exam 1: EKG Flashcards
which ventricle is most anterior in the heart
right
which ventricle is electrically dominant
left
what connects the aorta and the pulmonary artery
ligamentum arteriosum
what does the RCA supply
R atrium
SA node
AV node
posterior septum
what does the R marginal supply
RV
apex
what does the Posterior interventricular supply
RV
posterior LV
Posterior 1/3 of IVS
what does the LCA supply
LA
LV
IVS
AV bundle
what does the LAD supply
RV
LV
anterior 2/3 IVS
what does the left marginal supply
LV
what does the circumflex supply
LA
LV
what does the LBB split into
left anterior fascicle
left posterior fascicle
what supplies the LA electrically
bachmann bundle off the anterior internodal tract
what would happen rate wise if RCA MI
bradycardia
what is resting Vm SA and why is it low
-55 to -60mv, leaky sodium channels
the anterior internodal pathway gives off the
what does it cross
bachmann bundle
interatrial septum
the middle internodal pathway is also the
wenkebach tract
runs behind behind SVC
the posterior internodal tract is also known as the
thorel tract
where is the AV node located
posterior wall of RA behind the tricuspid valve
what does the bundle of HIS prevent
APs from retrograde conduction from ventricles to atrium
what does the RBB split to
purkinje fibers
what does the LBB split to
septal, anterior and posterior fascicles, purkinje fibers
what are the two types of cardiac muscle fibers
contractile and conductile
what are the conductile muscle fibers
SA, AV node, AV bundle, L&RBB, purkinje fibers
what is vagal tone of the heart
parasympathetic power of SA node overrides SA nodes sponataneous rate of 100-110 bringing it down to 60-80 bpm
(at rest)
what is point A in SA node AP
minimum negative potential (-60 mv)
what is phase 4 in SA node AP
resting potential
gentle slope from influx of NA
what is point B in SA node AP
threshold around -40 to -45 mv
what is phase 0 in SA node AP
depolarization
what is phase 3 in SA node AP
repolarization
what is phase 0 cardiac AP
depolarization 2/2 fast Na
what is phase 1 cardiac AP
partial repolarization 2/2 Na channels closing
what is phase 2 cardiac AP
plateau 2/2 Ca++ channels being open
some K open
what is phase 3 cardiac AP
repolarization
Na and Ca channels are closed
K channel opened
what is phase 4 cardiac AP
resting membrane potential (-90 mv) 2/2 Na/K atpase pumps (3na/2k)
what is the period where an action potential cannot occur
effective or absolute refractory period
what are the phases of the absolute refractory period of the cardiac AP cycle
0-depolarization
1- partial repolarization
2- plateau
what is A to B on ventricular action potential
absolute refractory period
phase 0-mid 3
what do you call the two r waves in a LBBB
R and R’ (r prime)
what is B to C on ventricular action potential
relative refractory period
only a weak AP can be induced
phase mid3-4
T wave on EKG
what is resting membrane potential of ventricular muscle
-90mv
how long is atrial conduction time
0.2 sec
how long is ventricular conduction time
0.3 sec
how long is av delay
0.25 sec
what happens if you shock someone during the relative refractory period?
how do you prevent this?
V-Tach V-fib
synchronized cardioversion
what causes blocks
scar tissue from non-conductive fibroblasts developed during ischemia or hypoxia
scar tissue blocks electrical current from going through contractile cells
can muscle have tetany?
no
what is the typical duration of a p wave
0.08-0.11 sec
what happens during PR interval
depolaraziation through AV node, AV bundle, BBs and purkinje fibers
1 small box on an EKG = _______ mv
0.1 mv
1 large box on an EKG = _______ mv
0.5 mv
what is depolarizing at the end of the PR interval that is too weak for the EKG to record
ventricular conducting system (BBs, purkinjes)
what is size of normal Q wave
<0.04 sec
what is the first downward deflection after p wave
Q wave, often absent
where are septal Q waves normal
1, aVL, V6
due to septal innervation
non-pathologic
what is a pathologic q wave
> 0.04 sec or > 1/4 the height of the R wave
indicates MI or previous MI
where are Q waves abnormal
1, 2, 3, aVF, V3-V6
what is the first upward deflection of Q wave
R wave
what is a downward wave preceded by an upward wave
S wave
if the entire QRS is one downward deflection what kind of wave is it
QS
what is the ST segement
the horizontal baseline after the QRS
what is happening during ST segment
initial phase of ventricular repolarization that is too weak to record on EKG
what does any ST segment elevation mean
infarction or ischemia until proven otherwise
what is a J point
junction between end of QRS complex and start of ST segment
inspected for MI
what does J point measure
amplitude above baseline
what is the T wave
rapid phase of ventricular repolarization
when is the end of absolute refractory period on EKG
peak T wave
when is the earliest cardiac myocytes can respond to another stimuli
peak of T wave and after (relative refractory)
what is a U wave?
when is it visible?
hypokalemia
follows T wave
repolarization of purkinje fibers
what is the Q-T interval
ventricular systole
beginning of Q to end of T
what is normal QTc
half of RR interval or <450 ms (about 11 little boxes)
what is QTc>450ms
prolonged QT
what is QTc>500 ms
torsades
how can you treat long QT of patients
increase HR to decrease QTc
what does prolonged QT interval put you at risk for
ventricular arrythmias
what are limb leads
bipolar leads 1,2,3
what are the unipolar leads
augmented
aVR, aVL, aVF
precordial
V1-V6
what is common ground
the negative body area caused by the two negative leads in augmented leads
AVF is a combination of which 2 leads
2&3
what are causes of Left axis deviation
changes of position (end expiration, laying down, obese_
LVH
LBBB
what are causes of Right Axis deviation
change in position (end of deep inspiration, standing, really skinny people)
RVH (pulm htn or COPD)
RBBB
LV infarct
what are signs of RV strain
inverted T waves and ST depression in V1, V2, V3
what are EKG signs of RVH
right axis deviation
tall R wave V1
RV strain
peake p waves in lead 2 (r atrial enlarge)
prominent s waves in V5, V6
how do R waves appear in V leads
progression
r wave gets more positive 2/2 angle of lead
what in inferior wall MI cause
hiccups, K irritating diaphram
what is normal axis
-30 to +100
What is left axis deviation?
-30° and -90°
what is right axis deviation
+100 to +180
what is extreme right axis deviation
-180 to - 90
what causes LVH
sustained HTN
aortic stenosis
LVH raises risk of
arrythmias,
stroke,
sudden cardiac death
MI
CHF
how do you check for rhythm regularity
RR intervals
how do you do rate with 2 RRs
divide 1500 by # of smaller boxes
300, 150, 100, 75, 60, 50
60/rr interval
what is one small box height on height on EKG
one large box
1mm
5mm
what is a small box lengthwise on EKG
large box
.04 sec
.2 sec
what do you check on P waves
regular
every P has QRS
uniformity
difficult to decipher
what is normal QRS length
0.12 sec
a q wave = __________ MI
old
what is Sinus Rhythm
Regular?
Rate?
PR?
QRS?
yes
60-100
PR<.2 sec
QRS <.12
what is Sinus Brady Rhythm
Regular?
Rate?
PR?
QRS?
yes
<60
PR<.2
QRS <.12
what is Sinus Tachycardia Rhythm
Regular?
Rate?
PR?
QRS?
yes
>100
PR <.2
QRS<.12
what is Sinus arrythmia
Regular?
Rate?
PR?
QRS?
no, increased and decreased rate with respiration
60-100 BPM
<.2
<.12
sinus arythmia is a _________ variation
normal, with respiration
what is PAC
Regular?
Rate?
P wave?
PR?
QRS?
irregular
rate 60-100
non-uniform P wave
PR <.2
QRS <.12
what cuases premature contractions
irritability
what causes irritability
caffeine, lack of sleep, ischemia, SNS activity, cocaine, amphetamines, stretch of atria/ventricles
what can make P wave difficult to see in PACs
P waves can be in t waves, T wave is larger
where does P wave occur in PAC
in atria, not in SA node
what is PVC
Regular?
Rate?
P wave?
PR?
QRS?
irregular
HR varies
no P wave
no PR interval
QRS >0.12 sec
what is difference in PAC/PJC/PVC
PJC and PAC has normal appearing QRS,
in PJC P wave occurs before, during or after QRS and is inverted
PVC no visible p
what causes PVCs
irritability- usually hypoxia
what is polarity of QRS in PVC
opposite of other QRSs on lead
why is QRS long in PVC
going through muscle so takes a long time
what if multiple PVCs all look the same
unifocal, one area of irritability/foci
what if multiple PVCs all look different
multifocal, multiple areas of irritability/foci
what is pathological # PVCs
6 PVS in one minute
what is WAP
Regular?
Rate?
P wave?
PR?
QRS?
irregular
60-100 BPM
P waves non-uniform
PR interval
QRS-<.12, uniform
what if WAP with rate >100 BPM
multifocal atrial tachycardia
p waves tend to be _________- in WAP
lengthened
what is multifocal atrial tachycardia
Regular?
Rate?
P wave?
PR?
QRS?
irregular
rate >100
p waves- non uniform
PR
QRS- unifrom <.12
what disease is correlated with multifocal atrial tachycardia
COPD
what is difference of A-fiB and MAT
MAT you can pick out P waves
what is a fib
Regular?
Rate?
P wave?
PR?
QRS?
irregular
HR varies but usually >100
p wave- not visible
PR
QRS <.12 but irregular
why doesnt every foci in afib lead to a QRS
AV is in control and in refractory period= no QRS
what is Junctional Escape Rhythm
Regular?
Rate?
P wave?
PR?
QRS?
regular
40-60
p waves absent or inverted
QRS uniform
what is junctional rate
40-60
what is ventricular rate
20-40
an escape rhythm occurs when ___________ fails to do its job
SA node
Escape Rhythm is a backup
what causes p wave to be inverted in junctional rhythm
retrograde depolarization from AV-SA
what is idioventricular rhythm?
what is rate?
do you have p waves?
SA and AV fail
20-40 rate
wide QRS
usually no P waves, palmer said it can? but then that is a block… either that or i know nothing which is possible
what is V-tach
Regular?
Rate?
P wave?
PR?
QRS?
regular
150-250 BPM
p waves in QRS
QRS> .12 sec
what causes v -tach
coronary ischemia
how many areas of foci in unifocal V-tach
1
how do you determine V-tach vs wide complex SVT
Vtach: coronary artery disease QRS>0.14 sec, extreme Right axis deviation
what is Torsades the Pointes
Regular?
Rate?
P wave?
PR?
QRS?
regular
250-350 BPM
p waves hidden in QRS
QRS- non uniform
what is atrial flutter
Regular?
Rate?
P wave?
PR?
QRS?
regular rhythm-usually
HR 60-150 can be normal
Pwaves uniform and regular
QRS-uniform
what causes Torsades
low K
long QT- congenital
CCBs (bepridil)
why is atrial rate faster than ventricular rate in A flutter
AV junction refractory period
what is SVT
Regular?
Rate?
P wave?
PR?
QRS?
regular
150-250
p and t waves combined
QRS uniform-usually <.12 can be up to 0.14
what can SVT be confused with?
paroxysmal atrial tachycardia, treatment is the same so no worries
what is A- fib
Regular?
Rate?
P wave?
PR?
QRS?
irregular
HR>300
no p waves
QRS- uniform but irregular
is v fib a real rhythm
no its a lack of a rhythm…
how do you treat V fib
dfib
what is 1st degree block
Regular?
Rate?
P wave?
PR?
QRS?
regular
hr 60-100 BPM
P wave- uniform and before every QRS
PR >0.2 sec
QRS <.12 uniform
in simple terms 1st degree block is a __________ in AV node
delay
what is 2nd degree type 1 block
Regular?
Rate?
P wave?
PR?
QRS?
irregular
60-100
pwaves uniform
PR- progressive lengthening
QRS <.12, consistently dropped
progressive lengthening of PR interval until dropped QRS
what is usual cause of 2nd degree type 1 block
parasympathetic excess inhibits AV node
what is another name for 2nd degree type1 block
wenckebach
what is a 2nd degree type 2 block
Regular?
Rate?
P wave?
PR?
QRS?
regular
Hr slow- 100
P waves regular and faster than QRS, P-P same
PR interval regular <.2
QRS- uniform
what is largest difference in 2nd degree type 1 and type 2
type 2 pr interval <.2 and consistent
what is another name for second degree type 2 block
mobitz
what does a 3:1 ratio mobitz mean
3 P waves to every 1 qrs complex
what is a second degree block in simple terms
partial block
what is a third degree block in simple terms
complete block
what is 3rd degree block
Regular?
Rate?
P wave?
PR?
QRS?
regular
HR- <60
p waves uniform and regular
QRS- normal or widened
P waves and QRS have no relationship
if 3rd degree block has 40-60 rate and narrow QRS where is block
high in AV (junctional escape)
if 3rd degree block has 20-40 rate and wide QRS where is block
low in AV (ventricular escape)
what is Bundle Branch Block
Regular?
Rate?
P wave?
PR?
QRS?
regular
HR 60-100
p waves normal uniform
PR normal
QRS >.12
what causes widened QRS complex in BBBs
one ventricle (bundle) depolarizes before the other 2/2 a block in slower bundle
What branch in delayed in LBBB
left
what branch is delayed in RBBB
right
what leads do you look at in BBB
V1, V2, V5, V6
what are lateral leads
V5 and V6
What are the septal/anterior leads?
V1, V2
how does RBBB appear in septal leads
RSR (2 r waves with large s wave in between)
carrot
how does LBBB appear in lateral leads
bunny ears
what is diphasic p wave
Regular?
Rate?
P wave?
PR?
QRS?
regular
60-100 BPM
p wave regular and diphasic
qrs <.12 normal
positive and negative deflection
where do atrial issues appear
p wave
what is the best lead to look at for atrial issues
V1, lead II
how does R atrial enlargement appear on EKG
in V1 upward deflection is larger than downward inflection
how does L atrial enlargement appear on EKG
in V1 negative deflection is larger than positive deflection
if any p wave in any lead is >2.5mm in positive deflection without diphasic element this is
R atrial enlargement
where do we look for R vent hypertrophy
V1 through V6,
R wave starts high in V1 and steadily decreases to V6
V1-V3 T inversion and ST depression (strain)
V5V6 large S wave
how do you determine L vent hypertrophy
large S waves V1,
large r waves V5
V1+ V5= >35mm deflection then LVH
also LV strain signs ( inverted sloped t wave V5V6)
what causes LV strain
aortic stenosis
where do you look for LV strain
T waves in V5 V6 are downward sloped
what wave form shows ischemia
T-wave inversion
what is pathological ischemia
t wave inversion V2-V6
what is marked inversion of T wave in V2 V3
wellens syndrome
stenotic LAD
how does a patient feel ischemia
angina
what are inferior leads
II, III, aVF
what are septal leads
V1, V2
what are lateral leads
I, aVL, V5, V6
what is injury/infarction
recent ongoing cardiac damage
how does injury/infarction appear
ST segment elevation
ST segment depression
what is the earliest most consistent MI signs you will see on 12 lead
STEMI
What causes flat ST depression?
subendocardial infarction
MI not going through all of ventricle
digitalis
where does elevated troponin come from
cardiac muscle cells being damaged
what is ST elevation with no Q waves present
larger injury will soon occur
What is Brugada syndrome?
accounts for half of sudden cardiac deaths in younger healthy individuals
vfib
hereditary dysfunction of Na channels in myocytes
How does Brugada Syndrome present on the EKG?
RBBB with ST elevation in leads V1, V2, and V3
no angina
what does a significant Q wave mean on EKG
old necrotic tissue, hx MI
what is a significant Q wave
-one small square wide (>.04 sec) or one-third the size of the QRS complex in height?
can necrotic tissue depolarize
no
necrotic tissue appears to have _________ vectors
negative, as a result of “seeing through” to back side of heart
what wave do you not use for necrosis
AVF, just upside R wave down lead 2
where do insignificant q waves occur in healthy patient
V5V6, smaller than 0.4 or 1/3 QRS
what are leads 2, 3, AVF
inferior heart
what are leads I, AVL, V5, V6
lateral heart
what are leads V1, V2
septum/anterior
what are leads V3, V4
anterior
what is large R waves in V1, V2 with ST depression
posterior MI picked up by anterior leads, reversed 2/2 opposing vectors
what is involvement in 2, 3, AVF artery wise
inferior heart
RCA
CAD affects _________ arteries
multiple
what is involvement in Leads 1, AVL, V5, V6
lateral heart
circumflex
what is involvement in V1 and V2
septal
LAD,
RCA- could be posterior involvement
what is involvement in V3, V4
anterior
LAD
common cause LV strain
AV stenosis
what artery feeds the AV node
RCA
the Q-T interval represents
ventricular systole
what is a normal Q-T interval
less than half the R-R interval
what are the measurements of the small boxes on EKG
1mm x 1mm
what are the measurements of the large boxes of the EKG
5mm x 5mm
what do the height of the waves on an EKG correlate to
amplitude
10 mm on an EKG = _____________ mV
1 millivolt
what is the horizontal axis on an EKG
time
what is a small box of EKG in time
.04 sec
what is a large box of EKG in time
.2 sec
what are the two lateral leads?
where is the +
I & AVL
+ L arm
what are the three inferior leads
where is the +
2, 3 & AVF
+ L foot
what is the “center” that the chest/precordial leads look at
AV node
what do leads V1 V2 look at
R heart
what do leads V3 V4 look at
Intraventricular septum
what do leads V5 V6 look at
L heart
what kind of receptors does norepinephrine work on in the heart
adrenergic
what kind of receptors does acetylcholine work on in the heart
cholinergic
adrenergic receptors that increase HR/contractility are ________ receptors
B1
adrenergic receptors that cause venous constriction are ________ receptors
A 1
what is sinus rhythm <60
bradycardia
what is sinus rhythm >100
tachycardia
what is SA rate
60-80
what is AV rate
40-60
what is Ventricular (purkinje) rate
20-40
what is the trick for counting rate using R waves
use an R wave on a thick black line, then count large boxes
300, 150, 100, 75, 60, 50
what is a U wave
repolarization of the purkinje fibers
what is WAP and how does it present
wandering atrial pacemaker
-shape of p wave varies
-atrial rate <100
irregular vent rhythm
what is MAT and how does is present
Multifocal Atrial Tachycardia
-p wave shape varies
-atrial rate exceeds 100
-irregular ventricular rhythm
what disease often leads to MAT
copd
how does AFib present
irregular rhythm
continuous chaotic atrial spikes
irregular vent rhythm
how does a sinus escape rhythm
sinus arrest,
atrial rhythm continues after a pause but with a different shaped p wave
60-80 bpm
where does junctional escape rhythm originate
AV node
what is a junctional escape rhythm
SA node failure leads to pause
40-60 rate
normal QRS
inverted p waves before during or after QRS from AV conduction towards SA
to SA from AV
what is difference between accelerated and junctional escape rhythm
accelerated can have higher rate
still funky P waves
what is a ventricular escape rhythm
SA and AV node fialure
20-40 rate
wide QRS
what are examples of premature beats
PAB, PJB, PVB
what substances cause PAB, PJB
epi/norepi
sns
digitalis, toxins, occaisionally ethanol
hyperthyroidism
stretch
what does a PAB do to rhythm
resets pacing
what is an early P wave followed by a wide QRS
PAC setting of a wide ventricular contraction
“aberrant ventricular conduction”
what causes aberrant ventricular conduction
a BB that isnt fully repolarized
what is a PAB that doesnt cause qrs
non-conducted
av node isnt repolarized yet
what is one PAB following every normal rhythm
atrial bigeminy
what is one PAB following every other normal rhythm
atrial trigemeny
what is a slightly widened QRS with inverted t wave before during or after qrs that comes early
PJB
what stimulates ventricular foci
airway obstruction
decreased O2
decreased CO
low K
mitral valve prolapse
myocarditis
stretch
QT prolonging meds
how to PVCs appear
early, wide, opposite deflection of normal beat
when are PVCs considered to be pathalogic
6 or more per minute
what are PVCS every other beat, every two beats, every 3 beats
ventricular bigeminy, trigeminy, quadrigeminy
what do PVCs warn of
hypoxia
what is ventricular parasystole
produced by a ventricular automaticity focus that suffers from entrance block (not irritability) - it is not susceptible to overdrive suppression so it paces at its inherent rate
sinus rhythm with vent rhythm added
What is a run of Vtach
3 or more
what is minimum vtach
longer than 30 sec
what is run of PVCs with all different shapes/sizes
multifocal PVCs
what is barlows syndome
mitral valve prolapse causes PVCs
what happens when PVC fires on T wave
R on T,
what is rate of Paroxymal tachycardia?
150-250
for PAT, PJT, PVT
what is rate of a flutter
250-350
what is rate of a fib
350-450
what does paroxymal mean
sudden
what causes paroxymal runs
VERY irritated foci
what is AV nodal reentry tachycardia
form of paroxymal junctional tachycardia
What is supraventricular tachycardia?
Narrow QRS complex tachycardia with regular RR intervals, rate of 150-250 beats per minute
invovles PAT and PJT, no p waves 2/2 fast rate
V tach is a form of
AV dissociation
VT is often caused by
coronary insufficiency/ischemia
what distinguishes wide QRS complex SVT from V tach
tach QRS is > .14 sec (wider)
what is Torsades caused by
Low K
long QT
congenital
What is the rate of Torsades de Pointes?
250-350
how are p waves in a flutter
identical
what is a flutter rate
250-350
what is v flutter rate
250-350
what does v flutter turn into
v fib
how do you differentiate v flutter and torsades
v flutter is a smooth sine wave
what causes fibrillation
multiple foci firing
what is rate of fibrillation
350-450
how are R waves in a fib
irregular
What is Wolfe Parkinson White Syndrome?
THe bundle of Kent, a shortcut between the Atrium and Ventricle that shouldn’t be there, allows a second connection.
delta wave-sloping QR sergment
Do not use Rate Control or you will block the AV Node and increase Current through the Shortcut.
What is Lown-Ganong-Levine Syndrome?
short PR interval with a normal but narrow QRS complex
Bundle of James accessory pathway connects to the bundle of HIS
what is a sinus block
skipped beat from SA
What is sick sinus syndrome?
Physiologically inappropriate sinus bradycardia, sinus pause, sinus arrest, or episodes of alternating sinus tachycardia and sinus brady. Occurs most often in elderly due to scarring of the heart’s conduction system or infants who have had heart surgery
what is 1 degree block
PR interval >.2 sec, consistant PR interval, every p wave has a QRS
what is 2 degree type one block
lengthening PR interval with one dropped QRS every few beats
occurs in AV node
what is second degree type 2 block
several P waves to illicit one QRS complex
normal PR interval
occurs in bundle of HIS
what is third degree block
complete block, P waves and QRS are independent
if 3rd degree block is high in AV node what controls the ventricular rhythm
junctional focus
how are QRSs in 3rd degree block with junctional focus?
what is rate?
narrow
40-60
if 3rd degree block is below the AV node what controls the ventricular rhythm
ventricular focus
how are QRSs in 3rd degree block with ventricular focus?
what is rate?
wide
20-40
what is a wide complex bradycardia with no p waves?
what can cause it
downward displacement of pacemaker
hyperkalemia
what is a double R wave or “rabbit ears” QRS
how long is complex
bundle branch block
> .12 sec
in RBBB which ventricle is first R wave
L, it goes first
in LBBB which ventricle is first R wave
R, it goes first
RBBB will show up in which leads
V1V2
LBBB will show up in which leads
V5V6
what is the best lead to view anterior and posterior infarction of the left ventricle
V2
vectors shift toward___________ and away from __________
hypertrophy
infarction
what is axis deviation in the V leads
axis rotation
what is normal range for isoelectric QRS
V3V4
what if there is a rightward rotation in V leads where would it shift
V1V2
where would a leftward rotation shift in the V leads
V5V6
what lead tells us the most about atrial enlargement
V1
what kind of P wave occurs in atrial enlargement
diphasic
if the initial component of diphasic P wave is larger this is __________ enlargement
R atrial
if the terminal component of diphasic P wave is larger this is __________ enlargement
L atrial
which is larger in V1 R or S wave
S (negative)
what is occurring if the R wave is bigger than the S wave in V1
R ventricular hypertrophy
in R ventricular hypertrophy what happens to the R wave in V2v3v4
progressively smaller
how are vector shifted in R vent hypertrophy
R axis deviation
rightward rotation
what would cause large QRS deflections in V waves
Left vent hypertrophy
how do V1 and V5 appear in left ventricular hypertrophy
large S wave in V1
large R wave in V5
how do you mathematically determine LVH
mm S in V1 + mm R in V5
if more than 35mm than LVH
how is t wave in LVH
inverted, assymetric
what is ventricular strain
ST segment depression and hump in ventricular hypertrophy
how is the electrical supply in infarcted area
dead, no depolarization
what is the cardiac infarction triad
ischemia
injury
necrosis
what does an inverted T wave on EKG point to
ischemia (t wave is also symmetrical)
what if T wave is inverted in V2-V6
pathological
what does elevate ST segment mean
cardiac injury
what kind of MI does ST elevation mean
STEMI
but what i meant was acute
what is a ‘significant” Q wave
one small square (.04 sec) wide
on third of the QRS amplitude
means infarction/necrosis
what is a significant Q wave in V1-V4
anterior infarction
what is a significant Q wave in I & AVL
lateral infarct of L ventricle
what is a significant Q wave in 2,3, AVF
inferior infarct of L ventricle
what are large R waves in V1 and V2 mean
posterior infarction
how is ST segment in posterior infarction
ST depression in V1V2 (think everything is opposite 2/2 - leads)
ST elevation and Q waves in V1V2 is
anterior infarct
ST depression and large R waves in V1V2 is
posterior infarct
a lateral infarct is caused by the blockage in the
circumflex branch of Left Coronary Artery
an anterior infarct is caused by blockage in the
Left Anterior Descending (LAD)
a posterior infarct is caused by blockage in the
Right Coronary Artery (RCA)
RBBB
LBBB
inferior MI
Q wave in 2,3, AVF also ST elvation
Junctional Escape Rhythm
R vent hypertrophy
V1-V6 R wave linear decrease
Sinus Arrhythmia
irregularity during respiration
PAC
p wave is occuring during T wave making it appear larger
PVC
WAP
wandering atrial pacemaker
differeing p waves 2/2 change in atrial foci
Multifocal Atrial Tachycardia
-P-waves still discernable unlike afib
WAP with increased rate >100
afib
Continuous Junctional Escape Rhythm
unifocal V-tach
Torsades de pointes
atrial flutter
SVT
vfib
1st degree block
PR >.2
2nd degree type 2 block
normal PR, missed QRS
3rd degree
block on bottom of AV
2nd degree type 1 block
longer longer longer drop
PJB with retrograde p wave
inverted T wave
inferior: 2,3, AVF
septal: V1, V2
anterior: V3,V4
lateral: V5
LV hypertrophy
large S wave in V1, Large R waves V5, T wave inversion in V5 V6 with gradual downward slope
V1+ V5 deflection+ 35 mm=LVH
PJB with retrograde depolarization of atria
inverted p wave after QRS
wellens syndrome
marked T wave inversion in V2V3
anterior descending coronary artery stenosis
PJB with retrograde depolarization of atria
long QT syndrome
QT longer than half of cardiac cycle
Brugada syndrome
RBBB with ST elevation in V1, V2, V3
Brugada syndrome
RBBB with ST elevation in V1, V2, V3
subendocardial infarction
flat ST depression
2nd degree type 1 block
1-degree block
2nd degree type 2 block
Multifocal PVCs
Ventricular bigeminy
run of 3 PVCs
v-tach 3 beat run
vtach
vfib
LVH
V1 large S wave
V5 large R wave
S+R= >35mm
wolf parkinson white syndrome
delta wave in QRS makes PR interval look short and QR interval look long
bundle of kent
L ventricular strain- humped asymmetric inverted t-wave
1-normal
2- RAE
3- LAE
4- LAE and RAE
Sinus Bradycardia
35 BPM
sinus tach
sinus arrhythmia
PAC
PVC
WAP
Multifocal Atrial Tachycardia
afib
Junctional Escape Rhythm
junctional escape rhythm
Accelerated Idioventricular Rhythm (AIVR)
ventricular tachycardia-unifocal
Torsades de pointes
atrial- flutter
SVT
Vfib
1st degree block
2nd degree type 1 block
2nd degree type 2 block
3rd degree block with junctional Foci
3rd degree block with ventricular foci
1- normal
2-RBBB (RSR in septal/anterior leads
3- LBBB (rabbit ears)
RVH (right ventricular hypertrophy)
LVH
wellens syndrome
marked t wave inversion V2 v3
LCA stenosis
q waves 2,3,AVF- inferior necrosis
ST elevation- 23, AVF- infarction
Brugada syndrome
RBBB (v1-v6)
ST elevation in V1, V2, V3
inferior MI
STEMI 2, 3, AVF
(RCA or LCA or BOTH) posterior
anterolateral MI
circumflex + LAD
STEMI 1, AVL, V5, V6 and V3 V4
lateral MI
circumflex
STEMI 1, AVL, V5, V6
posterior MI
RCA
large R waves V1 V2 with st depression
septal MI
LAD
STEMI V1V2
this one also has v3 v4, LAD supplies both, so anterior septal might be the more correct answer
anterior MI
LAD
STEMi V3, V4
Accelerated Junctional Rhythm
Atrial Bigeminy
ventricular parasystole
Wolfe-Parkinson-White Syndrome
delta wave
First degree AV block
2nd type 1 block
also inferior MI?
2nd degree type 2 block
RBBB
LBBB
R axis deviation, PVCs
L axis deviation
LVH + LV strain
T wave inversion 2, 3, AVF
inferior ischemia Left Axis Deviation
anterior MI (LAD)
some lateral(circumflex) and septal wall (LAD) involvement
anteroseptal STEMI
LAD
lateral STEMI
circumflex
anterolateral STEMI
LAD, circumflex
Posterior MI
RCA
posterior/inferiorMI
RCA
LCA (in L dominant heart 10%)
posterior/inferior MI
RCA/LCA
inferior MI
RCA/LCA
J wave
right atrial enlargement
