- QRS = 0.08-0.10 sec (2-2.5 squares)

EKG Flashcards by Jenny P

look at what to determine rhythm?

P wave before every QRS? P’ waves? wide QRS? PR interval, QT interval

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look at which leads for axis?

lead 1 and AVF

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look at which leads to determine hypertrophy?

atrial: V1-V2, then lead 2
vent: V1, then V5/V6

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what 3 things signifjy infarction?

inverted T waves, ST elevation or depression, big Q waves

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normal PR interval

0.12-0.2 sec (3-5 little squares)

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normal QRS interval

QRS = 0.08-0.10 sec (2-2.5 squares)

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normal P wave height and length

o Height = <0.25mV (2.5 little squares)

o Length = <0.12 sec (3 small squares)

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axis points toward what and away from what?

toward hypertrophy, away fro infarction

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which leads have largest sinus P waves?

lead 2, V1

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in which lead is everything inverted?

AVR

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look in which leads for RBBB?

V1, V2

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suspect what for very large R wave in V1

posterior MI or R vent hypertrophy

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which lead has the deepest S wave?

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which lead has tallest R wave?

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3 PVCs in a row

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PVCs for >30 sec

sustained VT

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delta wave and decreased PR segment length, slightly widened QRS. due to going through bundle of Kent

o Wolff Parkinson White

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no delta wave, very short PR segment, normal QRS. due to James bundle

o Lown ganong levine

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o No P or QRS for 1 cycle

o Then resumes normal

sinus block

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 Multiple epidsodes of sinus block

 No escape foci

sick sinus syndrome

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 Intermittent episodes of SVT, atrial flutter, or afib

 Mingled w/ sinus bradycardia

o Bradycardia – tachycardia syndrome (SSS variant)

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what is present if there is at least 1 long PR interval?

AV block

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 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

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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

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* 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)

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?

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)