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157 Cards in this Set
- Front
- Back
- 3rd side (hint)
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question
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answer
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Lateral leads?
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I, aVL, V5, and V6
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High Lateral Leads?
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I and aVL
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Inferior Leads?
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II, III, and aVF
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Anterior leads?
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V1-V4
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Anteroseptal leads?
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V1 and V2
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Anteroapical leads?
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V3 and V4
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QTc > x is considered long?
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QTc > 440 is long
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Four causes of poor R wave progression from V1-V6?
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1. anterior infarct (left ventricle) 2. poor lead placement 3. obesity 4. LVH (takes longer for signal to progress)
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Three causes of "early" R wave progression?
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1. RVH 2. Posterior infarct 3. RBBB
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An R wave is abnormal if the R in V3 is greater than x boxes in height?
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If R in V3 > 3 boxes in height, then R in V3 is abnormal
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SxQyTz sequence in pulmonary embolism?
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S1Q3(inverted)T3
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Which AXIS OF DEVIATION corresponds with a LEFT POSTERIOR Hemiblock?
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RAD
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What is the SxQy sequence for RAD?
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S1Q3
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What is the SxQy sequence for LEFT POSTERIOR Hemiblock?
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S1Q3
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Which AXIS OF DEVIATION corresponds with a LEFT ANTERIOR Hemiblock?
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LAD
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What is the SxQy sequence for LAD?
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S3Q1
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What is the SxQy sequence for LEFT ANTERIOR Hemiblock?
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S3Q1
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For either RAE or LAE, which leads does one look at?
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II and V1
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For RAE, do you look at the heighth of boxes or the width?
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RAE = height
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For LAE, do you look at the heighth of boxes or the width?
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LAE = width
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What are the two P waves morphologies for leads II and V1 in RAE, respectively?
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Lead II: pyramid > 2.5 boxes in height; Lead V1: initial segment wider than later and > 1.5 boxes in height
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What are the two P waves morphologies for leads II and V1 in LAE, respectively?
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Lead II: "bosom" double hump > 3 boxes wide; Lead V1: later segment wider than initial segment and > 1 box in width and > 1 box deep (height)
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What lead does on consult for suspected LVH?
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aVL
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In LVH, what is the morphology of Lead aVL and > how many boxes?
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LVH: look at aVL; R wave > 11 little boxes in height
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Besides aVL, what other leads may be consulted to evaluate for LVH?
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For LVH, look at S waves for EITHER V1 OR V5 + R waves for EITHER V2 OR V6 and ADD THEM TOGETHER to find overall addition > 11 boxes tall
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What is the morphology of LV strain?
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LV strain: elongation of LATERAL LEAD T waves
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LVH + strain can only occur on what leads?
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LVH + strain on LATERAL LEADS ONLY
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What criteria in what leads determine RVH?
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For Leads V1 and V2, the R wave > S wave in the presence of RAD
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What criteria in what leads determine/differentiate a POSTERIOR MI from RVH?
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For Leads V1 and V2, the R wave > S wave in the presence of LAD OR NORMAL AXIS WITH OR WITHOUT ACCOMPANYING INFERIOR INFARCT
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What leads should one consult for suspected LBBB?
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For LBBB, consult the LATERAL LEADS: I, aVL, V5, and V6
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How does one calculate the Ventricular Rate in an EKG with an IRREGULAR RHYTHM?
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R to R Method: 1. Count TOTAL SECONDS BETWEEN TWO R WAVES. 2. DIVIDE 60 BY TOTAL COUNTED SECONDS TO GET BPM. *1 horizontal small box = 0.04 seconds
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Criteria for 1st DEGREE AV BLOCK?
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P wave precedes each QRS complex regularly, but PR INTERVAL, although uniform, is > 0.2 seconds (>5 small boxes)
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Criteria for 2nd DEGREE AV BLOCK (WENCKEBACK)?
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P waves look normal, but PR INTERVAL > 0.2 seconds (>5 little boxes). Successively longer PR intervals until one QRS fails.
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What are the atrial and ventricular rhythms, respectively in 2nd DEGREE AV BLOCK (WENCKEBACK)?
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Atrial rhythm is regular, but ventricular rhythm is irregular
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What are the criteria for 2nd DEGREE AV BLOCK (MOBITZ)?
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PR intervals do NOT lengthen. Sudden dropped QRS without prior PR changes. P waves are punctual and normal, UNLIKE NON-CONDUCTED PAC, WHICH HAVE EARLY P WAVES!
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How does one distinguish b/w 2nd DEGREE AV BLOCK (MOBITZ) and PAC?
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P waves are punctual and normal, UNLIKE NON-CONDUCTED PAC, in which the P waves are EARLY!
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Rhythm of SINUS ARREST?
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Sinus Arrest has an IRREGULAR RHYTHM
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What are the P wave AND P TO P INTERVAL characteristics in SINUS ARREST?
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Identical P waves before each QRS. New rhythm begins after a pause. The P to P interval is disturbed.
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What is the PR interval in seconds in SINUS ARREST?
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PR interval: 0.12 to 0.20 seconds
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What is the duration of the QRS complex in SINUS ARREST?
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QRS < 0.12 seconds in SINUS ARREST
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What are the CRITERIA FOR RBBB (LOOKING AT QRS 1ST FOR EACH)?
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For RBBB: Total QRS complex prolonged (>0.12 seconds). V1 and V2 have an R,R1 wave. Leads I, V5, and V6 have a "slurred S wave," which looks like a "checkmark."
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What are the CRITERIA FOR LBBB (LOOKING AT QRS 1ST FOR EACH)?
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For LBBB: Total QRS complex prolonged (>0.12 seconds). Leads I, V5, and V6 have a "blunted" positive QRS's, ST DEPRESSION, and inverted T waves. Leads V1-V3 have predominately negative QRS's.
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Criteria for Myocardial Ischemia?
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ST segment depression >= 1 mm below baseline between end of P wave and start of Q wave AND DURATION OF >= 0.04 seconds STARTING FROM "J POINT."
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What physiological function does myocardial ischemia delay?
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Ischemia delays repolarization
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Criteria for Myocardial Injury?
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Injured area remains electrically positive, causing ST segment elevation > 1 mm ABOVE BASELINE FOR LIMB LEADS (I/aVL) and/or elevation > 2 mm ABOVE BASELINE FOR CHEST LEADS (V1-V6); ALSO: duration >= 0.08 seconds to right of "J POINT." Look for in two or more leads facing same direction
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Criteria for Myocardial Infarct?
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Deep Q waves
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Characteristics of Upsloping ST depression?
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>= 1 mm ST depression. 0.08 seconds after QRS. 30-40% error rate
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Characteristics of Horizontal ST depression?
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>= 1 mm ST depression. 0.08 seconds after QRS. VERY LOW ERROR RATE IN HORIZONTAL ST DEPRESSION
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Characteristics of Downsloping ST depression?
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>= 1 mm ST depression. 0.08 seconds after QRS. 5-10% error rate
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What region of what artery is occluded in an ANTERIOR MI?
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OCCLUSION OF PROXIMAL LAD IN ANTERIOR MI.
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What leads should one consult for an ANTERIOR MI?
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Leads I and V1-V4
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What leads should one consult for an INFERIOR MI?
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Leads II, III, aVF, V6
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What 3 possible arteries may be occluded in a LATERAL MI?
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1. LEFT CIRCUMFLEX CORONARY ARTERY 2. MARGINAL BRANCH OF LEFT CIRCUMFLEX ARTERY 3. DIAGONAL BRANCH OF LAD
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What leads should one consult for a LATERAL MI?
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Leads I, aVL, V5, and V6
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What lead should one consult in a POSTERIOR MI?
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Lead V1
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What GENERAL elements of an EKG should be Interpreted? (seven)
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1. Rate 2. Rhythm 3. Axis 4. Intervals 5. Hypertrophy 6. Infarction 7. Electrolyte abnormalities
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How does one assess REGULAR RATE?
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1. Count number of LARGE boxes b/w consecutive R waves. 2. Rate = 300/# LARGE BOXES.
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How does one assess IRREGULAR RATE?
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1. Count number of RR intervals in 6 seconds. 2. Rate = Multiply # of RR intervals by 10.
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How does one assess RHYTHM?
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1. Check for sinus rhythm: single P waves before each single QRS complex. 2. All P waves look alike?. 3. P waves upright in LEAD II and INVERTED in LEAD aVR? 4. Ectopic beats (PAC or PVCs)? 4. RR intervals regular: baseline jagged w/ each RR interval varying in duration = irregularly irregular rhythm = atrial fibrillation)
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UP/DOWN orientation of LEADS I, II, AND aVF in a NORMAL AXIS?
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LEAD I: UP LEAD II: UP LEAD aVF: UP (ALL UP)
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UP/DOWN orientation of LEADS I, II, AND aVF in a LEFT AXIS DEVIATION?
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LEAD I: UP LEAD II: DOWN LEAD aVF: UP
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UP/DOWN orientation of LEADS I, II, AND aVF in a RIGHT AXIS DEVIATION?
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LEAD I: DOWN LEAD II: UP LEAD aVF: UP
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UP/DOWN orientation of LEADS I, II, AND aVF in a EXTREME AXIS DEVIATION?
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LEAD I: DOWN LEAD II: DOWN LEAD aVF: DOWN (ALL DOWN)
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How does one assess INTERVALS?
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1. PR interval for AV block (>0.2 seconds) 2. QRS for bundle branch block (>0.12 seconds, RBBB vs. LBBB) 3. QT interval using correct interval: QTc = QT/RR
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Quick method to check QT interval?
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QT interval should be less than half of the RR interval.
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Method to check QRS for RBBB?
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1. RSR' ("rabbit ears") in V1 and V2. 2. Lead I and V6: wide S
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Method to check QRS for LBBB?
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1. RR' ("slurred") in Leads I and V6. 2. Lead V1: wide S
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Method to check for RAH?
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LEAD V1: 1. Biphasic P 2. peaked in first portion 3. >2.5 mm height OR 4. > 1 x 1 mm = "p pulmonale" 5. "RIGHT IS HEIGHT!"
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Method to check for LAH?
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LEAD V1: 1. Biphasic P 2. wide, negative terminal portion 3. > 0.8 mm duration = "p mitrale." 5. "LEFT IS LENGTH."
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Method to check for RVH?
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LEAD V1: 1. R > S 2. S persists in V5 and V6 3. RAD 4. Widened QRS interval
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Method to check for LVH?
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1. Amplitude of S in V1 + R in V5 > 35 mm. 2. LAD 3. Wide QRS 4. Inverted/asymmetric T wave
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Method to check for infarction?
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1. Look for Q waves (old transmural infarct) 2. Inverted T waves. 3. ST-segment elevation or depression.
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What constitutes a "significant Q wave?"
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Significant Q wave = 1 mm wide or more than one-third the amplitude of QRS
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What does an inverted T wave likely indicate?
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Inverted T wave = ischemia
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What does ST-segment depression mean (two possibilities)?
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1. ischemia 2. subendocardial infarct (non-ST elevation MI)
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Artery responsible for an INFERIOR MI?
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INFERIOR MI = DOMINANT CORONARY ARTERY, USUALLY RIGHT
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Artery responsible for a LATERAL MI?
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LATERAL MI = LEFT CIRCUMFLEX ARTERY
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Artery responsible for an ANTERIOR MI?
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ANTERIOR MI = LAD ARTERY
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Artery responsible for a POSTERIOR MI?
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POSTERIOR MI = RIGHT CORONARY ARTERY
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Leads corresponding to an INFERIOR MI?
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INFERIOR MI = LEADS II, III, and aVF
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Leads corresponding to an LATERAL MI?
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LATERAL MI = LEADS I, aVL, V5, and V6
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Leads corresponding to an ANTERIOR MI?
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ANTERIOR MI = V1-V4
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Leads corresponding to a POSTERIOR MI?
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LEADS V1 AND V2: LARGE R AND ST DEPRESSION
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Leads corresponding to a SEPTAL MI?
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SEPTAL MI = LEADS V2 AND V3
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ELECTROLYTE ABNORMALITIES IN HYPERKALEMIA?
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Hyperkalemia -> peaked T waves -> short PR interval -> loss of P wave -> wide QRS -> sine wave
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ELECTROLYTE ABNORMALITIES IN HYPOKALEMIA?
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Hypokalemia -> flat T wave -> U wave -> prominent U wave
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ELECTROLYTE ABNORMALITIES IN HYPERCALCEMIA?
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Hypercalcemia -> short QT interval
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ELECTROLYTE ABNORMALITIES IN HYPOCALCEMIA & HYPOMAGNESEMIA?
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Hypocalcemia + Hypomagnesemia -> prolonged QT interval -> torsades de pointes
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Which degrees of AV block require a pacemaker?
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1. Second degree AV block, Mobitz Type II 2. Third degree AV block
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Method to determine REGULAR rate?
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1. Count # of large blocks (with five little squares) between each R wave. 2. Divide this number by 300 (distance between large blocks represents 1/300 minute)
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Method to determine IRREGULAR rate?
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1. Count # of beats in 6 seconds. 2. Multiply # by 10
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What LEAD should one consult to determine rhythm?
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Determine rhythm with LEAD II.
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What two possibilities may an ECG possess?
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1. Regularly irregular or 2. irregularly irregular
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What is the axis for an ECG if both LEADS I AND aVF are mainly negative?
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EXTREME RIGHT AXIS DEVIATION
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A normal PR INTERVAL should be (> or <) x seconds?
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NORMAL PR INTERVAL IS < 0.2 SECONDS
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In FIRST-DEGREE HEART BLOCK, THE P-R INTERVAL IS (> OR <) x seconds/box(es)?
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FIRST DEGREE HEART BLOCK = P-R INTERVAL > 0.2 SECONDS (>ONE LARGE BOX)
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is the P-R INTERVAL IN MOBITZ TYPE II form of second-degree heart block constant?
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yes
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Are all P waves IN MOBITZ TYPE II form of second-degree heart block followed by a QRS complex?
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no
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The ratio of P waves to QRS complexes in MTII form of second-degree heart block is x
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constant
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A normal QRS complex should be (> or <) x seconds?
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Normal QRS complex < 0.12 seconds.
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What are three causes of prolongation of the QRS complex?
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1. BBB 2. Ventricular rhythms 3. paced rhythms
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What three things should one identify on an ECG with RBBB?
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1. Widened QRS complex 2. rSR wave in the chest leads 3. LEAD I: wide S wave
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What three things should one identify on an ECG with LBBB?
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1. Widened QRS complex LEADS I, V5 OR V6: 2. Loss of Q waves 3. Broad, notched R waves in LEADS I, V5, OR V6
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The normal QT interval should be less than half of the x?
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Normal QT interval < half of the R-R interval (<0.42 seconds)
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Medications that may prolong the QT interval?
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TCAs, phenothiazines, nonsedating antihistamines; class IA, IC, and III antiarrhythmics
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Electrolyte disturbances that may prolong the QT interval?
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hypocalcemia, hypokalemia
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Congenital cause of prolonged QT interval?
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Congenital long QT syndromes
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Miscellaneous causes of prolonged QT interval?
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ischemia, bradyarrhythmias, and certain CNS lesions
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Hallmarks of LAE?
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1. Wide P wave (>0.12 s) in Lead II 2. Diphasic P wave with deep terminal component in V1
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Hallmarks of RAE?
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1. Tall P wave (>2.5 mm) in Lead II 2. Diphasic P wave with a large initial component in V1
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What type of atrial tachycardia consists of at least three different P wave morphologies on the same ECG tracing?
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Multifocal atrial tachycardia
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What two factors determine the significance of Q waves?
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1. > 0.04 seconds wide 2. >25% of QRS amplitude
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What Lead commonly has normal isolated Q waves?
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aVR
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The QRS complex should be < x seconds?
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< 0.12 sec
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Four parameters of LVH?
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1. S wave in V1 or V2 >= 30 mm high 2. R wave in V5 or V6 > 26 mm high 3. S wave in V1 + R wave in V5 or V6 > 35 mm high in adults over age 30 4. LAD
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Four parameters of RVH?
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1. R wave >= 7 mm in V1 2. R/S ration in V1 >= 1 3. Progressive decrease in R wve height across the precordial leads 4. RAD
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Causes of ST segment depression (five)?
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1. Myocardial ischemia 2. Subendocardial MI 3. Digitalis 4. Hypokalemia 5. LBBB
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Can ST segment elevation persist in an old MI?
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yes
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ST segment elevation is a key indicator of?
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myocardial necrosis
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ST segment elevations in which four leads are consistent with a lateral wall MI (circumflex coronary artery)?
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ST segment elevation in LEADS I, aVL, V5, and V6
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ST segment elevation in which four leads are consistent with an anterior wall MI (LAD coronary artery)?
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ST segment elevation in LEADS V1-V4
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ST segment elevations in what three leads are consistent with an inferior wall MI (terminal branches of right or left coronary artery)?
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ST segment elevations in LEADS II, II, and aVF
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Small, concave ST segment elevation may be x in young people?
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normal
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What is the electrophysiological cause of small, concave ST segment elevations?
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early repolarization
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If LBBB is present, ST segment x may be present and are an unreliable indicator of ischemia/infarction
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ST segment elevations in LEADS II, II, and aVF
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ST segment DEPRESSIONS in which two leads with large R waves are consistent with a posterior wall MI?
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Large R waves and ST segment depressions in Leads V1 or V2
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Three causes of PEAKED T WAVES?
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1. Very early stages of MI before true infarction 2. HYPER kalemia 3. HYPER magnesemia
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Seven causes of T WAVE INVERSIONS?
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1. Myocardial ischemia/infarction 2. pericarditis 3. Cardiomyopathy 4. Intracranial bleeding 5. Electrolyte disturbances, acidosis 6. LBBB, LVH 7. Small T wave inversions may be normal in the limb leads
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Number of big boxes in 1.0 second?
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Five big boxes in 1.0 second
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Easiest Lead to determine RATE, QRS COMPLEX WIDTH, RHYTHM, AND PR INTERVAL DURATION?
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LEAD II
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Sequence for QRS complex per x boxes?
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300-150-100-75-60 BEATS PER MINUTE
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One QRS per box = x BPM?
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One QRS per box = 300 beats per minute
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A QRS complex should NOT be any more than x little boxes?
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Three little boxes
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Narrow QRS complexes indicate impulses are traveling through the x cardiac electrical circuits?
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normal
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Wide QRS complexes indicate that impulses are traveling through x channels
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Wide QRS complexes = ectopic channels
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How does one assess rhythm?
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Regular rhythm = constant R-R length
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What is the next step after determining if a rhythm is regular?
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Is the regular rhythm a SINUS RHYTHM?
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Criteria for a regular sinus rhythm?
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1. Normal, consistently morphic P waves? 2. Is every P wave followed by onely one QRS and does each QRS get followed by only one P wave?
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The P waves should look like little x's in Lead II?
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Lead II P waves look like "little hills."
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The P waves should look like S-shaped "x-phasic" in Lead V1?
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Lead V1 P waves are S-shaped and "biphasic."
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None
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What is the next step after determining if a rhythm is irregular?
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1. Is it irregularly regular (predictable)? 2. Is it irregularly irregular?
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If the QRS complex in LEAD I POINTS DOWN, AND THE QRS complex in LEAD II POINTS UP, they are pointing toward, or returning to each other. Returning = x -axis deviation?
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Right-axis deviation
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If the QRS complex in LEAD I POINTS UP, AND THE QRS complex in LEAD II POINTS DOWN, they are pointing away from each other, or leaving each other. Leaving = x-axis deviation
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Left-axis deviation
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A normal PR interval is < x sec long (x big box(es))?
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Normal P-R interval is < 0.2 seconds or < one big box
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Third degree heart block = x heart block
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complete heart block
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R-R interval with regard to normal QT interval duration?
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The QT should be < 1/2 the R-R interval
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CHANGES IN LEADS V1 AND V2 in RBBB?
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QRS COMPLEXES SHOW TWO SYMMETRICAL PEAKS ("RABBIT EARS" = RIGHT BBB).
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CHANGES IN LEADS V1 AND V2 in LBBB?
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DEEP S WAVES IN LBBB
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ST SEGMENT ELEVATION W/ Q WAVES INDICATES?
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an evolving infarct
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ST SEGMENT ELEVATION WITHOUT Q WAVES INDICATES?
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Acute myocardial injury
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Are Q wave and non-Q wave Mis treated differently?
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yes
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Two drugs used for chemical stress test?
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1. Dipyridamole (Persantine) 2. adenosine
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Definition of scintigraphy?
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Nuclear imaging tests using radioisotopes to assess coronary blood flow after being given dipyridamole or adenosine to dilate vessels chemically
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Two radioisotopes used for scintigraphic chemical stress tests?
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1. Thallous chloride (TI-201) or 2. Technetium (Tc 99m), short half life extended by linking it to Sestamibi
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Thallium is a x analog and is taken up by cells at a rate proportional to blood flow.
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Thallium is a potassium analog
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Technetium is an x analog taken up at a rate related to blood flow.
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Technetium is a calcium analog.
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