EKG Flashcards by Alegra Mendez

Normal QRS axis

-30 and +100

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PR interval

120-200 ms (3-5 small boxes)

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QRS interval

<80 ms (2 small boxes or less)

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QT interval

<1/2 R-R interval

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QTC

QT int/sq rt(R-R)

~400 ms

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PR interval boundaries

from start of P to start of Q

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narrow PR

pre-excitation

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Prolonged PR

more than one big box

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LVH

inc QRS amp

amp of S-wave (v1) + R-wave (V5. V6) >35mm (7 big boxes)
OR
amp of R-wave in aVL >11mm
OR
amp of R-wave in l>15mm

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Inc QRS

LVH

(systemic HTN
AV stenosis
HCM)

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dynamic ST elevation

acute MI

pericarditis

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stable ST elevation

LV aneurysm, LBBB

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sudden ST depression

sudden myocardium ischemia

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chronic ST depression

LVH

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anterior STEMI

leads
I
aVL
V2-V4

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inferior STEMI

leads
II
III
aVF

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T wave inversion

recent bout of myocardial ischemia

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first degree AV block

PR int > 200 ms

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progressive inc PR then non-conducted

second degree AV block
Mobitz I AV block
Wenkebach

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fixed PR then non-conducted

second degree AV block

Mobitz II

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regular R-R intervals
varying P waves
narrow QRS

third degree AV block
complete block
w/ AV escape

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regular R-R intervals
varying P waves
wide QRS

third degree AV block
complete block
w/ ventricle escape (UNSTABLE)

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QRS >120 ms

sinus or supra ventricular rhythm

RBBB or LBBB

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QRS >120 ms
sinus or supra ventricular rhythm
RsR’ (V1-2)

RBBB

rabbit ears

QRS >120 ms sinus or supra ventricular rhythm negative wave in V1

LBBB

preceded by P-wave usu narrow QRS may not conduct to ventricle resets SA

supraventricular PAC

no p-wave wide QRS may not conduct to atrium usu no effect on SA

ventricular PVC

bigeminy

alternating normal beat and premature beat

irregularly irregular

A-fib

saw-tooth

atrial flutter | saw tooth=p's

AV reciprocating Tacyhcardia Wolff-Parkinson-White Syndrome

"Bypass tract": connecting atria to ventricle "preexcitation" of ventricle by bypass track (in addition to activation by AV node pathway)

____ tachyarrhythmias are responsive to electrical cardioversion

ventricular

monomorphic VT

wide complex tachycardia, similar QRS wide bc VT lacks coordinate electrical activities of ventricles reentry arrhythmia from one area of ventricle (often prior myovcardial infection scar)

polymorphic VT

wide complex tachycardia, variable QRS acute ischemia, meds that prolong QT can progress to Vfib TORSADES DE POINTES drugs, dec K/Mg, congenital abnml Tx: Mg sulfate

SVT w/ aberrancy

can have wide QRS if BBB AV association (P before QRS)

wide QRS (>120ms) can be

V tach (monomorphic or polymorphic) or supraventricular w/ BBB

first degree AV block tx

benign, no tx needed

lyme disease

AV blocks

P waves and QRS complex dissociation atria rate>ventricle rate

complete AV block

delta wave | short PR

WPW

wide complex irregular tachycardic

a fib in WPW

torsade de pointes

ventricular tachycardia w/ prolonged QT triggered by a PVC at this time

muscle weakness | U waves

hypOkalemia

hypERkalemia

peaked T waves

hypERkalemia

confusion vol depletion short QT

hypERcalcemia

muscle spasms tetany prolonged QT

hypOcalcemia

if sinus pause >3 sec

pacemaker no med therapy options

acute MI EKG

ST elevation

hrs after STEMI EKG

ST elevation dec R wave Q wave begins

days 1-2 post MI EKG

T wave inversion | Q wave deeper

days after MI

ST normalizes | T wave inverted

weeks after MI

ST and T normal | Q wave persists

circumnavigating tricuspid valve annulus

a flutter

paroxysmal supraventricular tachycardia

- regular tachycardia (typically narrow QRS complex) - sudden onset/offset - P waves may be hidden in the QRS complex or buried in ST segment - AVNRT - AVRT

AVNRT

- reentrant arrhythmia contained within the AV node - fast path (slow repolarization) - slow path (fast repolarization) - wave arrives at AV node while fast path has not yet depolarized, so wave travels down slow but then reenters fast and goes up. - activation of ventricles and atria each time process repeats terminates via block of AV node (vagal maneuvers or adenosine)

AVRT

- caused by "bypass tract" connecting atria to ventricle (WPW) - "preexcitation" of ventricle - accessory path of myocardial fibers exists that traverses the AV groove acting as a parallel conduction system - usu ORTHODROMIC (narrow QRS) ----> impulses go down AV and depolarize ventricle, then return to atrium retrograde via bypass tract (impulse going ventricle --> atria) and activating atrium. AV node activate and process repeats. - rarely antegrade (antidromic) - NO decremental conduction properties characteristic of the AV node --> shortened PR

most feared complication of WPW

a fib