EKG Flashcards
Axis Measurements:
- Normal
- LAD: pathologic and non pathologic
- RAD
NL: 0 to 90
LAD pathologic: < -30
LAD non-path: 0 to -30
RAD: >90
I and AVF
- Nl
- LAD
- RAD
Nl: both up
LAD: I up, AVF down
* look at lead II: if positive or iso, then non pathologic, if negative, pathologic
RAD: I down, AVF up
Chart to remember to calculate axis
I: 90 II: -30 III: 30 AVR: -60 AVL: 60 AVF: 0
Electrical movement in heart
- Bundle of His to R and L sides
- Left splits into L anterior and L posterior fascicles
Bundle Branch Block
- Overview
- must have wide QRS (=> 120 ms)
- V1 and V2: what it is
- I and V6: what it ain’t
Right BBB
- Bunny in V1 (rabbit in V1 is right)
- I and V6: leaning L/slurred S
Left BBB
- Bunny in I and V6
- V1: leaning L/slurred S
How to find fascicular blocks
- Anterior: Q wave in I and AVL but no Q in II, III, AVF
- Posterior: Q wave in II, III, AVF but no Q in I and AVL
- must be pure
- First look at II and AVL: if both + or - Q, no fascicular block, if one has Q and other does not, look for a block
Definition of MI on EKG
- ST elevation in two contiguous leads in a family
AND - reciprocal changes in two separate contiguous leads in a family (ST depression or T wave inversion)
Definition of ischemia on EKG
- ST depression
- T wave inversion
- NO other signs of MI
In what circumstance should you place V4 on the right side of the body and why
- Inferior wall MI (esp if signs of CHF)
- Very likely if have inferior wall MI will also have RV infarct (1 mm ST elevation on right side).
- Tx = more fluid
Pathologic Q wave definition
- =>0.04 sec and 1/4 height of QRS
What does PR elevation throughout indicate?
Pericarditis
What does a posterior MI look like?
V2: very tall R wave and scooped S
In what situation can you not call a MI on a EKG?
LBBB
RAE
- Peaked P wave in II and V1
- Usually dt pulm issues, mitral issues
- “P pulmonale”
LAE
- Lead II: broad and m-shaped p wave
- V1: biphasic or inverted P-wave
BAE
features of both LAE and RAE
LVH
- AVL R wave >11
- V1 S + V5/V6 R >35
- Does not require LAD
- Often dt HTN
RVH
- V1, V2, V3 Large R wave (esp compared to V4-V6)
- RAD required
- AVR R wave >5
- V1 R wave >7
Normal R wave progression
increases from V1-V4 where it peaks, then slight decrease from V4-V6
What is special about V1
should not have a T wave or will have upside down T wave
How to tell if correct arm placement of leads?
QRS in I + QRS in III = QRS II
What does “possible anterior infarct” on the EKG mean
poor R wave progression
Pulmonary embolism on EKG
S1Q3T3
I: deep S
III: Q wave and flipped T
Bat wing
- deep inverted T waves
- SAH
- Usually in V leads, can be anywhere
Hyperkalemia
peaked T-waves with a point
- think renal failure
WPW
- Delta wave on QRS
- can lead to SVT
- “heart raced, feel better now”
Prolonged QTc
- T wave > 2 big box from QRS
- Usually dt hypocalcemia or meds
- R on T = torsades
- “fainted, feel better now”
Short QTc
- can lead to vtach
- often hypercalcemia
- “felt woozy”
Hypertrophic cardiomyopathy
- weekend warriors
- Deep Q, Tall R, deep flipped T in lateral leads
- Usually also LVH
Burgada syndrome
- “shark fin syndrome”
- T wave in V1 or V2
- Na ion channelopathy
- leads to vtach and vfib
Arrythmogenic RV dysplagia/cardiomyopathy
- “almost passed out, ok now”
- V1 and V2 ST seg epsilon wave, looks like a nipple
Electrical alternans
- Extreme SOB
- cardiac tamponade
Wellen sign
- “ZZ top”
- “Chest pain but ok now”
- EKG findings normally when not in pain
- May be one on a QRS but not the next one…
- Associated with proximal LAD lesions
Hyperacute T wave
- Broad and asymmetrical (vs. peaked from hyperkalemia)
- Percursor to MI
What to look at on AVR
- PR elevations: pericarditis
- ST seg elevation: L. main obstruction
- RR’: TCA poisoning (also will prob be tachycardia and wide QRS)
- ST seg elevation with tachycardia: re-entrant phenomena
