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157 Cards in this Set

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