EKG V and VI Flashcards
What do you look at on an EKG to determing AV block
The PR interval is the key to differentiating AV blocks
What are the four types of AV blocks
- First degree 2. Second degree Mobitz 1 (wenckebach) 3. Second degree Mobitz 2 4. Third degree (complete Heart Blcok)
Characterisics of first degree AV block
If its just an AV block the rest of the EKG will be normal except the PR interval will be prolonged >0.2 in all beats and will be consistent
Weneckbach Characteristics
The PR interval gets longer and longer until a missing beat weeeeerrrrrrrnnnnnnnneeeeeeckkkkkk BACH
Second degree AVB Mobitz type II Characteristics
-This is when some impulses to the ventricles are completely blocked so missing ventricular beat - The PR interval remains CONSTANT but then a beat is dropped, PR can be prolonged
What can a second degree Mobitz type II block turn into
a Third degree complete heart block
Third Degree Heart BLock what will be regular what will be irregular
the P-P the R-R There wont be a 1:1 to ratio (1 P wave for every QRS)
Will ventricles in a third degree AV block be narrow or wide?
They will be Wide because they are pacing themselves
Which leads do you look at for bundle branch blocks
Diagnosed by RR’ in V1 and V6
What is a bundle branch block, where does the block occur
This is a delay or interruption in the transmission of electrical impulse that occurs below the bifurcation of the bundle of his Can be complete or incomplete
Which is worse RBBB or LBBB
LBBB- this does not occur in a healthy heart, espically alarming if its a new diagnoses RBBB- Can occur in a healthy heart
What can cause a RBBB
CAD HTN Acute pulmonary embolism Chronic electrical degeneration
What can cause a LBBB
HTN Cardiomyopathy Acute MI Aortic Stenosis Extensive CAD Diseased electrical system
Man Characteristic of LBBB
Rabbit ears on lead V6
Which is more concerning discordance or concordance
Concordance
What is discordance
In a BBB if the QRS wave is up the T-wave should be down or if the QRS is down the T-wave should be up
what is Concordance
This is alarming and is when a BBB has both T-wave upright and QRS upright and can be suggestive of Ischemia or MI
what is the difference btw ischemia and infarction
with ischemia the heart muscle is still savable whereas with infarction it is dead
A clot in the RCA would cause which kind of heart attack
A. Inferior
B. Anterior
C. Posterior
D. Septal
A. Inferior seen in leads I,II, III
A clot in the top portion of the LMA would have what effects on the heart?
A. An anterior MI and Lateral MI
B. Septal MI
C. Anterior MI
D. Posterior MI and Septal MI
Best answer is A
A block in the LMA will show st elevation in the anterior and lateral leads
What two types of MIs can bee seen with a block to the LAD?
A. Posterior and inferior
B. Septal and anterior
C. Septal and lateral
D. Anterior and lateral
B. Septal and anterior
You see ST elevation in leads I, avL, V5 and V6. What kind of MI is the pt having and which artery is being occluded?
Latreral MI with the circumflex artery occluded
If suspecting a Posterior MI what could you do to make sure your suspicion is right?
Place leads 7 - 9 on the back of the pt
With a posterior MI are you going to see elevated ST segments or Depressed ST segements? Also in which leads would you see these findings?
It would be ST depression and in the septal and anterior perocardial leads V1-V4
Later leads refer to which?
A. II, III, AVf
B. I, avL, V5, V6
C. V1, V2
D. V2, V3, V4
B. I, avL, V5, V6
Septal Leads refer to which?
A. V1, V2
B. V4, V5, V6
C. I, II, III
D. V2, V3, V4
A. V1, V2
which of the following are inferior leads?
A. I, II, III
B. I, II, avF
c. II, III, avF
D. avF, avL, avR
C. II, III, avF
Which of the following are anterior leads
A. V1, V2, V4
B. V2, V3, V4
C. V5, V6
D. V1, V2,V3
B. V2, V3, V4
If you see ST elevation is only one lead can you call it myocardial ischemia?
No there needs to be two points of ST depression or T-wave inversion
What leads do you look at when considering myocardial ischemia with st depression
Leads V5 or V6
and III or avF
How large must the ST depression be in leads V5 and V6 and also III and avF for it to be considered myocardial ischemia
Which leads is it normal to see T-wave inversion
Leads avL and V1
