PGY3 - EKGs

Question 1

Answer 1

LAFB

Slightly prolonged QRS duration (Not quite 120 msec or < 3 small boxes)

Left axis deviation

qR complex in leads I and aVL (Depolarization going towards these leads)

rS complex in leads II, III, and aVF (Depolarization going away from these leads)

LAFB - LAD

Question 2

Answer 2

LPFB

• Slightly prolonged QRS duration (Not quite 120 msec or < 3 small boxes)
• Right axis deviation
• qR complex in leads II, III, and aVF (Depolarization going towards these leads)
• rS complex in leads I and aVL (Depolarization going away from these leads)
• Absence of right ventricular hypertrophy or prior lateral myocardial infarction

Question 3

SEE EKG

Answer 3

RBBB + LPFB

Essentially RBBB with RAD

Question 4

SEE EKG

Answer 4

RBBB + LAFB

Essentially RBBB + LAD

LAFB - LAD

Question 5

Clinical Sig of Bifascicular Block

Answer 5

Syncope presentation - likely progression

Admit/Monitor

May need pacemaker

Question 6

Trifascicular Block

Answer 6

= Bifascicular + Long PR (Type I)

Question 7

SEE EKG

Answer 7

TCA Overdose

• Sinus Tachycardia
• QRS > 100 ms in lead II
• Terminal R wave > 3 mm in aVR
• R/S ratio > 0.7 in aVR

Question 8

SEE EKG

Answer 8

WPW

• PR <120
• Delta Wave
• QRS > 110
• ST-segment and T-wave discordant changes – i.e. in the opposite direction to the major component of the QRS complex
• Pseudo-infarction pattern in up to 70% of patients – due to negatively deflected delta waves in the inferior / anterior leads (“pseudo-Q waves”), or as a prominent R wave in V1-3 (mimicking posterior infarction)

Question 9

SEE EKG

Answer 9

Wellen’s Waves

Specific for LAD stenosis

Indication for PCI

• Type A = Biphasic T Wave
• Type B = Deeply inverted T Wave

Question 10

SEE EKG

Answer 10

Hypothermia

• Bradyarrhythmias
  
  • Sinus bradycardia (may be marked)
  • Atrial fibrillation with slow ventricular response
  • Slow junctional rhythms
  • Varying degrees of AV block (1st-3rd)
• Osborne Waves (= J waves)
• Prolonged PR, QRS and QT intervals
• Shivering artefact
• Ventricular ectopics
• Cardiac arrest due to VT, VF or asystole

Question 11

LVH Criteria

Answer 11

LVH

Criteria

• Voltage
  
  • Deepest S in V1 or V2 + Tallest R in V5/V6 = 35+

and/or

R in aVL = 12+

• Age 35+
• LV Strain (non-specific ST changes)

Question 12

SEE EKG

Answer 12

MAT

Question 13

SEE EKG

Answer 13

De Winter’s

= STEMI EQUIVALENT

Question 14

SEE EKG

Answer 14

HOCM

• Dagger like Q Waves
• Signs of LVH
• Apical Variant - Deeply Inverted T Waves

Question 15

SEE EKG

Answer 15

Brugada Type 3

• Morphology of either:
  
  • Type 1 (Shark Fin)
  • Type 2 (Saddleback)
• But with <2mm of ST segment elevation

Only Type 1 is Diagnostic

Question 16

SEE EKG

Answer 16

Brugada Type 2

• >2mm of saddleback shaped ST elevation.
• Only Type 1 is Diagnostic

Question 17

SEE EKG

Answer 17

Brugada Type 1

• Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave.
• This is the only ECG abnormality that is potentially diagnostic.

Question 18

SEE EKG

Answer 18

Left Atrial Enlargement

• Lead II-
  
  • Bifid P
  • > 40 ms between 2 peaks
  • total duration > 110 ms
• V1-
  
  • Biphasic with terminal neg portion > 40 ms or > 1 mm deep Mitral stenosis, HTN, AS, HCM

Question 19

SEE EKG

Answer 19

Right Atrial Enlargement

“P Pulmonale”

• Peaked P wave with amplitude:
  
  • >2.5 mm in inferior leads
  • > 1.5 mm in V1 and 2
• Pulm HTN, cor pulmonale, TS, congenital heart disease

Question 20

SEE EKG

Answer 20

Bilateral Atrial Enlargement

• In lead II
  
  • Bifid P wave with
  • Amplitude ≥ 2.5mm AND
  • Duration ≥ 120 ms
• In V1
  
  • Biphasic P waves with
  • Initial positive deflection ≥ 1.5mm tall AND
  • Terminal negative deflection ≥ 1mm deep AND
  • Terminal negative deflection ≥ 40 ms duration
• Combination criteria
  
  • P wave positive deflection ≥ 1.5 mm in leads V1 or V2 AND
  • Notched P waves with duration >120 ms in limb leads, V5 or V6