ECG

Question 1

Territory distribution on ECG

Answer 1

Inferior: II, III, AVF
Anterior: V1-V4
(septal V1-V2)
Lateral: V5-6, I, AVL

Question 2

What supplies the SA node?

Answer 2

RCA 90%

LCX 10%

Question 3

Criteria for emergency revasculation

Answer 3

ST elevation in 2 contiguous leads after NTG
Typical symptoms up to 12 hours
Persistent symptoms to 24 hours
New LBBB with typical symptoms (not really used anymore)

Question 4

ST segment elevation criteria?

Answer 4

>1 mm above baseline (limb)
>2 mm above baseline (chest)
0.08 seconds to right of J point
compare to baseline of TP segment  
Look for 2 contiguous leads

Question 5

What are ECG findings in RV infarct?

Answer 5

STE III>II
STE in V1
STE in V4R

Question 6

5 findings of Posterior MI on 12 lead ECG?

Answer 6

Leads V1-V3: ST depression
Prominent R wave
R>S in V2
Prominent upright T wave
Co-existing acute inferior and/or lateral MI

Question 7

DDx of tall R wave in V1

Answer 7

RBBB
Posterior MI 
RVH
RV strain
Pediatric
WPW
Muscular dystrophy

Question 8

What criteria define pathologic Q waves?

Answer 8

Duration >40 ms (1 small box)
>25% of QRS complex amplitude
2 contiguous leads
age indeterminate MI

Question 9

What are criteria for low voltage ECG?

Answer 9

< 5 mm QRS complex in all limb leads

Question 10

ECG findings of left main occlusion?

Answer 10

Widespread ST depression (inferior, anterior, lateral)
STE in AVR >/= 1 mm
STE in V1 >/= 1 mm

Question 11

What is the DDx of left axis deviation?

Answer 11

LVH
LAFB
Inferior ischemia/Q waves

Question 12

What are Sgarbossa’s Criteria?

high specificity, low sensitivity

Answer 12

Concordant ST elevation of 1 mm = 5 mm
Concordant ST depression of 1 mm V1-V3 = 3 points
Excessive discordant ST segment elevation of >5 mm = 2 points
Score >/=3 has 90% specificity for diagnosing MI

Question 13

DDx of inverted T waves (6)

Answer 13

Ischemia
RV strain (PE, COPD, pulm HTN)
Persistent juvenile T waves
Intracranial pathology 
Hyperventilation
Electrolytes (K)

Question 14

4 causes of acute RBBB that can kill you

Answer 14

Ischemia
PE
TCA/Na channel blockade
Hyperkalemia

Question 15

DDx ST elevation (10)

Answer 15

STEMI
vasospasm
aortic dissection
BER
Pericarditis
takotsubo
LBBB
RBBB
LV aneurysm
Brugada
Osborne wave
Epsilon wave
Post cardioversion
PE

Question 16

Ddx of Wide QRS

Answer 16

Acidosis
HyperK
Sodium channel blockade
BBB

Question 17

Ddx of long QT

Answer 17

Congenital
Metabolic - hypoK, hypoMg, hypoCa
Medications 
Antiarrhythmics, anti emetics, antibiotics, analgesics, antipsychotics
Chemotherapy agents 
Ischemia
Post cardiac arrest 
Hypothermia

Question 18

DDx of irregularly irregular rhythm?

Answer 18

Atrial fibrillation
Atrial flutter with variable conduction
Multi focal atrial tachycardia
(>/= 3 P wave morphological with distinct PR intervals and HR >100)

Question 19

A fib with slow ventricular response? DDx

Answer 19

Digoxin toxicity
Beta blocker toxicity
CCB toxicity 
Adenosine toxicity
Amiodarone toxicity
AV nodal conduction disease
Ischemia
Hyperkemia

Question 20

Where is the source of a complex that is R>R1?

Answer 20

Ventricle

Question 21

What vessel perfumes the AV node?

Answer 21

RCA in 90%

Question 22

DDx of R>S in V1-2

Answer 22

Posterior MI
RBBB
Pediatric
Lead reversal 
RVH
VTach
WPW

Question 23

What is the initial setting of a transvenous pacer? After placement?

Answer 23

1. V00 - low sensitivity

2. VVI - senses beats