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66 Cards in this Set
- Front
- Back
The averafge direction of electirical activity with the ventricle's during depolarization is ?
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AXIS
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The ____ is visualized on a 360 degree circle drawn in a frontal plane, determined by leads I, II, III and AVR, AVL, AVF.
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mean qrs vector
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Abnormal axis may indicate abnormal __
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depolarization
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Abnormal axis can help to identify the origin of wide __ tachycardia
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complex
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Abn. axis may indicate a change in the pt's __ status.
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cardiovascular
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causes of axis deviation may be mechanical or __.
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electrical
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name 3 electrical causes of axis deviation
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MI
V tach hemiblocks |
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name 5 mechanical causes of axis deviation
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ascities
obesity pregnancy trauma chamber hypertrophy |
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A normal axis is located in the _ to_ degrees in the frontal plane
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0-90
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For a normal axis deviation the P or QRS waves must be in the __ position
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positive in Lead I and AVF
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Axis is the "______" when given in degrees.
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mean qrs vector
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the normal axis range is __-__degrees
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0-90
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Left axis deviation is when the range is from __-__ degrees.
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0 to -90
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IN LAD in what positions will lead I and AVF be in?
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Lead 1-upright/positive
AVF-negative |
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A + in lead I and + in AVF =
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NAD
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A + in lead I and negative in AVF=
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LAD
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name multiple causes of LAD
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normal variant
inferior MI L-anterior sided blocks mechanical shifts due to pregnancy, obesity, ascites Left BBB cardiac pacing ventricular ectopic rhythms |
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LAD is __-__ degrees
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0 to -90 degrees
positive in I, negative in AVF |
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In an AMI there is a cecrotic area of heart that has lost its blood supply and does not depolarize. The unopposed vectors from the other side __ the mean qrs vector away from the infarct.
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draw
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Right Axis Deviation is located between __-__ degrees
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90 to 180
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In RAD lead I will be _ and AVF will be _.
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lead I-negative
AVF-positive |
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In the axis circle where is RAD located?
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bottom left quarter.
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in RAD the lead one tracing must be mainly __ to be considered RAD.
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negative
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Causes of RAD?
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normal variant
RVH anterolateral MI mechanical shifts |
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Some other causes of RAD?
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Acute PE
dextrocardia A/V septal defect ventricular ectopic rhythms severe pulm. htn |
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RAD is located between _-_degrees and will have a _ lead I and _ AVF.
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90-180
negative lead I positive AVF |
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Intermediate Axis is also called ___
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no man's land
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Intermediate axis is located between __-__ degrees
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180-270 (-90)
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Inter. axis deviation will show __ in lead I and __ in AVF.
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negative in both
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A pt. with a + lead I and negative AVF has a __
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LAD
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A pt. with a - lead I and - AVF has a
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intermediate axis located between 180 and -90 (270)
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A pt. with a - lead I and +AVF has a __
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RAD
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An intermediate axis can be caused by what?
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right vent. pvc/vt
extreme right vent. hypertrophy |
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upright in I and AVF is?
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NAD
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negative in I and AVF is ?
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intermediate or no man's land deviation
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upright in lead I and negative in AVF is?
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LAD
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negative in lead I and upright in AVF is ?
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RAD
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T/F
the EKG is/is not a very accurate diagnostic tool for determining cardiac chamber enlargement. |
is not
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T/F
EKG is a very sensitive and specific test for determining left ventricular hypertrophy? |
false and is even worse with atrial's and rvh
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What is the diagnostic test of choice for determining chamber enlargement?
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echo
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terminology:
there is atrial ___ and ventricular ___ |
enlargement
hypertrophy |
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Which lead is the best for detecting atrial enlargement and why?
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V1-as it lies right over the left atria
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name common causes of RAE
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acute cor pulmonale
pulm htn rvh copd PE CAD acute left vent. failure hypoxia |
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What will you see on an EKG to indicate RAE?
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-inc. p-wave amplitude in II, III, and AVF
-amplitude> 2.5mm in lead II -usually peaked p waves -biphasic p-waves in V1 with initial deflection more prominent |
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in what leads are the p waves best visualized?
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II and VI
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If you see peaked P-waves in II, III, and AVF you must think?
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RAE
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a biphasic p wave in V1 with initial deflection more prominent is indicative of ?
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RAE
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peaked p waves in lead II? is also called
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p pulmonale
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in LAE, name some causes?
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mitral valve dx
aortic valve dx htn cad lvh idiopathic hypertrohic subaortic stenosis |
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p waves described as:
-wider, more squared, or M-shaped in II, III, and AVF --or-- biphasic p wave in V1 with 2nd deflection more prominent is.... |
LAE
p-mitrale |
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p-mitrale means....
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wider, squarer, or M shaped p waves in LAE
p-mitrale |
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a biphasic p wave in V1 with the second deflection more prominent is....
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lae
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causes of rvh?
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mitral stenosis
tricuspid insufficiency copd pulm. stenosis transplantation of great vessels tetralogy of fallot |
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what often accompanies rvh?
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rae
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these findings are suggestive of what other condition?
RAD (or indeterminant axis) RAE Incomplete BBB low voltage ekg persistant precordial S waves "STRAIN" in R vent leads (V1,2,3, or II, III, or AVF) Tall R waves in lead V1 |
suggest RVH
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tall R waves in V1 indicate?
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RVH
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a ST depression in V5 can indicate?
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RVH
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causes of lvh?
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htn
aortic valve dx coarctation of the aorta |
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To dx lvh, which 2 numbers should you remember?
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35 and 12
35=deepest S wave in lead V1 or V2 plus TALLEST R wave in lead V5 or V6 =35mm and/or R wave in lead AVL >12 patient > 35 y.o. left vent. strain pattern |
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LVH- what do the numbers 20 and 25 remind you of?
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Deep S wave (>20-25mm) in leads V1 or V2
Tall R wave (>25 in lead V5, or >20mm in lead V6) An R wave >20mm in any inferior lead (II, III, or AVF). |
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When looking for LVH on an ekg if you add mm of S in V1 and mm of R in V6, if greater than __MM =LVH
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S in V1 + R in V6 of greater than 35 mm =LVH
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you will often see ___ with LVH.
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lae
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V1 importance...in chamber sizing...
-initial deflecation of biphasic p-wave is up |
rae
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second deflection of biphasic p wave is down
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lae
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larger R than S wave in V1 =
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RVH
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larger S wave than R wave in V1 =
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LVH
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