ECG's

Question 1

Persistent ST segment elevation (on the order of days) think what?

Answer 1

After an NSTEMI or STEMI continued ST segment elevation should raise concern for LV aneurysm or LV dyskinesis- Dr. Azzo

Question 2

LVH diagnosis (one that I use not the weird ones)

Answer 2

LVH can be diagnosed with the number of small boxes in V1’s S wave plus the small boxes in either V5 or V6’s R wave (whichever is larger). If the number of boxes in amplitude is greater than 35 LVH can be diagnosed.

Question 3

LA dilation can be diagnosed how?

Answer 3

LAE produces a broad, bifid P wave in lead II (P mitrale) and enlarges the terminal negative portion of the P wave in V1.

In lead II
Bifid P wave with > 40 ms between the two peaks
Total P wave duration > 110 ms

In V1
Biphasic P wave with terminal negative portion > 40 ms duration
Biphasic P wave with terminal negative portion > 1mm deep

Question 4

Sinus Rhythm is? How to check?

Answer 4

Any Rhythm coming from the SA node.

P waves should be upright in II, III, aVF. and Negative in aVR.

Question 5

What are Regular Narrow QRS complex tachycardias

Answer 5

Sinus Tach
PSVT
A-Flutter
PAT

Question 6

What are irregular narrow complex tachycardias

Answer 6

A-Fib
A-Flutter
MAT
PAT
ST PAC / PVC

Question 7

What are regular wide QRS complex tachycardia’s?

Answer 7

VT

SVT aberrant

Question 8

What are irregular wide complex tachycardia’s

Answer 8

PVT

A-Fib

Question 9

What are narrow complex regular bradycardia’s?

Answer 9

Sinus Brady
A-Fib / Flutter
Junctional
1 AVB
2 AVB / I or II
3 AVB

Question 10

What are the wide complex bradycardia’s?

Answer 10

Idioventricular
Bradycardia w/ BBB
2 AVB / II
3 AVB

Question 11

Widened QRS indicating bundle branch block what is the next step?

Answer 11

Indicating which ventricle is blocked

Question 12

Criteria with RBBB?

Answer 12

R axis deviation plus a + R wave in V1 (usually will see negative Wave in V6)

Question 13

A biphasic p wave in V1 indicates?

Answer 13

This is a normal finding

Question 14

STEMI Criteria?

Answer 14

A greater than 1mm ST (J-point) elevation in any lead following a specific vessel distribution
Note: in V1 and V2 we need 2mm elevation and in young people some Cardiologists think 2.5mm.

Question 15

In young patients with Wide QRS complex afib need to think?

Answer 15

Need to think of WPW or other accessory bundles

Question 16

In WPW with afib need to avoid? why?

Answer 16

Avoid AV nodal blocking agents since this can cause a loop in the ventricles leading to V fib.
Use IV procainamide

Question 17

In a young patient with known Afib and WPW who is RVR with a narrow complex tachycardia do what?

Answer 17

You CAN use IV procainamide here but since it is narrow QRS you can use AV nodal blocking agents since you know the accessory pathway is not being used.

Question 18

WPW diagnosis? How does it appear with Afib RVR?

Answer 18

WPW is commonly diagnosed on the basis of the electrocardiogram in an asymptomatic individual. In this case, it is manifested as a delta wave, which is a slurred upstroke in the QRS complex that is associated with a short PR interval. The short PR interval and slurring of the QRS complex are reflective of the impulse making it to the ventricles early (via the accessory pathway) without the usual delay experienced in the AV node.

If a person with WPW experiences episodes of atrial fibrillation, the ECG shows a rapid polymorphic wide-complex tachycardia (without torsades de pointes). This combination of atrial fibrillation and WPW is considered dangerous, and most antiarrhythmic drugs are contraindicated.

Question 19

What is the Cornell Criteria for LVH?

Answer 19

Cornell criteria: Add the R wave in aVL and the S wave in V3. If the sum is greater than 28 millimeters in males or greater than 20 mm in females, LVH is present.

Modified Cornell Criteria: Examine the R wave in aVL. If the R wave is greater than 12 mm in amplitude, LVH is present.

Question 20

Do most patients with Accessory pathways have delta waves?

Answer 20

Approximately 30–50% of patients with APs do not have delta waves because they have only a retrograde electrical connection

Question 21

Patient’s with Left axis deviation and no clear reason think what?

Answer 21

LAFB, left anterior fascicular block

Question 22

Patient with RAD and no explainable reason think?

Answer 22

Posterior fascicular block

Question 23

What cause U waves?

Answer 23

The underlying cause of U waves is uncertain. For testing purposes, it should be remembered that the most common cause of significant U waves is severe hypokalemia. Other causes include significant bradycardia, antiarrhythmic drugs, intracranial hemorrhage, coronary ischemia, and long-QT syndrome.