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EKG Basics > EKGs > Flashcards

EKGs Flashcards

1
Q

Criteria for sinus rhythm

A

1) P before each QRS
2) Upright P in lead II
3) Biphasic P in lead V1

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2
Q

Heart rate with 1 large box between Rs

A

300 bpm

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3
Q

Heart rate with 3 large boxes between Rs

A

100 bpm

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4
Q

Heart rate with 4 large boxes between Rs

A

75 bpm

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5
Q

Heart rate with 5 large boxes between Rs

A

60 bpm

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6
Q

Quick criteria for normal QRS axis

A
  • QRS positive in lead aVF and positive in lead I (0 to +90 degrees)
  • QRS positive in lead aVF, negative in lead I, and positive in lead II (0 to -30 degrees)
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7
Q

Quick criteria for left axis deviation

A
  • QRS negative in lead aVF, positive in lead I, and negative in lead II
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8
Q

Quick criteria for right axis deviation

A
  • QRS positive in lead aVF and negative in lead I
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9
Q

Quick criteria for indeterminate (Northwest) axis

A
  • QRS negative in lead aVF and negative in lead I
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10
Q

Normal ST segment finding

A

Isoelectric

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11
Q

What physiological processes are represented in the QT interval?

A

Beginning of ventricular depolarization (QRS) to the end of ventricular repolarization (T)

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12
Q

Normal QT interval

A

400-440 ms (controversial)

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13
Q

Quick way to determine if QT interval is prolonged

A

T wave ends beyond the halfway point of RR interval

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14
Q

What does the QTc correct for?

A

Heart rate

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15
Q

What is a normal QTc interval?

A

< 450 ms in men; < 470 ms in women

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16
Q

Bezett’s formula

A

QTc = QT / √RR

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17
Q

Common electrolyte abnormalities leading to prolonged QT interval

A
  • Hypocalcemia
  • Hypomagnesemia
  • Hypokalemia
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18
Q

Normal T wave findings

A
  • Upright in most leads (exceptions include aVR and V1)

- Assymetric with steep decline (compared to incline)

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19
Q

What is a Q wave?

A

Any downward deflection immediately following the P wave

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20
Q

How long is an abnormal widened QRS complex?

A

120 ms

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21
Q

What is the S wave?

A

Downward deflection following R wave

22
Q

Signs of pulmonary embolism on ECG

A
  • Most commonly, sinus tachycardia
  • Classically, McGinn-White (S1Q3T3) sign of acute cor pulmonale, consisting of a large S wave in lead I, a Q wave in lead III, and an inverted T wave in lead III
23
Q

What is an R wave?

A

First upward deflection following the P wave

24
Q

What is “normal R wave progression”?

A
  • In lead V1, R &laquo_space;S
  • R:S ratio increases in precordial leads
  • By lead V4, R > S
  • In lead V6, R&raquo_space; S
25
Q

What is “poor R wave progression”?

A

R remains small in leads V3-V4

26
Q

Causes for R > S in lead V1

A
  • Wolff-Parkinson-White syndrome
  • Right bundle branch block
  • Acute posterior MI
  • Right ventricular hypertrophy
  • Isolated posterior wall hypertrophy (Duchenne’s MD)
27
Q

ECG criteria for right bundle branch block

A

1) QRS > 120 ms
2) R and R’ waves with intervening S wave (rsR “bunny ears”) in leads V1-V3
3) Slurred (rounded) S waves in leads I and aVL (and often in V5 and V6)

28
Q

Signs of pathologic Q waves

A
  • More than one small box wide (40 ms)
  • More than 2 mm (two small boxes) deep
  • More than 25% of total QRS amplitude
  • Present in leads V1-V3
29
Q

What do pathologic Q waves indicate?

A

Myocardial infarction (usually OLD, developing hours to days after, particularly when revascularization does not occur)

30
Q

Sequence of ECG changes in transmural myocardial infarction

A

1) Hyperacute T waves (transient, usually missed)
2) ST elevation at the J point (“tombstoning”)
3) Resolution of ST elevation; development of pathologic Q waves

31
Q

What is the J point?

A

Junction of the QRS complex and ST segment

32
Q

What can PR segment depression indicate?

A

Pericarditis or atrial infarction

33
Q

What physiological process is occurring during the P wave?

A

Atrial depolarization

34
Q

Why is the ventricular rate in atrial fibrillation slower than the atrial rate of 400-600 bpm?

A

AV node is intermittently refractory (this causes irregularly irregular rhythm)

35
Q

Best lead to see P waves when evaluating irregularly irregular rhythm (i.e. suspected atrial fibrillation)

A

Lead II (sometimes V1)

36
Q

Which arrhythmia has a sawtooth appearance on ECG?

A

Atrial flutter

37
Q

Criteria for multifocal atrial tachycardia (MAT)

A
  • Ventricular rate above 100 bpm

- At least 3 different P wave morphologies (wandering atrial pacemaker)

38
Q

Four characteristics of premature atrial contractions

A

1) Premature
2) Ectopic, with altered P wave morphology
3) Narrow complex
4) Compensatory pause

39
Q

Signs of Wolff-Parkinson-White syndrome on ECG

A
  • Shortened PR interval (due to accessory pathway)

- Delta wave (slurring of QRS upstroke) in some individuals

40
Q

What is the pharmacologic treatment for WPW? What should NOT be given if the patient has WPW + A fib? Why not?

A
  • Give procainamide for WPW
  • Do NOT give amiodarone, adenosine, beta-blockers, calcium channel blockers, or digoxin (ABCD)
  • Blocking the AV node causes atrial action potentials to use the faster accessory pathway, potentially causing ventricular fibrillation
41
Q

What type of arrhythmia is Wolff-Parkinson-White syndrome? (category)

A

Atrioventricular Reentrant Tachycardia (AVRT); congenital

42
Q

What is an atrioventricular nodal reentrant tachycardia (AVNRT)?

A

There is a reentrant circuit present within the AV node itself (two pathways through AV node)

43
Q

Signs of AVNRT on ECG

A

1) Narrow complex tachycardia
2) In some patients, P wave after QRS complex (pseudo-S on lead II; pseudo-R on V1)
3) P wave absent in most cases
4) Tachycardia that quickly terminates with AV blocking maneuvers (carotid massage, adenosine)

44
Q

What is a first degree AV block?

A

When conduction is slowed through the AV node, producing a prolonged PR interval on ECG ( > 1 big box)

45
Q

What occurs in a Wenckenbach/ Mobitz I/ type 1 second degree AV block?

A

AV conduction is slowed and increases with each beat until P wave fails to conduct through the AV node (progressive elongation of PR interval)

46
Q

What occurs in a Mobitz II/ type 2 second degree AV block?

A

AV node becomes completely refractory to conduction on an intermittent basis (NO progressive elongation of PR interval)

47
Q

What occurs in third degree AV block (complete heart block)?

A

No conduction through AV node, so there is complete dissociation between atrial and ventricular rhythms (P and QRS are unrelated)

48
Q

Left bundle branch blocl (LBBB) criteria

A

1) QRS Duration greater than 120 ms
2) Lead V1 should have either a QS or a small r wave with large S wave (large V appearance)
3) Lead V6 should have a notched (or ‘slurred’) R wave and no Q wave

49
Q

Criteria for right ventricular hypertrophy (RVH)

A

1) R wave > 7 mm in lead V1
- OR-
2) R > S in lead V1

50
Q

Sokolow-Lyon Criteria for left ventricular hypertrophy (LVH)

A

[S wave in lead V1] + [R wave in V5 or V6] > 35 mm

51
Q

What is the Brugada criteria/algorithm used for? What are the signs that it assesses?

A

Used for diagnosing ventricular tachycardia.

1) Concordance in precordial leads (V1-V6)
2) RS interval > 100 ms (wide complex)
3) AV dissociation
4) LBBB, RBBB, etc. morphology patterns

EKG Basics (2 decks)

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