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EKG Method > EKG Interpretation > Flashcards

EKG Interpretation Flashcards

1
Q

6 Steps:

A 
1 Rate
2 Intervals
3 Axis
4 Rhythm
5 Ischemia and Infarct
6 LVH and RVH
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2
Q

Rate:

A

Calculate using number of boxes in 10 sec x6 or doing 1500 divided by number of small boxes in one RR interval.
Normal rate is 60-100 bpm.
Regular or irregular?
Irregularly irregular?

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3
Q

Intervals:

A

PR
QRS
QT

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4
Q

PR interval:

A

Normal is .120-.2 or 3-5 small boxes. Measure in lead II then march across, checking if all intervals are equal. Also note height and width of P wave.

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5
Q

What is RAE?

A

If P wave greater than 2.5 mm tall.

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6
Q

What is LAE?

A

If P wave greater than .11s wide

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7
Q

If P wave normal in lead II:

A

Check biphasic P wave in lead V1. If first part of biphasic wave is greater than 2 mm tall, RAE. If second part of biphasic P wave is greater than 1 mm wide and 1 mm deep, LAE.

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8
Q

QRS Complex:

A

Normal is less than .120 s. Measure in lead II and or V1.

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9
Q

What is RBBB?

A

If P greater than .120 s plus V1 more upgoing

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10
Q

What is LBBB?

A

If P greater than .120 plus V1 more downgoing

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11
Q

QT:

A

Normal is .35-.45 or about 2 large boxes.

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12
Q

Axis:

A

Look at QRS in leads I and aVF. If both pos, normal. If both neg, extreme RAD. If lead I pos, LAD. If lead aVF pos, RAD.

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13
Q

What if axis is abnormal?

A

Find the lead that is most isoelectric, then look at a lead that is perpendicular to it. If that one is positive, then axis is about deg of that lead. If neg, axis is plus or minus 180 deg from that lead.

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14
Q

Rhythm:

A

1 PRN Interval
2 Ectopy
3 Block

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15
Q

PRN Interval Varies:

A

…but all P waves look alike, look for blocks.

…and P waves differ: Normal Rate: Wandering Atrial Pacemaker, HR greater than 100, Multifocal Atrial Tachycardia (MAT)

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16
Q

PR Interval Short W:

A
  • Delta Wave- Wolff-Parkinson-White (WPW) Syndrome

- No Delta Wave- Ectopic atrial rhythm (similar to wandering but PR constant)

17
Q

No P waves and normal rate:

A

Normal QRS - Afib, Aflutter, or junctional (accelerated jxnl if HR greater than 60)
Wide QRS - Vent Paced or Idioventricular (accel. idioventricular if HR greater than 40)

18
Q

No P waves and tachycardia and normal QRS:

A

Regular - Supraventricular tachycardia (SVT)
Irregular (Only 3) - MAT, Aflutter w/variable block, afib
No P waves/wide complex tachycardia - Vtach (80 percent) and wide complex SVT

19
Q

Others you can’t miss:

A

Vent fib and torsades

20
Q

Is there ectopy?

A
  • PAC (atrial), Has p wave and narrow QRS
  • PJC (junctional), No p wave and narrow QRS
  • PVC (ventricular), No p wave and wide bizarre QRS
21
Q

Is there a block?

A
  • First AV block - PR greater than .20 but constant and no dropped QRS
  • Second AV block, Type I (Wenckebach) - PR lengthens and dropped QRS complex
  • Second AV block, Type II - PR constant
  • Third AV block - PR changes but PP intervals and RR intervals constant
  • Wide QRS equals bundle branch block
  • If you have LBBB, can’t interpret anything else.
22
Q

Ischemia and infarct

A

ST Elevation - acute infarct
ST Depression - Ischemia
Inverted T waves (but no Q waves) - Ischemia (if w/Q waves then infarct)

23
Q

Q waves

A

Infarct, age indeterminate (Q is 1 mm wide of .04 sec or a Q wave one third amplitude of QRS complex

24
Q

Lateral MI

A

I, aVL, V4, V5, V6

25
Q

Anterior MI

A

V1, V2, V3

26
Q

Inferior MI

A

aVR, II, III, aVF

27
Q

Posterior MI

A

Inverted views of V1 and V2

28
Q

Check for LVH and RVH:

A
  • Look at aVL, if R wave greater than 11 mm, LVH
  • If not, look at V1, if DEEP S, add to R in V5 or V6, if greater than 35 mm total, LVH, If tall R: if R greater than 7 mm and greater than S, RVH
  • Determine if with strain
29
Q

How to determine strain:

A

RVH strain - look for inverted T wave or slurred ST in R chest leads (V1-2).
LVH strain - look for inverted T wave or slurred ST in L chest leads (V5-6)
-If strain is present, you must ignore any previously identified ST-T wave ischemia-infarct as there is no way to tell if it is real or a change due to the L/RVH

EKG Method (1 decks)

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