like infarct)

Question 6

Pace and etiology

Answer 6

• 150-250: SVT
• 250-350: atrial flutter
• 350+: Afib

Question 7

Wide qrs complexes: 2 options

Answer 7

• ventricular origin to rhythm OR

- bundle branch block

Question 8

Tall QRS complexes

Answer 8

• L vent hypertrophy (more muscle bigger impulse)

Question 9

V1-V6 Precordal lead trend

Answer 9

• V1 - deflection
• V3/4 equal +/- deflection
• V 6 + deflection

Question 10

Multiple forms of p wave appearing on lead II @ rhythm > 100 BPM

Answer 10

• MAT

Question 11

Identifying which side of heart bundle block is on

Answer 11

• ID the Precordal lead with biggest QRS interval, and that’s the side the block is on

Question 12

Physiological effect of severe ischemia (injury)

Answer 12

La- altered Na/K -> decrease intracellular K -> membrane potential increases and ST segment increases

Question 13

Classic triad of changes in infarction

Answer 13

• ST elevation
• q wave
• inverted T wave

Question 14

Left ventricular hypertrophy ECG changes

Answer 14

• S wave in V1 + R wave in V 5-6 >= 35mm

Question 15

Right ventricular hypertrophy ECG changes

Answer 15

• R wave in V1 is >= S wave in V1

Question 16

ST elevation not related to infarction

Answer 16

Variant (prinzmetal) angina

Question 17

Abnormally large T wave

Answer 17

• potentially hyperkalemia

Question 18

Etiology and morphology of MAT

Answer 18

• typically due to COPD

- varying P wave shape

Question 19

L axis deviation in lead III of >= - 40

Answer 19

• left anterior hemiblock

Question 20

QRS axis >= 120 in lead III

Answer 20

• left posterior hemiblock

Question 21

Prolonged PR interval

Answer 21

• 1st degree block

Question 22

P wave without following QRS complex upon progressive elongation of PR interval

Answer 22

• 2nd AV block Mobitz wenckebach

Question 23

P wave without following QRS complex

Answer 23

• 2nd degree Mobitz type 2

Question 24

P wave and QRS complex have no relationship to each other

Answer 24

3rd degree heart block

Question 25

Normal QRS complexes without p wave/ delayed qrs complex following normal rhythm without p wave stimulation

Answer 25

• junctional rhythm/junctional escape rhythm

Question 26

Negative deflection of P wave in V1

Answer 26

• right atrial enlargement

Question 27

Biphasic Pwave

Answer 27

• left atrial enlargement

Question 28

Multiform P waves @ rhythm < 100 BPM on lead II

Answer 28

WAP

- wandering atrial pacemaker