EKGs Flashcards
What does infarction mean?
blood flow is blocked
What does ischemia mean?
blood flow is reduced
What is normal for a P-wave?
3 small boxes or less and less than 2.5mm tall
What’s a normal p wave in V1?
biphasic and similar size of +/- deflections
What does an inverted p wave mean?
impulse from AV node instead of SA node
If the p wave is too tall what should you think?
right atrial enlargement
If the p wave is too wide or notched, or biphasic/notched, what should you think?
left atrial enlargement
What is normal for the PR interval?
less than .20 seconds (one big box)
What does a bigger than one big box PR interval mean?
first degree AV block
What does a short PR interval mean?
WPW (delta wave)
When is the q wave pathologic?
> 1 small box duration and
depth of wave > 1/4-1/3 height of R wave
What’s a normal QRS duration?
<3 small boxes
What should you think with a >.12s QRS duration (wide)?
bundle branch block
What’s a normal QT interval?
half the distance of R-R interval
What does a flat T wave mean?
hypokalemia
What does a broad or peaked T wave mean?
hyperkalemia or hyperacute of acute ischemia
What do inverted, deep, symmetric T waves mean?
ischemia
What are u waves?
another bump matching T wave that cam mean hypokalemia, bradycardia, or medications like digitalis or amiodarone
What’s a prominent U wave size and what does it mean?
> 1 or 2mm in amplitude and means higher likelihood of lethal arrhythmia (Torsdes de points)
What does a negative U wave mean?
ischemia, HTN, valvular disease, RVH
Review
Walls, their leads, their vessels
Where is the blockage of a posterior descending artery most likely?
RCA
10% left circumflex and both
Which axis deviation is normal in children, young and thin adults?
RAD
Which axis deviation is normal in older, obese adults?
LAD
What can cause RAD?
RVH, COPD w/o RVH, left posterior fascicular block, lateral wall MI, WPW pattern
What can cause LAD?
LVH, elevated diaphragm from ascites, pregnancy, left anterior fascicular block
What is a normal HR?
60-100
What is an irregular, rapid atrial rhythm?
atrial fibrillation
What is a life-threatening arrhythmia originating in ventricles?
ventricular tachycardia
What is an ST elevation or depression, pathologic Q waves?
myocardial infarction
What can cause sinus bradycardia?
vagal stimulation, medications (beta blockers), athletic heart
What can cause sinus tachycardia?
exercise, fever, anxiety, hypovolemia, anemia
What can cause sinus arrhythmia?
breathing pattern, normal variant in healthy/young
What’s an EKG of varying P-P intervals but consistent QRS complex?
sinus arrhythmia
What does it signify when there’s no discernable P waves, a chaotic pattern?
atrial fibrillation
What causes a fib?
HD, hyperthyroidism, ETOH
What does it signify when there’s no p waves and a sawtooth pattern?
atrial flutter
What causes atrial flutter?
HD, post-surg, PE
What does it signify with HR >150 with narrow complex tachy, absent p waves?
supraventricular tachycardia (SVT), usually upon reentry in young, healthy patients
What do inverted or absent P waves with a normal QRS signify, w/ a rate of 40-60BPM?
junctional rhythm from SA node dysfunction
What does a faster rate of junctional rhythm mean/caused by?
digoxin toxicity, beta agonists, MI
What do wide QRS complexes, rapid rate, and no p waves mean?
ventricular tachycardia
What does rapid, erratic, electrical activity with no coordinated contraction, no identifiable QRS complexes or p waves from heart attack or electrical disturbances?
v fib
What does early, wide, bizarre QRS complexes w/o preceding P wave signify?
Premature ventricular contraction (PVC)
What can cause PVCs?
caffeine, stress, ischemia
What does an early p–wave with the atria contracting too early mean?
premature atrial contraction from idiopathic, thyroid, anxiety, pregnancy, caffeine, stimulants
What does a prolonged PR interval (>3 small boxes) signify?
1st degree heart block
What could a 1st degree heart block mean?
often benign but could be BBB
What does a PR interval steadily increasing then QRS is dropped mean?
Mobitz Type I Winkenbach
What does a PR interval staying constant and then QRS dropped mean?
Mobitz Type II
What does it mean when there’s no relationship between p waves and QRS waves are unrelated?
3rd degree complete block
What does prominent aVL amplitude (>11mm) and S in V1, R in V5/V6 are»_space;>
any R or S in precordial leads >45mm?
left ventricular hypertrophy
What does R wave height > S wave depth in V1
or
R wave in V1 super tall
and probably RAD
mean?
right ventricular hypertrophy
right ventricular hypertrophy
V1 = R wave is higher than S or R wave >7mm, w/ RAD!!!
left ventricular hypertrophy
V1 = S wave is higher than R AND R in V5 and V6 with a TALL aVL
What does a dominant S wave in V1 with a broad monomorphic R wave in I, aVL, V5-6 mean?
left bundle branch block
What causes LBBB?
MI, HTN, AS, dilated cardiomyopathy
What does a wide slurred S wave in I, aVL, V5, V6 mean and a RSR pattern in V1-3 “M shape”?
Right bundle branch block
What causes RBBB?
PE, RVH, myocarditis, cardiomyopathy
What does a small Q1 and deep S3 with the S>R in II, III, aVF in absence of MI?
left anterior fasicular block
What does a I and aVL small R and deep S wave with II, III, aVF small Q waves/taller R waves mean?
left posterior fasicular block which is very hard to diagnose
What is the slurring of the QRS as it begins its upstroke?
delta wave
What are the sequences of changes with ischemia/infarction?
T wave inverts in first 1-2min –> T wave becomes upright and peaked –> ST elevation occurs (signs of injury) –> Q waves then develop (cells dying)
What should you do if you suspect ischemia/infarction?
get prior EKG
What is an ST-segment elevation that could indicate myocardial injury that includes clinical symptoms consistent with ACS (>20m duration) w/ persistent >20m CG features in >2 leads of:
>/ 2.5mm (small squares) ST elevation in leads V2-3 in men under 40 years
>/1.5mm ST elevation in V2-V3 in women
>/ 1mm ST elevation in other leads
- New LBBB
STEMI
if it kinda makes a frowny face
STEMI
if it makes a concave smiley face
nSTEMI like benign early repolarization or acute pericarditis
If there is an anterior infarct, there are ____ reciprocal changes
inferior reciprocal changes
If there is an inferior infarct, there are ____ reciprocal changes
lateral reciprocal changes
If there is an septal infarct, there are ____ reciprocal changes
posterior reciprocal changes
What does an NSTEMI indicate?
indicates ischemia or previous infarction
-ST-segment depression in nstemi
-T wave inversion in nstemi
What is the Sgarbossa criteria for?
criteria to diagnose infarction in LBBB setting
What are the Sgarbossa criteria?
1) concordant ST elevation >/1mm in >/1 lead
-any lead where QRS is positive, if ST elevation is at least 1 mm in same direction = 5 points
2) concordant ST depression >/ 1 mm in >/ 1 lead in V1-V3
-if ST depression at least 1mm in same direction of QRS = 3 points
3) discordant ST elevation >/ 5mm
-ST segment will shift in opposite direction of main QRS vector, elevation at least 5mm = 2 points
3+ = AMI
What does any concordant shift indicate?
STEMI
What is a hyperkalemic t wave?
stretched taught, poking out
calcium gluconate stabilizes EKG!
What wave form looks almost like a waveform of sound?
Torsades de pointes until proven otherwise
What is multifocal atrial tachycardia (MAT)?
irregular but p waves are present with various p wave morphologies
caused by COPD, hypoxia, pulmonary HTN
manage w/ O2, treat underlying condition, rate control
What is a de winter sign?
down and up ST/T wave complex that indicates + for anterior STEMI and 2% of acute LAD occlusions
upsloping ST depression and peaked T waves in precordial leads
What is Wellens clinical syndrome?
biphasic or deeply inverted T waves in V2 + V3 + recent CP that has resolved
-specific for critical stenosis of LAD
-normal to mildly elevated cardiac markers
What are some EKG troubleshooting/pitfalls?
-electrode placement errors
-artifact
-common mistakes
What can cause low voltage?
obesity, COPD, pleural or pericardial effusion, myocardial infiltration, hypothyroidism
What’s a voltage issue that is from the heart shifting back and forth from a pericardial effusion?
electrical alternans
What does widespread ST elevation with Spodick’s sign (downsloping of TP segments, best in II and V4-6)?
pericarditis
What is takotsubo rhythm?
acute stress -> catecholamine surge -> SNS activation -> microvascular spasm
generally transient
What dictates hypothermia rhythm?
J (osborn) waves, PR, QRS, QT prolongation
What is brugada syndorme?
-sodium channelopathy
-men, FH of sudden death, <45yo, asymptomatic
-coved ST segment elevation >2mm in >2 of V1-V3 followed by a negative T wave
Type 1 - wide and large J waves, most concerning
Type 2 - has >2mm of saddleback shaped ST elevation
Type 3 - either type 1 or 2 but with <2mm elevation
What is a Dig effect?
downsloping ST depression, biphasic T waves, short QT interval
“Salvador Dali’s mustache”, hockey stick sign
little slope from S-T
what can cause a prolonged QT interval?
<1/2 RR interval
- congenital long QT syndrome
- antiarrythmcis Ia, Ic, III
- antipsychotics
- antiemetics
- quinolones
- macrolides
- hypocalcemia
- hypothyroidism
- hypothermia
What are changes on an EKG that could indicate a TCA overdose?
sinus tachy
QRS and QT prolongation
RAD
