Gary's Ekg Heart

Front 1

Standardization

Back 1

Should be standardized to 10 mm, if not, must adjust vertical measurements

Front 2

Heart Rate

Back 2

Method 1: Count 300, 150, 75, 60, 50, 42
Method 2: Divide 300 by number of boxes between R waves

Front 3

Rhythm

Back 3

P for each QRS
Regular sinus rhythm: 60-100
Sinus Tachycardia: >100
Sinus Bradycardia: <60

Front 4

PR Interval

Back 4

Normal: .12 to .20 seconds
1st Degree block: > .20
WPW: <.12, Wide QRS, and Delta Wave

Front 5

QRS Width

Back 5

Normal: < or = .10 sec
Incomplete BBB: .11 sec
Complete BBB: > or = .12 sec
LBBB: big QS (-V1)
RBBB: rabbit ears (+V1)

Front 6

QT Interval (Normal)

Back 6

Normal: HR 70, QT .40; HR 100, QT .35-.36

Front 7

QT Interval (Abnormal)

Back 7

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

Front 8

Axis

Back 8

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

Front 9

Standardization

Back 9

Should be standardized to 10 mm, if not, must adjust vertical measurements

Front 10

Heart Rate

Back 10

Method 1: Count 300, 150, 75, 60, 50, 42
Method 2: Divide 300 by number of boxes between R waves

Front 11

Rhythm

Back 11

P for each QRS
Regular sinus rhythm: 60-100
Sinus Tachycardia: >100
Sinus Bradycardia: <60

Front 12

PR Interval

Back 12

Normal: .12 to .20 seconds
1st Degree block: > .20
WPW: <.12, Wide QRS, and Delta Wave

Front 13

QRS Width

Back 13

Normal: < or = .10 sec
Incomplete BBB: .11 sec
Complete BBB: > or = .12 sec
LBBB: big QS (-V1)
RBBB: rabbit ears (+V1)

Front 14

QT Interval (Normal)

Back 14

Normal: HR 70, QT .40; HR 100, QT .35-.36

Front 15

QT Interval (Abnormal)

Back 15

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

Front 16

Axis

Back 16

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

Front 17

Axis Interpretation

Back 17

I aVf Quadrant/Disease
+ + RLQ – Normal
- - ULQ – Extreme Derivation
- + LLQ – RAD
+ - Look at Lead II:
+ = URQ (Normal)
- = URZ - LAD

Front 18

Hypertrophy (limb leads)
Right Atrial Enlargement

Back 18

1. P wave > or = 2.5 mm tall

Front 19

Hypertrophy (limb leads)
Left Atrial Enlargement

Back 19

1. P wave > or = .12 seconds wide
2. P mitral
3. P in V1 Neg component >.04 sedonds or > or = 1 mm depth

Front 20

Hypertrophy (limb leads)
Right Ventricular Hypertrophy

Back 20

1. Right Axis Deviation - must have this
2. R>s in V1
Strain (upside-down backwards checkmark)

Front 21

Hypertrophy (limb leads)
Left Ventricular Hypertrophy

Back 21

(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

Front 22

Subendocardial

Back 22

Non-Q waves

Front 23

SUBENDOCARDIAL
Ischemia or Angina

Back 23

Transient ST segment depressions (goes away with treatment)

Front 24

SUBENDOCARDIAL
Infarction

Back 24

1. ST depressions
2. +/- T wave inversions
3. No Q waves

Front 25

Transmural Acute

Back 25

Q waves

Front 26

TRANSMURAL ACUTE
Ischemia or angina

Back 26

Transient ST segment elevations
Prinzmetal's

Front 27

TRANSMURAL ACUTE
Infarction

Back 27

1. ST elevations **Key**
2. Q waves (> or = .04 sec or > 1/3 height QRS)
3. Hyperacute T waves

Front 28

TRANSMURAL ACUTE
Evolving

Back 28

1. Must have Q waves
2. ST back to baseline
3. Inversion of T waves

Front 29

TRANSMURAL ACUTE
Resolving

Back 29

1. T waves back to normal
2. +/- Q wave disappearance

Front 30

Locations

Back 30

Inferior = II, III, aVf
Anterior = V2-V5
Septal =V1
Lateral =V6, I, aVL
Posterior = Reciprocal in V1 and V2

Front 31

Baseline

Back 31

Between P and QRS

Front 32

CHF

Back 32

Small limb leads
Tall V leads
Poor R waves

Front 33

Pericarditis

Back 33

ST elevations everywhere

Front 34

V2 and V3, something to keep in mind...

Back 34

V2 and V3 are largest amplitudes and thus 1 square of elevations is ok

Front 35

High HR

Back 35

Tachycardia

Front 36

Low HR

Back 36

Bradycardia

Front 37

PR > .20

Back 37

1st degree block

Front 38

PR < .12

Back 38

WPW
Wide QRS and delta wave

Front 39

QRS </= .12

Back 39

Left posterior hemiblock, RAD
or
Right posterior hemiblock, LAD

Front 40

QRS = .11

Back 40

Incomplete BBB

Front 41

QRS>/= .12

Back 41

Complete BBB

Front 42

QRS >/= .12
Big QS (-V1)

Back 42

LBBB
Can't read MI with LBBB

Front 43

QRS >/= .12
Rabbit Ears (+V1)

Back 43

RBBB

Front 44

QRS >/= .12
PR < .12 and Delta

Back 44

WPW

Front 45

QT Shortening
Scooping of ST in leads with tall R's

Back 45

Digitalis

Front 46

QT Shortening, Peaked T waves

Back 46

Hyperkalemia
Hypercalcemia

Front 47

QT Lengthening

Back 47

Procainanide, Quinidine, Hypocalcemia

Front 48

QT Lengthening
U waves

Back 48

Hypokalemia

Front 49

Axis: RAD (90 to 180)
R > S in V1

Back 49

RVH

Front 50

Axis: RAD (90 to 180)
Axis >/= 120
QRS .12

Back 50

Left Posterior Hemiblock

Front 51

Axis: LAD (-90 to -30)
Axis </= -45
QRS < .12

Back 51

Left Anterior Hemiblock

Front 52

P wave >/= 2.5 mm

Back 52

RAE

Front 53

P wave >/= .12 sec
P mitral
P in V1 negative
(2 of 3)

Back 53

LAE

Front 54

RAD - must have
R > S in V1
Strain - upside down checkmark or T waves not symmetrical

Back 54

RVH

Front 55

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

Back 55

LVH

Front 56

Transient ST segment depressions, goes away with treatment. Non-Q wave

Back 56

Subendocardial Ischemia

Front 57

P wave >/= 2.5 mm

Back 57

RAE

Front 58

P wave >/= .12 sec
P mitral
P in V1 negative
(2 of 3)

Back 58

LAE

Front 59

RAD - must have
R > S in V1
Strain - upside down checkmark or T waves not symmetrical

Back 59

RVH

Front 60

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

Back 60

LVH

Front 61

Transient ST segment depressions, goes away with treatment. Non-Q wave

Back 61

Subendocardial Ischemia

Front 62

ST depressions
+/- T wave inversions
Non Q wave

Back 62

Subendocardial Infarction

Front 63

Transient ST segment elevations
Q waves
Goes awaywith treatment

Back 63

Transmural Acute Ischemia
Printzmetal's

Front 64

Transient ST segment elevations
Q waves
Does not go away with tx

Back 64

Transmural Acute Ischemia

Front 65

ST elevations
Q waves >/=.04 sec or 1/3 ht QRS
Hyperacute T waves

Back 65

Transmural Acute Infarction

Front 66

ST back to baseline
Inversion of T waves
Q waves

Back 66

Transmural Acute Evolving Infarction

Front 67

T waves back to normal
+/- Q wave disappearance

Back 67

Transmural Acute Resolving Infarction