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12 Lead > ECG Weekly > Flashcards

ECG Weekly Flashcards

1
Q

What does a convex ST segment indicate?

A

ST elevation

5/28/18

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2
Q

What are the three components of the hypokalemia triad?

A

PVCs
ST Depression
Long QT Interval (>500ms)

10/15/18

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3
Q

What are the two most common causes of a long QT?

A

Hypokalemia
Methadone

10/15/18

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4
Q

List six hypokalemia ECG findings

A 
U-wave
Prolonged QT
Flattened or inverted T-wave
NikEleKem T-wave
ST elevation in AvR
PVCs

10/15/18

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5
Q

What are the two types of hyper-acute T-waves?

What do they indicate?

A
  • T-wave is as large or larger than the entire QRS
  • initial upslope of T-wave is straightened (not concave)

Ischemia

10/8/18

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6
Q

What is the SPECIFIC and SENSITIVE definition of low voltage?

A

SPECIFIC: QRS amplitude <5mm in all limb leads or <10mm in all chest leads
SENSITIVE: QRS amplitude of I+II+III<15mm or V1+V2+V3<30mm

5/14/18

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7
Q

What two things cause low voltage?

A

Blockage of electricity and weak “battery”

5/14/18

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8
Q

What is a significant differential diagnosis in a patient with low voltage and tachycardia?

A

Pericardial Effusion

5/14/18

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9
Q

What are the three main causes of low voltage from blockage and three causes from a “weak battery”?

A

Blockage: Fluid - pericardial or pleural effusion
Fat
COPD
Weak Battery: Hypothyroidism
Cardiomyopathy
Infiltrative diseases

5/14/18

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10
Q

What usually causes monomorphic V-tach?

A

Anatomical pathology, i.e. scar from previous ACS

6/18/18

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11
Q

What usually causes generic polymorphic V-tach?

A

Ischemia or Acute Coronary Syndrome

6/18/18

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12
Q

What is the cause of Torsades de Pointes?

A

Long QTc conditions

6/18/18

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13
Q

What is the treatment for monomorphic V-tach?

A

Shock and Amioderone

6/18/18

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14
Q

What is the treatment for generic V-tach?

A

Shock and Amioderone

6/18/18

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15
Q

What is the treatment for Torsades de Pointes?

A

Shock
Magnesium
Treat underlying condition

6/18/18

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16
Q

What should never be used on Torsades de Pointes and why?

A

Anti-arrhythmics - Amioderone, Procainamide, and Lidocaine

They are sodium channel blockers and can prolong the QTc.

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17
Q

What are the acceptable ST elevation for women, men >40, and two for men <40?

A

1.5mm in leads V2 and V3 and 1mm in all others

2mm in leads V2 and V3 and 1mm in all others

2.5mm in leads V2 and V3 and 1mm in all others

IF NO RECIPROCAL CHANGES

6/4/18

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18
Q

What does ST depression indicate?

A

Reciprocal changes

6/4/18

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19
Q

ST depression in aVl can be an early indicator of what?

A

Inferior STEMI

6/4/18

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20
Q

When does elevation in leads V2 and V3 indicate an MI?

A

When there are reciprocal changes.

6/4/18

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21
Q

What does a hyper-acute t-wave indicate?

A

Early ischemia

6/11/18

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22
Q

What is a DeWinter T-wave (4 criteria)?

What is it highly predictive of?

A
  • Tall precordial T-waves
  • Up-sloping ST depression
  • No ST elevation in precordial leads
  • ST elevation in aVR

LAD occlusion

6/11/18

23
Q

What are the three types of V-tach?

A

Monomorphic
Generic Polymorphic
Torsades de Pointes

6/18/18

24
Q

What is a common mimicker of V-tach or V-fib?

What are two clues it is not V-tach or V-fib?

A

Artifact

  • Pt does not “look sick”
  • A regularly spaced anomaly (the QRS complex).

6/25/18

25
Q

What does a flipped T-wave in aVL indicate?

A

Early sign of inferior MI or an right coronary artery blockage

7/2/18

26
Q

List three things that cause an irregular narrow complex tachycardia.

A
  • A-fib
  • A-flutter with variable conduction
  • Multifocal atrial tachycardia

7/2/18

27
Q

What two tachy dysrhythmias are never shocked?

A
  • Sinus tachycardia
  • MAT (multifocal atrial tachycardia)

7/2/18

28
Q

How is MAT (multifocal atrial tachycardia) treated?

A

By treating the underlying condition

7/2/18

29
Q

What are the three causes of narrow, regular tachycardia?

What is the differential for each?

A 
-Sinus tach
   P wave with every QRS
-SVT
   P wave misplaced or buried 
-A-Flutter 2:1
   Two P waves with each QRS

7/16/18

30
Q

When is A-flutter assumed until proven differently?

A

When the ventricular rates is 150+/-20

7/16/18

31
Q

What should be assumed if the P-wave is 1/2 way between R complexes?

(The Bix Rule)

A

A-flutter
The other P-Wave is buried

7/16/18

32
Q

What is the most common description of ACS pain in the elderly?

A

Epigastric burning/indigestion/heart burn

7/23/18

33
Q

What does an inverted t-wave in lead aVl is the first sign of what?

A

Inferior ischemia

7/23/18

34
Q

In what three leads is an inverted t-wave normal?

A

V1, aVr, III

7/23/18

35
Q

What does the straightening of the ST segment indicate?

A

Early ischemia

7/23/18

36
Q

What are five signs of hypothermia on a monitor?

A
  • Bradycardia
  • Prolonged Intervals
  • J-waves
  • Slow A-fin
  • Tremor artifact

7/30/18

37
Q

List and define three types of ventricular rhythms.

A

Ventricular escape: <40 bpm
V-tach: >120 bpm
Accelerated idioventricular: >40 & <120

7/30/18

38
Q

What is a short PR Interval?

A

<120ms

7/30/18

39
Q

What two things can a short PR Interval indicate?

A
  • Junctional rhythm
  • WPW (with delta wave)

7/30/18

40
Q

What does a T wave that is bigger than the QRS complex indicate?

A

ACS/STEMI

7/30/18

41
Q

What does a “check mark” ST segment indicate?

A

ACS/STEMI

7/30/18

42
Q

What does ST depression in V1, V2, and V3 with upright T-waves indicate?

A

Posterior STEMI

7/30/18

43
Q

List six ECG signs of hypokalemia.

A
  • U-wave (camel hump) Wellen’s wave
  • Prolonged QT
  • Flattened/Inverted T-waves
  • Reverse Wellen’s wave
  • aVR STE
  • PVCs

8/13/18

44
Q

List six things that can cause a prolonged QT.

A
  • Electolytes
  • Hypothermia
  • Medications/Drugs
  • Elevated ICP
  • ACS/Cardiac ischemia
  • Congenital

8/13/18

45
Q

What is Ashman’s Phenomenon?

A

An aberrant conduction, usually during A-fib, following a long-short cycle that looks like a PVC or V-tach. Often has an RBBB morphology.

8/20/18

46
Q

List nine ECG findings related to hyperkalemia.

A
  • Peaked T waves
  • Widening of QRS
  • Prolonged PR
  • Flattening then loss of P waves
  • Tachydysrhythmias or PaeudoVTach
  • Bradydysrhythmias, AVBs, sinus pauses
  • Axis changes (RAD)
  • Pseudo-ACS > new BBB, St changes
  • Sine wave

9/3/18

47
Q

What condition might cause an internal defibrillator to not work?

A

Hyperkalemia

9/3/18

48
Q

Hyperkalemia or toxins should be considered in V-tach if the rate is less than what?

A

130

9/3/18

49
Q

Hyperkalemia or toxins should be considered in V-tach if the QRS is greater than how wide?

A

200ms (1 big box)

9/3/18

50
Q

In regular wide QRS rhythm with a rate <130 and a QRS >200ms what drugs should be considered and why?

A

Calcium and Bicarbonate

It is probably Hyperkalemia

9/3/18

51
Q

When considering STEMI vs acute pericarditis what three factors indicate STEMI and what two factors indicate pericarditis?

Which over rules which?

A

1 - ST depression except in leads V1 and aVR
2 - ST elevation in III>II
3 - Horizontal or convex upwards ST elevation

1 - Friction rub
2 - PR depression in multiple leads

Always look for STEMI first

9/17/18

52
Q

What are the four critical history risk factors when considering ACS?

A
  • Chest pain + vomiting
  • Chest pain + radiation
  • Chest pain + sweat
  • Chest pain worsens with exertion

9/24/18

53
Q

What syndrome should be considered in a syncope patient?

What are the ECG findings?

What can be done to alleviate doubts?

A

Brugada

Coved or convex ST elevation with inverted T-wave in leads V1 and V2

Move leads V1 and V2 up one space

10/1/18

12 Lead (2 decks)

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