EKG Class

Question 1

Answer 1

DeWinters

ST dep EVERYWHERE + upright Ts

Patient is having a heart attack get em to the cath lab

Question 2

poor R wave progression

Answer 2

< 3 mm by V3

MALL COP (Myocarditis, Anterior MI/Amyloid, LVH, LBBB, COPD, Pneumothorax)

Question 3

Answer 3

Schamroth’s sign = COPD

Lead I –> isoelectric + low voltage

Question 4

normal PR interval

Answer 4

0.12 - 0.20 (< 1 big box)

Question 5

normal QRS interval

Answer 5

0.08 - 0.09 sec (< 1/2 a big box)

Question 6

normal QT

Answer 6

men 0.39 - 0.45, women 0.46 (< 2 big + 1 small box)

Question 7

low voltage

Answer 7

limb leads < 1 big box (5mm)

precordial leads < 2 big boxes (10mm)

Question 8

causes of low voltage

Answer 8

COPD, pericardial probs (effusion, itis), acute MI, hypothyroid, hypothermia, infections (Kawasaki, abscess), post-op fibrosis, obesity, meth

Question 9

causes of sudden death in young athletes

Answer 9

HOCM, commotio cordis, arrhythmogenic right ventricular cardiomyopathy (ARVC, italians, epsilon wave in V1-3)

Question 10

causes of long QT

Answer 10

congenital (Romano-Ward)

metabolic (hypo K, Mg, Ca)

sinus/AV nodes

Rx

…………………………………………………………………………..

3 ANTIs –> antiarrhythmics, anticholinergics AND organophosphate poisoning, antihistamines

6 you take when you’re SICK –> malaria, azoles, FQs, macrolides, HIV, metronidazole

cancer drugs, propofol, opioids, albuterol, zofran, haldol, TCAs, atomoxetine, cocaine

Question 11

Draw a normal axis

Answer 11

Question 12

Q1

Answer 12

normal

Question 13

Q2

Answer 13

right axis deviation, left posterior fascicular block, RVH (pulm HTN)

Question 14

Q3

Answer 14

no

Question 15

Q4

Answer 15

left axis deviation after -30, left ANTERIOR fascicular block

Question 16

inferior MI

Answer 16

II, III, AVF

Question 17

posterior MI

Answer 17

ST dep V1-V2, upright T, large R

Question 18

low lateral MI

Answer 18

V5-6 ST elev

Question 19

high lateral MI

Answer 19

I, AVL ST elev

Question 20

anterior MI

Answer 20

V3-4 = apical

V1-2 = septal

V1-4/5 = anterior

Question 21

get right sided leads

Answer 21

pt with CP/diaphoresis, etc w/ a normal EKG, V4 most sensitive, no nitro, give esmolol

Question 22

serial changes of a STEMI (not reperfused)

Answer 22

1 h = ST elev

12 h = ST elev + inverted T

18 h+ = Qs + inverted Ts

Question 23

pathologic Q

Answer 23

> 25% R

wider than 0.03 s (1 small box)

Question 24

non-pathologic Q

Answer 24

isolated III or V1

small, narrow

Question 25

Q waves all over the place

Answer 25

HOCM

Question 26

ST elev w/ well developed Qs

Answer 26

LV dyskinesis / LV aneurysm

Question 27

R in V1 or 2, isoelectric ST, upright T

Answer 27

old posterior MI

Question 28

MI complications

Answer 28

3-8 days after CP free wall rupture pap muscle rupture, systolic decrescendo murmur, pulm edema VSD, holosystolic murmur, thrill

Question 29

sounds of ischemia

Answer 29

S4 late systolic murmur (pap muscle)

Question 30

Q wave

Answer 30

atrial depol \< 3 mm width and height (~1/2 big box) big Q = tricuspid stenosis, Ebstein's anomaly

Question 31

heart rate

Answer 31

300, 150, 100, 75, 60, 50

Question 32

Answer 32

PR depression pericarditis, early repolarization

Question 33

short PR

Answer 33

WPW, heart block, junctional rhythm (upside down Ps in II, III, AVF)

Question 34

long PR

Answer 34

elderly, Rx (heart drugs, propofol), ARF, SLE, AV endocarditis (abscess obstructs the bundle of his)

Question 35

QRS width 0.09 - 0.11 s (\> 2 small boxes)

Answer 35

incomplete bundle branch block, IV conduction delay

Question 36

QRS width 0.12 - 0.16 s (\> 3 small boxes)

Answer 36

bundle branch block, V tach

Question 37

REALLY wide QRS

Answer 37

hyper K, give Ca gluconate/Ca chloride

Question 38

normal T wave

Answer 38

\< 1/2 R, same direction as QRS

Question 39

inverted T

Answer 39

amp \< 5mm (big box), hyperventilation, pain amp \> 5mm, ischemia (+CP), CNS T waves, cocaine Tokotsubo, pheochromocytoma)

Question 40

biphasic T

Answer 40

V1-4, Wellan's warning LAD stenosis

Question 41

U wave

Answer 41

if the computer thinks it's a ridiculous QT ~0.6 s think hypo K

Question 42

inverted P in AVL

Answer 42

COPD

Question 43

ST elev in V1

Answer 43

could be MI, but also think about acute R heart strain (PE)

Question 44

width of LV and RV free walls

Answer 44

1 cm, 2mm

Question 45

aneurysm v pseudoaneurysm

Answer 45

true = muscle, wide mouth, don't rupture, embolis, VT reentry arrhythmia, CHF pseudo = adventitia, narrow mouth, inferior wall infarcts, EMERGENCY

Question 46

acute posterior MI

Answer 46

V1/2 --\> Tall R, ST dep, upright T (old posterior = tall R, Ts may be up or down)

Question 47

RCA occlusion

Answer 47

inferior (PDA, II, III, AVF) posterior (V1-3 R, ST dep, upright T) lateral (V5-6)

Question 48

LAD occlusion

Answer 48

bifascicular block (before septal perforator) V1-6, I, AVL after septal perforator before diagonal V1-4/5/6, I, AVL after diagonal V1-4/5 apical V3-4 isolated diagonal I, AVL

Question 49

diffuse T wave inversions

Answer 49

cocaine, CNS, tokotsubo

Question 50

sinus arrhythmia

Answer 50

inspiration --\> negative pressure --\> BP drops --\> HR increases

Question 51

II-III/VI systolic flow murmur + fixed split S2 @ 2nd L intercostal space

Answer 51

ASD