Ekg

Front 1

Long Standing RV Overload - EKG findings

Back 1

1. Very Peaked P waves, V1 and Inferior leads. P wave axis will look vertical, around 85 degrees (nl p wave axis is 45-60 degrees)
2. Prominent T wave inversions in lead V1 and biphasic T waves in V2
3. Prominent R wave in V1, but the R/S ratio will still be <1
4. Terminal S waves in left chest leads (so instead of just a QR where R is typically the terminal wave, there is also an S. So will this affect the transition zone? Yes. there is no true transition zone when terminal S waves appear in the left chest leads.
5. Right axis deviation
If you suspect RV overload, look first at lead V1 - peaked P waves, T wave inversion, prominent R wave

Front 2

Hypokalemia on EKG

Back 2

1. ST depressions (also in ischemia)
2. T wave inversions (also in ischemia)
3. large U waves (less common in ischemia)

hypokalemia can mimic ischemia

Front 3

Although in the nl range, a PR Interval of 190 milliseconds may indicate slow AV conduction if the HR is increased or decreased?

Back 3

Increased! Normal range for PR interval 120-200ms. If tachycardic PR interval would be closer to low-normal range. This is because in sinus tachycardia there is increased symphathetic tone and decreased vagal tone, and hence the PR interval should also be decreased

Front 4

Tented T waves, prolonged PR interval with P wave flattening, and QRS widening with merging into the T wave are EKG findings c/w....?

Back 4

Hyperkalemia - causes an overall membrane depolarization which inactivates voltage dependent sodium channels. The inactivation of sodium channels leads to the prolonged PR interval with p wave flattening and QRS widening. What about peaked T waves? elevated K directly increases activity within certain K channels increasing membrane repolarization, and this appears as tented T waves. So elevated K has a direct effect of increased membrane repolarization which manifests as tented T waves. It has an indirect effect causing on overall membrane depolarization inactivating voltage dependent sodium channels, this prolongs PR interval, flattens the P wave, and widens the QRS. Direct affect is on potassium channels, indirect affect is on sodium channels.

Front 5

Junctional Escape Rhythm characterized on EKG by:

Back 5

1. Negative P waves - may appear before, after, or hidden within the QRS complex
2. PR interval - short (<0.1s)
3. Rate - 40-60 bpm
4. QRS duration is normal, nl complex

Front 6

Lown-Ganong-Levine vs. WPW on EKG

Back 6

1. Both have a shortened PR interval
2. WPW - widened QRS, while LGL narrow QRS
3. Only WPW with delta waves

Front 7

Strain Pattern means?

Back 7

refers to abnormalities in the ST-T segment of the EKG that indicate ventricular enlargement. An example: T wave inversions in V1 that occur with RV overload

Front 8

Misplacing these leads will result in a P wave inverted in lead 1 and a QRS in lead 1 that is inverted from that in V6 indicates what?

Back 8

Right-Left arm lead reversal - causes RAD on EKG

Front 9

Diffuse Mild ST Elevation in an asymptomatic patient could represent...?

Back 9

an early repolarization abnormality

with chest pain and friction rub - acute pericarditis

Front 10

Small q Waves (non-pathologic) common in most leads except?

Back 10

small q waves should never be seen in aVR, V1, V2, or V3

small q waves should be <0.03s

Front 11

Criteria in q wave MI?

Back 11

1. q wave changes in at least 2 contiguous leads
2. q wave depth >1mm

Front 12

bifid p wave in lead II <0.03s represents...?

Back 12

nothing! This is a normal phenomenon

Front 13

QRS voltage >12 in lead aVL represents...?

Back 13

LVH (just 1 of several criteria)
1. QRS >12mm in aVL

Front 14

2nd MCC of unexpected sudden death in young patients?
(leading cause is HOCM)

Back 14

arrhythmogenic RV cardiomyopathy - often require ICDs

Front 15

QTc?

Back 15

QT interval in seconds, divided by sq. root of the preceding RR interval in seconds
(for faster HR expect shorter QT)
(for slower HR expect longer QT)