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Flashcards in 12 lead ECG Deck (29):
1

(indicate if positive or negative)
Lead I is bipolar with the _______ electrode at the left arm and the ______ electrode at the right arm. Lead II is _____ in the left leg and ______ in the right arm. Lead III is _____ in left leg and _____ in left arm

positive
negative
positive
negative
positive
negative

2

A normal PR interval should be how big?

Less than 1 big box

3

V1-V6 chest leads are _____ and reflect changes in the __________ plane

unipolar
horizontal

4

Increased voltage from right ventricular hypertrophy is seen in which leads?

V1 and V2

5

Septal infarcts are most evident in which leads?

V1 and V2
(they are close to the septum)

6

Increased voltage from left ventricular hypertrophy and changes from anterolateral infarcts are most evident in which leads?

V5 and V6 bc they are close to the LV, especially its anterolateral portion

7

Normal depolarization of the ventricles goes from ____ to _____ and _____ from the right arm towards the left leg.

left
right
downward

8

Lead _____ which has its positive electrode to the upper right (right arm) is _____ since all forces are away from it leftward and downward

aVR
negative

9

Indicate if Pos or Neg:
Leads I and II are ________.
Leads V1 and V2 are mostly ______

- positive because forces are going towards their positive electrodes on the left arm and left leg respectively

- negative because predominant forces are away from the right ventricle.

10

Which degrees are referred to as a left axis deviation (LAD)?
Right axis deviation (RAD)?

-30°to -90°is

+90 to +180


*note the normal QRS axis is defined as ranging from -30°to +90°.

11

Normal axis is ______ in both leads I and II

Left axis is ______ in lead I and ______ in lead II

Right axis is _____in lead I and ______ in lead II

Indeterminate axis is _____ in both leads I and II

positive

positive, negative

negative, positive

negative

12

What does the P wave look like in RA enlargement?

In lead II you see a spike in initial P wave that dominates

or

Lead V1, the second half of the p wave is inverted with a smaller hump than if it was LA enlargement

*note: Lead II and V1 are good leads to look at the p-wave for abnormalities:

13

What does the P wave look like in LA enlargement?

In lead II you see a spike in second half of the P wave that dominates

or

Lead V1, the second half of the p wave is inverted with a more prominent hump than RA enlargement

*note: Lead II and V1 are good leads to look at the p-wave for abnormalities:

14

Rt sided leads

V1, V2

15

Lft sided leads

I and V6

16

In Right bundle branch block, what does the QRS look like in right and left sided leads?

Widened QRS

Upright (positive) in rt-sided leads (V1 and V2):
- rSR' "rabbit ears

Downward deflection(negative) in lt-sided leads (I and V6)
- qRS "S wave"

17

In Left bundle branch block, what does the QRS look like in right and left sided leads?

Widened QRS

Widened QRS away from (downward) V1
rS

and towards (upright) V6
R

18

Hemiblocks what are they and what do they show on the EKG?

(R or L fascicular blocks) cause axis shifts without widening the QRS

*Think about which direction the vectors will flow if the Ant Fasc. is blocked (to the left)

19

LEFT VENTRICULAR HYPERTROPHY

Normal QRS duration with extremely high
voltage especially in V5 and V6
(left sided leads)

20

RIGHT VENTRICULAR HYPERTROPHY

There are large R waves (high voltage) in V1 and V2 (rt sided leads).

21

ANTERIOR VS. INFERIOR
INFARCT LOCATION:
V1-V2
V3-V4
V5-V6
II, III, aVF

V1-V2: anteroseptal wall
V3-V4: anterior wall
V5-V6: anterolateral wall
II, III, aVF: inferior wall

22

High lateral leads
Lateral leads
inferior leads
Anterior leads

High lateral leads: I, AVL
Lateral leads: V5, V6
Inferior leads: II,III,aVF
Anterior leads: V2, V3

(*note: anteroseptal leads consists of V1, V2, V3, V4
- Septal: V1, V2
- Anteroapical: V4, V4)

23

ACUTE INFERIOR MI
?

ST elevations and Q waves in inferior leads (II,III,aVF)
Reciprocal ST depressions in anterior leads (V2, V3)

*note: Order of seeing stuff for MI on an EKG:
1. Hyperacute T waves
2. ST elevations
3. Q waves

24

ACUTE ANTERIOR MI
?

ST elevations and Q waves in anterior leads (V1-V4)

*note: Order of seeing stuff for MI on an EKG:
1. Hyperacute T waves
2. ST elevations
3. Q waves

25

ACUTE PERICARDITIS

Diffuse ST elevations in multiple leads:
No localization

26

Name that abnormality:
Tall P (>2.5 mm in an inferior lead =Rt. atrial enlargement)
Wide notched P wave with late negativity in V1= ??

Lt. atrial
enlargement

27

Name that abnormality:
1. QRS wide? ≥ .12 secs usually _____
2. QRS right axis shift?
3. QRS left axis shift?
___
4. QRS waves?

1. ( ≥ .12 secs usually bundle branch block)

2. (Right axis - ?RVH or posterior hemiblock)

3. (Left axis - ?LVH or anterior hemiblock

4. Infarct usually

28

Name that abnormality:
ST elevation?
ST depression?

elevation: injury if localized or pericarditis if diffuse

depression: ischemia or subendocardial infarct

29

Name that abnormality:
T inversion?
Long QT?

T inversion? (ischemia or 2ndary to hypertrophy)

Long QT? (consider electrolyte imbalance, drug effect)