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29 Cards in this Set
- Front
- Back
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If the QRS is wide should you analyze ST segment or T waves?
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NO!
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Which lead is best to analyze for His-purkinje abnormalities?
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V1
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What is the dx criteria for RBBB?
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QRS> 120ms
RSR' in V1 or V2 (bunny ears, 2nd R wave normally larger than 1st R wave) S wave > 40ms in V6 and Lead I Normal R peak time in V5 and V6 Delayed R peak time in V1 |
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What is the dx criteria for incomplete RBBB?
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QRS < 120ms
RSR' in V1 or V2 S wave > 40ms in V6 and Lead I Normal R peak time in V5 and V6 Delayed R peak time in V1 |
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What is dx criteria for LBBB?
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QRS > 120ms
Broad, notched R wave in V5, V6 and aVL Left sided leads (I, aVL and V6) have absence of Q wave (aVL can sometimes have Q wave) R wave peak time > 60 ms in V5 and V6 R wave peak time normal in V1 and V2 |
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What is dx criteria for incomplete LBBB?
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QRS < 120 ms
Broad, notched R wave in V5, V6 and aVL Left sided leads (I, aVL and V6) have absence of Q wave (aVL can sometimes have Q wave) R wave peak time > 60 ms in V5 and V6 R wave peak time normal in V1 and V2 |
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What is the dx criteria for Nonspecific Intra-Ventricular Conduction Delay (NSIVCD)?
What are the most common causes? |
QRS > 120 ms
Not all criteria for LBBB or RBBB can be identified MC causes: meds, illicit drugs or electrolyte disturbances |
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What is the MC fascicular block?
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Left anterior fascicular block (LAFB)
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What is the MC cause of extreme left axis deviation?
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LAFB
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What are the dx criteria for LAFB?
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Left axis deviation
QRS < 120 ms Small Q and large R in leads I and aVL Small R and large S in leads II, III and aVF Late peaking R wave in aVR and aVL |
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Is posterior fascicular block common?
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No, extremely rare
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What are the dx criteria for posterior fascicular block?
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QRS < 120ms
Marked right axis deviation Large R and small S in lead I Small Q and large R in lead II, III and aVF Consider all other causes of RAD |
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What must be present to make the dx of posterior fascicular block?
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cannot make the dx w/o a prior EKG that does not demonstrate this finding
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What is the MC combo of QRS dysfunction?
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RBBB w/ LAFB (Bi-fascicular block)
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What is tri-fascicular block?
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RBBB, LAFB and 1st degree AV block
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What is a regular QT interval?
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> 350ms and < 430 in men, < 450ms in women
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What happens to the QT interval as HR increases?
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shortens
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What are the acquired reasons for long QT interval?
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Anti-arrhythmia meds
Antibiotics Antipsychotics Hypocalcemia Hypokalemia Hypomagnesaemia CNS trauma (hemorrhage or stroke) |
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What are the acquired reasons for a short QT interval?
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Hypercalcemia
Digoxin toxicity Hyperthermia |
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What are the causes of an abnormal QT interval?
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Acquired or congenital
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What does an inherited short QT interval predispose a pt to?
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Cardiac arrest
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True or False
Atrial chamber sizes can be determined if the EKG is abnormal? |
False
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What leads are best to look at for atrial enlargement?
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Leads II and V1
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What is the dx criteria for left atrial enlargement (LAE)?
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P waves > 120ms in leads I, II, III, aVR, aVL and aVF
Notched P waves in the limb leads (I, II and III) Biphasic P waves in lead V1 w/ negative portion broader than 40ms and deeper than 1mm |
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What are the dx criteria for right atrial enlargement (RAE)?
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Lead II P wave is taller than 2.5mm
Lead V1 P wave positive portion is taller than 1.5mm Q wave in V1 (caused by RA pushing RV out of the way) |
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What is the dx criteria for bi-atrial enlargement?
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Both criteria for LAE and RAE on the same EKG
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What is the dx criteria for left ventricular hypertrophy (LVH)?
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Voltage criteria:
-Tall R wave in leads V5 or V6 -Deep S waves in lead V1 -Amplitude of these must sum up to > 35mm -R wave > 11mm in aVL can be sufficient for voltage criteria Secondary criteria: - T wave must be opposite in direction of QRS (consistent w/ strain in LV) *need both voltage and secondary for dx |
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What is the dx criteria for right ventricular hypertrophy (RVH)?
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R wave in V1 plus S wave in V5 or V6 sums up to > 10mm
R:S ratio in V5 or V6 < 1 (S wave should be deeper than R wave is tall) T wave is opposite in direction of QRS Right axis deviation |
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What is the dx criteria for bi-ventricular hypertrophy?
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EKG meets one or more criteria for LVH and RVH
or Precordial leads (V1-6) show LVH w/ RAD |
