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19 Cards in this Set
- Front
- Back
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isoelectric line
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the lead where positive vs negative voltages are the most equal
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positive in 1 and aVF
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normal, bottom right quadrant
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positive in 1 and negative in aVF
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top right quadrant, left
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- in 1 and - in aVF
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top left quadrant, north west, emphysema and dysrhythmias
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- in 1 and + in aVF
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bottom left quadrant, right
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isolating the axis
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1. find the quadrant
2. isolate the isoelectric and smallest lead ( becomes top of T) 3. Isolate the closest lead (most positive)-draw perpendicular to isoelectric 4. If one deflection is less than 2 times the size of the other=10 degree adjustment 4. isolate the vector |
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cause of right axis dev
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babies, RVH, left posterior hemiblock, dextrocardia, rhythm abnormalities
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cause of left axis dev
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left anterior hemiblock, rhythm abnormalities, LVH
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RBBB findings
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QRS 0.12 seconds or greater
RSR’ pattern in lead V1 ( the lead closest to the right ventricle) R’ wave larger voltage than the R wave Slurred S wave in leads I and V6: Leads that overlie the left ventricle, looking at slowed electrical activity going away from the left ventricle, toward the Right ventricle |
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MI with BBB
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floppy eared bunny
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LBBB criteria
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Duration at least 0.12 seconds
Broad, monomorphic R waves in I and V6 (left ventricle closest) with no Q’s there Broad monomorphic S in V1, (small R wave from right ventricle possible) CAN HAVE: R waves in V1 Notching of the R in lead V6 |
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Causes of LBBB
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Hypertension
Coronary Artery Damage Cardiomyopathy Rheumatic heart disease Infiltrative process in muscle Idiopathic |
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IVCD criteria
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QRS is wide
S slurred in I and V6? Increased R:S ratio in V1? Neither LBBB nor RBBB |
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left anterior hemiblock
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Depolarization has to come from the septum, inferior wall and posterior wall toward the anterior and lateral walls.
This gives rise to a vector (unopposed) that points superior and leftward. Expect a qR complex or large R in lead I and a rS complex in III. (lower case indicates less prominence) The cause of the small q and r is the abnormal direction of septal depolarization |
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Left Anterior Hemiblock Criteria
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Left axis deviation with the axis -30 to -90 degrees
qR or an R wave in lead I + in I, - in aVF and - in II rS complex in III |
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Left Posterior Hemiblock
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Difficult to diagnose
RARE, Depolarization of inferior and posterior aspects of the LV delayed. The unopposed vector (the septum and superior-anterior walls) is to the right. Therefore, small q in III, S in lead I |
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Criteria of Left Posterior Hemiblock
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1. Axis 90 (100) to180 (right)
2. S in I, q in III 3. Exclusion of RAE and of RVH: can’t call LPH unless those two diagnoses are absent Diagnosis requires exclusion |
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RBBB+Left Anterior Hemiblock
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stable unless acute onset: MI
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RBBB+ Left Posterior Hemiblock
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UNSTABLE! Covers a larger area of myocardial tissue
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