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EM Boards > EKGs > Flashcards

EKGs Flashcards

1
Q

Persistent Juvenile T Wave Pattern

A
  • normal for kids to have t wave inversions in right precordial leads (V1-V3) which can often persist in people < 40 yo (especially women)
  • Should be asymmetric and shallow NOT symmetric and deep
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2
Q

How do you determine if in sinus rhythm?

A

p waves should be upright in I, II, III and aVF

if inverted then suggests ectopic origin of atrial beats

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3
Q

Benign Early Repolarization

A
  • ST elevations in multiple leads (but not aVR or V1),
  • precordial&raquo_space; limb
  • Notched or irregular J point
  • No reciprocal changes
  • Concave shaped J point elevation
  • ST elevation is <25% of the T wave height in V6
  • May have prominent T waves
  • Can be hard to distinguish from pericarditis, go by symptoms, also diffuse PR depressions point to pericarditis
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4
Q

AV Junctional Rhythm

A
  • Narrow complex, rate b/n 40-60 w/ p waves either hidden, before QRS with short PR or after QRS
  • If rate is 60-100 then called “accelerated junctional rhythm”
  • If rate > 100 then called “AV Junctional Tachycardia”
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5
Q

Accelerated Idioventricular Rhythm

A
  • Often seen w/ re-perfusion following MI

- A/V dissociation with ventricular escape rhythm that is > 40

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6
Q

RBBB

A
  • rSR’ or qR in lead V1
  • Slurred/wide s wave in lateral leads
  • QRS > 120 ms
  • ANY ASSOCIATED ST ELEVATIONS SHOULD PROMPT STEMI EVALUATION
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7
Q

LBBB

A
  • rS in V1 (small r with very deep and broad S wave)
  • R in I or V6 (broad monophasic R wave)
    • LAD
  • Discordance between QRS and ST segments in all leads (“appropriate discordance”)
  • Consider Sgarbossa Criteria
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8
Q

Left Anterior Fasicular Block

A
  • LAD
  • qR or R in I and aVL
  • rS in III
  • No other causes of LAD identified
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9
Q

Left Posterior Fasicular Block

A
  • Usually occurs with RBBB
  • RAD
  • qR in lead III
  • No other causes of RAD identified
  • Commonly see t wave inversions in inferior leads
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10
Q

Differential for LAD (7)

A 
LBBB
LAFB
inferior wall MI
LVH
WPW
ventricular ectopy
paced beats
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11
Q

Differential for RAD (8)

A 
LFPB
lateral wall MI
RVH
acute and chronic lung disease (PE, COPD)
normal young adults with horizontal slanted heart
ventricular ectopy
hyperkalemia
Na channel blocker OD
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12
Q

LVH Criteria

A
  • R amp > 11 mm in aVL

- R amp in V5 or V6 + S amp in V1 > 35 mm

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13
Q

RVH Criteria

A
  • R:S > 1 in V1
  • R:S < 1 in V6
  • R amp > 7 mm in V1 (if RBBB exists then R amp must be > 15 mm instead)
  • RAD
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14
Q

LAE Criteria

A
  • Notched p waves and duration > 110 ms in ANY lead

- Downward p wave deflection > 1 mm and duration > 40 ms in lead V1

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15
Q

RAE Criteria

A

p amp > 2.5 mm in ANY inferior lead

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16
Q

Differential for NARROW Complex Tachycardia

A

Regular

  • Sinus tachycardia, SVT, atrial flutter

Irregular

  • A fib, atrial flutter with variable conduction ratio, multifocal atrial tachycardia
17
Q

Hypothermia ECG Changes

A

J Waves/Osborne Waves - positive deflections at the end of the QRS complex

  • prolonged QRS and QT intervals
18
Q

2 Major Pacemaker ECG Findings

A

1 - should see pacer spikes followed by QRS complex (“capture”)

2 - should also see appropriate discordance between QRS and ST segments

19
Q

How do you detect a posterior wall STEMI?

A
  • If ST elevations in inferior leads (inferior wall MI), look to see if ST elevations in lead III are more prominent than in lead II
  • If inferior STEMI expect reciprocal changes in I, aVL and V5/6 but may be posterior extension if also see horizontal ST depressions in V1-V3
  • Enlargement of R waves in right-sided leads
    • Tall, broad (> 30 ms) R waves in V2-V3
    • R:S > 1 in V2
  • Can obtain R-sided precordial leads - RV MI if ST elevations in V4, V5 or V6 (PRELOAD DEP)
20
Q

Wellen’s Syndrome

A

biphasic t waves in anterior leads, represent large proximal LAD occlusion

21
Q

Poor R Wave Progression (definition + meaning)

A

R amp < or = 3 in V3

indicative of prior anterolateral MI

22
Q

Hyperkalemia

Hypokalemia

A

Hyperkalemia

- Peaked t waves
- Flattening of p waves
- PR and QRS prolongation 
- Bradycardia, bundle branch blocks, sinusoidal

Hypokalemia
- U waves - waves after t wave, typically smaller amp than t wave, causes camel hump shape, may make it look like QT is prolonged

23
Q

ECG Findings in Massive PE (6)

A
  • Tachycardia
  • RAD
  • Incomplete RBBB
  • S1Q3T3 - large S wave in lead I, q wave in lead III, inverted t wave in lead III)
  • Simultaneous t wave inversions in inferior and anteroseptal leads
  • Pointy p waves in V1
24
Q

Low Voltage Criteria and Differential

A
  • Criteria:
    • Amp of QRS in all limb leads < 5 mm
    • OR amp of QRS in all precordial leads < 10 mm
  • Diff:
    • Myxedema, large pericardial effusion, large pleural effusion, end stage cardiomyopathy, severe COPD, infiltrative myocardial diseases, constrictive pericarditis, prior massive MI
25
Q

Sgarbossa Criteria

A

when should you consider acute MI in LBBB?

Criteria:
- ST elevation > or = 1 mm concordant with QRS complex

  • ST depression > or = 1 mm in V1, V2 or V3
  • ST elevation > or = 5 mm discordant with QRS complex
26
Q

What is R on T phenomenon?

A

PVC right at final portion of t wave –> polymorphic VT

27
Q

Classic Findings in TCA OD?

A

tachycardia

RAD

terminal (at end) R wave (all Na channel blockers)

R amp > 3 mm in aVR

QRS prolongation

28
Q

Classic Findings in Dig Toxicity?

A

Atrial tachycardia w/ variable AV block

Hockey stick appearance of terminal R

Bidirectional V Tach

29
Q

Differential for R:S > 1 in V1 (7)

A

WPW

posterior MI

RBBB

RVH

RV strain (PE)

dextrocardia

misplaced leads (esp if upright p wave too)

30
Q

Brugada Criteria

A

Type 1 - > 2 mm coved ST elevation followed by negative t wave in V1-V3

Type 2 - > 2 mm saddleback ST elevation in V1-V3

Type 3 - either morphology but < 2 mm

31
Q

HOCM Findings (3)

A

Large QRS complexes

Deep and narrow q waves in inferior and lateral leads

Tall R waves in V1-V2

32
Q

What does it mean when there are persistent ST elevations in same leads as previous known MI w/o reciprocal changes?

A

Likely LV aneurysm

EM Boards (20 decks)

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