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67 Cards in this Set

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Standardization
Should be standardized to 10 mm, if not, must adjust vertical measurements
Heart Rate
Method 1: Count 300, 150, 75, 60, 50, 42
Method 2: Divide 300 by number of boxes between R waves
Rhythm
P for each QRS
Regular sinus rhythm: 60-100
Sinus Tachycardia: >100
Sinus Bradycardia: <60
PR Interval
Normal: .12 to .20 seconds
1st Degree block: > .20
WPW: <.12, Wide QRS, and Delta Wave
QRS Width
Normal: < or = .10 sec
Incomplete BBB: .11 sec
Complete BBB: > or = .12 sec
LBBB: big QS (-V1)
RBBB: rabbit ears (+V1)
QT Interval (Normal)
Normal: HR 70, QT .40; HR 100, QT .35-.36
QT Interval (Abnormal)
Shortening of QT:
Digitalis (scooping of sT seg in leads with tall R's)
Hyperkalemia (peaked T waves)
Hypercalcemia
Lengthening of QT:
Procainamide, Quinidine
Hypokalemia (U waves)
Hypocalcemia
Axis
Method 1: Axis is 90 deg to smalles QRS complex, if -, then go to - end of the perpendicular axis, not the reference lead
Method 2: Axis is plotted, net voltage in lead I on X axis, net voltage in aVf on -Y axis
Normal Axis: -30 to +100 degrees
If axis is < or = -45 deg and QRS <.12: LAH
If axis is > or = 20 deg and QRS <.12 (must rule out RVH): LPH
Standardization
Should be standardized to 10 mm, if not, must adjust vertical measurements
Heart Rate
Method 1: Count 300, 150, 75, 60, 50, 42
Method 2: Divide 300 by number of boxes between R waves
Rhythm
P for each QRS
Regular sinus rhythm: 60-100
Sinus Tachycardia: >100
Sinus Bradycardia: <60
PR Interval
Normal: .12 to .20 seconds
1st Degree block: > .20
WPW: <.12, Wide QRS, and Delta Wave
QRS Width
Normal: < or = .10 sec
Incomplete BBB: .11 sec
Complete BBB: > or = .12 sec
LBBB: big QS (-V1)
RBBB: rabbit ears (+V1)
QT Interval (Normal)
Normal: HR 70, QT .40; HR 100, QT .35-.36
QT Interval (Abnormal)
Shortening of QT:
Digitalis (scooping of sT seg in leads with tall R's)
Hyperkalemia (peaked T waves)
Hypercalcemia
Lengthening of QT:
Procainamide, Quinidine
Hypokalemia (U waves)
Hypocalcemia
Axis
Method 1: Axis is 90 deg to smalles QRS complex, if -, then go to - end of the perpendicular axis, not the reference lead
Method 2: Axis is plotted, net voltage in lead I on X axis, net voltage in aVf on -Y axis
Normal Axis: -30 to +100 degrees
If axis is < or = -45 deg and QRS <.12: LAH
If axis is > or = 20 deg and QRS <.12 (must rule out RVH): LPH
Axis Interpretation
I aVf Quadrant/Disease
+ + RLQ – Normal
- - ULQ – Extreme Derivation
- + LLQ – RAD
+ - Look at Lead II:
+ = URQ (Normal)
- = URZ - LAD
Hypertrophy (limb leads)
Right Atrial Enlargement
1. P wave > or = 2.5 mm tall
Hypertrophy (limb leads)
Left Atrial Enlargement
1. P wave > or = .12 seconds wide
2. P mitral
3. P in V1 Neg component >.04 sedonds or > or = 1 mm depth
Hypertrophy (limb leads)
Right Ventricular Hypertrophy
1. Right Axis Deviation - must have this
2. R>s in V1
Strain (upside-down backwards checkmark)
Hypertrophy (limb leads)
Left Ventricular Hypertrophy
(must rule out young person)
1. R in V5 or V6 plus S in V1 is >35mm
2. R in aVL is >13mm
Strain - can't have strain without hypertrophy
Subendocardial
Non-Q waves
SUBENDOCARDIAL
Ischemia or Angina
Transient ST segment depressions (goes away with treatment)
SUBENDOCARDIAL
Infarction
1. ST depressions
2. +/- T wave inversions
3. No Q waves
Transmural Acute
Q waves
TRANSMURAL ACUTE
Ischemia or angina
Transient ST segment elevations
Prinzmetal's
TRANSMURAL ACUTE
Infarction
1. ST elevations **Key**
2. Q waves (> or = .04 sec or > 1/3 height QRS)
3. Hyperacute T waves
TRANSMURAL ACUTE
Evolving
1. Must have Q waves
2. ST back to baseline
3. Inversion of T waves
TRANSMURAL ACUTE
Resolving
1. T waves back to normal
2. +/- Q wave disappearance
Locations
Inferior = II, III, aVf
Anterior = V2-V5
Septal =V1
Lateral =V6, I, aVL
Posterior = Reciprocal in V1 and V2
Baseline
Between P and QRS
CHF
Small limb leads
Tall V leads
Poor R waves
Pericarditis
ST elevations everywhere
V2 and V3, something to keep in mind...
V2 and V3 are largest amplitudes and thus 1 square of elevations is ok
High HR
Tachycardia
Low HR
Bradycardia
PR > .20
1st degree block
PR < .12
WPW
Wide QRS and delta wave
QRS </= .12
Left posterior hemiblock, RAD
or
Right posterior hemiblock, LAD
QRS = .11
Incomplete BBB
QRS>/= .12
Complete BBB
QRS >/= .12
Big QS (-V1)
LBBB
Can't read MI with LBBB
QRS >/= .12
Rabbit Ears (+V1)
RBBB
QRS >/= .12
PR < .12 and Delta
WPW
QT Shortening
Scooping of ST in leads with tall R's
Digitalis
QT Shortening, Peaked T waves
Hyperkalemia
Hypercalcemia
QT Lengthening
Procainanide, Quinidine, Hypocalcemia
QT Lengthening
U waves
Hypokalemia
Axis: RAD (90 to 180)
R > S in V1
RVH
Axis: RAD (90 to 180)
Axis >/= 120
QRS .12
Left Posterior Hemiblock
Axis: LAD (-90 to -30)
Axis </= -45
QRS < .12
Left Anterior Hemiblock
P wave >/= 2.5 mm
RAE
P wave >/= .12 sec
P mitral
P in V1 negative
(2 of 3)
LAE
RAD - must have
R > S in V1
Strain - upside down checkmark or T waves not symmetrical
RVH
R in V5 or V6 plus S in V1 >35 mm
R in aVL is >13 mm
Strain - upsidedown checkmark or T waves not symmetrical
LVH
Transient ST segment depressions, goes away with treatment. Non-Q wave
Subendocardial Ischemia
P wave >/= 2.5 mm
RAE
P wave >/= .12 sec
P mitral
P in V1 negative
(2 of 3)
LAE
RAD - must have
R > S in V1
Strain - upside down checkmark or T waves not symmetrical
RVH
R in V5 or V6 plus S in V1 >35 mm
R in aVL is >13 mm
Strain - upsidedown checkmark or T waves not symmetrical
LVH
Transient ST segment depressions, goes away with treatment. Non-Q wave
Subendocardial Ischemia
ST depressions
+/- T wave inversions
Non Q wave
Subendocardial Infarction
Transient ST segment elevations
Q waves
Goes awaywith treatment
Transmural Acute Ischemia
Printzmetal's
Transient ST segment elevations
Q waves
Does not go away with tx
Transmural Acute Ischemia
ST elevations
Q waves >/=.04 sec or 1/3 ht QRS
Hyperacute T waves
Transmural Acute Infarction
ST back to baseline
Inversion of T waves
Q waves
Transmural Acute Evolving Infarction
T waves back to normal
+/- Q wave disappearance
Transmural Acute Resolving Infarction