EKG's Clin Med

Question 1

Why obtain an EKG during screening (asymptomatic) patient?

Answer 1

Generally, only for those with high cardiac risk over 65

Screening for “silent” heart attacks, atrial fibrillation, and hypertrophy (big heart), or family history

Question 2

What are the scenerios to order an EKG for diagnostic purposes?

Answer 2

Chest pain
Shortness of breath
Syncope
Palpitations
Confusion/altered mental status
Weakness
Exercise Intolerance

Question 3

What is Piburn’s favorite saying when someone presents to the ED at risk for a cardiovascular event?

Answer 3

O2, IV, MONITOR

Question 4

Why would you place a trauma patient on a monitor?

Answer 4

Concern for central nervous system and cardiac trauma

Question 5

What are some medications that can cause QT prolongation?

Answer 5

Flouroquinalones, Phase 3 Antirhythmics (K+ channel blockers), antidepressants, antipsychotics

Question 6

What is the relationship of pacemaker cells to myocytes?

Answer 6

Pacemaker sends an electrical current through gap junctions to activate the myocytes to perform contraction (act as the guide to the “runner” in the para-olympics example)

Question 7

What is the normal beat per minute frequency in the SA node?

Answer 7

60-100

Question 8

What is the normal beat per minute frequency in the AV node?

Answer 8

40-60

Question 9

How long does a Zio Patch allow for continuous monitoring in the outpatient setting?

Answer 9

14 days

Question 10

A large square on an EKG strip is how many seconds?

Answer 10

0.2 seconds

Question 11

Is the interpretation of an EKG always reliable?

Answer 11

No, need to interpret for yourself (computer doesn’t know the patient)

Axis and other measurements are reliable and can be helpful in your interpretation

Question 12

Why don’t we see atrial repolarization?

Answer 12

It is buried in the QRS

Question 13

What is a normal QRS duration?

Answer 13

0.06 to 0.10 seconds

Question 14

What is occurring during QRS complex?

Answer 14

Ventricular depolarization

Question 15

What is occurring during the T wave?

Answer 15

Ventricular Repolarization

Question 16

What does an inverted T wave suggest?

Answer 16

Ischemia

Question 17

The U Wave is not usually seen, but if it is seen when does it occur?

Answer 17

After T-wave

Question 18

If there is a tall U Wave what pathology does it suggest?

Answer 18

Hypokalemia
Medication toxicity (anti-dysrhthmics, digitalis, and pheothiazines)

Question 19

How long is a normal PR interval?

Answer 19

Normal: 0.12 to 0.20 seconds (3 to 5 small squares)

Question 20

Does Wolf Parkinsons White (WPW) have a short or longer PR interval?

Answer 20

Short PR interval

Question 21

The PR interval ________ as HR increases and _________ as HR decreases

Answer 21

shortens, lengthens

Question 22

Longer, longer, longer, drop! Then you have a

Answer 22

Wenkebach

Question 23

What are the steps of the 6 step method in interpreting EKG?

Answer 23

1. Rate
2. Rhythm
3. Axis
4. Intervals
5. Hypertrophy
6. Ischemia/Infarct

Question 24

What is a normal rate?

Answer 24

60 to 100 bpm

Question 25

What rate is considered bradycardia?

Answer 25

< 60 bpm

Question 26

What rate is considered tachycardia?

Answer 26

> 100 bpm

Question 27

The sequence method only works if you have what kind of rhythm?

Answer 27

Regular

Question 28

What is indicative of normal sinus rhythm?

Answer 28

Upright P wave with single morphology, P before every QRS, and QRS is narrow

Question 29

In regular rhythm there is the _____ distance between each R wave?

Answer 29

Same

Question 30

In regularly irregular rhythm there is ____ of irregularity?

Answer 30

Repeating Pattern

Question 31

A short PR Interval can suggest?

Answer 31

Hypercalcemia Digitalis Toxicity WPW

Question 32

A long PR interval can suggest?

Answer 32

Beta/Calcium channel blockers Hypothyroidism AV Block

Question 33

A narrow (normal) QRS complex is presumed to be

Answer 33

Supraventricular

Question 34

A wide QRS complex can suggest?

Answer 34

Bundle branch blocks and ventricular rhythms

Question 35

A small square on EKG is how long in duration?

Answer 35

0.04 seconds

Question 36

How long is a each lead on a 12-lead EKG?

Answer 36

2.5 seconds long

Question 37

How long is a 12-lead EKG in standard configuration?

Answer 37

10 seconds long

Question 38

What is the anatomical position of V1 on a 12-Lead EKG?

Answer 38

Right side sternum, 4th intercostal space

Question 39

What is the anatomical position of V2 on a 12-Lead EKG?

Answer 39

Left side sternum, 4th intercostal space

Question 40

What is the anatomical position of V3 on a 12-Lead EKG?

Answer 40

Between V2 and V4

Question 41

What is the anatomical position of V4 on a 12-Lead EKG?

Answer 41

Left mid-clavicular, 5th intercostal space

Question 42

What is the anatomical position of V5 on a 12-Lead EKG?

Answer 42

Left anterior axillary, 5th intercostal space

Question 43

What is the anatomical position of V6 on a 12-Lead EKG?

Answer 43

Left mid-axillary, 5th intercostal space

Question 44

Adding augmented leads gives different vantage points, which allows the creation what system?

Answer 44

Hexaxial Reference System

Question 45

Electrical impulse in the ventricles starts where

Answer 45

The left side of the septum

Question 46

Both ventricles depolarize at the same time but this ventricle is faster due to its size?

Answer 46

Left ventricle

Question 47

What can cause right axis deviation?

Answer 47

COPD WPW Pulmonary embolism (any lung issue)

Question 48

What can cause left axis deviation?

Answer 48

Pregnancy (high diaphragm) Hyperkalemia Left sided hypertrophy

Question 49

What can cause extreme axis deviation?

Answer 49

No Man's land Misplaced leads Potentially Ventricular Tachycardia Very poor coronary artery perfusion

Question 50

In assessing axis deviation, if the QRS in lead I and aVF are both negative what is the meaning?

Answer 50

Extreme axis deviation

Question 51

In right axis deviation, what direction are lead I and aVF facing?

Answer 51

Lead 1 = down aVF = up

Question 52

In left axis deviation, what direction are lead 1 and aVF facing?

Answer 52

Lead 1 = up aVF = down

Question 53

The QRS is usually narrow and ____ small squares on EKG paper?

Answer 53

3

Question 54

What will cause a wider QRS?

Answer 54

Pace Rhythm (pace maker) Ventricular Rhythm Right Bundle Branch Block Left Bundle Branch Block

Question 55

Any QRS greater than 0.12 sec is considered

Answer 55

Wide

Question 56

In differentiating bundle branch blocks with the turn signal method, if the wave goes up from the J point it is what kind of block?

Answer 56

RBBB

Question 57

In differentiating bundle branch blocks with the turn signal method, if the wave goes down from the J point it is what kind of block?

Answer 57

LBBB

Question 58

Ventricular hypertrophy can be normal in what cohorts?

Answer 58

Thin Young adults Athletes

Question 59

In ST-segment depression slopes what type of slopes are pathologic?

Answer 59

Downsloping Horizontal (no slope)

Question 60

If an infarct is caught early, what change will likely be seen on EKG?

Answer 60

Changes in T-wave (hyperacute T waves minutes to hours after)

Question 61

What type of EKG should you order for an inferior STEMI?

Answer 61

Right sided EKG

Question 62

Brugada syndrome is what kind of channelopathy?

Answer 62

Sodium channelopathy

Question 63

What population is Brugada syndrome most prevalent?

Answer 63

Asian populations

Question 64

If you suspect hyperkalemia what should be the immediate work-up?

Answer 64

EKG, don't wait for potassium level from the lab

Question 65

What is the Osborn Wave?

Answer 65

Seen at J-point, notch between the J-point and the start of the ST segment

Question 66

An inverted T-wave (upside down from positive QRS) suggests

Answer 66

Ischemia

Question 67

What EKG findings will occur in Wolf-Parkinson-White Syndrome?

Answer 67

Short PR interval with delta wave

Question 68

How long is a normal PR Interval?

Answer 68

0.12 to 0.20 (120-200 ms) 3-5 small squares

Question 69

In a regular rhythm will you see the same distance between each R wave?

Answer 69

Yes

Question 70

What is the most common irregularly irregular arrhythmia?

Answer 70

Atrial Fibrillation

Question 71

What are some common causes of a short PR interval?

Answer 71

Hypercalcemia Digitalis Toxicity WPW

Question 72

What are some common causes of a long PR interval?

Answer 72

Beta/Calcium channel blockers, Hypothyroidism, and AV block

Question 73

A narrow QRS complex is persumed to be

Answer 73

Supraventricular