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CRRAB I Final > EKG Reading > Flashcards

EKG Reading Flashcards

1
Q

What is the common method for determining rate?

A

Looking at how many large boxes are present:

300-150-100-75-60-50

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2
Q

What is the six second method for determining rate?

A

R-R intervals in 30 large boxes x 10

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3
Q

What is the mathematical method for determining rate?

A

300/# large boxes between R waves

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4
Q

How do you assess Rhythm and Intervals?

A
  1. Check the bottom rhythm strip for regularity (regular, regularly irregular, irregularly irregular)
  2. Check for a P wave before each QRS, QRS after each P
  3. Check for PR interval (for AV blocks) and QRS (for bundle branch blocks). Check for prolonged QT (i.e. QT interval > 1/2 the R-R distance)
  4. Recognize “patterns” such as atrial fibrillation, PVCs, PACs, escape beats, ventricular tachycardia, paroxysmal atrial tachycardia, AV blocks, and bundle branch blocks
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5
Q

What is the normal axis range?

A
  • (+) Lead I, (+) Lead aVF
  • (-30 to +90 degrees)
  • Positive in lead I, negative in aVF, positive in lead II is also normal (-30 to 0)
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6
Q

What is left axis deviation?

A
  • (+) Lead I, (-) Lead aVF
  • (-30 to -90 degrees)
  • Also requires negative lead II
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7
Q

What is right axis deviation?

A
  • (-) Lead I, (+) Lead aVF

- (+90 to +180 degrees)

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8
Q

What is extreme axis deviation?

A
  • (-) Lead I, (-) Lead aVF

- (-90 to -180 degrees)

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9
Q

What is the differential for Left axis deviation?

A

LVH, Left ant. Fascicular block, inferior wall MI

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10
Q

What is the differential for Right axis deviation?

A

RVH, Left post. Fascicular block, lateral wall MI

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11
Q

What does LVH (left ventricular hypertrophy) look like on EKG?

A

S wave in v1 or v2 + R wave in v5 or v6 > 35 mm, or AVL R wave > 12 mm

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12
Q

What does RVH (right ventricular hypertrophy) look like on EKG?

A

R wave > S wave in v1 and gets progressively smaller in v1 to v6

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13
Q

What leads are atrial hypertrophy seen in?

A

Leads II and v1

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14
Q

What do you see in RAH (right atrial hypertrophy)?

A

Peaked P wave in lead II > 2.5 mm amplitude. P wave in V1 has increase in initial positive defection

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15
Q

What do you see in LAH (left atrial hypertrophy)?

A

Notched, wide (>3 mm) P wave in II. V1 has increase in the terminal negative deflection.

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16
Q

How do you see ischemia on an EKG?

A

Symmetrical T wave inversion.

Look in leads I, II, and leads v2-v6

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17
Q

How do you see injury on an EKG?

A

Acute damage.

Look for ST elevation.

18
Q

How do you see infarct on EKG?

A

“Pathologic” Q waves - To be significant, a Q wave must be at least one small square wide or 1/3 entire QRS height

19
Q

Area of injury by lead:

V1-2

A

Anterioseptal wall

20
Q

Area of injury by lead:

V3-4

A

Anterior wall

21
Q

Area of injury by lead:

V5-6

A

Anteriolateral wall

22
Q

Area of injury by lead:

II, III, aVF

A

Inferior wall

23
Q

Area of injury by lead:

I, aVL

A

Lateral wall

24
Q

Area of injury by lead:

v1, v2

A

Posterior wall (reciprocal)

25
Q

What is the most common cause of Left Axis Deviation?

A

Left ventricular hypertrophy

26
Q

How can you confirm Left Ventricular Hypertrophy after you’ve seen it on EKG?

A

ECHO or Chest X-ray

27
Q

What will Dr. P ask about?

A

Left ventricular hypertrophy

28
Q

How do you tell if there is left ventricular hypertrophy (according to Dr. P)?

A

Negative in V1 or V2 and Large positive R wave in V5 or V6 > 35 mm

29
Q

What do you see in MIs?

A

Pathologic Q wave and inverted T waves

30
Q

What do you see ST elevation in?

A

Ischemia (transmural infarction)

31
Q

What do you see ST depression in?

A

Infarct (subendocardial infarction - can be seen after someone had previous MI)

32
Q

What do you see in first degree heart block?

A

Prolonged PR interval but no missing QRS complexes.

33
Q

What do you see in second degree heart block?

A

Some dropped QRS complexes

34
Q

What do you see in 2nd degree heart block mobitz1?

A

Winckebach

  • Key feature: PR interval progressively lengthens and then you drop the beat
  • You have dropped beats every 4th, 5th or 6th cycle
35
Q

What do you see in 2nd degree heart block mobitz2?

A

Randomly drop beats, with no pattern to it.

Unpredictable

36
Q

What do you see in 3rd degree heart block?

A

Complete heart block

Very bad, need pacemaker and implantable defibrillator, all WRS and P waves are completely dissociated

37
Q

What do you use to treat PVST?

A

Adenosine

-Flush fluids after, heart spots and then restores itself 6 seconds later

38
Q

What do you see in PVST?

A

Can’t distinguish a single monomorphic P wave

39
Q

What do you see in a right bundle branch block?

A

Right-Rabbit

-You tend to see rabbit ears in V1 (in place of R wave)

40
Q

What do you see in left bundle branch block?

A

General widening of the QRS complex, may even look like a little ST elevation.

  • Had to distinguish acute ischemia from LBBB - need to ask about symptoms and compare EKGs
  • You can see this in multiple leads/all over

CRRAB I Final (21 decks)

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