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Clin Med > EKG's > Flashcards

EKG's Flashcards

1
Q

The pnemonic for the rate

A

300-150-100-75-60

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2
Q

What are the inferior leads

A

II, III, aVF

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3
Q

What are the lateral leads

A

I V5 V6

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4
Q

What are the septal leads

A

V1 V2

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5
Q

What the anterior leads

A

V3 V4

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6
Q

which lead dont we care about UNLESS your looking for Pericarditis?

A

aVR (PR elevation in aVR)

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7
Q

The unipolar leads are…

A

I II and III

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8
Q

The augmented leads are…

A

aVR, aVF, aVL

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9
Q

The precordial leads

A

V1-V6

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10
Q

1 small box =

A

.04 seconds

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11
Q

1 big box =

A

.2 seconds

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12
Q

PR interval range (in seconds)

A

.12 - .20

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13
Q

PR range (in boxes)

A

3 - 5 little boxes

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14
Q

QRS range (in seconds)

A

.06 - .10

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15
Q

QRS range (in boxes)

A

1.5 - 2.5 little boxes

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16
Q

QT range (in boxes only)

A

1.5 - 2.5 BIG boxes

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17
Q

another way to measure QT…

A

less than half of the preceding RR interval.

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18
Q

The axis is_______when Lead I QRS is positive, and Lead II QRS is positive…

A

Normal

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19
Q

The axis is_______when Lead I QRS is positive, and Lead II QRS is negative…

A

Left Axis Deviation

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20
Q

The axis is_______when Lead I QRS is negative, and Lead II QRS is positive…

A

Right Axis Deviation

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21
Q

The axis is_______when Lead I QRS is negative, and Lead II QRS is negative…

A

No Man’s Land

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22
Q

In checking for axis you see an isoelectric Lead II, what other lead can you use?

A

aVF (the final number will be a right angle to Lead II, but your using avF to figure out which one…either 30 or 150 degrees)

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23
Q

If Lead I is positive, and II is isoelectric, and aVF is positive, the axis is…

A

Right Axis Deviation

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24
Q

If Lead I is positive, and II is isoelectic, and aVF is negative, the axis is…

A

Left Axis Deviation

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25
Q

What leads check for atrial axis?

A

I, II, and avR

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26
Q

What should we see in normal atrial axis for I, II, and aVR?

A

Up in I and II, down in aVR

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27
Q

What is likely if you see inverted P’s?

A

Ectopic or junctional rhythm.

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28
Q

What is all P’s look different with each beat?

A

Multifocal Atrial Pacemaker

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29
Q

Is there one P wave before each QRS…and if there isn’t you think?

A

vectricular ectopy or competing rhythm (i.e. 3rd degree heart block)

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30
Q

Is there one QRS after each P wave…and if not you think?

A

Heart Block (AV block of some kind)

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31
Q

If there is no discernible P wave (multiple morphologies), with irregularly irregular complexes…you think?

A

Atrial Fibrillation

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32
Q

fast “sawtooth” P waves indicate…

A

Atrial Flutter (re-entry depolarization)

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33
Q

This rhythm shows huge fast wide tombstones with no baseline or p waves

A

Ventricular Tachycardia

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34
Q

This heart block shows an intermittent block from P waves, no PR lengthening, where the QRS complex occasionally appears every “X” number of Sinus beats.

A

2nd degree Type II (check for lyme disease)

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35
Q

This heart block shows simply elongated PR intervals (>.20)

A

1st Degree

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36
Q

This heart block shows complete dissociation of P vs. QRS complexes with a ventricular escape rhythm of between 30 - 45.

A

3rd Degree

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37
Q

This heart block shows progressively increasing PR interval, with a subsequent dropped QRS.

A

2nd degree type I (Wenckeback)

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38
Q

Criteria for Right Atrial Enlargement (RAE)

A

1) P wave height IN ANY LEAD is greater than 2.5mm. 2) P wave in V1 is biphasic with larger INITIAL portion.

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39
Q

Criteria for Left Atrial Enlargement (LAE)

A

1) P wave in LEAD II is notched more than 1 box wide. 2) P wave in V1 is biphasic with larger TERMINAL portion.

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40
Q

Criteria for Right Ventricular Hypertrophy (RVH)

A

Right Axis Deviation (L1-/L2+) AND V1 R-wave > 7mm

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41
Q

The most specific of the criterias for Left Ventricular Hypertrophy (LVH)

A

aVL R-wave > 12mm

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42
Q

The other less specific criteria for Left Ventricular Hypertrophy (LVH)

A

The biggest R + the biggest S in ANY precordial leads is greater than 45mm

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43
Q

Between 1-5, what is the most common type of MI?

A

Type 1 (Spontaneous MI associated with ischemia and due to a primary coronary event such as a plaque erosion, rupture, fissuring, or dissection)

44
Q

Criteria for an ST elevated MI?

A

ST > 1mm in 2 or more contiguous leads (ST elevations give away location, where ST depression do not)

45
Q

In an acute MI you may or may not see what evidence of an old MI?

A

A wide Q-wave (>1.5 boxes or .03 seconds)

46
Q

What does an ST depression >1mm usuall represent?

A

Ischemia (can be horizontal or down-sloping, and you

47
Q

What will T-waves show in Ischemia?

A

biphasic, symmetrical, or deeply inverted

48
Q

What does a very steep and short sloping ST elevation tell you?

A

Its hyperacute….HAPPENING NOW!

49
Q

Can you localize ischemia from ST depression in certain leads?

A

No

50
Q

What do you think if you WIDE DIFFUSE T-Wave inversions?

A

Ischemia (you can pattern recognize this one)

51
Q

What leads indicate a LBBB?

A

V5 and V6 (left sided precordials)

52
Q

What will you see on V5 V6 in LBBB?

A

Big and tall and wide QRS (>.12 or 3 boxes) (the left side of the heart depolarizes later and akwardly)

53
Q

Can you detect ischemia, infarct or hypertrophy in an LBBB?

A

No

54
Q

What leads indicate a RBBB?

A

V1 and V2 (right sided precordials)

55
Q

What do you see in V1 V2 RBBB?

A

Rabbit ear R-waves (with R-prime being a little taller). Also prolonged QT in those leads.

56
Q

Is the diagnosis of hypertrophy or infarct/ischemia affected with a RBBB?

A

Yes (you can still check for those infarct/ischemia in a RBBB)

57
Q

What is the (pattern recognition) sign for Pericarditis?

A

An difffusely upsloping ST-segment (a cup holding water)

58
Q

While most leads will show a PR depression in Pericarditis, what lead will ONLY show PR elevation?

A

aVR

59
Q

Why will Pericarditis show Electrical Alternans?

A

The heart moves around more within the fluid with each beat causing changes to R wave amplitude.

60
Q

What are the EKG findings for EARLY Hyperkalemia?

A

P waves are OK Qt is possibly shortened T waves are PEAKED AND TALL

61
Q

What are the EKG findings for MODERATE Hyperkalemia?

A

P waves begin to flatten QRS WIDENS T waves are still PEAKED AND TALL ST depression

62
Q

What are the EKG findings for SEVERE Hyperkalemia?

A

P WAVES ABSENT QRS BECOMES A WIDE BIZZARE SINE-WAVE (Can progress to V-tach, V-fib, Asystole)

63
Q

What are the EKG changes for HYPOKALEMIA?

A

U-WAVE IS SEEN Flat T-wave Big wide P-waves ST depression (Qt prolongation….sometimes)

64
Q

What is the number one sign for a Pulmonary Embolus?

A

SINUS TACHYCARDIA

65
Q

What instead are you gonna say to kiss ass to your cardiology PA on rotations if they ask you what EKG changes to expect in a PE?

A

S1 Q3 T3 (the number 2 sign)

66
Q

Besides SInus Tach, and the S1-Q3-T3, what 3rd finding will you see in PE?

A

T-Wave Inversions

67
Q

Besides Sinus Bradycardia, what EKG change will you see in hypothermia?

A

Osborne waves Diffuse RsR complex with a higher 1st R

68
Q

whats the axis

A

Normal

69
Q

Whats the axis

A

Left Axis Deviation

(Lead I is down, and II is up)

70
Q

Whats the axis?

A

Lead I is positive

Lead II is isoelectric (so the axis is one of its 90 degree values)

avF is negative sooo your using the only lead II value in the top hemisphere..

which is -30 (normal axus, almost leftward)

71
Q

Whats the rhythm? (check for sinus axis, morphology, P before QRS, and QRS after P)

A

Axis: up in I and II, down in avR

Morphology: Sinus (no MAP, multifocal atrial pacer)

1 P before each QRS (no ectopy)

1 QRS after each P (no block)

72
Q

whats the rate adn rhythm?

A

Rate: bradycardia @ ~50

Rhythm: Sinus

73
Q

Whats the rate & rhythm

A

Rate: 150

Rhythm: P wave morphology, could be MAP

74
Q

What is this?

A

Atrial Fibrilation

(Multifocal atrial tachycardia)

75
Q
A

Atrial Flutter

(Sawtooth pattern, P wave rate of 250-350)

76
Q

What EKG rhythm will this pathology produce?

A

Atrial Flutter

77
Q

ID this rhythm

A

Ventricular Tachycardia

(could also be SVT with abberant conduction)

78
Q

ID this type rhythm

A

1st degree block

(just a long PR)

79
Q

ID this rhythm

A

2st degree type I

(progressively lengthening PR then a dropped QRS, then restart)

80
Q

ID this rhythm

A

2nd degree type II (wenckebach)

(normal P conduction, with a consistent P wave block)

81
Q

ID this rhythm

A

3rd Degree block

(Complete dissociation between P and QRS with two different rates)

82
Q

What chamber is hypertrophied here and why?

A

Right Atrial Hypertrophy

a biphasic P wave be in V1 with larger INITIAL portion

83
Q

Besides the biphasic v1, what criteria can we use for RAE in any of the limb leads?

A

Any P wave > 2.5mm = RAE

84
Q

What chamber is hypertrophied and why via lead II?

A

Left Atrial Enlargement

(notched P wave separated by more than 1 llittle box)

85
Q

Besides the notched P wave in Lead II, what else can give away an LAE?

A

A biphasic P wave in V1 with TERMINAL portion being larger

86
Q

What leads and criteria here give away an RVH?

A
  1. Right Axis Deviation (Lead I is biphasic, II is +, avF is +)

AND

  1. R wave height in V1 > 7
87
Q

What does this tell you?

A

Left Ventricular Hypertrophy

(R > 26)

88
Q

What does this tell you?

A

Left Ventricular Hypertrophy

(aVL R-wave > 12mm)

THE MOST SPECIFIC CRITERIA

89
Q

What would you look for matching up any two of these precordial leads?

A

Any R + Any S wave = 45mm

(for LVH)

90
Q

What does this show?

A

Infarct

(A STEM producing a new Q wave > 1.5 boxes

91
Q

Where is the infarct?

A

Anterior, Lateral, and Septal leads

92
Q

Where is the infarct?

A

Inferior wall (Lead III ST elevation)

93
Q

Where is the infarct?

A

This is a hyperacute MI

Inferior (Lead III)

Septal (V1 V2)

Anterior (V3 V4)

Lateral (V4 V5)

94
Q

What do these downward slopoing ST segments mean?

A

Ischemia

95
Q

What do these flat but depressed ST segments mean?

A

Ischemia

96
Q

What do wide, diffuse, T-wave inversion represent?

A

Ischcemia

97
Q

What do wide notched QRS waves in V5 and V6 tell you (also V1)?

A

LBBB

(these leads also show ST depression and T-inversion in this heart block)

98
Q

What shows notched wide QRS complex in V1 and V2?

A

RBBB

(the R-prime usually larger…rsR complex)

99
Q

What pathology shows concave ST elevation and PR depression (holds water) across all leads?

A

Pericarditis

100
Q

What single lead in pericarditis shows instead PR elevation?

A

aVR

(all others show diffuse PR depression)

101
Q

What is happenin in this case of pericarditis?

A

Electical Alternans

(alternating amplitude changes)

102
Q

Why is this Stage I Hyperkalemia?

A

It shows narrow peaked T-waves with good P-waves

103
Q

Why is this stage II kyperkalemia?

A

P Waves: Flattened and wide

QRS: widened

T: still tall and peaked

104
Q

Why is this stage III hyperkalemia?

A

P wave: GONE

QRS: now a wide Sine-wave pattern

(watch out for v-tach,v-fib, and asystole after this one)

105
Q

What does this U-wave indicate?

A

HYPO kalemia

(will also see a big wide P, and a flat T)

106
Q

What is this?

A

S1 Q3 T3

(Pulmonary Embolus)

107
Q

What is this?

A

Osborne Wave

(Hypothermia)

Clin Med (14 decks)

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