PGY1 EKGs Flashcards
EKG Block Measurements
mm, sec, msec
Small Box = 1mm = 0.04 sec = 40 msec
x 5 =
Large Box = 5mm = 0.2 sec = 200msec
Axis Determination
- Normal = I Pos, aVF Pos
- LAD = I Pos, avF neg
- RAD = 1 Neg, aVF pos
PR Interval
120-200 msec (2-5 small boxes)
QRS Duration
80-120 msec (2-3 small boxes)
QT interval
400-430 msec
Or half the length of space between beats
STEMI Criteria
ST Elevation in 2 contiguous Leads:
- 1mm in all leads except for V2/V3
- V2/V3
- Men < 40 = 2.5 mm
- Men > 40 = 2 mm
- Women: 1.5 mm
Pathological Q Waves
- > 40 msec (1 block) wide
- > 2mm deep
- >25% depth of QRS
- Seen in Leads V1-3
May be normal in III and aVR
See EKG
LBBB
QRS > 120
If the QRS looks like W in V1 and M in V6 it is LBBB. (Wi_LL_iaM)
Or look at V1 - LBBB if main effect is down
See EKG
RBBB
QRS > 120
If the QRS looks like M in V1 and W in V6 it is RBBB. (MoRRoW)
Or look at V1 - RBBB if main effect of QRS is up
Lateral Infarct
- Leads
- Vessel
- Reciprocal
- I
- AVL
- V5-V6
LCX or Diagonal of LAD
V1
Anterior Infarct
- Leads
- Vessel
- Reciprocal
V1-V4
LAD
II, III, aVF
Inferior Infarct
- Leads
- Vessel
- Reciprocal
II, III, aVF
RCA usually, sometimes LCx
I, aVL
-40% with RV infarct - get right-sided EKG
Post Infarct
- Leads
- Vessel
- Reciprocal
- Suspect with Lateral or Inferior MI
- No STE on regular EKG
- Seen in Inferior and Lateral Ischemia -
- Horizontal STD in V1-V3
- V2 with R/S > 1
- Get posterior
- V1-V2
- Posterior Descending Branch of RCA
Septal Infarct
- Leads
- Vessel
- Reciprocal
Loss of R Wave in V1-V3
None
LAD or RCA
See EKG
1st Degree AV Block
Long PR - No Dropped Beat
(Long PR > 200msec)
See EKG
Second Degree Type I Block
Progressive PR lengthening until drop (looks like groups)
Second Degree Type II
Regular PR with nml P-R interval with occasional dropped beats
Third Degree Block
Complete Dissociation
Early Repol
Mod Hyper K (6.5-8.0)
Widening QRS
Loss of P-waves
ST-segment changes
Chronological ECG changes of hyperkalemia include:
- Peaked T waves
- Prolongation of PR interval
- Widening QRS Complex
- Loss of P wave
- “Sine Wave”
- Asystole
Early Hyper K (>5.5)
Peaked T waves
Long PR
Chronological ECG changes of hyperkalemia include:
- Peaked T waves
- Prolongation of PR interval
- Widening QRS Complex
- Loss of P wave
- “Sine Wave”
- Asystole
Severe Hyper K (6.5-8.0)
Sine Wave
Chronological ECG changes of hyperkalemia include:
- Peaked T waves
- Prolongation of PR interval
- Widening QRS Complex
- Loss of P wave
- “Sine Wave”
- Asystole
SVT
Pericarditis
LA/RA Reversal
LA/LL Reversal
LA/LL Reversal
Hypokalemia
EKG Rate
- Multiple Number of QRSs by 6
- # Boxes B/t QRS:
- 300, 150, 100, 75, 60
Right Sided Infarct
- Leads
- Vessel
- Reciprocal
- Seen in 30-50% of Inferior Infarcts
- Suggested if EKG
- STE in V1 + ST Depression in V2 (Highly Specific)
- STE in III > II
- Get Rt Sided EKG - V3R-V6R
- Avoid Nitro
- Give fluids
Inferior Infarct
- Leads
- Vessel
- Reciprocal
- Leads II, III, AvF
- RCA (80%), LCx (18%)
- I, aVL, Septal Leads
Rt Infarct
STE in III > II
STE in V1
