EKG Hypertrophy & Ischemia/Infarct Flashcards
What do you see for right atrial hypertrophy?
RAE (right atrial enlargement)
-Characterized by the tall (>2.5 mm) P waves in leads II, III, aVF
What do you see for left atrial hypertrophy?
- Increased P wave duration in Lead II
- Large negative component to P wave in lead V1
Where does the vector point?
Hypertrophied side
What do you see in RVH?
- RAD (negative in I, positive in aVF - around +150 deg)
- R > S wave in V1
- S wave persists in V5 and V6 (larger/pronounced here)
- Right precordial lead (V1-V3) ST depression
What do you see in LVH?
- S wave depth in V1/2 + R wave height in V5/6 > 35 mm
- LVH t-wave inverted
What should you scan all leads for with ischemia/infarct?
- Q waves
- Inverted T waves
- ST segment elevation or depression
What does ST elevation indicate?
Acute ischemia
MI
What does an ST elevation + significant Q waves indicate?
Acute or recent infarct
What does persistent ST depression represent?
“Subendothelial infarction”
-Shallow infarct just beneath the endocardium lining the L ventricle
Where will you see STe elevation in an inferior MI?
Lead II, III and aVF
What will you see in the EKG of Myocardial Infarction - Necrosis?
- Pathological Q wave
- -1 mm wide (.04 sec) or is a Q wave at least 1/3 the amplitude of the QRS complex
- Note leads where pathologic Q’s are present (Omit AVR) to determine infarct location and identify the vessel involved
What can happen with old infarcts?
-Pathologic Q waves remain for life
What can you use to determine infarction location and identify the vessel involved?
-Note leads where the pathologic Qs are present (Omit AVR)
What artery is occluded?
- Q waves in V2, V3, V4
- ST depression in II, III, aVF
- Acute/hyperacute anterior wall MI
- Reciprocal ST depressions
- Proximal Left Anterior Descending (LAD) occlusion
Whats is going on?
ST elevation in V1, V2, V3, V4, V5
Q waves in V1, V2, V3
Acute anterior wall myocardial infarction (MI) ST-elevation (STEMI), consistent with proximal left anterior descending (LAD) occlusion
Whats going on?
ST elevation V2-V5, associated with T wave inversion
Q waves in V2-V3
T waves: II, III, aVF
Evolving anteroseptal myocardial infarction secondary to cocaine.
-Occlusion of large left anterior descending (LAD) artery that wraps around base of heart
What’s going on?
Q waves: V2-3
ST elevation: V2-V5, I, aVL
ST depression - III
Acute anterior wall ST elevation MI (STEMI)
-Occlusion of proximal left anterior descending coronary artery
What does aVR normally look like?
Upside down
What is going on?
- QRS > 0.12
- RSR’ in V1 and V2 (bunny ears)
- Large R wave in V3 combined with average S wave in V5
- Right Bundle Branch Block (RBBB)
- Possible LVH
What if you have Q waves without any ST elevation?
Old infarct
What are the lateral leads?
Lead I and aVL
What are the anterior leads?
V1-V4
What’s going on?
- QRS > .12
- Broad notched R wave in V5 and V6
- V2 and V3 with S and S’ (looks like upside down R and R’ bunny ears)
-Left Bundle Branch Block (LBBB)
What is this?
PR
WPW (Wolf Parkinson White)
- S wave in V1 very large
- R wave in V5 very large
…if they are >35 mm then we have LVH (left ventricular hypertrophy)
- Flipped T waves on V1-4
- Q waves III, V1, V2
Ischemia - anterolateral
What is occluded:
-ST elevation in II, III, aVF
Inferior MI
-RCA (right coronary artery) likely occluded
- Elevated ST segments all over.
- Pathologic Q waves in V2, V3
- ST depression absent
- aVR only site not showing injury
Pericarditis!!
-Affects entire heart
