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EKG > EKG > Flashcards

EKG Flashcards

1
Q

Regular P waves are positive in what leads and negative in what lead to be normal sinus?

A

I, II

AvR

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2
Q

The normal sinus atrial rate ranges from 40-180, what rates distinguish brady, tacky and normal?

A

<60 brady, 60-100 normal, 100-180 tachy

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3
Q

A sinus p wave is never negative in what leads?

A

AvF and II

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4
Q

What is the rate of ectopic supra ventricular tacky?

A

130-220

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5
Q

What is the atrial rate of flutter?

A

220-360

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6
Q

If atrial analysis cannot be determined, and there are narrow QRS waves, war are the 3 possibilities and their rates?

A
  • VR < 140 → Sinus or A. flutter with 2:1 AV block
  • VR > 180 → PVST
  • VR 140-180 → any of the previous possibilities
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7
Q

If atrail analysis cannot be determined, and their are wide QRS, what should happen?

A

Go to ventricular analysis

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8
Q

In the atrioventricular analysis, what do we look at if the P:QRS ratio is 1:1?

A

PR interval length

- if greater than .2–> 1st degree AV block

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9
Q

In the atrioventricular analysis, what do we look at if the P:QRS ratio is not 1:1?

A

If AR>VR or vice versa

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10
Q

If AR>VR what types of blocks do we think about?

A

2nd and 3rd degree AV blocks

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11
Q

What type of block has PR intervals that vary?

How do we distinguish the difference?

A

Mobitz I and 3rd AV blocks

Does RR vary too?–if it does its Mobitz 1 or wenckebach

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12
Q

What type of block has AR>VR and the PR does not vary?

A

2nd degree mobitzII or 2:1 or advanced block

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13
Q

If AR<VR what is it?

A

Interference AV Dissasociation

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14
Q

When do we do a ventricular analysis?

A

Use when unable to find P waves or AV dissociation is present (3rd Degree AV block or interference)

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15
Q

What is the first think we look for in ventricular analysis?

A

is QRS >.12

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16
Q

If we have a wide QRS in ventricular dysrrhthymia , what are the 3 diagnosis and their rates?

A

< 40 → Ventricular escape rhythm

55-110 → Accelerated idioventricular rhythm
Often seen in the first few hours following a STEMI with Q waves

120-200+ → V. tach (monomorphic or Torsades) All regular and wide QRS tachycardias are V. tach until proven otherwise

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17
Q

If we are in the dysrrhthymia ventricular analysis and we have a normal QRS, what are the 3 diagnosis and their rates?

A

≤ 60 → Junctional escape rhythm

70-130 → Accelerated junctional escape rhythm

140-220 → PSVT

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18
Q

In ventricular analysis, we check the QRS first and then what next?

What are we looking for?

A

R-R intervals- unexpected QRS occurring early?

APCs or VPCs

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19
Q

What do we need to look at if their are unexpected long R-R intervals?

A

Whether or not a P wave is in the pause

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20
Q

If there is a long R-R and a p wave is in the pause in a premature fashion, what is the diagnosis? Ontime?

A

non-conducted APC

Mobitz I or II

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21
Q

If there is a long R-R and a p wave is absent in the pause, what is the diagnosis?

A

sinoatrial arrest

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22
Q

A normal QRS should be how big?

A

<.12

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23
Q

If the QRS is big and the PR is under .12, what should we immediately look for, and if we find it, what is the diagnosis?

A

Delta waves- WPW

DIAGNOSIS STOPS HERE

24
Q

If QRS is big and the PR is normal, what are the 3 possible diagnosis?

A

RBBB, LBBB, and non-specific IVCD

25
Q

If the QRS is big and the PR is normal. What do we see in RBBB?

A

RsR’ pattern or terminar R in the V1 or V2 leads

GO ON TO EVALUATE AXIS and Q waves

26
Q

If the QRS is big and the PR is normal. What do we see in LBBB?

A

If there is mid-QRS notching or a deep negative Q or S wave V5 or V6

DIAGNOSIS STOPS HERE

27
Q

AvL is at what degrees?

A

-30

28
Q

lead I is at what degrees?

A

0

29
Q

Lead AvR is at what degrees?

A

-150

30
Q

LEAD II is at what degrees?

A

60

31
Q

Lead III is at what degrees?

A

120

32
Q

LEAD AvF is at what degrees?

A

90

33
Q

What is the axis if lead I and II are positive?

A

-30 to 90= Normal

34
Q

What is the axis if positive in I and negative in II?

A

-30 to -90= LAD

35
Q

What is the axis if negative in I and positive in II?

A

90-180= RAD

36
Q

What is exclusively from -45 to -90?

A

left anterior hemiblock

37
Q

What can be the two possible diagnosis for an axis of -31 to -45?

A

Inferior MI or LVH

38
Q

What 3 diagnosis do we need to think of if there is an RAD?

A

RVH (and or COPD), high lateral MI, left posterior hemlock

39
Q

With RAD, what should we look for to diagnose RVH?

A

Huge R waves in V1

40
Q

With RAD, what should we look for to diagnose high lateral MI?

A

weird Qs in lead I

41
Q

What do we think if we don’t se large V1 R waves or Qs in lead I in RAD?

A

LPHB-(inferior MI signs might also be present and more confirmatory)

42
Q

to evaluate QRS, what leads do we look for abnormal Qs in?

A

Leads I, II, aVF, and V2-V6

43
Q

An abnormal Q is how big?

A

≥ 0.04 sec (≥ 1 small square in width), or 1/3 of the total QRS amplitude

44
Q

Any q wave in what lead is always pathogenic regardless of the size?

A

V2

45
Q

Abnormal Q waves in V2 or V3 suggest an infarct where?

A

anterior

46
Q

Abnormal Q waves in V5 or V6 suggest an infarct where?

A

Lateral

47
Q

Abnormal Q waves in V1 suggest an infarct where?

A

High lateral wall

48
Q

Abnormal Q waves in AvF suggest an infarct where? What else should we look for?

A

Inferior

Relation of the QRS axis in the presence of definite inferior MI

  • If the axis is -35 to -40 → LAD and inferior MI
  • If the axis is -45 or beyond → LAHB and inferior MI
49
Q

What should happen to R and S waves moving from V1 to V6?

A

R waves should become greater in magnitude while S waves become lesser in magnitude over the progression from Lead V1 to V6

50
Q

If there are large R waves >5mm in V1 and normal QRS width, what 2 things should we think? how do we distinguish them?

A

True posterior infarct or RVH

  • RAD?–>RVH
  • path Q in AvF–>true posterior infarct (same artery to get an inferior infarct as posterior)
51
Q

what is the Diagnosis If large R waves in Lead V5 or V6 and large Q or S waves in Lead V1 or V2

A

LVH needs to be >35mm

52
Q

What is the last thing we need to check for in EKg?

A

T waves and ST abnormalities

53
Q

If there are fairly localized ST elevations paired with ST depressions in the reciprocal leads, what does this suggest?

A

MI

54
Q

If there are diffuse ST elevations in all leads except Leads V1 and aVL, what does this suggest? what lead may have a reciprocal ST depression?

A

Pericarditis

aVR

55
Q

T_F–any ST depression is abnormal?

A

True

56
Q

If ST depression is straight and oriented horizontally or down-sloping, is suggestive of what?

A

subendocardial ischemia, injury or infarction (NSTEMI)

57
Q

What do we do after a 3rd degree AV block is determined?

A

QRS VENTRICULAR ANALYSIS

EKG (1 decks)

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