Stanley's EKG Flashcards by John Burnett

HEART?

Hypertrophy
Extent of intervals
Axis
QRS- ST Analysis
No T wave inversion

All signs of normal EKG

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Hypertrophy?

LVH if S+T>=35 mm
S=tallest S wave of V1, V2, V3
R= tallest R wave of V4, V5, V6 and/or

Rwave >= 12 mm Lead aVL only if age >=35 yrs

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Extent of intervals?

PR= .12-.20 sec

QRS < 1/2 of RR

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Axis is normal if?

Leads I and aVF positive
consider LAFB if axis < -45 degrees
Left axis: Lead I positive, and Lead aVF negative

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QRS- ST analysis, normal if?

No significant Q-waves
No ST segment changes
Transition zone occurs between (V2, V3, V4) inclusive
R wave propagation

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Depolarization of the heart?

SA node
AV node
Bundle of HIS
Left/Right Bundles (within interventricular septum)

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Contains automaticity?

SA node
internodal pathways
AV Junction tissue 
Bundle of HIS
Left and Right Bundle
Purkinje fiber

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Refractory period?

time after depolarization- repolarization where cell cannot undergo depolarization

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P wave?

depolarization of the right and left atrium

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Depolarization of SA and AV node?

very small voltage, not show on ECG machine

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QRS wave?

depolarization of the septum, right, left ventricles

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Repolarization of the atria?

not see on ECG since it is lost in QRS complex

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T wave?

repolarization of ventricles

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Why does the AV node slow?

prevent rapid fire signal from the SA node, prevent life threatening tachycardia

if rapid signals occur, met with refractory period of AV node

Problems- Wolff-Parkinson-White WPW, or Preexcitation Syndrome

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12 leads on a standard 12 lead and their electrical orientation?

Lead I
Lead II
Lead III
Lead aVL
Lead aVF
Lead aVR
Lead V1
Lead V2
Lead V3
Lead V4
Lead V5
Lead V6

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Lateral leads?

V6, V5, V4

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High lateral leads?

Lead I, aVL

Septal leads?

V1, V2

Anterior leads?

V2, V3, V4

Inferior leads?

Lead II, Lead III, aVF

Normal PR interval?

.12<=.20 sec

Normal QRS?

<= .10 sec

Normal QT?

<= 1/2 RR

Prolonged QT interval?

greater than 1/2 the RR interval

at heart rate btw 60-100

Limbs in the frontal plane?

Limb leads/ bipolar leads

Depolarization toward a positive electrode?

cause an upward deflection

Depolarization away form a positive electrode?

cause a downward deflection

Leads for the right ventricle or Posterior ventricle?

none

Lead that contains least useful information and discarded?

aVR

Which is stronger depolarization of right or left ventricle?

Left

R wave progression?

is normal in a normal ECG smallest in lead V1 and largest in V6 V1 S>R V6 R>S

Period where the R wave is equal in voltage to the S wave?

This is known as the transition zone, R=S

If Vtrans occurs before V2?

early transition, in V2 R>S

If transition zone occurs after V4?

late transition

What can an early transition mean?

Posterior MI, normal variant

What can a later transition mean?

COPD, MI, R/LBBB, normal variant

Criteria for left ventricular hypertrophy?

Age (>=35 yo) R+S>=35 mm R wave on aVL >=12 mm

Criteria for LBBB?

QRS >= .12 sec RSR' in leads V6, V5, or V4 (slur/notch) Lead I is all upright (slur or notch)

Criteria for RBBB?

QRS duration >= .12 sec RSR' in Leads V1, V2, or V3 (slur or notch) Lead I is biphasic with broad terminal S wave

Criteria for IVCD? (Interventricular conduction delay)

inverted t wave (concordance with negative portion of QRS (primary)) Some