EKG fun

Question 1

In what direction is left axis deviation?

Answer 1

superiorly to the left

Question 2

in what direction is right axis deviation?

Answer 2

inferiorly to the right

Question 3

in what direction is extreme right axis deviation?

Answer 3

superiorly to the right

Question 4

in what leads do you look to detect deviation?

Answer 4

Lead I and aVF

Question 5

Lead I and AVF both have upward QRS?

Answer 5

NORMAL deviation

Question 6

Lead I and AVF both have downward QRS?

Answer 6

Extreme right axis deviation

Question 7

Lead I has downward QRS and AVF has upward QRS?

Answer 7

right axis deviation

Question 8

Lead I has upward QRS and AVF has downward QRS?

Answer 8

Left axis deviation

Question 9

What if (e.g.) Lead III has a QRS complex that is biphasic and equiphasic?

Answer 9

The axis is perpendicular to Lead III

this is AVR, and is either at +30 or -150 degrees.

If AVR has an upward QRS, that means it’s +30 (normal)

If AVR has a downward QRS, that means it’s -150 (extreme R axis deviation)

Question 10

How do you measure rhythm?

Answer 10

Measure from the vertical line of one QRS to another

Question 11

How do you measure HR?

Answer 11

300 rule

Question 12

What does poor R wave progression indicate in the precordial leads?

Answer 12

Scar tissue in the interventricular septum or anterior heart is very likely.

Probably a pt who had an MI at some point in the past

Question 13

What is you have a biphasic and equiphasic QRS complex in Lead I?

Answer 13

This means the axis is perpendicular to lead I… therefore is AVF

AVF can be either +90 (if the wave is positive in AVF - normal to R axis deviation) or -90 (if the wave is negative in AVF - left axis to extreme R axis deviation).

Question 14

How do you assess for premature atrial contraction (PAC)?

Answer 14

in Lead II, some of the P waves will be early and will just look weird

Question 15

When would you see a p wave greater than 2.5 boxes high in lead II?

(also often seen in leads III and avf)

Answer 15

R atrial enlargement

Question 16

When would you see a biphasic p wave in V1 that has a greater downward portion (>1mm in width in depth)

Answer 16

Left atrial enlargement

Question 17

How do you determine if a patient has LVH based on the precordial leads?

Answer 17

1. R_{V5 of V6} + S_{V1 or V2} > 35mm*

2. R_{V5 alone} > 26mm
3. R_{V6 alone} > 18mm
4. R_V6 > R_V5

only need one, but the more you have, the more likely it is LVH

Question 18

How do you tell if a patient has LVH based on the limb leads?

Answer 18

1. Ravl > 13mm
2. R_avf > 21mm
3. R_lead1 > 14mm

4. R_lead1 + S_lead3 > 25mm*

Question 19

What does a patient have if you see R > S in V1

and/or

S > R in V6?

Answer 19

RVH

Question 20

What deviation must you have for RVH to be true?

Answer 20

Some type of R axis deviation