Ecg 2 Flashcards
What is the significance of lose of r waves?
Old infarction but need to see history
Rv hypertrophy sign
Normal: right ventricular lead (v1), the S wave > r wave
Hypertrophy: best seen in v1 as lv does not have usually effect on qrs
- height of r wave > S wave + deep save save in lead v6
Right atrium hypertrophied? Cause and ecg changes
La hypertrophied? “
Rah- p wave peaked due to tricuspid valve stenosis or pulmonary hypertension
Lah- broad and bifid p wave due to mitral stenosis
Qrs complex
- widen
- height
Tall r wave in which leads? Hypertrophy of which area
Widen - >120ms = abnormal intraventricular conduction in bbb and complexes from ventricular muscle
Increase height = ventricular hyper trophy
Right v hyper in v1 and lv hyper in v5-6
Q waves
- normal
- abnormal
Normal: lv leads due to depolarisation of septum from left to right (small one)
Abnormal: > than one small square in width and > 2mm depth = mi (window period where damage from inside out)
Q waves:
- Infraction in anterior walked left ventricles
- Infraction of both anterior and lateral surface of heart
- Inferior
- Posterior of left ventricle
- Q waves in v2-4 or v5
- Q waves in v3,4 and I, vl, v5-6 (lateral leads)
- Q waves in iii, avf
- Va have dominant r wave similar to ra hyper trophy (Rv occupies front of heart and depolarization of Rv going towards lead v1 is overshadow by depolarization of lv (move away from v1), therefore normal have deeper S wave than r wave, if infarct of posterior lv the shadowing effect on Rv decrease
St
Elevation and depression
Elevation: acute mi (more than 2 in chest leads and 1mm limb leads in 2 consecutive leads) or pericarditis (if all)
Depression: ischemia or (down ward sloping, reverse Nike) digoxin
T wave inversion
Normal and abnormal in??
Normal inverted in: vr, v1, iii, v2 and v3(blacks)
Occurs in:
Normal, ishcaemia, ventricular hyper trophy, Bbb, digoxin
(Leads adjacent to inverted t may show biphasic t)
Hypothermia
Sinus bradycardia
Serve- prolong qrs and qt interval
Afib - slow ventricular response and other atrial/ventricular dysrhythmias
Osborne j waves - hump like wave at junction of j point and st segment
Digoxin (Digitalis) at therapeutic effect and toxic levels
Use and side effects
Therapeutic levels: St downslop/scoop T wave depression or inversion Qt shorten +/- u waves Slow of ventricular rate in afib
Toxic;
Arrhythmias - paroxysmal atrial tachycardia with conduction block, serve bradycardia in afib, accelerated junction rhythms, pvc, ventricular tachycardia
Use: inotropes, inhibit na/k atpase -> increase kntracellular na and ca concentration and increased myocardial contractility, slows conduction through av node
Indicated for chf, afib
Ci in 2/3 degree av block, wow, hypokalemia
Features:palpitation, fatigue, yellow vision, decrease appetite, hallucination, confuse and depress
Cause of prolong qt interval and u waves
Many drugs like amiodarone, quinidine, phenothiazine, tricyclics antidepressant, antipsychotic, antihistamine,
Hyperkalemia and hypokalemia
Hyper k-
Mid to mod (5-7) tall peaked t waves
Serve (>7) progressive change where p waves flatten, disappear, qrs widen, bizzard, axis deviation, st shift with t wave
Hypok
- st depression, prolong qt, low t wave and prominent u wave (u>t)
HyperCa and hypo
Hyper - shorten qt interval
Hypo - prolong qt
Pe
Arrhythmia - sinus tachy, afib/atrial flutter (sawtooth in inferior)
Rad and rvh strain : s1q3t3 (s wave in I, q wave and inverted t wave in iii)
How to determine left ventricular hypertrophy via voltage criteria?
R waves > than 25mm in leads v5/6
Sum of r wave in lead v5/6 plus S wave in v1/2 > 35mm
