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EKG > QRS and Axis > Flashcards

QRS and Axis Flashcards

1
Q

how should the QRS look in leads AVF, II, III

A

mostly positive deflections; vectors coming toward these leads

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2
Q

how should the QRS look in lead AVR

A

mostly negative; stimulus traveling away

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3
Q

how should the QRS look in lead I and AVL

A

q wave is normal. mostly positive deflection because stimulus travels away

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4
Q

in the precordial leads V1 is mostly

A

negative deflection

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5
Q

as you move across the chest in the precordial leads from right to left the QRS deflection becomes

A

increasingly positive

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6
Q

what is the criteria for low voltage

A

<10mm in the precordial leads

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7
Q

an example of a situation that would have low voltage

A

pericardial effusion

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8
Q

an example of a situation with high amplitude/height of the QRS

A

hypertrophy

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9
Q

what is a normal QRS duration

A

< 0.12 seconds

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10
Q

name some causes of a wide QRS

A 
hyperkalemia**: not as fast as vtach <125 bpm
BBB
idioventricular rhythms
VPCs
vtach
WPW
abberancy
meds (tricyclics)
pacemaker
IVCD
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11
Q

how would you know a wide QRS is from a pacemaker

A

pacer spikes lines

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12
Q

what does multifocal PVCs look like

A

multiple PVCs in the same lead of different shape; coming from different foci in the ventricle

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13
Q

a QRS notch at the end of the complex ( j point)

A

benign, common in precordial leads

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14
Q

if you saw a QRS notch with a benign ST segment elevation what should you consider

A

pericarditis

early repolarization

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15
Q

what is an osborn wave

A

a large hump right after the QRS complex that is NOT the t wave

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16
Q

what condition does an osborn wave signify

A

hypothermia

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17
Q

in what conditions is a q wave considered benign/insignificant

A
  1. small q waves in leads AVL and I
  2. QS in V1 ONLY
  3. isolated q wave in lead III only
  4. Q wave in AVR
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18
Q

what classifies as a pathologic Q wave

A

height > 1/2 height of the R wave

width > or equal to 0.04 seconds or 1 small box

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19
Q

True or false: 1 lead in a region that has a q wave is concerning

A

false; 1+ leads in a region is where you get concerned for pathologic q waves

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20
Q

if you saw a q wave in leads V1, V2, V3 with no upward notching what is this

A

pathologic- MI

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21
Q

where is the normal transition zone of the precordial leads

A

between V3 and V4

22
Q

what classifies as an early transition

A

before V3

23
Q

what classifies as a late transition

A

after V4

24
Q

what is the normal QT interval measured from

A

the beginning of the QRS complex until the end of the t wave

25
Q

what is the normal duration of the QT interval

A

< 1/2 RR interval

26
Q

a prolonged QT interval can lead to…

A

torasades de point

27
Q

what can the ventricular axis help you diagnose

A 
hemiblock- definitively
R/L hypertrophy
PE
dextrocardia
lead misplacement
28
Q

what is the normal axis

A

0-90 degres

29
Q

what is LAD

A

left axis deviation -1 to -90 degrees

30
Q

what is RAD

A

right axis deviation 91 to 180 degree

31
Q

if QRS is + in lead I, and + in AVF what is the axis

A

NORMAL

32
Q

if QRS is + in lead I and - and AVF

A

LAD

33
Q

if QRS is - in lead I and + in AVF

A

RAD

34
Q

calculating normal axis:

if lead I > lead AVF what is the axis in degrees

A

0-40 degrees

35
Q

calculating normal axis:

if lead I < AVF what is the axis in degrees

A

40-90 degrees

36
Q

calculating normal axis:

if lead I = lead AVF

A

45 degrees

37
Q

calculating normal axis

if lead I is isoelectric

A

90 degrees

38
Q

calculating normal axis

if lead AVF is isoelectric

A

0 degrees

39
Q

causes of left axis deviation

A

normal variant with aging

left anterior hemiblock

40
Q

causes of right axis deviation

A 
normal variant in kids/teens
right ventricle hypertrophy
left posterior hemlock
dextrocardia
pulm pathology
41
Q

at what degree is LAD considered pathologic

A

greater than 30 degrees

< 30 is normal variant with aging

42
Q

if you have LAD and you look to lead II and see an isoelectric QRS deflection what degree could you assume

A

-30 degrees; borderline pathologic

43
Q

if you have an LAD and you look to lead II and see a negative deflection you know that the degree is

A

> -30 degrees; pathologic

44
Q

where is a left anterior hemiblock located

A

left anterior fasicle

45
Q

where is a left posterior hemiblock located

A

left posterior fasicle

46
Q

which is more common, LAH or LPH

A

LAH

47
Q

T or F: diagnosis with an EKG is definitive for LAH

A

true

48
Q

T/F: diagnosis with an EKG is definitive for LPH

A

false; dx of exclusion

49
Q

how does a LAH present

A

LAD: lead I is + lead AVF is -

lead II is negative

50
Q

what is a bifasicular block

A

RBBB + LAH/LPH

51
Q

RBBB + LPH ok or bad

A

BAD; concern for complete heart block and anterior MI

52
Q

RBBB + LAH

A

ok, common fin dinging

only not ok if ischemic

EKG (5 decks)

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