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EKG > ST segment and hypertrophy > Flashcards

ST segment and hypertrophy Flashcards

1
Q

what does the ST segment signify

A

period between ventricular depolarization and repolarization

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2
Q

where is the J point

A

where the QRS and ST segment meet

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3
Q

in what situations is the J point harder to identify

A

LVH with strain
early repel
pericarditis

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4
Q

what is considered a normal ST segment

A

at baseline; smooth transition to t wave

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5
Q

what is considered ST segment changes

A

> 2mm from baseline in 2 or more leads; can be above or below baseline=abnormal!

flattened ST segment with not much of a wave is also possible pathology

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6
Q

what does ST segment depression indicate

A

ischemia; NSTEMI

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7
Q

what does ST segment elevation indicate

A

infact; STEMI

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8
Q

name some benign ST segment changes and whether it would be elevated or depressed

A

pericarditis-elevation
early repol-elevation
LVH with strain- elevated or depressed
BBB-elevated/depressed

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9
Q

ST segment elevation with upward concavity (esp with notching of the j point) is….

A

benign

:) happy face

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10
Q

ST segment elevation with downward concavity/ “coving”…

A

BAD=infarct

:( sad face

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11
Q

how should the T wave normally look

A

assymetrical

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12
Q

if the t wave looked symmetrical and tall what could this indicate

A

ischemia/infarct

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13
Q

if the t wave was tall, narrow, peaked, and symmetrical what could this indicate

A

hyperkalemia

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14
Q

IF THE t wave was broad and wide what could this indicate (plus a wide QRS)

A

intracranial hemorrhage

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15
Q

what height is considered abnormal for a t wave

A

> 2/3 height of the R wave

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16
Q

the T wave is normally positive in which leads

A

I, II, V3-V6

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17
Q

which lead normally has a negative T wave

A

AvR

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18
Q

if a t wave is flat/inverted in 1 lead this is

A

benign

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19
Q

if a t wave is flat/inverted in multiple leads this is

A

pathologic for ischemia

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20
Q

if you have a biphasic T wave and the first part is + this is

A

benign

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21
Q

if you have a biphasic T wave and the first part is negative this is

A

pathologic

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22
Q

what are the clinical features of pericarditis

A

ST segment elevation
notching of the QRS
PR segment depression

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23
Q

what does early repolarization look like

A

benign ST seg elevation
NO PR segment depression
notching of the QRS
found in young/athletes

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24
Q

for right atrial enlargement what lead should you look at first

A

lead II

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25
Q

what does lead II show in RAE

A

> 2.5 mm in height, peaked shaped

think rising right!!

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26
Q

if the p wave in lead V1 is biphasic how can you tell if its RAE

A

the positive half is taller and wider

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27
Q

if the p wave in lead II is > 0.12 seconds long what is this indicative of

A

Left atrial enlargement

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28
Q

if you see a M shaped/ camel humped p wave in lead II what is this indicative of

A

LAE

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29
Q

how will the p wave look in V1 if there is LAE

A

biphasic wave with the - wave being wide (at least 1 small box) and deep

30
Q

how does biatrial enlargement appear

A

MIXED criteria of both LAE and RAE

31
Q

what are the 2 causes of LVH

A

increased pressure- HTN, AS

increased volume- AI, MR

32
Q

how can LVH with strain confuse you for ischemia

A

ST segment and t wave inversion is normal part of strain - not having an MI

33
Q

what is the criteria for diagnosis of LVH

A

the deepest S wave in leads V1/V2 + tallest R wave in V5/V6 = > 35 mm

34
Q

when can the criteria for LVH not be used

A

in the presence of LBBB, WPW, ventricular rhythms, e- disturbances, drug effects

BASICALLYYYY anything that effs with the QRS complex shape

35
Q

if the R wave in AvL is > 11mm what is this indicative of

A

LVH

36
Q

monomorphic S waves in I and V6 are indicative of what

A

LBBB

37
Q

ST depression and inverted t waves

A

ischemia

38
Q

ST elevation with or without t waves

A

infarct

39
Q

what is the normal limit of ST segment elevation before it is pathology

A

1mm in limb leads

40
Q

ST segment that con caves up is ….

A

strain

infarct

41
Q

very broad t waves is significant of

A

CNS events
stroke
intracranial hemorrhage

42
Q

if the t wave is >2/3 the height of the R wave this is

A

pathology

43
Q

if a t wave is flat this is

A

pathology

44
Q

a tall peaked t wave in the precordial leads

A

hyperkalemia

45
Q

hyperkalemia can lead to what

A

IVCD: Right and left BBB

46
Q

what is the criteria for RVH with strain

A 
RAE
RAD
RVH
ST depression concave down
inverted t wave

S1Q3T3

47
Q

S1Q3T3 is the pneumonic for what

A

PE

48
Q

T/F: ST elevation/depression if flat, is usually ischemia

A

TRRUUUE DAT

49
Q

what is the LVH with strain pattern

A

ST elevation concave upward in leads V1-V3 and ST depression concave downward in V4-V6

50
Q

what is the criteria for RVH

A

in lead V1 the R:S ratio is >1:1

51
Q

if you see concordance with a BBB this is significant for

A

ischemia concerning for infarct

52
Q

flat t waves signify

A

ischemia

infarct

53
Q

inverted t waves signify

A

ischemia
infarct
strain

54
Q

new LBBB with cardiac sx is considered

A

an MI equivalent

55
Q

describe the carousel pony of a posterior wall MI

A

in V1/V2 you see ST depression, a big fat tall R wave, and an UPRIGHT t wave

56
Q

when you see an inferior wall MI what else should you check for

A

right wall MI

posterior wall MI

57
Q

if you saw a carousel pony how could you distinguish it from RVH with strain

A

RVH with strain has an INVERTED t wave whereas pony has an upright t wave

58
Q

if there is an MI in the lateral wall where would the reciprocal changes be seen

A

Inferior leads

59
Q

which coronary artery supplies the anterior, lateral, and septal part of the heart

A

LAD

60
Q

what is the first sign of an MI progression

A

t wave inverts

then the ST segment depresses, ST elevates, q waves

61
Q

downward sloping ST depression in AvL is indicative of what

A

inferior wall MI

62
Q

criteria for an RVI

A

ST segment elevation in III > than that in II

IWMI

63
Q

which artery supplies the inferior wall and RV

A

RCA

64
Q

true or false: anteroseptal MI’s have reciprocal changes

A

false; we cannot see the posterior wall

65
Q

when you have a LWMI where are the reciprocal changes seen

A

inferior leads shows ST depression

66
Q

anteroseptal MI with lateral extension is caused by the blockage of which coronary A

A

LAD

67
Q

AMIs can cause

A

AV blocks
BBB
arhythmias

68
Q

if you have an Apical MI what area is involved

A

I, II, III, AVF, AVL, V2-V6

inferior, lateral, anterior

69
Q

an apical MI is caused by the blockage of what artery

A

RCA

70
Q

when you see ST elevation in I and II you should think its….

A

pericarditis
APICAL MI!!
aortic dissection with global infarct

71
Q

when you see an inferior wall MI you should…

A

order right and posterior leads!! think PWMI and RVMI

72
Q

which leads should you look at to check for a posterior wall MI

A

V1 and V2

EKG (5 decks)

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