Lec 2-3 EKG Images Flashcards
What type of rhythm is this?
Sinus arrhythmia = non-pathological variation with respiration = looks irregular in bunches
What type of rhythm is this?
premature atrial contraction = early QRS complex originated by abnormal P wave followed by compensatory pause; but QRS complex itself looks normal
What type of rhythm is this?
premature ventricular contraction
Is this sinus rhythm? What is it?
No! because P waves present and regular but not upright in I/II
since P wave = problem is not with atria,
must be problem with where focus is [atrial rhythm/tachycardia with focus coming from somewhere else], or heart just not where its supposed to be [dextrocardia] OR you put leads in the wrong dir [inverted right and left]
What causes this rhythm?
dextrocardia
inverted P wave in I, decreasing amplitude from V1 to V6 [opposite what you’d expect = muscle mass decreasing toward left]
What causes this rhythm?
p wave inverted 1, 2 but normal progression of QRS so unlikely to be dextrocardia
III + aVF = good; aVL should have been upright but its not; aVR should have been negative but its not
–> you accidentally switched L and R
Sinus or non-sinus? Normal, brady, or tachy?
sinus bradycardia
What rate? Sinus or non? Normal brady or tachy?
sinus tachycardia
What axis?
right axis deviation à V1 negative, AVF positive
What axis?
left axis deviation à V1 positive, AVF negative
What axis?
left axis deviation
What causes this type of axis?
left anterior fascicular block
What causes this?
left bundle branch block = broad QRS, looking down in V1
What causes this?
right bundle branch block = broad QRS, looking up in V1
What causes this?
right bundle branch block = broad QRS, looking up in V1
What causes this?
left bundle branch block = broad QRS, looking down in V1
What rhythm is this?
right BBB à broad QRS, rabbit ears, upright V1
What rhythm is this?
WPW à short PR, delta wave on upstroke of QRS, broad QRS
What rhythm is this?
posterior wall infarct –> huge positive R in V1, prominent Q waves in leads II and III [inferior leads]
What rhythm?
LVH
What rhythm?
RVH with right axis deviation
What rhythm is this?
Wolf parkinson white = WPW
What rhythm is this?
wolf parkinson white = WPW
What rhythm is this?
Wolf Parkinson White = WPW
What rhythm is this?
Right bundle branch block
What does this rhythm suggest?
posterior infarct
What does this rhythm suggest?
left ventricular hypertrophy
What does this rhythm suggest?
right ventricular hypertrophy
Which leads correspond to inferior wall? septal wall? anterior wall? anteroseptal wall? lateral wall?
inferior = leads II, III, aVF
septal = V1 and V2
anterior = V3 and V4
anteroseptal = V1, V2, V3, V4
lateral = I, aVL, V5, V6 [I/aVL = high lateral; V5/V6 = anterolateral]
What does this rhythm show?
diffuse subendocardial ischemia = ST depressions and T wave inversions
What does this rhythm show? Which specific leads/signs?
anterolateral and inferior ischemia
T inversion and ST depression on II, III, aVF –> inferior ischemia
ST depression on V4, V5, V6 –> anterolateral ischemia
What stage of MI is this?
[hyperacute, fully resolved, resolution, or chronic stabilized]
resolution phase
because you see:
- Q wave
- inverted T wave
- no ST elevation
What stage of MI is this?
[hyperacute, fully resolved, resolution, or chronic stabilized]
chronic stabilized
because you see
- Q wave
- upright T wave
- no ST elevation
What stage MI is this?
[hyperacute, fully resolved, resolution, or chronic stabilized]
hyperacute phase
this is because:
- huge ST elevation
- hyperacute tall T wave
- no Q wave yet
What stage MI is this?
[hyperacute, fully resolved, resolution, or chronic stabilized]
fully evolved phase
this is because:
- ST elevation
- start to see Q wave formation
- start to see T wave inversion
What pathology does this rhythm show? what phase?
anterior wall MI
hyperacute phase since T waves and STs still up
ST elevation in V3, V4, V5, V6
What does this EKG show?
If a patient presents with new onset of this type of EKG and chest pain what is the diagnosis?
this shows LBBB = wide QRS, QRS down in V1, rabbit ears notched/slurred in V5, V6
pt with new onset LBBB and acute chest pain = acute STEMI MI
this is an acute anterior wall MI
What does this EKG show?
Inferior wall MI
ST elevation in V2, V3, aVF
hyperacute phase
reciprocal ST depression/T wave inversion in 1 and aVL substantiate STEMI
What does this EKG show?
inferior and RV infarction –> RCA infarct
ST elevation in 2, 3, aVF [hyperacute] and in V4%, V5R, V6R
What does this EKG show?
inferior wall/posterior MI
II, III, aVF ST elevation = inferior wall MI
I and aVL ST depression = reciprocal changes
V1/V2 ST depression –> mirror image of posterior wall -> may signify posterior wall MI
What does this EKG show?
age-indeterminant inferior wall MI
- III, avF show Q wave = inferior infarction
What does this EKG show?
atrial fibrillation
- irregularly irregular R-R interval b/c some P waves transmitted down and some aren’t
- fibrillatory waves rather than discrete P waves
What does this EKG show?
multifocal atrial tachycardia
- atrial tachycardia with 3 or more different P wave morphologies
- irregularly irregular rhythm
What does this EKG show?
multifocal atrial tachycardia
- atrial tachycardia with > 3 different P wave morphologies
- irregularly irregular rhythm
- rate > 100 bpm
What does this EKG show? How should you treat?
supraventricular tachycardia
Give adenosine
What type of rhythm is this?
supraventricular tachycardia = SVT
What type of rhythm is this?
sinus tachycardia
P before every WRS and upright in 1 and 2 and inverted in aVR
What type of rhythm does this EKG show?
typical atrial flutter
- sometimes 1 or 2 or 3 p waves between each QRS
- irregularly irregular QRS
- saw tooth pattern P-waves
- typical means upright in II, III, aVF
- distinguish from AFib: clear p wave activity
What type of rhythm does this EKG show?
typical atrial flutter
- fast sawtooth p waves
- a few P waves for each QRS
- typical b/c upright in II, III, aVF
What type of rhythm does this EKG show?
atypical atrial flutter
- sawtooth p waves
- very distinctive p waves
- atypical = down in II, III, aVF
Match each of the following rhythm strips with the following types of rhythms:
- multi-focal atrial tachycardia [MAT]
- atrial fibrillation
- atrial flutter
- atrial tachycardia
- AVNRT/AVRT [SVT]
- sinus tachycardia
1 = sinus tachycardia
2 = AVNRT/AVRT = SVT
3 = atrial fibrillation
4 = atrial flutter
5 = atrial tachycardia
6 = multi-focal atrial tacycardia [MAT]
What type of rhythm is this?
Treatment?
ventricular tachycardia
= fast wide QRS complexes
Treat: synchronized cardioversion
What is this rhythm?
ventricular tachycardia with fusion and capture beats mean VT
AV dissociation = no real association betwen P and QRS
capture beat = in middle of VT a p wave able to capture a narrow normal QRS
fusion beat = QRS in between supraventricular and ventricular beats
What rhythm is this? How do you treat?
Ventricular fibrillation
- chaotic irregular deflections
- no P waves or QRS or T
treat by defibrillations [not cardioversion]
What rhythm is this? How should you treat?
This is a fake fibrillation = an artifact on exam
Not fib because its regular [in fib = irregular] not flutter b/c don’t have classic sawtooth pattern in II, III, aVF
don’t do fibrillation!!
What rhythm is this? How should you treat?
This is torsade de pointes
treat with IV magnesium
What rhythm is this? How do you treat?
WPW with AFib
- broad complex tachycardia
- irregularly irregular means not VT or VF –> must be AFib
- broad coming down accessory path
- WPW since broad QRS + delta complex pre-excitation = slurred QRS upstroke
Treat = procainamide or pronesta and synchronize cardiovert
What does this EKG show?
first degree AV block
- prolonged PR
- each P followed by QRS
- usually constant PR interval
What does this EKG show?
Mobitz type I 2nd degree EKG block [wenkebach]
- lots of p waves and irregularly irregular QRS = “group” beating
- progressive prolongation of PR until P fails to conduct
What does this EKG show?
second degree AV block mobitz type 2
more dangerous than type 1
lots of extra P waves
3 or more extra p waves for every QRS
no group beating like in wenkebach
What does this EKG show?
complete heart block
p waves show no relation to the QRS complexes
What does this EKG show?
sinus pause = longer than 2 seconds of no sinus activity = 10 big boxes
What does this EKG show?
electronic pacemaker spikes = artificially induced electronic stimuli that pace pts rhythm cause a blip or spike on the waveform
What is this patient’s most likely K level
A)4.5
B)5.0
C)5.5
D)6.5
E)8.5
mostly likely has 6.5
- peaked T waves mean K . 5.5
- loss of p waves mean K > 6.5
- but if 8.5 would have had wider QRS
Identify 3 ECG findings inidicative of possible hyperkalemia? Give what med?
- peaked T waves
- first degree AV block
- wide QRS
give IV calcium
What caused this EKG pattern?
hypokalemia = promiment U waves in V2/V3
What likely caused this EKG pattern?
acute pericarditis
= diffuse ST elevation, concave upwards, PR depression in V3
- may be tachycardic
What EKG finding is this?
electrical alternans
= QRS axis or amplitude alternates between beats
may be due to pericarditis or tamponade with fluid surrounding heart
What caused this EKG finding
Pulmonary embolism
S1Q3T3 pattern
- prominent S wave in lead I
- Q wave and inverted T wave in lead III
- sinus tachycardia
- T wave inversion in V1-V3
What caused this EKG finding?
digoxin effect = reverse tick/check sign = sagging ST
What kind of rhythm is this?
What is dysfunctioning here?
sinus bradycardia
represents dysfunction at SA node
What kind of rhythm is this?
What is dysfunctioning?
Sinus tachycardia
this is dysfunctional SA node
What kind of rhythm is this?
What causes this?
Supraventricular tachycardia
narrow QRS, fast, P waves not super distinct
reflects reentry through AV node
What does this rhythm show?
premature ventricular contractions
wide QRS from ventricles; two different shaped PVC means multiple ectopic foci
