Lec 2-3 EKG Images Flashcards

1
Q

What type of rhythm is this?

A

Sinus arrhythmia = non-pathological variation with respiration = looks irregular in bunches

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2
Q

What type of rhythm is this?

A

premature atrial contraction = early QRS complex originated by abnormal P wave followed by compensatory pause; but QRS complex itself looks normal

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3
Q

What type of rhythm is this?

A

premature ventricular contraction

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4
Q

Is this sinus rhythm? What is it?

A

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]

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5
Q

What causes this rhythm?

A

dextrocardia

inverted P wave in I, decreasing amplitude from V1 to V6 [opposite what you’d expect = muscle mass decreasing toward left]

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6
Q

What causes this rhythm?

A

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

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7
Q

Sinus or non-sinus? Normal, brady, or tachy?

A

sinus bradycardia

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8
Q

What rate? Sinus or non? Normal brady or tachy?

A

sinus tachycardia

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9
Q

What axis?

A

right axis deviation à V1 negative, AVF positive

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10
Q

What axis?

A

left axis deviation à V1 positive, AVF negative

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11
Q

What axis?

A

left axis deviation

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12
Q

What causes this type of axis?

A

left anterior fascicular block

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13
Q

What causes this?

A

left bundle branch block = broad QRS, looking down in V1

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14
Q

What causes this?

A

right bundle branch block = broad QRS, looking up in V1

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15
Q

What causes this?

A

right bundle branch block = broad QRS, looking up in V1

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16
Q

What causes this?

A

left bundle branch block = broad QRS, looking down in V1

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17
Q

What rhythm is this?

A

right BBB à broad QRS, rabbit ears, upright V1

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18
Q

What rhythm is this?

A

WPW à short PR, delta wave on upstroke of QRS, broad QRS

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19
Q

What rhythm is this?

A

posterior wall infarct –> huge positive R in V1, prominent Q waves in leads II and III [inferior leads]

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20
Q

What rhythm?

A

LVH

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21
Q

What rhythm?

A

RVH with right axis deviation

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22
Q

What rhythm is this?

A

Wolf parkinson white = WPW

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23
Q

What rhythm is this?

A

wolf parkinson white = WPW

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24
Q

What rhythm is this?

A

Wolf Parkinson White = WPW

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25
Q

What rhythm is this?

A

Right bundle branch block

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26
Q

What does this rhythm suggest?

A

posterior infarct

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27
Q

What does this rhythm suggest?

A

left ventricular hypertrophy

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28
Q

What does this rhythm suggest?

A

right ventricular hypertrophy

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29
Q

Which leads correspond to inferior wall? septal wall? anterior wall? anteroseptal wall? lateral wall?

A

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]

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30
Q

What does this rhythm show?

A

diffuse subendocardial ischemia = ST depressions and T wave inversions

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31
Q

What does this rhythm show? Which specific leads/signs?

A

anterolateral and inferior ischemia

T inversion and ST depression on II, III, aVF –> inferior ischemia

ST depression on V4, V5, V6 –> anterolateral ischemia

32
Q

What stage of MI is this?

[hyperacute, fully resolved, resolution, or chronic stabilized]

A

resolution phase

because you see:

  • Q wave
  • inverted T wave
  • no ST elevation
33
Q

What stage of MI is this?

[hyperacute, fully resolved, resolution, or chronic stabilized]

A

chronic stabilized

because you see

  • Q wave
  • upright T wave
  • no ST elevation
34
Q

What stage MI is this?

[hyperacute, fully resolved, resolution, or chronic stabilized]

A

hyperacute phase

this is because:

  • huge ST elevation
  • hyperacute tall T wave
  • no Q wave yet
35
Q

What stage MI is this?

[hyperacute, fully resolved, resolution, or chronic stabilized]

A

fully evolved phase

this is because:

  • ST elevation
  • start to see Q wave formation
  • start to see T wave inversion
36
Q

What pathology does this rhythm show? what phase?

A

anterior wall MI

hyperacute phase since T waves and STs still up

ST elevation in V3, V4, V5, V6

37
Q

What does this EKG show?

If a patient presents with new onset of this type of EKG and chest pain what is the diagnosis?

A

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

38
Q

What does this EKG show?

A

Inferior wall MI

ST elevation in V2, V3, aVF

hyperacute phase

reciprocal ST depression/T wave inversion in 1 and aVL substantiate STEMI

39
Q

What does this EKG show?

A

inferior and RV infarction –> RCA infarct

ST elevation in 2, 3, aVF [hyperacute] and in V4%, V5R, V6R

40
Q

What does this EKG show?

A

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

41
Q

What does this EKG show?

A

age-indeterminant inferior wall MI

  • III, avF show Q wave = inferior infarction
42
Q

What does this EKG show?

A

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
43
Q

What does this EKG show?

A

multifocal atrial tachycardia

  • atrial tachycardia with 3 or more different P wave morphologies
  • irregularly irregular rhythm
44
Q

What does this EKG show?

A

multifocal atrial tachycardia

  • atrial tachycardia with > 3 different P wave morphologies
  • irregularly irregular rhythm
  • rate > 100 bpm
45
Q

What does this EKG show? How should you treat?

A

supraventricular tachycardia

Give adenosine

46
Q

What type of rhythm is this?

A

supraventricular tachycardia = SVT

47
Q

What type of rhythm is this?

A

sinus tachycardia

P before every WRS and upright in 1 and 2 and inverted in aVR

48
Q

What type of rhythm does this EKG show?

A

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
49
Q

What type of rhythm does this EKG show?

A

typical atrial flutter

  • fast sawtooth p waves
  • a few P waves for each QRS
  • typical b/c upright in II, III, aVF
50
Q

What type of rhythm does this EKG show?

A

atypical atrial flutter

  • sawtooth p waves
  • very distinctive p waves
  • atypical = down in II, III, aVF
51
Q

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
A

1 = sinus tachycardia

2 = AVNRT/AVRT = SVT

3 = atrial fibrillation

4 = atrial flutter

5 = atrial tachycardia

6 = multi-focal atrial tacycardia [MAT]

52
Q

What type of rhythm is this?

Treatment?

A

ventricular tachycardia

= fast wide QRS complexes

Treat: synchronized cardioversion

53
Q

What is this rhythm?

A

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

54
Q

What rhythm is this? How do you treat?

A

Ventricular fibrillation

  • chaotic irregular deflections
  • no P waves or QRS or T

treat by defibrillations [not cardioversion]

55
Q

What rhythm is this? How should you treat?

A

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!!

56
Q

What rhythm is this? How should you treat?

A

This is torsade de pointes

treat with IV magnesium

57
Q

What rhythm is this? How do you treat?

A

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

58
Q

What does this EKG show?

A

first degree AV block

  • prolonged PR
  • each P followed by QRS
  • usually constant PR interval
59
Q

What does this EKG show?

A

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
60
Q

What does this EKG show?

A

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

61
Q

What does this EKG show?

A

complete heart block

p waves show no relation to the QRS complexes

62
Q

What does this EKG show?

A

sinus pause = longer than 2 seconds of no sinus activity = 10 big boxes

63
Q

What does this EKG show?

A

electronic pacemaker spikes = artificially induced electronic stimuli that pace pts rhythm cause a blip or spike on the waveform

64
Q

What is this patient’s most likely K level

A)4.5
B)5.0
C)5.5
D)6.5
E)8.5

A

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
65
Q

Identify 3 ECG findings inidicative of possible hyperkalemia? Give what med?

A
  • peaked T waves
  • first degree AV block
  • wide QRS

give IV calcium

66
Q

What caused this EKG pattern?

A

hypokalemia = promiment U waves in V2/V3

67
Q

What likely caused this EKG pattern?

A

acute pericarditis

= diffuse ST elevation, concave upwards, PR depression in V3

  • may be tachycardic
68
Q

What EKG finding is this?

A

electrical alternans

= QRS axis or amplitude alternates between beats

may be due to pericarditis or tamponade with fluid surrounding heart

69
Q

What caused this EKG finding

A

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
70
Q

What caused this EKG finding?

A

digoxin effect = reverse tick/check sign = sagging ST

71
Q

What kind of rhythm is this?

What is dysfunctioning here?

A

sinus bradycardia

represents dysfunction at SA node

72
Q

What kind of rhythm is this?

What is dysfunctioning?

A

Sinus tachycardia

this is dysfunctional SA node

73
Q

What kind of rhythm is this?

What causes this?

A

Supraventricular tachycardia

narrow QRS, fast, P waves not super distinct

reflects reentry through AV node

74
Q

What does this rhythm show?

A

premature ventricular contractions

wide QRS from ventricles; two different shaped PVC means multiple ectopic foci

75
Q
A