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160 Cards in this Set
- Front
- Back
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Normal QRS |
Normal transition across Precordium |
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QRS abnormalities |
Abnormalities in height - high/low voltage Abnormalities in width - WPW - BBB - IVCD Hemiblocks could be with axis determination |
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Abnormal QRS EKG complex components |
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If the first wave of QRS is positive, then it is the ________ wave |
R wave |
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If the first wave of the QRS is negative, then it is the ______ wave |
Q wave |
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Any negative wave after a preceding R wave is the _______ wave |
S wave |
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QRS is due to __________ ___________ |
ventricular depolarization |
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QRS complex normally lasts |
0.6 to 0.11 seconds |
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Axis of QRS is between ________ and ________ |
-30 and +105, downward and to the left |
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The QRS is the __________ of the vectors |
summation |
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Parts of the QRS can be ___________ in some leads |
Isoelectric |
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QRS depolarization sequence |
1) Septum depolarizes L to R 2) Main vector is then posterior and inferior 3) Then finally, main vector is posterior-superior |
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LV contains ________% of cardiac muscle in most people |
70% - most electrical activity points towards the LV NO matter what lead you're reading |
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Example of LV predominance on EKG |
A lead over right heart will amplify the right heart voltage a little because it is sitting over the RV BUT the major voltage is going away from that lead toward the dominant left ventricle |
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QRS changes across the pericordium |
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QRS complex in V1 is _________ |
Negative |
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QRS complex in V2 is _________ |
Negative |
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QRS complex in V3 is ____________ |
Negative but leaning more towards isoelectric |
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QRS complex in V4 is _________ |
positive |
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QRS complex in V5 is ___________ with prominent but equal _________ and ________ waves |
QRS in V5 is positive Prominent negative Q and S waves |
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QRS complex in V6 is ___________ with larger ______ wave than _______ wave |
Positive Larger negative Q wave than S wave |
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Areas of change in the precordial leads where the QRS switches from mostly negative deflection to mostly positive deflection |
Transition zone |
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The normal transition zone is between __________ and _______ |
V3 and V4 |
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Q waves are significant if they have what characteristics? |
Greater than 0.03 seconds Depth is equal to or greater than 1/3 of R wave |
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Q waves in MI are _________ and not large enough with most only occurring in 1 lead |
Benign |
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Q waves are more indicative of _________ __________ |
PRIOR MI |
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An MI of significant size must have Q waves in at least __________ contiguous leads |
2 continguous leads |
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What do you need to diagnose an Acute MI? |
ST-T wave changes |
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Insignificant Q waves can be seen in __________ ___________ |
septal depolarization |
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Significant Q's can be seen in ________ muscle, ______ in more than _______ lead |
DEAD muscle, MI, in more than one lead |
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QS waves can occur with no ___________ inbetween |
No R wave |
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Pseudo Q waves can appear in _________ |
WPW |
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Septal Q waves are seen in leads _________ and _______ |
I and aVL |
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QS waves are seen only in _____________ |
VI |
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Significant Q graphical representation |
Q > 1/3 of R height Q > 0.03 s wide |
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Which leads have the Q waves? This defines the site of infarction |
Leads I, II, aVR, aVF, V4-6 |
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Small notch is often seen at the ________ of QRS |
End |
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QRS notching is insignificant unless the person is a ______________ |
Curly haired Italian Male |
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Osborn Wave is a _______ seen in _________ |
J wave HYPOTHERMIA |
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The colder the temp, the ____________ the J wave |
Higher the J wave |
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J waves on EKG (blue arrows) |
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Another example of J wave EKG |
Pronounced positive deflection on QRS complex due to hypothermia |
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LVH would cause _______ voltages on EKG |
Increased |
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MI and concurrent loss of LV muscle would cause _________ voltage on EKG |
Decreased - Yellow scar, wall thinning - Decrease in voltage - Increase in Q waves |
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Pericardial effusion would cause _________ voltage |
Decreased |
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Men and youth have _______ voltages leading to _______ amplitudes |
higher voltages, greater amplitudes |
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Precordial leads are __________ voltage than limb leads because the precordial leads are _________ to the heart |
Higher voltage Closer to the heart |
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Pathological increases in amplitude caused by |
LVH/RVH |
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Low voltage is _____ common than high voltage |
LESS common |
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Causes of Lower voltages on EKG |
MI's - scar tissue is electrically inert Marked increases in body fat Huge left pleural effusion Pericardial effusion Recording at half standard |
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What do you have to make sure to look at when recording EKG's? |
Make sure you're not at half standard, and if you are, adjust the reading accordingly |
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Scar tissue is electrically __________ |
inert and causes decreased voltages |
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In pericardial effusions, the limb leads will record less than ________ mm voltage |
5 mm voltage |
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In pericardial efusions, the precordial leads will record less than _________ mm voltage |
10 mm voltage |
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The larger the effusion, the ________ the QRS |
Smaller - Affects all components, not just QRS |
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Half Standard |
Rectangle height is only 1 big square - Need to double to normalize |
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Standard speed is ____________ |
25 mm/sec |
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Each little box equates to _______ |
.04 seconds |
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Each big box equates to ___________ |
.2 seconds (5 little boxes) |
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Whole EKG strips spans __________ seconds |
6 |
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Pericardial effusion EKG |
Low voltage all waves |
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LVH leads to ___________ voltages |
Increased |
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LVH causes |
Outflow obstruction - Aortic stenosis/HTN Less likely with volume overload problems - Mitral Regurg/Aortic Regurg |
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Increased muscle mass causes ______ AP, _____ vector with resultant increased EKG _________ |
Increased action potential Increased vector Increased EKG amplitude |
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EKG Criteria for LVH |
S in V1/V2 + R of V5/V6 > 34mm Any precordial lead > 45mm R wave in aVL > 10 mm R wave in lead I > 11mm R in AVF > 19mm |
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In LVH, the ____ wave in leads V1/2 are added to the ______ wave of V5/V6 with a sum greater than _______ |
S wave of V1/2 R wave of V5/6 Greater than 34 mm |
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In LVH, precordial lead voltage has to be greater than ___________ |
45 mm |
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In LVH, The R wave in aVL has to be greater than ________ |
10mm |
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In LVH, the R wave in lead I has to be greater than ____________ |
11mm |
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In LVH, the R wave in AVF has to be greater than __________ |
19mm |
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Can't have LVH if _______________ is present |
Left bundle branch is present |
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You must use calipers to calculate LVH |
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LVH EKG changes |
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LVH EKG |
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RVH is ________ common than LVH |
Less common |
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An additional vector produced by the enlarged RV causes increased voltages in leads ______ and _________ |
V1 and V2 |
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Right Ventricle is located right underneath the _________ |
sternum |
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RVH vector is directed to the ______ and ________ |
anterior and right |
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In RVH, you have the summation of the ___________ forces and ________ RV forces |
Septal forces and enlarged RV forces |
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RVH measurement via calipers |
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RVH causes |
Secondary to pathology of RV or distal to RV
- lungs - left heart failure |
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Mimicry of RVH (can't make diagnosis) includes |
Right BBB Very young children WPW Posterior wall MI |
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RVH EKG |
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Abnormal QRS duration is greater than |
0.12 seconds |
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If tachycardia with a wide QRS think, _______________ until proven otherwise |
V tach |
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Etiology of wide QRS complexes |
LBBB/RBBB Intraventricular conduction delays WPW |
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Bundle Branch Block EKG |
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How many bundles are there? |
Two, Right and Left |
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Left bundle divides left _________ and ________ fascicles |
anterior and posterior fascicles |
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Blocked bundle affects both ______ and _______ |
conduction and axis via cell to cell transmission |
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Bundle branch blocks have slow, _______, and _________ QRS complexes |
slow, wide, and bizarre |
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Bundle branch blocks have ___________ conduction until the block |
Normal conduction until the block |
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If there's a wide QRS consider |
LBBB RBBB IVCD - HYPERkalemia Ventricular tachycardia - sinus tachycardia with a bundle branch block |
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Any lead in which the QRS is greater than 0.12 seconds or greater means that _____________ lead is of that duration |
EVERY lead is at least 0.12 second |
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When checking for QRS width, look at the ________ QRS in any lead |
widest QRS in any lead |
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During RBBB, there is ______ impulse to the left bundle |
Normal impulse to left bundle |
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In RBBB, part of the ______ and right ______ are delayed secondary to cell to cell spread on the Right |
Septum and Right Ventricle |
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Delayed cell to cell spread slows depolarization time leading to ___________ QRS |
prolonged R' is the additional slow vector, LATE |
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RBBB has a QRS greater than ________ |
0.12 seconds |
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In RBBB, there is an _________ pattern with _______ > _______ in lead V1 |
RSR' pattern R' > R |
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Slurred ____ wave in leads 1 and V6 during RBBB |
Slurred S wave - Lead overlies L ventricle, looking at slowed electrical activity going away from you toward R ventricle |
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In RBBB, the ST wave is in the _________ direction of QRS |
opposite direction of QRS |
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RBBB EKG |
Look for slurred S wave in leads I and V6 RSR' pattern in lead VI |
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RSR' Bunny Ears picture |
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Slurred S waves picture |
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RBBB EKG |
Look for Rabbit Ears RSR' |
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In RBBB, __________ has a small _________ wave at the beginning aka Mutant Rabbit |
V1 has a small r wave |
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Floppy Eared Bunny = _____________ with a negative Q wave and Positive R' |
MI
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Floppy Ear (MI) in VI |
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Floppy Ear Example with Q, R, and R' on VI |
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LBBB is called an ___________ by Heibel |
Unglygram |
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If both parts of the left side are involved, the doctor should be ___________ |
more concerned |
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LBBB is a ____________ wave |
Monomorphic wave |
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In LBBB, there are discordant _______ waves that occur in ____________ direction |
discordant T waves opposite directions |
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In LBBB, the RV is ________ with the left being ________ via cell to cell |
RV is OK, left is slow cell to cell |
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LBBB criteria |
Duration of atleast 0.12 seconds Broad, monomorphic R waves in I and V6 with no Q's Broad monomorphic S in V1, small R wave possible |
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LBBB must last for at least _____________ |
0.12 seconds |
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LBBB have broad __________ R waves in _____ and ________ with no Q's |
Monomorphic I and V6 |
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In LBBB, there is broad monomorphic ______ in V1 with a small ______ wave |
Monomorphic S wave in V1 Small R wave possible |
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The R waves in V1 - variation of LBBB |
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In LBBB, there may be notching of the R wave in lead ________ |
V6 |
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LBBB EKG |
Look for notching in R wave on V6 R waves in V1 Monomorphic S wave in V1 Monomorphic R waves in 1 and V6 |
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Can you diagnose LVH and LBBB on the same EKG? |
No |
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Causes of LBBB |
Hypertension CAD Cardiomyopathy Rheumatic Infiltrative Idiopathic |
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IVCD Criteria |
Intraventricular Conduction Delay - Doesn't have to be 0.12 seconds - Has some but not all features of either RBBB/LBBB - LVH, peri-infarction, Hyperkalemia, Quinidine and Flecanide (1A/C) |
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In IVCD, the QRS is __________ |
wide |
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In IVCD, the S in slurred in ___ and ________ |
S slurred in 1 and V6 |
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In IVCD, there is an ___________ R:S ratio in V1 |
Increased |
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IVCD EKG |
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Hemiblocks occur only on the ________ and involves __________ of the ________ bundle |
left, half of left bundle |
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Left anterior hemiblock is called ____________ |
Left anterior fascicular block |
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Left posterior hemiblock is also called _______________ |
left posterior fascicular block |
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Left anterior fascicle is ___________ and innervates the __________ walls of the LV |
Thin, anterolateral walls of LV |
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Left posterior fascicle is _________ dispersed and fans supplying the ___________ and ________ walls with electrical stimulation |
inferior and posterior walls |
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Graphical representation of Hemiblocks |
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Left Anterior Hemiblock sequence |
1) Depolarization has to come from the septum, inferior wall and posterior wall toward the anterior and lateral walls 2) Unopposed vector arises that points superior and leftward 3) Expect a qR complex or Large R in lead I and an rS complex in III 4) cause of small q and r is the abnormal direction of septal depolarization |
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In Left Anterior Hemiblock, expect a qR complex or large R wave in lead ____________ and an rS complex in lead ________ |
qR complex/R wave - lead I rS complex - lead III |
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Left anterior hemiblock graphical representation |
Vector is superior and leftward |
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Left anterior hemiblock criteria |
Left axis deviation with axis -30 to -90 qR or an R wave in Lead I rS complex in III |
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To recognize left Anterior Hemiblock, use leads |
I, AVF, and II |
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In Left anterior hemiblock, lead I will be ___________, lead II will be ____________, and aVF will be ____________ |
I - positive II - negative avF - negative |
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Left anterior hemiblock EKG |
R wave in lead I rS complex in lead III (no Q wave) |
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Left Posterior hemiblock is ______ to diagnose and ________ |
difficult to diagnose and RARE |
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Left posterior hemiblock sequence |
1) Depolarization of inferior and posterior aspects of LV delayed 2) Unopposed vector from the septum and anterior walls is to the right 3) small q in III, and S in lead I |
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Criteria for left posterior hemiblock
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1) Axis 90 to 180 to the right 2) S wave in lead I 3) q wave in lead III 4) Exclusion of RAE/RVH - can't call LPH unless these two are absent |
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In Left posterior hemiblock, there is an _______ wave in lead I |
S wave |
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In left posterior hemiblock, there is a ______ wave in lead III |
q wave |
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Left posterior hemiblock requires _______________ |
Exclusion - other causes of R axis deviation - exclude RVH, RAE S1, Q3, T3 can indicate PE |
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Most common cause of R axis deviation is ____________ |
RVH |
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Most common cause of RAE is ___________ |
anything distal to the RA |
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What three leads/waves can indicate PE? |
S wave in lead I Q wave in lead III T wave in lead III |
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Left Posterior Hemiblock EKG |
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What is the diagnosis of this EKG? |
Not a clue |
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What is the diagnosis of this EKG? |
Not a clue |
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Bifasicular Block must have a __________ component |
RBBB component |
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Bifasicular Block Types |
Must be RBBB+ RBBB + LAH - stable unless acute RBBB + LPH - Unstable |
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RBBB + LAH is __________ unless acute |
stable unless acute |
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RBBB + LAH is ___________ |
UNSTABLE |
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What is the diagnosis of this EKG? |
No clue |
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What is the diagnosis of this EKG? |
No clue |
