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ER 2 > EKG > Flashcards

EKG Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Axis Measurements:

  • Normal
  • LAD: pathologic and non pathologic
  • RAD
A

NL: 0 to 90
LAD pathologic: < -30
LAD non-path: 0 to -30
RAD: >90

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2
Q

I and AVF

  • Nl
  • LAD
  • RAD
A

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

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3
Q

Chart to remember to calculate axis

A 
I: 90
II: -30
III: 30
AVR: -60
AVL: 60
AVF: 0
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4
Q

Electrical movement in heart

A
  • Bundle of His to R and L sides

- Left splits into L anterior and L posterior fascicles

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5
Q

Bundle Branch Block

- Overview

A
  • must have wide QRS (=> 120 ms)
  • V1 and V2: what it is
  • I and V6: what it ain’t
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6
Q

Right BBB

A
  • Bunny in V1 (rabbit in V1 is right)

- I and V6: leaning L/slurred S

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7
Q

Left BBB

A
  • Bunny in I and V6

- V1: leaning L/slurred S

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8
Q

How to find fascicular blocks

A
  • 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
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9
Q

Definition of MI on EKG

A
  • 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)
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10
Q

Definition of ischemia on EKG

A
  • ST depression
  • T wave inversion
  • NO other signs of MI
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11
Q

In what circumstance should you place V4 on the right side of the body and why

A
  • 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
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12
Q

Pathologic Q wave definition

A
  • =>0.04 sec and 1/4 height of QRS
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13
Q

What does PR elevation throughout indicate?

A

Pericarditis

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14
Q

What does a posterior MI look like?

A

V2: very tall R wave and scooped S

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15
Q

In what situation can you not call a MI on a EKG?

A

LBBB

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16
Q

RAE

A
  • Peaked P wave in II and V1
  • Usually dt pulm issues, mitral issues
  • “P pulmonale”
17
Q

LAE

A
  • Lead II: broad and m-shaped p wave

- V1: biphasic or inverted P-wave

18
Q

BAE

A

features of both LAE and RAE

19
Q

LVH

A
  • AVL R wave >11
  • V1 S + V5/V6 R >35
  • Does not require LAD
  • Often dt HTN
20
Q

RVH

A
  • V1, V2, V3 Large R wave (esp compared to V4-V6)
  • RAD required
  • AVR R wave >5
  • V1 R wave >7
21
Q

Normal R wave progression

A

increases from V1-V4 where it peaks, then slight decrease from V4-V6

22
Q

What is special about V1

A

should not have a T wave or will have upside down T wave

23
Q

How to tell if correct arm placement of leads?

A

QRS in I + QRS in III = QRS II

24
Q

What does “possible anterior infarct” on the EKG mean

A

poor R wave progression

25
Q

Pulmonary embolism on EKG

A

S1Q3T3
I: deep S
III: Q wave and flipped T

26
Q

Bat wing

A
  • deep inverted T waves
  • SAH
  • Usually in V leads, can be anywhere
27
Q

Hyperkalemia

A

peaked T-waves with a point

- think renal failure

28
Q

WPW

A
  • Delta wave on QRS
  • can lead to SVT
  • “heart raced, feel better now”
29
Q

Prolonged QTc

A
  • T wave > 2 big box from QRS
  • Usually dt hypocalcemia or meds
  • R on T = torsades
  • “fainted, feel better now”
30
Q

Short QTc

A
  • can lead to vtach
  • often hypercalcemia
  • “felt woozy”
31
Q

Hypertrophic cardiomyopathy

A
  • weekend warriors
  • Deep Q, Tall R, deep flipped T in lateral leads
  • Usually also LVH
32
Q

Burgada syndrome

A
  • “shark fin syndrome”
  • T wave in V1 or V2
  • Na ion channelopathy
  • leads to vtach and vfib
33
Q

Arrythmogenic RV dysplagia/cardiomyopathy

A
  • “almost passed out, ok now”

- V1 and V2 ST seg epsilon wave, looks like a nipple

34
Q

Electrical alternans

A
  • Extreme SOB

- cardiac tamponade

35
Q

Wellen sign

A
  • “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
36
Q

Hyperacute T wave

A
  • Broad and asymmetrical (vs. peaked from hyperkalemia)

- Percursor to MI

37
Q

What to look at on AVR

A
  • 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

ER 2 (10 decks)

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