Sarma-Pathological Ekg's

Front 1

P wave height 2 and half small squares, width also 2 and half small squares in Lead 2 (wide notched p wave in lead 2).
In lead V1 the negative component of the P wave (which is the left atrial component) is > 0.04 sec in duration and > 0.01 mv in height (bisphasic p wave with larger negative component in lead V1).

Back 1

left atrial hypertrophy

Front 2

P wave height in lead II is >2 and half small squares and are also tall and peaked.
Positive component of biphasic P wave in V1 > 1 “small box” in area (biphasic p wave with larger positive component in lead V1)

Back 2

right atrial hypertrophy

Front 3

What is the Estes criteria?

Back 3

diagnostic of left ventricullar hypertrophy-score of 5 or greater is diagnostic, 4 is probable

Front 4

What are factors in Estes criteria?
*note-a lot of variability in QRS voltage-look for other Estes criteria to confirm diagnosis of LVH

Back 4

A. Voltage criteria (3 points):
1. any R or S >20mm in limb leads
2. S in V1/V2 >30mm
3. R in V5/V6 >30mm
B. ST abnormalities
1. without digitalis (3 points)
2. with digitalis (1 point)
C. Left atrial enlargement in V1 (3 points)
D. Left axis deviation (2 points)
E. Wide QRS duration >.09 (1 point)
F. Delayed intrinsicoid deflection in V5 or V6 >0.05 sec (1 point)

Front 5

What factors point toward right ventricular hypertrophy?
*note-no one criteria is highly specific, so look at multiple criteria

Back 5

1. Wide QRS in V1
2. S wave greater than R wave in leads I, II, and III
3. R:S V1> R:S V3/V4
4. Negative T wave V1-V3
5. large p wave in lead II

Front 6

What are characteristics of biventricular hypertrophy?

Back 6

large QRS complexes in all leads

Front 7

Delay or failure to conduct electrical impulses in one of the cardiac electrical bundles.
The left ventricle has a larger Left Bundle with an anterior fascicle and a posterior fascicle.
Right bundle is one thin bundle as RV is a thin walled cavity

Back 7

bundle branch block

Front 8

For complete block the duration of the QRS complex is >0.12 sec. With incomplete block an rSR' pattern will be seen in lead V1 but the QRS duration will be within the limits of normal
The QRS axis may be normal or there may be right or left axis deviation
The T wave is almost always inverted in lead V1 and may be inverted in V2. In the other precordial leads, and in the limb leads, the T wave is directed opposite to the terminal portion of the QRS complex

Back 8

right bundle branch block

Front 9

The duration of the QRS complex is 0.12 secs or greater in limb leads
No Q wave is seen in leads I, aVL, and V6.
Broad slurred R in V6 with absent q, depressed ST segment and inverted T wave. Tall R wave is seen in lead V6.Usually a broad slurred R in I and avl
Prominent QS pattern is observed in lead V1 with or without a small initial R wave. Deep S wave in V1-V2

Back 9

left bundle branch block

Front 10

QRS axis of more than -30 degrees
Q in lead I and AVL
QRS duration of less than 0.10 secs
Deep S wave in limb leads III and AVF
Poor R wave progression across the precordial leads.

Back 10

left anterior hemiblock

Front 11

What changes in EKG are associated with ischemia?

Back 11

inverted T wave
depressed ST segement

Front 12

Exercise EKG to diagnose ischemia at high heart rate

Back 12

Horizontal or down sloping ST depression is more specific for ischemia.
ST depression early in the exercise and persisting long into recovery.
Upsloping ST depression doesn't indicate ischemia

Front 13

ST segment is elevated.
No Pathological Q waves seen in the same lead. ( Q wave duration >0.04 msec)
At least 2 consecutive leads show ST elevation.
T waves may be normal, biphasic or inverted.

Back 13

myocardial injury

Front 14

Pathological Q waves present.
ST segment returns to normal.
T waves inverted.
QRS amplitude may be decreased due to loss of muscle.
Loss of R waves due to loss of muscle.

Back 14

infarction

Front 15

T wave flattens and shortens

Back 15

hypokalemia

Front 16

T wave peaks
QRS complex widens

Back 16

hyperkalemia