EKG

Question 1

Where to look for RAE

Answer 1

Lead II and V1

Right atrial enlargement: p wave will be too tall, and 1st part will be exaggerated

Question 2

Where to look for LAE

Answer 2

Lead II and V1

Left atrial enlargement: p wave duration will be too long, and 2nd part will be exaggerated

Question 3

LVH

Answer 3

look at leads V1-V2, V5-V6, and avL

V1-V2 very deep
V5-V6 very tall
avL >11

Question 4

RVH criteria

Answer 4

Tall in V1-V2
Deep in V5-V6
RAD will be present

Question 5

RAD

Answer 5

Lead II and avF

negative in Lead II
positive in avF

Question 6

LAD

Answer 6

Lead II and avF

positive in Lead II
negative in avF

Question 7

With BBB, what will we see?

Answer 7

wide QRS duration

Question 8

LBBB, what leads do we look at?

Answer 8

Lead I and V6

wide UP part (the R wave will be wide)

Question 9

RBBB criteria

Answer 9

Lead I and V6
wide DOWN part (the S wave)

also may see M shape rabbit ears in V1-V2

Question 10

LAHB is associated with

Answer 10

strong LAD

look at lead II, if negative, strong indication that LAHB is present

Question 11

LPHB is assoc with

Answer 11

strong RAD

Question 12

LAHB criteria

Lead I and Lead III

Answer 12

Lead I: tall

Lead III: deep

Question 13

LPHB

assoc w strong RAD

Answer 13

tall in Lead III

lead III is the part of pie slice on the RAD side

Question 14

Between Ventricular hypertrophy and BBB, which one trumps on an EKG?

Answer 14

BBB

can’t assess for ventricular hypertrophy in the setting of BBB

Question 15

WPW syndrome

Answer 15

short PRI
wide QRS

“delta waves”

vulnerable to supraventricular tachycardia

Question 16

LGL syndrome

Answer 16

short PRI

no delta waves

Question 17

Strong, peaked T waves

Answer 17

Hyperkalemia

Question 18

Flattened T waves

+ “U waves”

Answer 18

Hypokalemia

Question 19

What is Ca2+ relationship with QT intervals?

Answer 19

inverse

HYPERcalcemia: short QT

HYPOcalcemia: long QT interval

Question 20

Short QT interval

Gradual downslope of ST segment making it “coved”

Answer 20

“Dig effect”

Question 21

All intervals are prolonged
+
“Osborn waves”

Answer 21

Hypothermia

Question 22

Spike is showing up where it should not be,

not sensing the natural activity of the heart

Answer 22

Failure to sense

Question 23

pacemaker is throwing its vibes out there, but the heart is not responding

Answer 23

failure to capture

a spike not followed by a p wave or QRS wave

Question 24

overestimating the heart’s ability to do anything naturally, uhhhhhh hello?

Answer 24

failure to pace

Question 25

Posterior MI

Answer 25

look at V1-V2 ST depression, but they are not d/t reciprocal changes. the rest of the EKG is normal

Question 26

What are reciprocal changes?

Answer 26

ST depression in the leads opposite of where the MI is

Question 27

Signs of PE | other than sinus tachy

Answer 27

S1 Q3 T3 large S (down part) in lead I in lead III: large Q (down part) and inverted T wave

Question 28

HyperCa puts pt at increased risk for:

Answer 28

BBB and AV blocks

Question 29

What causes prolonged QT?

Answer 29

low Ca low Mg Low K and "T-PAM" TCA Phenothiazines Anti-arrhythmic Macrolides

Question 30

WPW is d/t pre-excitation going through the:

Answer 30

Bundle of Kent

Question 31

LGL is d/t pre-excitation going through the:

Answer 31

James fibers

Question 32

J point notching ST elevation but we see the J point notch all up in the QRS's business

Answer 32

Benign early repolarization young, healthy patients

Question 33

Electrical alternans assoc with

Answer 33

Pericarditis with LARGE effusion heart may be rotating freely in the fluid making ever changing QRS complexes

Question 34

SQT 1:3:3

Answer 34

Large PE

Question 35

QTc interval

Answer 35

"corrected QT interval" represents both depol and repol but corrected for Heart Rate

Question 36

QTc increases the risk for TdP what are the criteria for Men and Women?

Answer 36

>0.44 in M | >0.46 in F

Question 37

"U waves"

Answer 37

Hypokalemia

Question 38

Digoxin effects

Answer 38

Slows HR and AV conduction, but Increases myocardial contractility

Question 39

Toxic blood levels of Digoxin, what happens?

Answer 39

>2.4 Conduction blocks or Tachy-dysrhythmia or BOTH Increased risk if you have Kidney dz already or Hypokalemia

Question 40

"Dig effect" therapeutic levels, ok, do not need to discontinue drug

Answer 40

Flattened T waves short QT interval Gradual downslope of the ST segment, "coved"

Question 41

What is the most common rhythm disturbance d/t Digoxin?

Answer 41

PAT w 2nd degree AV block (2:1)

Question 42

Dig toxicity associated with

Answer 42

Hypokalemia

Question 43

When to stop drug if it is affecting the QTI?

Answer 43

if >25% prolongation develops

Question 44

"osborn waves"

Answer 44

Hypothermia

Question 45

With Hypothermia, "osborn" waves, there is early repol, but how is it different than early benign repol?

Answer 45

With osborn waves, it dips way down after the early repol

Question 46

Brugada syndrome

Answer 46

Rare, inherited Autosomal Dominant Results in EKG abnormalities that cause sudden death d/t A-Fib

Question 47

Tx for Brugada syndrome

Answer 47

ICD (implanted defibrillator) 3 diff types with variable ST elevation

Question 48

What two things cause decreased/shorter QT interval?

Answer 48

High Ca2+ | Digoxin