List the 3 ventricular arrhythmias.
1) PVC
2) ventricular tachycardia
3) ventricular fibrillation
List the 3 atrial arrhythmias.
1) atrial flutter
2) atrial fibrillation
3) PAC
A tall and wide QRS complex with a T wave opposite deflection of R can indicate what dysrhythmia?
PVC
What is ventricular tachycardia?
3 or more PVCs in sequence with HR >100bpm
What does ventricular fibrillation look like?
chaotic electric activity with no clear P, QRS, or T
- just a bunch of small bumps up and down everywhere
What is the difference between a 1st degree AV block and a second degree?
1st = PR interval is longer than normal (>5 small boxes) 2nd = PR interval progressively lengthens until atrial impulse isnt conducted to ventricle (dropped QRS)
What is a mobitz type I (Wenckebach) block?
a type second degree AV block (PR gets smaller and smaller until QRS is dropped)
What is a mobitz type II block?
PR interval constant, atrial conduction is intermittent (signified by dropped QRS’s)
often occurs with wide QRS
The mobitz blocks are what form of dysrhythmia?
second degree AV blocks
In which AV block is the PR interval constant, but intermittent atrial conduction is present?
second degree, mobitz type IIf
Describe what a 3rd degree AV block looks like.
PP and RR intervals regular, no relationship between P and R waves
What diagnosis will have R and R’ on chest leads?
BBB’s: RBBB and LBBB
With an EKG that shows a large S wave in the left leads, R/R’ in V1 and V2, as well as long QRS and opposite T-wave, what is the abnormality?
RBBB
A notched or broad QRS on V5-6 could indicate what?
LBBB
Describe LBBB vs RBBB
LBBB: notched/broad QRS on V5-6, deep S on V1-2, opposite T
RBBB: R/R’ on V1-2, deep S on V5-6, opposite T
When there’s a hemiblock, where is the block occuring?
in the septal fascicle, L ant or L post
L ant hemiblock usually has what kind of axis deviation? L post?
L ant = LAD
L post = RAD
Which is more common, L ant hemiblock or L post hemiblock?
L anterior, seen in normal and diseased hearts (L post seen more in diseased hearts)
T/F: QRS looks different for hemiblocks than normal.
false, no change in QRS complex in hemiblocks, or ST/T
What does a L ant hemiblock look like?
LAD with larger S waves in inferior leads
What does a L post hemiblock look like?
RAD with larger S waves in lateral leads
Larger S waves in inferior leads may indicate what dysrhythmia?
L ant hemiblock
What are the different types of blocks that can occur in the heart?
1) AV block (1-3rd degree, mobitz type I-II for 2nd degree)
- looking at PR intervals and dropped QRS
2) BBB (LBBB and RBBB)
- looking at R/R’ on V1-2 for RBBB, V5-6 for LBBB
- notched/broad QRS on V5-6 for LBBB
- deep S waves on opposite chest leads
3) hemiblock (L ant or L post)
- looking at RAD and deep S’s on lateral leads = post
- looking at LAD and deep S’s on inferior leads = ant
To have R ventricular hypertrophy, what deviated axis should be occuring?
RAD
To have L ventricular hypertrophy, what does the axis look like?
LAD
What dysrhythmia encompasses the following traits:
- RAD - R>S in V1 - S>R in 1
R ventricular hypertrophy
What dysrhythmia encompasses the following traits:
- LAD - great deflection of S in V1 - great deflection of R in V5
L ventricular hypertrophy
A tall P wave in lead II could indicate what?
R atrial hypertrophy
What indicates L atrial hypertrophy?
greater neg deflection of P than positive in the biphasic p wave in V1
Describe the difference between L and R atrial hypertrophy.
L atrial hypert = greater neg deflection of P in V1
R atrial hypert = tall p-wave in lead II
T/F: T wave inversion in aVR is abnormal and indicates MI.
false, t wave inversion in AVR is normal
What does depressed ST interval indicate?
ischemia
Elevated ST interval indicates what?
myocardial injury
What does acute myocardial infarction look like?
acute ST elevation, almost 4 small boxes
T/F: MI can present with ST elevation with OR without an inverted T wave
true, T wave can be inverted or normal for MI to happen (with ST elevation present)
What does it mean if a Q-wave is significant?
either 1 box wide or it’s 1/3 the height of the QRS complex
What are the hallmarks of an MI?
inverted T, elevated ST interval
- inverted T occurs on day 1-2 and then days later
- elevated ST occurs acutely
If significant Q waves are found in inferior leads, which coronary artery is responsible?
RCA
What lead areas does the RCA supply?
inferior (II,III, AVF) and posterior (V1-2) leads
L anterior descending artery supplies what lead areas?
antero septal leads (V1-2)
What artery supplies the antero lateral leads?
circumflex L branch
I, AVL, V5-6 = anterolateral
What leads does the L ant descending artery supply?
anteroseptal (V1-2)
- look for abnormal Q waves in V1-2 to see if L ant descending is at fault
The distal LAD supplies the antero apical leads (V3-4)
What artery supplies the anteroapical and anteroseptal leads of the heart?
L ant descending (apical = distal branch)
What supplies the inferior and posterior leads of the heart?
RCA
What supplies the anterolateral leads of the heart?
circumflex