ECG

Question 1

J point

Answer 1

Junction between the QRS complex and beginning of the ST segment

Question 2

1 heavy box is ___ seconds

Answer 2

0.2 seconds

Question 3

PR interval in first degree AV block

Answer 3

Greater than 1 heavy box (longer than 0.2 seconds)

Question 4

RBBB- which leads to check

Answer 4

QRS greater than 0.12 seconds. 2 R waves present in V1 and V2. Also, the last QRS deflection should be pointing upward.

Question 5

LBBB- which leads to check

Answer 5

QRS greater than 0.12 seconds. Two R waves present in V5 and V6. The last QRS deflection pointing downward.

Question 6

What can you NOT diagnose when BBB present?

Answer 6

Infarct pattern, axis, or ventricular hypertrophy

Question 7

Lead I and lead AVF in Right axis deviation

Answer 7

Lead I negative, lead AVF positive

Question 8

Lead I and lead AVF in extreme right axis deviation

Answer 8

Both Lead I and AVF negative

Question 9

Lead I and lead AVF in left axis deviation

Answer 9

Lead I is positive, lead AVF negative

Question 10

Lead I is positive, and lead AVF is negative. What is your next step

Answer 10

Check lead II. If negative, confirm LAD. If positive, axis is normal.

Question 11

What axis deviation might you find in healthy children or really tall thin adults?

Answer 11

RAD

Question 12

Patient with occlusion of Left anterior descending artery and left circumflex a. Which way does the axis deviate?

Answer 12

LAD artery occlusion- infarction of left ventricular anterior areas. Left circumflex occlusion causes necrosis of lateral left ventricle. causes RAD.

Question 13

Patient with WPW syndrome. Axis deviation…

Answer 13

If right sided accessory pathway- causes LAD. If left sided accessory pathway- causes RAD

Question 14

Patient with pulmonary stenosis (due to pulmonary embolism), causing increased afterload. RVH results- what finding do you look for in ECG?

Answer 14

Look at Lead V1- usually small R and large S. In RVH, LARGE R present. (but don’t confuse with posterior infarction)

Question 15

70 year old man with aortic stenosis due to calcification of valve. Increased afterload, causing LVH. What finding do you look for in ECG?

Answer 15

Large S wave in V1, and large R wave in V5. Each peak should be greater than 35 mm. (35 small squares)

Question 16

Ischemia on ECG signified by

Answer 16

Symmetric T wave inversions

Question 17

Transmural ischemia vs. subendocardial ischemia

Answer 17

transmural- st elevation, subendocardial ischemia- st depression.

Question 18

What should you not confuse with ST elevation?

Answer 18

J point elevation- concave up T wave in leads V2-V5

Question 19

When is a Q wave pathologic?

Answer 19

Greater than 0.04 seconds (1 small square), if depth is at least 1/3 the height of the R wave, and is present in two or more contiguous leads

Question 20

Anterior wall infarction involves leads

Answer 20

V1-V4

Question 21

Inferior wall infarction involves leads

Answer 21

II, III, AVF

Question 22

Lateral wall infarction involves leads..

Answer 22

V5 and V6

Question 23

Posterior wall infarction signified by..

Answer 23

Large R wave and ST depression in V1 and V2

Question 24

4 key properties of myocardial cells

Answer 24

automaticity, excitability, conductivity, and contractility

Question 25

Normal P wave height and duration

Answer 25

0.5-2.5 mm, and 0.06-0.10 seconds in duration

Question 26

Most common cause of atrial tachycardia

Answer 26

digitalis toxicity

Question 27

What rhythm is COPD often associated with?

Answer 27

Multifocal Atrial tachycardia

Question 28

WPW Tx

Answer 28

Ablation. antiarrhythmics

Question 29

What consequence may occur if atrial fibrillation sustains for more than 2 days?

Answer 29

Emboli formation in arteries

Question 30

What is holiday heart syndrome associated with, and what rhythm might result?

Answer 30

Binge drinking- atrial fibrillation

Question 31

HR of junctional arrhythmia

Answer 31

40-60 bpm

Question 32

HR of accelerated junctional arrhythmia

Answer 32

60-100 bpm

Question 33

HR of junctional tachycardia

Answer 33

100-190 bpm

Question 34

Most common cause of ventricular dysrhythmia

Answer 34

ischemia

Question 35

Idioventricular rhythm HR

Answer 35

20-40 bpm

Question 36

Accelerated idioventricular HR

Answer 36

between 40-100 bpm

Question 37

Ventricular tachycardia HR

Answer 37

more than 100 bpm

Question 38

Why should you be very concerned with ventricular tachycardia?

Answer 38

can turn into ventricular fibrillation

Question 39

example of polymorphic VT

Answer 39

torsades de pointes

Question 40

Tx for congenital prolonged QT syndrome

Answer 40

beta blockers with pacemakers

Question 41

Acquired causes of prologed QT syndrome

Answer 41

drugs- antiarrhythmic agents, antidepressants, electrolyte imbalances, myocardial ischemia, significant bradycardia