Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiac For NA > EKG > Flashcards

EKG Flashcards

1
Q

Precordial lead placement:

A

V1: 4th ICS R sternal border
V2: 4th ICS L sternal border
V3: between V2 + V4
V4: 5th ICS mid clavicular line
V5: between V4 + V6
V6: 5th ICS mid axillary line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

12 lead ekg (site of heart, leads, reciprocal leads, vessel/s involved)
Lateral

A

Lateral wall

leads: I and aVL (high lateral), V5 and V6 (low lateral)
reciprocal leads: II, III, aVF
vessels: LAD (LCx + Diag)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

12 lead ekg (site of heart, leads, reciprocal leads, vessel/s involved)
Inferior

A

Inferior Wall

leads: II, III, aVF
reciprocal: I and aVL
vessels: RCA or LCx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

12 lead ekg (site of heart, leads, reciprocal leads, vessel/s involved)
Anterior / septal

A

Anterior Wall

leads: V1+V2 (septal), V3+ V4 (anterior)
reciprocal: NONE
vessel: LAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

12 lead ekg (site of heart, leads, reciprocal leads, vessel/s involved)
Posterior

A

Posterior wall

leads: NONE
reciprocal: V1-V4
vessel: RCA (PDA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Atrial enlargement
RAE criteria

A

TALL symmetric p wave (P pulminale)

leads II, III, aVF >2.5mm
lead V1+V2 >1.5mm, biphasic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Atrial enlargement
LAE criteria

A

wide, notched P wave (P mitrale) > 0.1s in ANY lead

leads II, III, aVL notches + > 0.12s
lead V1 downward deflection + 1mm amplitude + 0.04s
V1 + V2 biphasic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Best lead to look for atrial enlargement?

A

V1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

RVH criteria

A

can have peaked P wave (RAE)

II, III, V1 tall R wave (>7mm V1)
V1: R>S wave
V1-V6 R gets smaller

Deep S wave: I, V4-V5, wave persists in V5 + V6
ST segment: down sloping depression >1mm in II, III, aVF, and V1
T wave: inversion in II, III, aVF, and V1

RAD, slight wide QRS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

LVH criteria

A

can have wide, notched P wave (LAE)

-V1 S wave + V5 R wave > 35mm

-tall R wave I(>20mm), aVL(>11mm), V5-V6 (>30mm)
-deep S wave III (>20mm), V1 + V2 (>30mm)
-ST seg: I, aVL, V5+ V6 (1mm+ depress), V1-V3 (1mm+ elevation)
-inverted T wave I, aVL, V5 + V6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Axis - simple way
Lead I = +
Lead aVF = +

A

normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Axis - simple way
Lead I = -
Lead aVF = +

A

RAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Axis - simple way
Lead I = +
Lead aVF = -

A

LAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Axis - simple way
Lead I = -
Lead aVF = -

A

northwest axis / extreme RAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Determine axis rotation in horizontal plane ( find most isoelectric lead)
-V1 or V2

A

rightward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Determine axis rotation in horizontal place (find most isoelectric lead)
-V3 or V4

A

normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Determine axis rotation in horizontal plane (find most isoelectric lead)
-V5 or V6

A

leftward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Coronary arteries: LCA
-branches
-what they supply

A

LCA > LAD + LCx

LAD = LV anterior + inferior, RBB + LBB(anterior fascicle), septum

LCx = LA + LV posterior + lateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Coronary arteries: RCA
-what it supplies

A

RA
RV
septum
LBB (posterior fascicle)
Electrical areas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

T/F the LBB is supplies by 2 arteries, so if there is a block there isa lot of damage/ ischemia

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Coronary artery: area of LV + artery supply
-Inferior LV (apex)

A

LAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Coronary arter: area of LV + artery supply
-Anterior

A

LAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Coronary artery: area of LV + artery supply
-Lateral

A

LCx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Coronary artery: area of LV+ artery supply
-Posterior

A

PDA (80-85%)
Circ (10-15%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Coronary artery: area of LV + artery supply
-Septum

A

Anterior 2/3 of LAD
Posterior 1/3 of RCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which membrane of heart is most vulnerable to ischemia?

A

EPICARDIUM not endocardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

CPP(coronary) =

A

aortic DBP - LVEDP
-low BP or increased LVEDP = reduced coronary perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

coronary blood flow =

A

250mL/min @ rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

T/F Tachycardia increases coronary perfusion.

A

false. they perfuse during diastole and if less time in diastole, less time for perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Myocardium regulates blood flow between pressures of _ - _

A

50-120, beyond these pressures, blood flow is PRESSURE dependent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Infarcted areas of myocardium are _ shaped and have the wider side along the _

A

wedge
endocardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

T/F Ischemia, injury, and infarction are reversible.

A

False. ischemia + injury are reversible NOT infarction (cell death)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How does heart protect itself from ischemia?

A

-overlapped areas of perfusion (collateral)
-O2 from ventricles can diffuse into cells in nearby tissue
-some vessels, “thebesian veins” arise directly from ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Main mechanism of ischemia/ injury:

A

demands of heart > than blood
supply
-increased demand OR decreased supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Things that cause increased O2 demand in heart:

A

-tachycardia
-HTN
-big heart/CM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Things that cause decreased O2 supply in heart

A

-low Hgb
-low pO2
-fixed narrowing
-growing obstruction
-coronary spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Basic mechanism to relieve ischemia:

A

lessen demand, increase O2/blood supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Acute Coronary Syndromes
-3 types

A

-unstable angina (+/- ekg s/s ST depress + T wave invert, NROMALY cardiac enzymes)

-NSTEMI (ST depress or T wave inversion + ELEVATED enzymes)

-STEMI (transmural injury occurs often, coronary occlusion is usualy cause)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Criteria of STEMI:

A

STE in 2+ contiguous leads and > 2mm V1-V3 or >1mm in other leads

-some YA can have 1mm STE in V1-V3 so need more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

MI progression
-T wave inversion

A

ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

MI progression
-STE

A

infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

MI progression
-pathologic Q wave

A

infarction (late)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Ischemia affects a wedge shaped portion of the heart and is thinner along the _ and wider along the _

A

endocardium
epicardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Area of ischemia on heart is more _ (pos/neg) causing ST _ (ele/depression) and T wave inversion, causing repolarization to take an abnormal path.

A

negative
depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

T/F A normal T wave is symmetrical

A

false! asymmetrical
an inverted T wave is usually symmetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

T/F T wave inversion is more often seen in precordial leads

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

T/F T wave inversion is NORMAL in lead II and Avf

A

FALSE
III and aVR!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Which is more specific to ischemia, T wave inversion or ST depression?

A

ST depression

-T wave inversion is cell running out of energy at END of repolarization
-ST depress is cell running out of energy at START of repolarization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Wellens warning/syndrome warns for stenosis of the _ artery.

A

LAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Wellen’s Warning/Syndrome ekg changes

A

marked T wave inversion in V2-V6
-alerts for critical stenosis of LAD, may have no pain and no elevation in enzymes at time of EKG but high risk of extensive anterior wall MI in days/wks
-may be biphasic T wave and have 0 or minimal STE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Ischemic injury remains more _ (pos/neg) than surrounding tissue causing ST (elev/depression)

A

positive
elevation
-T wave stays flipped bc abnormal repolarization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

ST elevation tells us there has been a/an (recent/old) injury

A

recent
-will return to baseline as time passed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

ST elevation
-patho

A

-atherosclerosis + thrombus
-transmural MI = STEMI, affecting more than just subendocardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

ST elevation in _ or more contiguous leads = _ % occlusion

A

2+
100% occlusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

J point

A

end of QRS and beginning of ST seg

-measure ST elevation here

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

J point elevation

A

not a big deal normally
-if elevation in inferior leads = riskier
-not the same as ST elevation technically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

NSTEMI aka non _ _ MI

A

non Q wave MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Pericarditis ekg =

A

WIDESPREAD STE + PR depression
concave STE

-not in V1 and aVR

reciprocal ST depression and PR elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

T/F infarcted tissue is electrically neurtral

A

T
-doesnt generate any APs
-like an electrical “window” in the wall of myocardium
-unopposed positive vector > Q wave

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Q wave is considered significant when: (2 criteria)

A

> 0.04s OR 1/3 ht of QRS

-never significant in aVR
-QS wave in V1 usually benign
-I and aVL normally show Q wave from septal depolarization
-benign Q waves found in pregnant pt or obese pts in lead III (horizontal placement of heart)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Necrotic myocardial tissue cannot depolarize so you can’t see _ (toward/away) vectors, only _ (toward/away vectors)

A

toward
away

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Give 4 situations Q waves don’t matter:

A
  1. never significant in aVR
  2. QS wave in V1 usually benign
  3. I and aVL normally show Q wave from septal depolarization
  4. benign Q waves found in pregnant pt or obese pts in lead III (horizontal placement of heart)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

_ (RAE /LAE) is often precursor to afib

A

LAE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

P - _ happens when depolarization of R and L atrium are both seen in the P wave

A

MITRALE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

T/F P wave is normally biphasic in V2

A

false, V1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Causes of BIatrial enlargement
-by itself

A

MITRAL STENOSIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Causes of BI atrial enlargement
-WITH LVH

A

-HTN
-AS
-mitral incompetence
-hypertrophic CM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Biatrial enlargement criteria:
-MUST meet criteria of both RAE + LAE

A

lead II:
-notch p wave, amp >2.5, >0.12s

lead V1:
-biphasic p wave, initial pos deflection >1.5mm, terminal neg deflection >1mm deep, terminal neg deflection >0.4s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

LVH leading cause:

A

HTN
-also valve dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Bumper sticker for RVH:

A

BIG R in V1
-V1 sits above RV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

T/F LVH often have some STE or depression with it

A

true, not always an AMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Unstable angina definition:

A

severe ischemic state WITHOUT progression to permanent cell damage yet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Unstable angina
-3 subtypes

A

-new onset
-rest
-crescendo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Unstable angina
-s/s

A

cp @ rest or in crescendo pattern
SOB
diaphoresis
palps
N/V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Unstable angina
-ekg
-enzymes

A

EKG: normal OR ST depression AND/OR T wave inversion

enzymes: negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

NSTEMI definition:

A

severe ischemic state w/ typical s/s of MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Main difference between NSTEMI and unstable angina =

A

lab tests confirming myocardial cell damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

NSTEMI
-ekg
-enzymes

A

EKG: ST depression or T wave inversion

enzymes: positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

STEMI criteria on EKG

A

-STE on 2+ contiguous leads
-STE must be > 2mm in V1, V2, and V3 and >1mm in other leads

79
Q

STEMI definition

A

ischemic syndrome assoc w ST elevations and coronary occlusions
-typically caused by transmural ischemia/ infarction

80
Q

“Contiguous leads” means:

A

leads that are anatomically next to each other, same area of heart

81
Q

T/F Presence of a Q wave confirms a transmural infarct

A

false, may be from noncontiguous parts of myocardium

82
Q

_ (Q wave/ non Q wave) infarcts associated with higher rate of acute mortality, tissue damage, and CHF where _ (Q wave/ non Q wave) infarcts have higher rate of long-term mortality if tx not taken

A

Q wave = acute mortality, damage, CHF

non Q wave = long term mortality

83
Q

ACS: cp, EKG changes, enzymes
-unstable angina
-NSTEMI
-STEMI

A

UA: cp, possible EKG change, neg
NSTEMI: cp, ekg changes, enzymes
STEMI: cp, ekg changes, enzymes

84
Q

Which wall of heart can have Q waves disappear possibly?

A

inferior wall

85
Q

Inferior wall MI often involve _ infarction and some develop bradycardia from _ or _ degree AVB

A

RV
2nd or 3rd AVB
BRADY!!!!!!!

86
Q

STE leads: pattern of elevation, injury location, and coronary artery involved
-I and aVL

A

I, aVL = lateral = Cx

87
Q

STE leads: pattern of elevation, injury location, and coronary artery involved
-I, II, aVF

A

I, II, aVF = apical = LAD

88
Q

STE leads: pattern of elevation, injury location, and coronary artery involved
-V1 and V2

A

V1 and V2 = septal = LAD, PDA

89
Q

LCA normally supplies the _, the intraventricular _, and _ (septal, anterior, and lateral walls)

A

LA
intraventricular septum
LV

90
Q

LCA branches
-LAD

A

septal + diag branches

supplies:
-anterior 2/3 of intraventricular septum
-RBB + LBB
-anterior + posterior papillary muscles of MV
-anterior + apical walls of LV
collateral circulation of anterior wall of RV

91
Q

LCA branches
-L Cx

A

supplies:
-LA wall
-lateral LV (sometimes posterior LV)

92
Q

Most important DETERMINANT of coronary blood flow:

A

myocardial O2 demand

93
Q

Coronary blood flow is CONTROLLED primarily via:

A

variations in coronary arterial tone

94
Q

What is pseudo-normalization of T wave inversion?

A

pt has normally flipped T waves, ischemia causes them to become normal

compare old EKGs

95
Q

T/F T wave inversion is diagnostic for infarction

A

false
-dx for ischemia only

96
Q

Pericarditis s/s

A

cp (pleuritic, retrosternal, tachy, worse laying flat, dyspnea

97
Q

Why does infarction cause Q waves?

A

can happen with injuries that don’t go all the way thru the heart, depolarization reverts back to cell-cell transmission , when this happened Q wave briefly appears to be unopposed

98
Q

Anterior wall MI
-leads
-area of heart
-s/s

A

V3 + V4

infarcts of septum, lateral wall or both

HD compromise + shock

may not have Q waves but lose normal R wave progression

99
Q

Anteroseptal wall MI
-leads
-vessel

A

V1-V4: STE + T wave invert, QS complex

LAD

100
Q

Inferior Wall MI
-leads
-vessel
-s/s

A

II, III, aVF
recip: I and aVL
RCA

-q waves may disappear
-often come with RV infarction > BRADYCARDIA (AVB)

101
Q

Lateral wall MI
-leads
-vessel
-s/s

A

I, aVL, V5 and V6 Q waves
-I and aVL Q waves may be “normal septal Q waves”
recip: ST depress in II, III, and aVF
L Cx

often occur in combos (inferolateral, anterolateral, posterolateral, etc)

102
Q

T/F BBB is wide bc there are basically 2 QRS’s, one for each ventricle

A

T

103
Q

T/F PVC is aberrantly conducted since conception whereas BBB starts normal until reaching BB

A

T

104
Q

T/F May be easier to check for BBB in LIMB leads, bc precordial leads can be larger

A

T

105
Q

RBBB causes a _ (faster/slower) depolarization time

A

slower, >0.12s QRS = an additional wave or abberation of existing wave

106
Q

RBBB is seen in right precordial leads of _ and _ as a RSR’ complex

A

V1 and V2
-doesn’t always have rabbit ear appearance

107
Q

R’ in a RBBB is a sign of slow conduction thru the _ _ and _

A

intraventricular septum and RV

108
Q

1st _ (up/down) deflection after P wave is the R wave

A

upward = R wave

109
Q

Main criteria for RBBB:

A

QRS > 0.12s (even just one lead)

SLURRED S WAVE IN I AND V6
-various morphologies but all prolonged + slow

RSR’ pattern in V1 with R’ taller than R (all predominantly positive)

110
Q

Normally _ ventricle gives rise to the QRS complex, but in late innervation of septum and RBBB, the _ creates a new, slower vector

A

LV
RV

111
Q

T/F 1st half of QRS is irrelevant in dxing RBBB

A

true

main criteria = slurred S wave V6 and I

112
Q

Why is RSR’ in V1 not enough to dx RBBB?

A

bc it is seen in anteroseptal MI too

-LOOK FOR SLURRED S IN I and V6!!!!!

113
Q

RBBB can have other weird RSR’ morphologies but always look for =

A

slurred S wave V6 and I

114
Q

With RBBB you can only dx _ ventricular hypertrophy but not the other.

A

LVH
bc RBB only affects the terminal portion of the complex

115
Q

T/F You can dx atrial enlargement with their normal criteria with RBBB

A

true

116
Q

_ BBB is usually composed of monomorphic complexes (all + or all -) and are uglier

A

LBBB

117
Q

_ BBB have ST depression or elevation and broad, discordant T waves associated with them

A

LBBB

-t wave goes in opposite direction of end of QRS

118
Q

LBBB is either from:

A

-block of LB
-block of BOTH fascicles of LB

119
Q

Depolarization occurs from L > R by cell-cell transmission in _ BBB

A

LBBB

120
Q

Which complexes appear sharper, RBBB or LBBB

A

RBBB
-BROAD MONOMORPHIC COMPLEXES IN LBBB

121
Q

LBBB: Complexes in V1 and V2 are _ (pos/neg) and in V5 and V6 they are _ (pos/neg)

A

V1+2 = NEGATIVE

V5+6 = POSITIVE

122
Q

3 main criteria for LBBB:

A
  • QRS > 0.12s

-broad, monomorphic R wave in I and V6 with NO Q WAVE

-broad, monomorphic S wave in V1, maybe small R wave

-others: LBBB notched in V6, no rabbit ears, LAD

123
Q

Look for BBB in which leads mainly?

A

I, V1, V5 or V6

124
Q

Common causes of LBBB:

A

HTN
CAD
dilated CM
HD
Infiltrative diseases

may be 1st clue to other serious dz:
-advanced CAD, CM, valve dz, HTN dz

125
Q

Can you dx LVH or RVH with LBBB?

A

NO!

126
Q

Can you dx LVH or RVH with RBBB?

A

LVH, not RVH bc true size of complex can’t be assessed bc beats are abberent

127
Q

Can you dx an infarction with a L or R BBB?

A

yes, both. Same with AE

128
Q

T/F A localized intraventricular conduction delay is > 0.12s for QRS

A

false
-looks like QRS with many peaks
-GENERALIZED ICD is >0.12s without BBB criteria

129
Q

Localized Intraventricular conduction delays are often seen in lead _

A

III

130
Q

When noting a generalized intraventricular conduction delay with >0.12s QRS without BBB criteria you should anticipate _ abnormalities

A

electrolyte
-HYPERKALEMIA

131
Q

4 possibilities of wide QRS complexes:

A

-LBBB
-RBBB
-IVCD (hyper K)
-ventricular or aberrantly conducted beats (VT?)

132
Q

Most LBBB have a _ or _ axis

A

normal or LAD

133
Q

Which type of BBB can you dx ventricular hypertrophy in?

A

RBBB and only LVH
-can also do atrial enlargement

134
Q

Intraventricular conduction delays
-Localized will have a _ (normal/prolonged) QRS
-Generalized will have a _ (normal/prolonged) QRS

A

Local = normal

Generalized = prolonged

135
Q

Hemiblock is half of _ BBB is blocked after splitting into _ and _ fascicles

A

LBBB
anterior and posterior fascicles

136
Q

The left _ fascicle has organized, thin fibers and give rise to Purkinje fibers.

A

anterior

137
Q

The left _ fascicle has loose, fanning fibers.

A

posterior

138
Q

The left anterior fascicle innervated the _ and _ wall of the LV

A

anterior and lateral

139
Q

The left posterior fascicle innervated the _ and _ walls of LV

A

inferior and posterior

140
Q

Which fascicle innervates the anterior + lateral LV wall

A

LAF

141
Q

Which fascicle innervates the inferior + posterior LV wall

A

LPF

142
Q

Hemiblocks alter vectors produced by the _ ventricle

A

L

143
Q

Hemiblocks will cause _ _ and _ (will/will not) prolong the QRS.

A

axis dev
will NOT prolong QRS

-look at LIMB leads for dx

144
Q

Look at _ leads to dx hemiblocks

A

limb

145
Q

Single most useful lead to distinguish RBBB and LBBB is _. With RBBB last segment of QRS will always be _ (pos/neg) and LBBB will always be _ (pos/neg)

A

V1!!!!

RBBB last seg QRS = positive

LBBB last seg QRS = negative

146
Q

Which is more common, L anterior fascicle block or L posterior fascicle block?

A

LAFB

147
Q

LAFB causes _ axis dev

A

LAD -30 to -90

148
Q

L anterior hemiblock criteria:

A
  • LAD (-30 to -90)

-qR complex or R wave in lead I

-rS complex in lead III, possibly II and aVF

SHORTCUT: QRS complex is positive in I and negative in aVF and II

149
Q

T/F LPH is rare because hard to block from wide range fibers so lesion would have to be huge

A

t

150
Q

LPH criteria:

A

-Axis of 90-180 in R quadrant (RAD)

-s wave in I and q wave in III

-exclude RAE (tall P wave >2.5mm in limbs) and/or RVH (R>S in V1 and S>R in V6)

151
Q

Most common cause of RAD is

A

RVH

152
Q

If there is RAD but no signs of RAE or RVH what is it most likely?

A

L posterior hemiblock!
-dx of exclusion!

153
Q

P waves are normally positive in leads (5 total):
Negative in lead _
Commonly biphasic in lead _

A

Positive: I, II, V4, V5, V6

Negative: aVR

Biphasic: V1

154
Q

Which lead NORMALLY has a negative P wave?

A

aVR

155
Q

Which lead has a NORMALLY biphasic p wave?

A

V1

156
Q

Best leads to look for atrial enlargement?

A

II and V1

-II is parallel to mean vector of atrial depolarization
-V1 perpendicular to mean vector of atrial depolarization and closest to atria (MAYBE SINGLE BEST LEAD TO LOOK AT FOR THIS)

157
Q

RAE criteria:
-tall/narrow

A

P wave in inferior leads (II,III, aVF) >2.5mm

P wave in V1 or V2 >1.5mm

R rotation

158
Q

Main cause of RAE

A

COPD, pulm HTN

159
Q

P pulmonale is mainly found in leads _ and _

A

II and III

160
Q

P wave in p pulmonale must be _ mm tall

A

2.5

161
Q

P pulmonale is a sign of _ atrial enlargement

A

RAE

162
Q

T/F peaked P wave <2.5mm is assoc with RAE

A

false
can be less than this in precordial leads

163
Q

T/F P Pulmonale is seen in precordial leads

A

false

164
Q

LAE criteria:

A

-prolonged (>0.11s), notches P with 0.04s between waves in II

-term portion of p wave >1mm below isoelectric line in V1

-term portion of pwave >0.04s in width

165
Q

T/F LAE seen best in inferior leads

A

t

166
Q

Most reliable dx for LAE is:

A

Terminal portion of p wave > 0.04s wide (look in inferior leads II, III, aVF)

167
Q

P mitrale is assoc with _ AE

A

L

168
Q

P mitrale width of notched p must be at least _ s

A

0.04

169
Q

T/F P mitrales are a common finding

A

F

170
Q

Notching of P wave in P mitrale is due to slower conduction thru the _ atrium

A

LA

171
Q

LAE causes:

A

severe systemic HTN
aortic or mitral valve dz
restrictive CM
LV failure

172
Q

T/F Obstructive CM is a cause of LAE

A

false, RESTRICTIVe

173
Q

LVH effect on EKG:

A

more mass/cells = more APs generated = larger vector = increased amp (esp in precordials!)

pushed heart closer to CW = larger QRS complexes!!

174
Q

LVH criteria:

A

**(S in V1 or V2) + (R in V5 or V6) = or > 35mm

any precordial lead QRS >45mm**

R in aVL >11mm
R in I >12mm
R in aVF >20mm

175
Q

RVH criteria:

A

Limb leads:
-RAD (axis >100)
-lead I more negative than positive

Precordial:
-R wave prog disrupted
-V1 = largest, R>S wave
-V5 and V6 = smallest S>R wave

176
Q

Hexaxial system: leads + degrees
I

A

I = 0deg

177
Q

Hexaxial system: leads + degrees
II

A

II = 60deg

178
Q

Hexaxial system: leads + degrees
III

A

III = 120deg

179
Q

Hexaxial system: leads + degrees
aVR

A

aVR = -150deg

180
Q

Hexaxial system: leads + degrees
aVL

A

aVL = -30deg

181
Q

Hexaxial system: leads + degrees
aVF

A

aVF = 90deg

182
Q

What is Einthovens Law and why do we care?

A

size of QRS in lead I + QRS in lead III = QRS in lead II
-if EKG taken simultaneous with limb leads (I,II,III), potential in lead II = sum of I and III

We care bc if leads are placed wrong, this will not be true so abnormal ekg may just be bad lead placement

183
Q

Axis Dev:
Normal, RAD, LAD, Extreme RAD

A

N: 0-90deg
RAD: 90-180deg
LAD: 0-(-90deg)
Extreme RAD: 180 - (-90deg)

184
Q

Axis Dev:
Lead I +
Lead aVF +

A

normal

185
Q

Axis Dev:
Lead I -
Lead aVF +

A

RAD

186
Q

Axis Dev:
Lead I+
Lead aVF -

A

LAD

187
Q

Axis Dev:
Lead I -
Lead aVF -

A

extreme RAD

188
Q

Axis Dev:
Lead I +
Lead aVF biphasic/=

A

borderline N/LAD

189
Q

Axis Dev:
Lead I biphasic/=
Lead aVF +

A

borderline N/RAD

190
Q

EKG truths:
impulse moving toward + electrode = _ (pos/neg) complex

A

positive

191
Q

EKG truths:
impulse moving away from + electrode = _(pos/neg) complex

A

negative

192
Q

EKG truths: impulse moving perpendicularly to + electrode = _ complex

A

isoelectric

193
Q

T/F Only one isoelectric limb lead is on EKG bc only one ventricular axis

A

T

194
Q

Precise axis:

A

look for most biphasic LIMB lead

look perpendicular to that (two directions)

determine axis from I and aVF then use perpendicular line to see precise quadrant

Cardiac For NA (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions