ECG Foundation Flashcards
Einthoven’s triangle: green electrode:
Blue electrode:
Red electrode:
= neutral/ground
= Negative
= Positive
Einthoven’s triangle: Lead 1 & view:
Lead 2 & view:
Lead 3 & view:
= negative RA → positive LA (Left lateral camera view)
= negative RA→ positive LL (Inferior camera view)
= negative LA→ positive LL (slight lateral Inferior camera view)
(Coronary) left coronary artery supplies:
Left coronary artery 2 major branches are:
= L-ventricle, Intraventricular septum, part of R-ventricle & lower conductive system
= anterior descending artery and the circumflex artery
(T wave) Limb leads Amplitude:
Precordial “chest” leads amplitude:
= <5mm in LL
= <10mm in precordial
1 cause of death when having a MI
is from a lethal dysarrhythmia
12/15 Lead ECG Kev Approach) 1st.
2nd.
3rd.
4th.
5th.
6th.
7th.
8th
1st} Is there a clear isoelectric baseline? (Skin prep correctly)
2nd} Are QRSs upright leads I, II & III (Check attachment correctly)
3rd} good R wave progression? (Check lead placement)
4th} Is the monitor in the correct mode(diagnostic)? (0.05 to either 40 or 150 Hz)
5th} Is the axis normal? Any axis deviation present?
6th} Is there any ST elevation present? If yes, do you see it in 2 or more contiguous leads?
7th} Is there any ST depression? If yes, do you see it in 2 or
more contiguous leads?
8th} any pathological Q waves present? Yesterday’s news!
A Lateral Wall high view:
B Left Lateral low view:
C Inferior wall view:
D Septal wall view:
E L-Anterior view:
A= Lead I & aVL= LA
B= Lead 1, aVL, V5 & V6: views LCX & LAD
C= 2,3,aVF: LL most common block(RCA) Lots of blockages/infarcs
D= V1 & V2: Along sternal borders blockages from LAD commonly
E= V3 & V4: left anterior wall : LAD & LMCA blocks
3 Is of cardiac) Ischemia:
“Infarct” Injury:
Infarction:
= Ischemia: ST depres/, Hyperacute T waves>5chest avf >10 precordial
= “Infarct” Injury: ST elevation 50%,
= Infarction: old MI; >25% Q or QRS >1SB
3 I’S of cardiac) Pathologic Q
Infarction
3 I’S of cardiac) ST Elevation:
Injury
3 I’S of cardiac) ST Elevation:
Injury
A blockage of which of the following would result in the entire left ventricle not receiving blood supply?
Left Main Coronary Artery (LMCA)
ECG Camera views) Anterior
Lead V3 V4
Leads V3 & V4 view
Leads V1 & V2 view
Leads 2,3, & aVF view
Leads 1, aVL, V5, V6 view
= Anterior
= Septal
= Inferior
= Lateral
ARTsclerosis:
ATersclerosis:
= harding of arternia
= tunica media plaque build up in layers of media & intima pushing & narrowing lumen size,
Heart blocks are
blocks in AV node partial or complete
“Putting a rock or pebble on a cable”
Bundle Branch A&P) Fascicle of the conduction system:
Bundle branch blocks:
= Facilitates syncytium
= ventricles out of sync
Congitual:
Reciprocal changes:
Spodicks sign:
= same view leads
= mirrored effect in oppisute/corresponding leads for sure MI
= pericarditis PR slopes down aka STEMI imposter
De Winter’s T Waves:
V2 V3 most commonly but can happen any lead
ST depression at the J-point & upsloping ST-segments w/ tall, symmetrical T- waves in the precordial leads (LMCA or LAD occlusion)
“Hyper T w/ STD”
ECG Camera views) Left Lateral
Lead I, aVL, V4, V5
ECG Camera views) Septal
Lead V1 V2
ECG Camera views) LMCA - 3 vessel disease
Lead aVR
ECG Camera views) Posterior
Lead V5 V6
ECG Camera views) Right
Lead V4R
ECG Heart waves – P wave:
QRS complex:
T wave:
= Atrial depolarization
= Ventricular depolarization
= Repolarization of ventricles
ECG Lead coronary arteries) Anterior
(LAD) Left Anterior Descending
ECG Lead coronary arteries) Inferior
(RCA) Right Coronary Artery
ECG Lead coronary arteries) Posterior
(RCA) Right Coronary Artery &/or (LCX)
ECG Lead coronary arteries) Right
(RCA)
ECG Lead coronary arteries) Lateral
(LCX) Left Circumflex
ECG Lead views) Lead aVR
LMCA - 3 vessel disease
ECG Lead views) Lead V5 V6
Lateral
ECG Lead views) Lead V3 V4
Anterior
ECG Lead views) Lead V1 V2
Septal
ECG Lead views) Lead I, aVL, V4, V5
Left Lateral
ECG Lead views) Lead V4R
Right
ECG Lead views) Lead aVR
LMCA - 3 vessel disease
ECG Lead views) Lead V8 V9
Posterior
ECG Lead views) Lead V3 V4
Anterior
ECG Lead views) Lead V1 V2
Septal
ECG Lead views) Lead V4R
Right
Horizontal Boxes: Each small box ?secs:
5 small boxes equal:
Each large box is ?secs:
= 0.04 sec
= 1 large box
= 0.20 sec
Isoelectric line:
Used for:
= Down 1mV of calibration bar/ line (bottom of cal)
= ST seg depress/elevation, Hypertrophy, amplitude
LBBB Definer Turn criteria
Down deflection before J point “turning left”
STE leads criteria) Lead aVR, aVL, aVF
≥ 1mm
STE leads criteria) Lead V1
Lead V2-3
Lead V1 ≥ 1mm
Lead V2-3}≥ 2mm M>40, 2.5mm M<40 1.5 all women
STE leads criteria) Lead V4-6
≥ 1mm
STE leads criteria) Lead V4-6
≥ 1mm
15 leads views) Lead V4
Lead V5
Lead V6
Lead V4
Lead V5
Lead V6
STE leads criteria) Lead V4R
Lead V8-9
Lead V4R ≥ 1mm
Lead V8-9 ≥ 0.5mm
STE leads criteria) Lead V4R
Lead V8-9
Lead V4R ≥ 1mm
Lead V8-9 ≥ 0.5mm
STE leads criteria) Lead V4R
Lead V8
Lead V8
Lead V4R
Lead V8
Lead V8
15 leads views) Lead V4R
Lead V8
Lead V8
Lead V4R
Lead V8
Lead V8
Leads 2, 3, aVF reciprocal leads
leads 1, aVL, V1-6
Leads 1, aVL, V1-6 reciprocal leads
2, 3, aVF reciprocal leads
Leads II, III and aVF look at what part of the heart?
Inferior wall (most common blockacke(RCA)
Leads V1 and V2 look at what part of the heart?
Septal (blockages from LAD commonly)
Leads 1, aVL, V5, V6 look at what part of heart:
L-Lateral (low view : views LCX & LAD)
Leads V1 and V2 look at what part of the heart?
Septal (blockages from LAD commonly)
Leads 1, aVL, V5, V6 look at what part of heart:
L-Lateral (low view : views LCX & LAD)
Leads V3 and V4 look at what part of the heart?
L-Anteriorwall (LAD & LMCA blocks)
Mirror Criteria
V1&2 leads (v2 most sensitive w/ R): ST depression w/ big R wave (accompany 15-20% inferior or lateral STEMI)
Most common reason for MI & Stroke
ARTHsclerosis: Scab of artery can break open from intima, Body constricts, hemostasis, blocks blood flow (Asprin biggest helper antiplatelet) (R side of heart only) L side Lungs filters clots)
Orthodromic Re-entry loop:
Antidromic Re-entry loop
= Clockwise rentry conduction loop >narrow QRS
= counterclockwise reentry conduction loop > wide QRS
Posterior MI w/o post leads
V1 V2leads Mirror test
Precordial Posterior Lead Placement) V8(5)
V9(6):
= Mid-Scapular
= ½ way in-between the Scapula & Spine
PRI:
ST segment:
P-T is:
RR:
= AV holding impulse for sync
= ventricular contraction
= 1 full cardiac cycle
= gives rate & rhythm
Printz metal angina
Coronary artery spasm usually w/ stimulant (cocaine) & then occlusion arteries
QRS complex:
T wave:
U wave:
QT segment:
= ventricular depolarization
= ventricular depolarization
= “late bloomer
= all ventricle’s action
RBBB Definer turn criteria
Up defelection before J point “turning right”
Re-entry loops
= stuck in nascar loop in a chambers pathway causing commonly SVT / no P waves
Reciprocal leads:
Right BBB can produce:
LBBB can produce a
a classic rsR’ (r prime) R prime “2nd version of wave”, NO BUNNY EARS
QRS complex Discordis (oppisite)
RPM:
LAC:
RPM: Posterior & Marginal
LAC: anterior descending circumflex
Rs 6sec strip method:
big box method:
Small box method:
Triplicate method:
= # of Rs x 10
= 1R to R BB#s then 300/BB#
= 1R-R SB#s then 1500/ SB#
= descend W/ SB 300, 150, 100, 75, 50, 43, 38
SA node rate:
AV node rate:
Purjunkie rate:
=100-60BPM
=60-40BPM
=40-15BPM
Spodicks sign:
sloping down P wave into QRS (evidence of pericarditis)
3 I’S of cardiac) ST depression, Hyperacute or flipped T Wave:
Ischemia
STE leads criteria) Lead I-III
≥ 1mm
STE leads criteria) Lead I-III
≥ 1mm
Systematic approach
- rate, 2. rhythm, 3. P waves, 4. PRI, 5. QRS
Coronary) Right coronary artery (RCA) supplies:
Right Coronary arteries’ 2 major branches:
= part R-atrium & ventricle, upper part conduction system
= posterior descending artery & marginal artery
Coronary) Right coronary artery (RCA) supplies:
Right Coronary arteries’ 2 major branches:
= part R-atrium & ventricle, upper part conduction system
= posterior descending artery & marginal artery
Unipolar Limb Leads:
aVR:
aVL:
aVF:
= Augmented by the cardiac monitor
= Right Arm positive (inferior)
= Left Arm positive (lateral )
= Left Leg positive (inferior)
V1 & V2
V1 V2 leads view:
Septum
V3 & V4
V3 V4 leads look at
Left lateral wall
V5 & V6
V5 V6 leads look at
Inferior
V8 & V9 STEMI criteria:
0.5mm or greater
Vertical Boxes Each small box is:
Each small box also equals:
5 small boxes equal:
Each large box is:
2 large boxes equal: 1 mV
= 0.1mV
= 1 mm
= 1 large box
= 0.5 mV
= 1 mV
Wellen’s wave type A:
Biphasic T waves in V2 or V3, min STE <1mm (V2 usually biggest shower
Highly specific for for a critical blockage of the LAD
Wellen’s wave type B:
DEEP inverted T waves V2 or V3,
When obtaining a 12 lead ECG, where do you place V2?
When obtaining a 12 lead ECG, where do you place V5?
When obtaining a 12 lead ECG, where do you place V6?
When obtaining a 12 lead ECG, where do you place V3?
When obtaining a 12 lead ECG, where do you place V1?
When obtaining a 12 lead ECG, where do you place V4?
When obtaining a 15 lead ECG, where do you place V4R?
= 4th ICS just left of Sternum
= Left 5th ICS anterior of auxiliary
= 5th ICS midaxillary
= ½ in between V2 & V4
= Right of Sternum 4th ICS
= 5th ICS left Midclavicular
= Right ICS midclavicular
Which coronary artery feeds the inferior wall of the heart?
Right Coronary Artery (RCA)
Which coronary artery feeds the left lateral wall of the heart?
Left Circumflex (LCX)
ECG change represents active myocardial injury:
ST-Segment Elevation
Which of the following ECG changes represents myocardial ischemia:
Hyperacute T-Waves
