EKG Test with Pictures

Question 1

Answer 1

RBBB

QRS is prolonged (gt 120), V1 is positive (RSR’ in V1), and there’s a slurred S in V6

(when V1 is positive it is either RVH, which is narrow QRS, or it’s RBBB, which is wide QRS)

Question 2

Answer 2

Peaked T-waves = hyperkalemia

(this is sinus tachycardia)

Question 3

Answer 3

STEMI in inferolateral leads (II, III, aVF, V5, V6)

(ST elevations needs to be in 2 continguous leads, and greater than 2 boxes in chest leads, and 1 box in limb leads - 1 box is 1mm)

Question 4

Answer 4

Afib (no pwaves, irregularly irregular, narrow complex)

Question 5

Answer 5

3rd degree heart block

(p wave and QRS are not related, there are more p waves than QRS complexes, AV node is completely dysfunctional)

(QRS complex comes from the lower part of the AV node as in this case since QRS is narrow - if it were coming from ventricle QRS would be wide)

Question 6

Answer 6

LBBB

(neg in V1, positive in V6 and no Q in V6)

(wide QRS with sinus rhythm; QRS can also come from ventricle, but here the rhythm is sinus so it started in the SA node, not ventricle)

Question 7

Answer 7

RVH with strain

(V1 is positive and QRS is not wide (if it were wide, you would think RBBB); and an inverted t-wave = strain)

Question 8

Answer 8

NOT Vfib - artifact

(if there is QRS with a p in any leads, the pt is not dead! aka not in v-fib)

Question 9

Answer 9

V-tach

(wide QRS coming from the ventricle)

Question 10

Answer 10

Atrial flutter

(sawtooth waves; one organized reentry circuit in atrium, which is very fast (atrial rate = 300) - AV node halves it to 150, but in this case pt may be on CCB or BB since ventricular rate is about 75)

Question 11

Answer 11

Anterolateral STEMI

(ST elevations in lateral = I, aVL, V5/6; anterior = V3, V4; septal: V11, V2)

Question 12

Answer 12

LVH with strain

(LVH: add S in V1, R in V5 or V6 and if greater than 35 = 7 big boxes, then LVH)

Strain = inverted T waves

Question 13

Answer 13

Paced rhythm

(pacing the ventricle - likely due to AV block, SA node/pwave was functioning but it wasn’t conducting to ventricle)

(QRS is wide since we are starting conduction in the ventricle - we are pacing it)

Question 14

Answer 14

Normal sinus rhythm

Question 15

Answer 15

WPW

(we reach ventricle faster since we don’t go through AV node (short PR) but QRS is wide since it originates in ventricle)

(also see an up-sloping Delta wave)

Question 16

Answer 16

Prolonged QT interval

(normal QT is 400-430)

Question 17

Answer 17

Switched leads - aVR and aVL are flipped