EKG Flashcards
Where to look for RAE
Lead II and V1
Right atrial enlargement: p wave will be too tall, and 1st part will be exaggerated
Where to look for LAE
Lead II and V1
Left atrial enlargement: p wave duration will be too long, and 2nd part will be exaggerated
LVH
look at leads V1-V2, V5-V6, and avL
V1-V2 very deep
V5-V6 very tall
avL >11
RVH criteria
Tall in V1-V2
Deep in V5-V6
RAD will be present
RAD
Lead II and avF
negative in Lead II
positive in avF
LAD
Lead II and avF
positive in Lead II
negative in avF
With BBB, what will we see?
wide QRS duration
LBBB, what leads do we look at?
Lead I and V6
wide UP part (the R wave will be wide)
RBBB criteria
Lead I and V6
wide DOWN part (the S wave)
also may see M shape rabbit ears in V1-V2
LAHB is associated with
strong LAD
look at lead II, if negative, strong indication that LAHB is present
LPHB is assoc with
strong RAD
LAHB criteria
Lead I and Lead III
Lead I: tall
Lead III: deep
LPHB
assoc w strong RAD
tall in Lead III
lead III is the part of pie slice on the RAD side
Between Ventricular hypertrophy and BBB, which one trumps on an EKG?
BBB
can’t assess for ventricular hypertrophy in the setting of BBB
WPW syndrome
short PRI
wide QRS
“delta waves”
vulnerable to supraventricular tachycardia
LGL syndrome
short PRI
no delta waves
Strong, peaked T waves
Hyperkalemia
Flattened T waves
+ “U waves”
Hypokalemia
What is Ca2+ relationship with QT intervals?
inverse
HYPERcalcemia: short QT
HYPOcalcemia: long QT interval
Short QT interval
Gradual downslope of ST segment making it “coved”
“Dig effect”
All intervals are prolonged
+
“Osborn waves”
Hypothermia
Spike is showing up where it should not be,
not sensing the natural activity of the heart
Failure to sense
pacemaker is throwing its vibes out there, but the heart is not responding
failure to capture
a spike not followed by a p wave or QRS wave
overestimating the heart’s ability to do anything naturally, uhhhhhh hello?
failure to pace
Posterior MI
look at V1-V2
ST depression, but they are not d/t reciprocal changes.
the rest of the EKG is normal
What are reciprocal changes?
ST depression in the leads opposite of where the MI is
Signs of PE
other than sinus tachy
S1 Q3 T3
large S (down part) in lead I
in lead III: large Q (down part) and inverted T wave
HyperCa puts pt at increased risk for:
BBB and AV blocks
What causes prolonged QT?
low Ca
low Mg
Low K
and “T-PAM”
TCA
Phenothiazines
Anti-arrhythmic
Macrolides
WPW is d/t pre-excitation going through the:
Bundle of Kent
LGL is d/t pre-excitation going through the:
James fibers
J point notching
ST elevation but we see the J point notch all up in the QRS’s business
Benign early repolarization
young, healthy patients
Electrical alternans assoc with
Pericarditis with LARGE effusion
heart may be rotating freely in the fluid making ever changing QRS complexes
SQT
1:3:3
Large PE
QTc interval
“corrected QT interval”
represents both depol and repol but corrected for Heart Rate
QTc increases the risk for TdP
what are the criteria for Men and Women?
> 0.44 in M
>0.46 in F
“U waves”
Hypokalemia
Digoxin effects
Slows HR and AV conduction, but
Increases myocardial contractility
Toxic blood levels of Digoxin, what happens?
> 2.4
Conduction blocks or Tachy-dysrhythmia
or BOTH
Increased risk if you have Kidney dz already or Hypokalemia
“Dig effect” therapeutic levels, ok, do not need to discontinue drug
Flattened T waves
short QT interval
Gradual downslope of the ST segment, “coved”
What is the most common rhythm disturbance d/t Digoxin?
PAT w 2nd degree AV block (2:1)
Dig toxicity associated with
Hypokalemia
When to stop drug if it is affecting the QTI?
if >25% prolongation develops
“osborn waves”
Hypothermia
With Hypothermia, “osborn” waves, there is early repol, but how is it different than early benign repol?
With osborn waves, it dips way down after the early repol
Brugada syndrome
Rare, inherited Autosomal Dominant
Results in EKG abnormalities that cause sudden death d/t A-Fib
Tx for Brugada syndrome
ICD (implanted defibrillator)
3 diff types with variable ST elevation
What two things cause decreased/shorter QT interval?
High Ca2+
Digoxin
