EKG's Flashcards
1
Q
The pnemonic for the rate
A
300-150-100-75-60
2
Q
What are the inferior leads
A
II, III, aVF
3
Q
What are the lateral leads
A
I V5 V6
4
Q
What are the septal leads
A
V1 V2
5
Q
What the anterior leads
A
V3 V4
6
Q
which lead dont we care about UNLESS your looking for Pericarditis?
A
aVR (PR elevation in aVR)
7
Q
The unipolar leads are…
A
I II and III
8
Q
The augmented leads are…
A
aVR, aVF, aVL
9
Q
The precordial leads
A
V1-V6
10
Q
1 small box =
A
.04 seconds
11
Q
1 big box =
A
.2 seconds
12
Q
PR interval range (in seconds)
A
.12 - .20
13
Q
PR range (in boxes)
A
3 - 5 little boxes
14
Q
QRS range (in seconds)
A
.06 - .10
15
Q
QRS range (in boxes)
A
1.5 - 2.5 little boxes
16
Q
QT range (in boxes only)
A
1.5 - 2.5 BIG boxes
17
Q
another way to measure QT…
A
less than half of the preceding RR interval.
18
Q
The axis is_______when Lead I QRS is positive, and Lead II QRS is positive…
A
Normal
19
Q
The axis is_______when Lead I QRS is positive, and Lead II QRS is negative…
A
Left Axis Deviation
20
Q
The axis is_______when Lead I QRS is negative, and Lead II QRS is positive…
A
Right Axis Deviation
21
Q
The axis is_______when Lead I QRS is negative, and Lead II QRS is negative…
A
No Man’s Land
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)
23
Q
If Lead I is positive, and II is isoelectric, and aVF is positive, the axis is…
A
Right Axis Deviation
24
Q
If Lead I is positive, and II is isoelectic, and aVF is negative, the axis is…
A
Left Axis Deviation
25
What leads check for atrial axis?
I, II, and avR
26
What should we see in normal atrial axis for I, II, and aVR?
Up in I and II, down in aVR
27
What is likely if you see inverted P's?
Ectopic or junctional rhythm.
28
What is all P's look different with each beat?
Multifocal Atrial Pacemaker
29
Is there one P wave before each QRS...and if there isn't you think?
vectricular ectopy or competing rhythm (i.e. 3rd degree heart block)
30
Is there one QRS after each P wave...and if not you think?
Heart Block (AV block of some kind)
31
If there is no discernible P wave (multiple morphologies), with irregularly irregular complexes...you think?
Atrial Fibrillation
32
fast "sawtooth" P waves indicate...
Atrial Flutter (re-entry depolarization)
33
This rhythm shows huge fast wide tombstones with no baseline or p waves
Ventricular Tachycardia
34
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.
2nd degree Type II (check for lyme disease)
35
This heart block shows simply elongated PR intervals (\>.20)
1st Degree
36
This heart block shows complete dissociation of P vs. QRS complexes with a ventricular escape rhythm of between 30 - 45.
3rd Degree
37
This heart block shows progressively increasing PR interval, with a subsequent dropped QRS.
2nd degree type I (Wenckeback)
38
Criteria for Right Atrial Enlargement (RAE)
1) P wave height IN ANY LEAD is greater than 2.5mm. 2) P wave in V1 is biphasic with larger INITIAL portion.
39
Criteria for Left Atrial Enlargement (LAE)
1) P wave in LEAD II is notched more than 1 box wide. 2) P wave in V1 is biphasic with larger TERMINAL portion.
40
Criteria for Right Ventricular Hypertrophy (RVH)
Right Axis Deviation (L1-/L2+) AND V1 R-wave \> 7mm
41
The most specific of the criterias for Left Ventricular Hypertrophy (LVH)
aVL R-wave \> 12mm
42
The other less specific criteria for Left Ventricular Hypertrophy (LVH)
The biggest R + the biggest S in ANY precordial leads is greater than 45mm
43
Between 1-5, what is the most common type of MI?
Type 1 (Spontaneous MI associated with ischemia and due to a primary coronary event such as a plaque erosion, rupture, fissuring, or dissection)
44
Criteria for an ST elevated MI?
ST \> 1mm in 2 or more contiguous leads (ST elevations give away location, where ST depression do not)
45
In an acute MI you may or may not see what evidence of an old MI?
A wide Q-wave (\>1.5 boxes or .03 seconds)
46
What does an ST depression \>1mm usuall represent?
Ischemia (can be horizontal or down-sloping, and you
47
What will T-waves show in Ischemia?
biphasic, symmetrical, or deeply inverted
48
What does a very steep and short sloping ST elevation tell you?
Its hyperacute....HAPPENING NOW!
49
Can you localize ischemia from ST depression in certain leads?
No
50
What do you think if you WIDE DIFFUSE T-Wave inversions?
Ischemia (you can pattern recognize this one)
51
What leads indicate a LBBB?
V5 and V6 (left sided precordials)
52
What will you see on V5 V6 in LBBB?
Big and tall and wide QRS (\>.12 or 3 boxes) (the left side of the heart depolarizes later and akwardly)
53
Can you detect ischemia, infarct or hypertrophy in an LBBB?
No
54
What leads indicate a RBBB?
V1 and V2 (right sided precordials)
55
What do you see in V1 V2 RBBB?
Rabbit ear R-waves (with R-prime being a little taller). Also prolonged QT in those leads.
56
Is the diagnosis of hypertrophy or infarct/ischemia affected with a RBBB?
Yes (you can still check for those infarct/ischemia in a RBBB)
57
What is the (pattern recognition) sign for Pericarditis?
An difffusely upsloping ST-segment (a cup holding water)
58
While most leads will show a PR depression in Pericarditis, what lead will ONLY show PR elevation?
aVR
59
Why will Pericarditis show Electrical Alternans?
The heart moves around more within the fluid with each beat causing changes to R wave amplitude.
60
What are the EKG findings for EARLY Hyperkalemia?
P waves are OK Qt is possibly shortened T waves are PEAKED AND TALL
61
What are the EKG findings for MODERATE Hyperkalemia?
P waves begin to flatten QRS WIDENS T waves are still PEAKED AND TALL ST depression
62
What are the EKG findings for SEVERE Hyperkalemia?
P WAVES ABSENT QRS BECOMES A WIDE BIZZARE SINE-WAVE (Can progress to V-tach, V-fib, Asystole)
63
What are the EKG changes for HYPOKALEMIA?
U-WAVE IS SEEN Flat T-wave Big wide P-waves ST depression (Qt prolongation....sometimes)
64
What is the number one sign for a Pulmonary Embolus?
SINUS TACHYCARDIA
65
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?
S1 Q3 T3 (the number 2 sign)
66
Besides SInus Tach, and the S1-Q3-T3, what 3rd finding will you see in PE?
T-Wave Inversions
67
Besides Sinus Bradycardia, what EKG change will you see in hypothermia?
Osborne waves Diffuse RsR complex with a higher 1st R
68
whats the axis
Normal
69
Whats the axis
Left Axis Deviation
| (Lead I is down, and II is up)
70
Whats the axis?
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
Whats the rhythm? (check for sinus axis, morphology, P before QRS, and QRS after P)
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
whats the rate adn rhythm?
Rate: bradycardia @ ~50
Rhythm: Sinus
73
Whats the rate & rhythm
Rate: 150
Rhythm: P wave morphology, could be MAP
74
What is this?
Atrial Fibrilation
| (Multifocal atrial tachycardia)
75
Atrial Flutter
(Sawtooth pattern, P wave rate of 250-350)
76
What EKG rhythm will this pathology produce?
Atrial Flutter
77
ID this rhythm
Ventricular Tachycardia
(could also be SVT with abberant conduction)
78
ID this type rhythm
1st degree block
| (just a long PR)
79
ID this rhythm
2st degree type I
(progressively lengthening PR then a dropped QRS, then restart)
80
ID this rhythm
2nd degree type II (wenckebach)
(normal P conduction, with a consistent P wave block)
81
ID this rhythm
3rd Degree block
(Complete dissociation between P and QRS with two different rates)
82
What chamber is hypertrophied here and why?
Right Atrial Hypertrophy
a biphasic P wave be in V1 with larger INITIAL portion
83
Besides the biphasic v1, what criteria can we use for RAE in any of the limb leads?
Any P wave \> 2.5mm = RAE
84
What chamber is hypertrophied and why via lead II?
Left Atrial Enlargement
(notched P wave separated by more than 1 llittle box)
85
Besides the notched P wave in Lead II, what else can give away an LAE?
A biphasic P wave in V1 with TERMINAL portion being larger
86
What leads and criteria here give away an RVH?
1. Right Axis Deviation (Lead I is biphasic, II is +, avF is +)
AND
2. R wave height in V1 \> 7
87
What does this tell you?
Left Ventricular Hypertrophy
| (R \> 26)
88
What does this tell you?
Left Ventricular Hypertrophy
(aVL R-wave \> 12mm)
THE MOST SPECIFIC CRITERIA
89
What would you look for matching up any two of these precordial leads?
Any R + Any S wave = 45mm
| (for LVH)
90
What does this show?
Infarct
(A STEM producing a new Q wave \> 1.5 boxes
91
Where is the infarct?
Anterior, Lateral, and Septal leads
92
Where is the infarct?
Inferior wall (Lead III ST elevation)
93
Where is the infarct?
This is a hyperacute MI
Inferior (Lead III)
Septal (V1 V2)
Anterior (V3 V4)
Lateral (V4 V5)
94
What do these downward slopoing ST segments mean?
Ischemia
95
What do these flat but depressed ST segments mean?
Ischemia
96
What do wide, diffuse, T-wave inversion represent?
Ischcemia
97
What do wide notched QRS waves in V5 and V6 tell you (also V1)?
LBBB
(these leads also show ST depression and T-inversion in this heart block)
98
What shows notched wide QRS complex in V1 and V2?
RBBB
(the R-prime usually larger...rsR complex)
99
What pathology shows concave ST elevation and PR depression (holds water) across all leads?
Pericarditis
100
What single lead in pericarditis shows instead PR elevation?
aVR
(all others show diffuse PR depression)
101
What is happenin in this case of pericarditis?
Electical Alternans
| (alternating amplitude changes)
102
Why is this Stage I Hyperkalemia?
It shows narrow peaked T-waves with good P-waves
103
Why is this stage II kyperkalemia?
P Waves: Flattened and wide
QRS: widened
T: still tall and peaked
104
Why is this stage III hyperkalemia?
P wave: GONE
QRS: now a wide Sine-wave pattern
(watch out for v-tach,v-fib, and asystole after this one)
105
What does this U-wave indicate?
HYPO kalemia
(will also see a big wide P, and a flat T)
106
What is this?
S1 Q3 T3
| (Pulmonary Embolus)
107
What is this?
Osborne Wave
| (Hypothermia)
