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EKG > EKG Axis and Blocks > Flashcards

EKG Axis and Blocks Flashcards

1
Q

Axis range for Left Axis Deviation (LAD)

A

-90 to -30

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2
Q

Axis range for Right Axis Deviation (RAD)

A

+90 to +180

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3
Q

Axis range for normal axis

A

-30 to +90

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4
Q

Axis range for extreme axis

A

+180 to -90

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5
Q

Qualitative approach to finding axis deviation

A

Look at leads I and aVF. I is + and aVF is -, look at lead II. + in lead II is normal and - is LAD.

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6
Q

Equiphasic approach to finding axis deviation

A
  1. Equiphasic
  2. Lead 90 degrees to that
    • lead, QRS is that angle
    • lead, QRS is 180 degrees of that angle
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7
Q

What does is mean when all leads are equiphasic?

A

COPD

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8
Q

What are the EKG signs of right atrial enlargement?

A 
Lead II P wave is >2.5mm
Lead V1 (biphasic) P wave is bigger + (>1 small box)
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9
Q

What are the EKG signs of left atrial enlargement?

A 
Lead II P wave has two humps and >120ms
Lead V1 (biphasic) P wave is bigger - (>1 small box)
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10
Q

What are the EKG signs of right ventricular hypertrophy?

A

QRS axis shifted to the right >+90
Tall R +/- secondary repolarization abnormalities (Downsloping T wave and T wave inversion) in V1 and V2
RAE
RBBB

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11
Q

What are the EKG signs of left ventricular hypertrophy?

A

QRS axis shifted to the left
LAE
Increased R wave in left leads
Increased S wave in right leads (There are criteria to quantitatively calculate QRS voltage).

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12
Q

RBBB Criteria

A

QRS >120ms
M shaped QRS in V1
Prominent s wave in I and aVL
Secondary abnormalities in V1 and V2

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13
Q

LBBB Criteria

A 
QRS >120ms
Broad R wave in I, aVL, V6
Lack of septal q waves in I and v6
Secondary abnormalities in I, aVL, V6
V1 negative QRS
Lead I and V6 positive
New LBBB with an acute MI increases mortality and morbidity.
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14
Q

What is normal septal depolarization direction?

A

q wave which is left to right.

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15
Q

Morphology of an incomplete BBB

A

Same morphology, QRS < 120ms

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16
Q

An important etiology of LBBB

A

acute anterior MI

17
Q

1st degree AV Block

A

PR interval > 200ms. Can get even if healthy. If QRS is wide, there is a block distal to sinus node (BBB?).

18
Q

2nd degree AV Block Type I

A

PR interval progressively lengthens until QRS complex is blocked. PP intervals are regular. Usually due to functional suppression of the AV conduction system. Results in “grouped” beating, detectable on exam as a regular irr rhythm.

19
Q

2nd degree AV Block Type II

A

PR interval is constant, random QRS complex dropped, often at unpredictable times. His-Purkinje system block due to structural damage. If QRS is wide, block is distal to the Bundle of His. Narrow QRS is intranodal (AV).

20
Q

3rd degree AV Block

A

No atrial conduction to the ventricles. Complete AV Dissociation. P waves are constant. Wide QRS is ventricular escape rhythm. Narrow QRS is AV or His escape rhythm.

21
Q

Left Anterior Fascicular Block (LAFB)

A 
Initial vector is downward and rightward. Then upward and leftward.
LAD
small q: I and aVL
small r and big S: II, III, aVF
Intrinsicoid deflection >45ms
Increased limb lead QRS voltage
22
Q

Left Posterior Fascicular Block (LPFB)

A 
Initial vector is upward and to the left, then the electrical activity spreads freely down the ventricle.
RAD
small q and tall R: II, III, aVF
small r and deep S wave: I, aVL
Intrinsicoid deflection >45ms
No additional evidence of RVH
23
Q

How would you quantitatively calculate LVH criteria (specific one)?

A

Sokolov-Lyon criteria: S wave in V1 and tallest R wave in V5 or V6 > 35mm

24
Q

What should you remember when diagnosing LVH?

A

Use both voltage and non-voltage criteria.

25
Q

What is the voltage criteria for LVH in the limb leads?

A

R wave in lead I + S wave in lead III > 25mm
R wave in aVL > 11mm
R wave in aVF > 20mm
S wave in aVR > 14mm

26
Q

What is the voltage criteria for LVH in the precordial leads?

A

R wave in V4, V5, or V6 > 26mm
Sokolov-Lyon Criteria (S V1 + R V5 or V6 > 35mm)
Largest R wave + largest S wave >45mm

27
Q

What is the NON-voltage criteria for LVH?

A

Increased R wave peak time aka intrinsicoid deflection (>50ms)
ST depression and T wave inversion in left-sided leads “Strain pattern”. ST elevation in V1-V3 (discordant to ST depression in left-side)

EKG (7 decks)

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