EKG Flashcards
look at what to determine rhythm?
P wave before every QRS? P’ waves? wide QRS? PR interval, QT interval
look at which leads for axis?
lead 1 and AVF
look at which leads to determine hypertrophy?
atrial: V1-V2, then lead 2
vent: V1, then V5/V6
what 3 things signifjy infarction?
inverted T waves, ST elevation or depression, big Q waves
normal PR interval
0.12-0.2 sec (3-5 little squares)
normal QRS interval
- QRS = 0.08-0.10 sec (2-2.5 squares)
normal P wave height and length
o Height = <0.25mV (2.5 little squares)
o Length = <0.12 sec (3 small squares)
axis points toward what and away from what?
toward hypertrophy, away fro infarction
which leads have largest sinus P waves?
lead 2, V1
in which lead is everything inverted?
AVR
look in which leads for RBBB?
V1, V2
suspect what for very large R wave in V1
posterior MI or R vent hypertrophy
which lead has the deepest S wave?
V2
which lead has tallest R wave?
V5
3 PVCs in a row
VT
PVCs for >30 sec
sustained VT
delta wave and decreased PR segment length, slightly widened QRS. due to going through bundle of Kent
o Wolff Parkinson White
no delta wave, very short PR segment, normal QRS. due to James bundle
o Lown ganong levine
o No P or QRS for 1 cycle
o Then resumes normal
sinus block
Multiple epidsodes of sinus block
No escape foci
sick sinus syndrome
Intermittent episodes of SVT, atrial flutter, or afib
Mingled w/ sinus bradycardia
o Bradycardia – tachycardia syndrome (SSS variant)
what is present if there is at least 1 long PR interval?
AV block
Consistently lengthened PR interval by the same amount in every cycle
No dropped Ps or QRSes (normal P QRS T in every cycle)
1st degree AV block
- PR interval gradually lengthens
- Then lone P wave missing a QRS
- Set ratio of 3:2, 4:3, et
2nd degree AV block type 1
- Multiple P waves, then 1 P-QRS-T in a set ratio (3:1, 4:1, etc)
- Consistent and normal PR interval length.
2nd degree AV block type 2
Mobitz after vagal maneuver?
becomes 1:1 or no change
Independent atrial and ventricular rates. SA node or atrial foci continue firing. Junctional or ventricular foci fire independent rhythm
P waves look the same
Each QRS will look the same unless containing P wave
T wave in same direction as R
3rd degree heart block
o No P waves
o Wide and tall QRS
regular rhythm
downward displacement of pacemaker
o R wave has 2 peaks in V1 and V2
o QRS is >0.12 sec (3 small squares)
RBBB
in V1 or V2, Peaked P wave > 1.5mm in width
Initial portion of V1 biphasic P wave is larger and peaked
right atrial hypertrophy
Height of P wave in any limb lead exceeds 2.5mm (esp 2, 3, AVF)
right atrial hypertrophy
V1 has biphasic P wave whose end component is taller or longer than initial (can be subtle). >40ms (1 square) in width and >1mm deep
Lead 2 has a broad bifid P wave >40ms (1 square). Total P wave duration >110ms (3 squares+)
L atrial H
- In V1, R wave is larger than S wave (>7mm tall or R/S ratio >1)
- Right axis deviation in frontal plane of +110 degrees or more
- In V5 or V6, S wave is bigger than R wave (>7mm tall or R/S ratio <1)
- QRS duration <0.12 s
RVH
V1 S wave depth + V5 or V6 R wave height >35mm) (voltage)
• In V5 and V6, there is often an asymmetric and inverted T wave
LVH
o ST segment depression and T wave inversion in left sided leads
LVH
Charaterised by ST segment depression with upward bump in the middle
• Esp in V1
ventricular strain (R if V1)
Inferior leads ST elevation
Hypotension, rhythm disturbance (bracycardic)
No pulmonary edema
R vent infarct
how do you confirm R vent infarct?
put V4 on R side and see ST elevation
Big R wave in V1-V4 esp V1-V3
ST depression in V1-V4 esp V1-V3
posterior infarct
what confirms posterior infarct?
ST elevations in V7-V9
classic sign of ischemia?
inverted T wave (symmetric)
transient T wave inversion and ST depression
angina
persistent ST elevation that never reetruns to baselein
ventricular aneurysm
ST elevation in V1-V4 without Q wave
anterior left vent active transmural MI
ST depression in V1 or V2 With large R waves
acute transmural MI in posterior wall
large Q wave >0.04 sec or 1/3 of entire QRS amplitude
necrosis
Q wave in lead 1 and deep S wave in 3 (Q1, S3) confirms diagnosis
anterior hemiblock
In inf leads (2,3, AVF), small R waves, then deep S waves
In high lateral leads (1, AVL), small Q waves, then tall R waves
In AVL, increased R wave peak time
anterior hemiblock
S1Q3 (deep/wide S wave in lead 1, Q in 3)
In high lateral leads (1, AVL), small R waves, deep S waves
In inferior leads (2,3, AVF), small Q waves, tall R waves
In AVF, increase R wave peak time
posterior hemilblock
RBBB (RR’ and QRS>0.12) with ST elevation in V1, V2, V3
Susceptible to deadly arrhythmias
o Brugada syndrome (genetic)
Caused by stenosed LAD
Marked T wave inversion in V2, V3
wellens syndrome
QT interval >1/2 cardiac cycle (R to R interval) in any lead (use the one that is easiest to calculate)
long QT syndrome
most common abnormality seen w/ PE
sinus tachycardia
S1Q3T3 in 20% of pts (large S wave in lead 1, Q wave in 3, inverted T wave in 3)
PE
tall peaked T waves
hyperkalemia
flat T wave, prominent U wave
hypokalemia
short QT interval
hypercalcemia
hypocalcemia
prolonged QT interval
PABs are often earliest warning sign
Gradual downward curve of ST segment
Best observed in leads with no S waves (L chest or limb leads)
R wave
digitalis
super narrow vertical spikes
artifical pacemakers
ST elevattion in all leads
pericarditis
anterior infarct vessels
L coronary a, LAD
lateral infarct vessels
circumflex
septal infarct vessels
LAD
inf infarct vessel
RCA
R vent infarct
branch of RCA
post infarct vessels
RCA, circumflex
afib, a flutter, tachydysrhythmais, PVCs, 2nd degree AV block can indicate infarct where?
anterior
PVCs can indicate infarct where?
ant, lateral, inf, or R vent (everywhere except post)
sinus bradycardia seen w/ infarct where? which vessel?
inferior. RCA
AV nod blocks can be ASW infarct in any area except?
lateral
Infarct in which area presents as only 2nd or 3rd degree heart block?
septal (V1-V2)
