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cardio exam 2 > Lec 2-3 EKG > Flashcards

Lec 2-3 EKG Flashcards

1
Q

What is normal p-wave height/width?

A

height < 2.5 mm [< 2.5 small sq]

width < 0.11 sec [<3 small sq]

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2
Q

What is normal PR interval?

A

0.12-0.2 sec [3-5 small sq] = P wave + PR segment

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3
Q

What is normal QRS complex duration?

A

< 0.12 sec [3 small sq]

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4
Q

What is normal QTc interval duration?

A

< 460 ms [11 small sq]

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5
Q

What are the standard 12 leads of ECG?

A

6 precordial [chest] leads V1 to V6 right to left= cross-sectional view of heart

6 limb leads [I, II, III, aVR, aVL, aVF] = frontal view of heart

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6
Q

What are characteristics of normal sinus rhythm?

A
  • p waves axis upright in I, II, inverted in AVR
  • each p wave followed by a QRS
  • p wave rate 60-100 bpm
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7
Q

In normal sinus rhythm, which leads have upright p wave and which inverted?

A
  • p waves upright in I, II

- p waves inverted in AVR

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8
Q

What does the pr segment represent?

A

time from atria to AV node

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9
Q

What does the p wave represent?

A

depolarization of the atria

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10
Q

What does the pr interval represent?

A

p wave + pr segment = time from SA node to AV node

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11
Q

How many mV is one small square on EKG?

A

0.1 mV

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12
Q

How much time is one small square on EKG

A

0.4 seconds = 40 mS

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13
Q

What does the QRS complex represent?

A

duration of depolarization of the ventricles

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14
Q

What is the ST segment?

A

time from end QRS to T wave → duration of repolarization of ventricles

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15
Q

What is QT interval?

A

start of Q though end of T = everything depolarizing and repolarizing in ventricles

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16
Q

What are the 2 leads that are essentially negative normally?

A

AVR, V1

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17
Q

How does HR change in inspiration?

A

INspiration = Increase; variation from inspiration to expiration should be less than 10%

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18
Q

What does premature atrial contraction look like?

A
  • early QRS complex originated/preceded by abnormal P wave

- QRS complex itself looks normal

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19
Q

What does premature ventricular contraction look like?

A

broad QRS wave, not preceded by P wave

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20
Q

What is cheat method for determining rate of HR from EKG?

A

distance between QRS waves: 300 = 1 big square; 150 = 2 big sq; 100 = 3 big sq; 75 = 4 big sq; 60 bpm = 5 big sq
Thus if 5 big squares between QRS waves = 60 bpm
3-6 big boxes = normal

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21
Q

What is non-cheat method for determining HR from EKG?

A

1500/n → n = number of small squares between R-R

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22
Q

What is sinus bradycardia?

A

rate < 60/min; normal P wave axis

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23
Q

What is sinus tachycardia?

A

rate > 100/min; normal P wave axis

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24
Q

What is lead II direction?

A

toward left foot [+60]

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25
Q

What is lead III direction?

A

down and right [+120]

26
Q

What is einthoven’s triangle?

A

leads 1, 2, and 3 together

27
Q

What is aVR direction?

A

-150

28
Q

What does it mean” normal people stand upright”?

A

normal = both lead I and AVF are upright

29
Q

What does it mean “right people always meet”?

A

right axis deviation = lead 1 down, AVF up

30
Q

What does it mean “leftists don’t see eye to eye”?

A

left axis deviation = lead I upright, AVF down

31
Q

What is normal heart axis?

A

range: 0 to +90

32
Q

What axis degree if right axis deviation?

A

+90 though + 180

33
Q

What axis degree if left axis deviation

A

0 though -90

34
Q

What axis if lead 1 upright and AVF negative?

A

left axis deviation

35
Q

What axis if both lead 1 and AVF negative?

A

indeterminate

36
Q

What axis if lead 1 negative and AVF upright?

A

right axis deviation

37
Q

How do you get lead I?

A

right arm –> left arm [1 L]

38
Q

How do you get lead II?

A

right arm –> left leg [2 Ls]

39
Q

How do you get lead III?

A

left arm –> left leg [3 Ls]

40
Q

What is meant by S1Q3 pattern of right axis deviation?

A
  • lead 1 has a deep S wave

- lead 3 has a deep Q wave

41
Q

What is moderate vs marked right axis deviation?

A 
moderate = 90 to 120
marked = 120 to 180
42
Q

What should you look out for when you are diagnosing left axis deviation?

A

make sure it is an S wave causing the big negative wave in AVF –> do this by looking to make sure theres a tiny little blip of a R wave right before the down wave

if its a Q wave –> might be an infarct

43
Q

What is most important cause of left axis deviation?

A

left anterior fascicular block

44
Q

How do you determine if left anterior fascicular block?

A
  1. extreme left axis devation [-45 to -90

2. negative lead II

45
Q

What should you think if broad > 120 ms QRS looking down in V1 but normal p and pr?

A

think left bundle branch block

46
Q

What produces rabbit ears of QRS?

A

two ventricles are depolarized separately = two R waves

due to bundle branch block in one side

47
Q

What do you see in right bundle branch block?

A
  • prolonged QRS > 0.12 sec
  • secondary R wave [R’] with R’ greater than initial R
  • wide S wave
  • positive V1 QRS
48
Q

Where do you see QRS rabbit ears in RBBB? LBBB?

A

RBBB = in V1 [+ V2 right precordial leads]

LBBB = in V4 and V5 [left precordial leads]

49
Q

What do you see in left bundle branch block?

A
  • prolonged QRS > 0.12 sec

- negative V1 QRS

50
Q

Normal QRS in V1 is pos or neg?

A

negative

51
Q

What 4 common conditions can cause big positive V1 QRS wave?

A
  • RBBB
  • posterior wall MI
  • WPW syndrome [wolf-parkinson-white]
  • RVH [right ventricle hypertrophy
52
Q

What are sokolow criteria for LVH?

A

S in V1 + R in V5 or V6 > 35 mV

add the two together

53
Q

What are cornell criteria for LVH?

A

S in V3 + R in AVL > 28 mV in men

S in V3 + R in AVL > 20 mV in women

54
Q

What are framingham criteria for LVH?

A

R in AVL > 11 mV or R in I > 13 mV

55
Q

What should you see in LVH?

A
  • large QRS in left precordial [V4, V5, V6]

- repolarization abnormalities [ST depression, T wave inversion]

56
Q

What are criteria for RVH?

A
  • right axis deviation > + 100
  • positive V1

plus one or more of the following:

  • R in V1 + S in V5 or V6 > 10
  • right atrium enlarged
  • R wave in V1 > 7
  • S wave in V1 < 2
  • etc
57
Q

What should you think if positive V1 QRS and deviation?

A

RVH

58
Q

What are criteria for Wolf-parkinson-white?

A
  • short PR interval less than 3 squares (< 120 ms)
  • delta wave on upstroke QRS [pre-excitation]
  • broad QRS
  • secondary ST and T wave changes [inverted T, ST depression]
59
Q

What are 3 types of rhythms with ST/T wave changes from which you can’t interpret ischemia/infarction?

A
  • LBBB
  • LVH
  • WPW
60
Q

What does direction of V1 tell you about WPW?

A

V1 negative –> accessory path on right side

V1 positive [upright] –> accessory path on left side

cardio exam 2 (19 decks)

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