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EKG > MI/ hypertophy > Flashcards

MI/ hypertophy Flashcards

1
Q

Large, diphasic P wave with tall INITIAL component

A

Right atrial hypertrophy

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2
Q

Left Atrial Hypertrophy

A

Large, diphasic P waves with WIDE terminal component

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3
Q

when the second half of the biphasic P wave is larger than the left in V1 suspect:

A

Left Atrial Hypertrophy

may also see a notched P wave in Lead 2

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4
Q

RAD with wide QRS

Rightward rotation in the horizontal plane

A

Right Ventricular Hypertrophy

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5
Q

Right Ventricular Hypertrophy R/S wave

A

R wave greater than S in V1, but R waves get progressively smaller from V1-V6
S wave persists in V5 and V6

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6
Q

How to calculate Left Ventricular Hypertrophy

A

S wave in V1
+ R wave in V5 =
> 35 mm consistent with LVH

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7
Q

LAD with slightly wide QRS

Leftward rotation in horizontal plane

A

Left Ventricular Hypertrophy

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8
Q

LVH T wave pattern?

A

Inverted T wave

slants downward gradually then up rapidly

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9
Q

Reciprocal of Anterior leads V1 and V2?

A

Posterior heart

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10
Q

What is the reciprocal of the lateral leads? I and aVL?

A

Inferior leads!!! II, III, aVF

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11
Q

II, III and aVF lets you see an MI on what wall

A

Inferior wall

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12
Q

V1 V2 V3 and V4

A

Anteroseptal Leads

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13
Q

V5 and V6

I and aVL

A

Lateral Leads

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14
Q

II, III, aVF

A

inferior leads

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15
Q

Ischemia

A

T wave inversion

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16
Q

T wave inversion

what to look for:

A

Inverted T wave is symmetrical (mirror image)
Normally T wave is upright when QRS is upright
Leads with acute infarct show both Q waves and ST elevation
Isolated ischemia may be seen, narrow coronary vessel may be determined by T wave inversion

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17
Q

Myocardial Ischemia EKG

A

> 1mm below baseline at point 0.04 sec to the R of the J point in at least 2 leads facing same anatomical direction
+/- T wave inversion
depression of ST segment is due to delay in repolarization
Note: Flat depression of ST segment- sub endocardial injury

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18
Q

Subendocardial Infarction

A

infarct that doesn’t extend through the full thickness of ventricular wall

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19
Q

ST elevation/depression is a signal of?

A

Acute Injury

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20
Q

ST elevation with significant Q waves indicates:

A

acute infarction

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21
Q

ST depression may represent

A

“subendocardial infarct” or “non-Q wave infarct”

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22
Q

Myocardial Injury

A

> 1mm (limb) or > 2mm (precordial) above baseline at least two leads facing same anatomical direction
elevated ST segment

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23
Q

Benign early repolarization

A

mc in young healthy males- complaint free

NEVER SYMPTOMATIC pt

24
Q

Q wave means

A

Necrosis

25
Q

Significant Q

A

> 1mm or 1/3 the amplitude of QRS complex

clue in to MI location

26
Q

MI credentials

A

Q wave=

  1. duration >= 0.04 sec
  2. amplitude >= 1/3 of the R wave
  3. present in at least 2 contiguous leads
27
Q

reciprocal change-

ST depression means

A

T wave is UPright

28
Q

Q wave + Reciprocal Change of ST elevation

A

T wave is flipped

29
Q

Defining leads?

A

V3 V4

bc R wave progression

30
Q

Q wave in V1-V4

A

anterior wall infarction of the LV

31
Q

Lateral Wall defining leads

A

V5 V6 I and aVL

32
Q

Inferior wall defining leads

A

II, III and aVF

33
Q

What do you see with an MI in the posterior wall

A

ST depression in leads V1 and V2
Upright T waves
R wave >= S wave

34
Q

LAD

what leads have abnormalities

A

V1-V6
Anterior
Septal
Anteroseptal

35
Q

Circumflex-

what leads have abnormalities

A

V4-V6
I, aVL
Anterolateral, Lateral, Apical

36
Q

Right Coronary

What leads have abnormalities

A

II, III, aVF
V1-V2 (reciprocial)
Inferior, Posterior

37
Q

Subendocardial MI, what leads are involved?

A

ANY LEADS!

38
Q

Wellens Syndrome

LAD coronary T wave syndrome

A 
H/o angina CP, preinfarct stage
normal-high cardiac enzymes
T wave inversion V2 and V3, NO Q waves
no ST elevation
normal R progression
39
Q

PR

A

Tachycardia
junctional rhythm
pre-excitation (WPW- delta waves)

40
Q

> 200ms “normal in”

A 
focal fibrosis
digitalis
ischemic heart disease
rheumatic heart disease
hyperkalemia
41
Q

Wolf Parkinson White there is a

A

Delta Wave

42
Q

Hyperkalemia

K

A

Wide flat P wave
Wide QRS
peaked T

43
Q

Hyperkalemia

K >7.5 mEq

A

no P wave
wide QRS “sine wave”
R-S-T sinoventricular rhythm

44
Q

Hypokalemia (

A

Moderate- flat or inverted T wave
U wave
Extreme: prominent P + U waves, prolonged QRS duration and QT interval

45
Q

Hypercalcemia

QT is

A

SHORT

46
Q

Hyopcalcemia

QT is

A

PROLONGED

this is worse bc you can get the R on T phenomenon

47
Q

Pulmonary Embolism

A 
S1Q3T3
wide S in I
Large Q and inverted T in III
acute RBBB, RAD
inverted T in V1-V4 and ST depression in II
48
Q

Pericarditis

A

PR depression, ST depression in: aVR, V1 + V3
diffuse concave up ST segment elevation
T wave depression bc ST elevation
no reciporical ST changes

49
Q

Pericardial Effusion you will see

A

Electrical Alternans

50
Q

Electrical Alternans is

A

beat to beat alternation of QRS appearance

common in tamponade

51
Q

Electrical Alternans is result of

A

back and forth swinging of the heart in the pericardial sac

52
Q

Digitalis

“digitalis effect”

A

T wave depressed or inverted
QT interval shortened

excess (blocks): SA block, PAT with block, AV block, AV dissociation

53
Q

EKG- Prolonged QT is with what mineral/electrolyte thing

A

Quinine + Quinidine

54
Q

excess Quinidine or hypokalemia may initiate…

A

Torsades de pointe

55
Q

Pacemakers “triggered”

A

when pt rhythm ceases or markedly slows

56
Q

Pacemakers “inhibited”

A

if pts rhythm resumes at a reasonable rate

57
Q

Pacemakers “reset”

A

to synchronize with premature beat

EKG (2 decks)

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