Cardiology (Ekg At The Bedside)

Front 1

normal PR interval

Back 1

3-5 small box (120-200 msec)

Front 2

normal QRS

Back 2

2-3 small box (80-120 msec)

Front 3

normal QTc

Back 3

9-11 small box (360-440 msec)

Front 4

1 mm (small box) = ?

Back 4

0.04 sec or 40 msec

Front 5

to check p-wave, look at lead ___.

Back 5

II (mainly), III, aVF

Front 6

normal PR interval

Back 6

3-5 small box (120-200 msec)

Front 7

normal QRS

Back 7

2-3 small box (80-120 msec)

Front 8

normal QTc

Back 8

9-11 small box (360-440 msec)

Front 9

1 mm (small box) = ?

Back 9

0.04 sec or 40 msec

Front 10

to check p-wave, look at lead ___.

Back 10

II (mainly), III, aVF

Front 11

atrial fibrillation will show up as what ekg?

Back 11

no p-wave with QRS complex irregular spacing (this is most common arrhythmia)

Front 12

what's the HR jingle that Dubin taught you?

Back 12

300, 150, 100...75, 60, 50 (from thick line to thick line)

Front 13

bifid or notched p-wave in lead II shows ____ ____ _________.

Back 13

left atrial enlargement.

Front 14

what will you look for in right atrial enlargement?

Back 14

tall p wave > 2.5 mm (small boxes) in lead II

Front 15

what would you look for on ekg:
- left atrial enlargment
- right atrial enlargement
- AV block

Back 15

- bifid P in lead II
- tall P wave > 2.5
- prolonged PR interval (> 5 boxes or 0.20 sec)

Front 16

name some reversible causes of P-R prolongation (AV node block)

Back 16

-drugs (beta blockers, ca channel blockers, digoxin)
-acute ischemia or infarction

Front 17

what is an irreversible cause of PR prolongation?

Back 17

degenerative or calcific dz of the conduction system (Lev's dz)

Front 18

name the triad caused on the ekg by wolff-parkinson-white (WPW)

Back 18

short PR (<120 msec)
wide QRS (>3 blocks)
delta wave (slurring at initial rise of R wave)

Front 19

what does delta wave ALWAYS mean?

Back 19

that the conduction is anterograde depolarization down the accessory pathway, bypassing the AV node (this is less common - 20% - and is more dangerous)

Front 20

what happens to QRS complex in BBB?
also, differentiate b/w RBBB and LBBB

Back 20

ventricle with BBB is depolarized late, so that you have an R(prime) for the later ventricle

you'll have:
- wider QRS (3+ boxes)
- for RBBB: look in V1 and V2 for "rabbit ears"
- for LBBB: look in V5 and V6 (not rabbit ears)

Front 21

causes of BBB

Back 21

- ischemia/infarct of BB
- eccentric hypertrophy of that ventricle (will take longer to depolarize causing wider QRS and RSR')

Front 22

most common congenital dz presenting in adulthood

Back 22

ASD (atrial septal defect) = shows up as R BBB/R eccentric hypertrophy (blood shunts from left to right atrium, filling RV with more blood)

Front 23

what is the normal QTc? how do you calculate it?

Back 23

360-440 msec

QT divided by square root of R-R interval

Front 24

complication of long QT interval

Back 24

Torsades de Pointes (poly morphic ventricular tachycardia)

Front 25

causes of prolonged QT interval

Back 25

- drugs (anti-arrythmics, anti-psychotics, TCAs)
- electrolyte abnormalites (low K, low Mg or low Ca)

Front 26

what is the most common electrolyte abnormality leading to prolonged QT interval?

Back 26

low K

Front 27

name the drugs that prolong PR (block AV node)

Back 27

beta blockers, Ca channel blockers, digoxin, amiodarone, clonidine

Front 28

what do you look for on an ekg if it's volume overload (eccentric hypertrophy)?

Back 28

LBBB or RBBB

Front 29

what do you look for on an ekg if it's pressure overload (concentric hypertrophy)?

Back 29

RVH, LVH

Front 30

what is the voltage criteria for LVH and RVH?

Back 30

LVH: R (V5 or V6) + S (V1 or V2) > 35 mm

RVH: Tall R > 5 mm or R>S in V1 or V2

Front 31

what's the axis criteria for LVH and RVH?

Back 31

LAD in LVH and RAD in RVH: “Overall QRS axis shifts to the hypertrophied ventricle”

Front 32

name the 11 steps in ekg reading

Back 32

-rhythm
-rate
-P wave morphology
-QRS axis
-PR interval
-QRS interval
-QT interval
-Chamber enlargement: LVH, RVH
-pathologic Q waves
-ST and T wave changes
-Precordial R wave progression

Front 33

What are the 3 criteria for pathologic Q waves?

Back 33

1. negative initial QRS
2. WIDER than 0.04 sec (40 msec) - one small box
3. deeper than 1/3 of subsequent R wave in same QRS

Front 34

what are the 3 hallmarks of an evolving MI?

Back 34

pathologic Q wave
ST elevation
inverted T waves

Front 35

1)ST elevation =
2)ST elevation AND path Q waves =
3)path Q waves ONLY =

Back 35

acute MI
evolving MI
old MI

Front 36

ST depression signals _____ ____.

ST elevation signals _____.

Back 36

1) subendocardial ischemia (this is the first part to have ischemia - since it's in the area that's farthest from coronary arteries) --> you'll see this before elevation

2) acute MI

Front 37

what are the 3 things you see wrong in this ekg?

Back 37

pathologic Q waves
ST elevation
inverted T waves

this is an evolving MI!!

Front 38

The ST segment depression that is most characteristic of ischemia is:
a. downsloping
b. upsloping
c. horizontal
d. A and C

Back 38

D. downsloping and horizontal

upsloping ST segment depression can occur in nl person during stress test

Front 39

The most life-threatening cause of ST segment elevation is:
a. Acute Myocardial Infarction
b. Acute Pericarditis
c. Coronary vasospasm (Prinzmetal’s angina)
d. Early Repolarization

Back 39

a. AMI

Front 40

differentiate acute MI vs. pericarditis in terms of 1) ekg lead, 2) presence of pathologic Q waves, 3) PR morphology

Back 40

acute MI = localized ST elevation (think only one artery/branch involved), path Q wave, NO PR depression

acute pericarditis = diffuse ST elevation, no path Q waves, depressed PR

Front 41

what are the 3 things ST elevation could be?

Back 41

-AMI
-pericarditis
-coronary vasospasm (Prinzmetal's angina)

Front 42

if you see tall ST segment elevations in leads I, aVL and V2-V6, dx?

Back 42

massive acute MI

Front 43

three things to spot for evolving MI

Back 43

pathologic Q wave
ST elevation
inverted T wave

Front 44

what can a peaked/tall T wave (>10mm) mean?

Back 44

high potassium (mainly!)
AMI
ischemia

Front 45

what if you only see ST elevation?

Back 45

acute MI!!

Front 46

what could a tall R in V1/V2 indicate (precordial R wave progression)?

Back 46

old posterior MI
RVH
RBBB
WPW

Front 47

by itself, what are pathologic Q waves indicative of?

Back 47

an old myocardial infarction