ECG Interpretation Flashcards by Korey koper

Axis gives us the _________ of depolarization?

direction

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The progressive depolarization of the __________ moves in a certain direction.

myocardium

AV node is the tail of the vector

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Positive wave of depolarization is moving ______ a positive electrode, an ______ deflection.

toward

upward

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What does a vector show?

the generalized direction of depolarization of the heart

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Vector normally points down to between _ and ___ degrees.

0 and +90 degrees

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When the left ventricle is thickened as in LVH then the vector ( wave of depolarization) will have a ______ deflection to the ____.

bigger
left

horizontal axis

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Vectors swing ____ from damaged heart?

away

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Mean QRS Vector?

AV node is the tail of the vector

To determine the axis:
use leads I and AVF

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To determine the axis of the QRS vector use what leads?

I and AVF

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QRS deflection of:
Lead 1: positive
AVF: positive

what is the resulting axis?

Normal

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QRS deflection of:
Lead 1: positive
AVF: negative

what is the resulting axis?

LAD

left axis deviation

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QRS deflection of:
Lead 1: negative
AVF: positive

what is the resulting axis?

RAD

Right axis deviation

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QRS deflection of:
Lead 1: negative
AVF: negative

what is the resulting axis?

Extreme RAD or Extreme LAD

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What can cause an extreme RAD or extreme LAD?

Extreme RAD: severe pulmonary HTN, severe RSHF, severe COPD

Emphysema
Hyperkalemia
Lead transposition
Ventricular pacing
Ventricular arrhythmia

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What can cause a LAD?

HTN
Valvular disease

Past inferior MI
left anterior fascicular block
Ventricular pacing
Emphysema
Hyperkalemia
WPW- right sided accessory pathway
Tricuspid atresia
Ostium primum atrial septum defect

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What can cause a RAD?

Past MI on the left
RVH
Pulmonary HTN
PE

Normal in kids
LVH
COPD
previous anterolateral MI
PE
ASD or VSD
Dextrocardia
Pectus excavatum
WPW - left sided accessory pathway
Left posterior fascicular block
reversed arm leads

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If LVH, what will you see in lead II?

Bifid P wave with > 40 ms between the two peaks

Total P wave duration > 110 ms

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If LVH, what will you see in V1?

Biphasic P wave with terminal negative portion > 40 ms duration

Biphasic P wave with terminal negative portion > 1mm deep

one side has a stronger vector or wave of depolarization -

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Right atrial enlargement (RAH) produces a peaked _ wave with amplitude: > ___ mm in the inferior leads (II, III, AVF) and > ___ mm in V1 and V2

P wave ( P pulmonale)

> 2.5 mm in inferior leads

> 1.5 mm in V1 and V2

V1 sits right above the right atrium so we get a big upward deflection in V1 with RAH

If RVH, V1 will show?

Large R wave

Small S wave

If LVH, V1 will show?

Deep S wave

If LVH, V5 will show?

Tall R wave

LVH, Sokolov-Lyon criteria?

S wave depth in V1 + tallest R wave height in V5-V6 > 35 mm.

What is ischemia (MI) and what is it characterized by on ECG

Reduced blood supply causing hypoxia

Characterized by inverted T waves

inverted T wave from an area in the heart that is not getting oxygen

If we are having an acute infarct ( happening now) what will we see on the ECG?

ST segment elevation: >1mm in limb leads > 2mm in 2 continguous precordial leads

What are reciprocal changes with MI injury?

St depression in other leads on the other side of the heart. because the vector is swinging Ex. 2, 3, avf - inferior part of the heart ( inferior leads) - ST elevation then..... st depression in 1 and avl ( lateral leads) - this is the reciprocal change

With an Mi, what indicated necrosis on ECG?

Q wave indicates necrosis Significant Q wave is 1 mm wide or 1/3 of the QRS amplitude q waves are pathologic and indicated necrosis

Area of ECG changes correlates with area of ischemia: Anterior?

V1-V4

Area of ECG changes correlates with area of ischemia: Anteroseptal?

V1 and V2

Area of ECG changes correlates with area of ischemia: Anterolateral ?

V3 and V4

Area of ECG changes correlates with area of ischemia: Lateral?

I and AVL

Area of ECG changes correlates with area of ischemia: Inferior?

II, III, AVF

Area of ECG changes correlates with area of ischemia: Posterior?

Large R wave or ST depression in V1/V2 posterior MI are very hard to see on an EKG - cardiac enzymes for better determination

Area of ECG changes correlates with area of ischemia: Subendocardial?

Infarction that doesn’t extend through entire LV wall, flattened ST segments.

Brugada Syndrome is?

Familial condition caused by dysfunctional cardiac Na+ channels.

Brugada Syndrome findings on ECG

RBBB and ST elevation in leads V1-V3 ST segment convex to the top ST segment downward straight

Pericarditis ECG findings?

Elevated the entire T wave from baseline Produces elevated ST segments it is the way the vector is going through the inflamed tissue ST elevation in all of the leads

Pulmonary Embolism ECG findings?

S1Q3T3: Large wide S in I Large Q in III Inverted T in III Sinus Tachycardia is the most common finding on a EKG with a PE

COPD ECG finding?

Low voltage amplitude in all leads RAD barrel chested and a small heart ( small heart in a large chest ) “all the leads with kind of dampen”

Hyperkalemia ECG finding?

P wave flattens ( >9.0 mEq/L) QRS widens (>7.5) Peak T waves( >6.0) electrolyte disturbances elevated potassium levels - peaked T waves = because K is used in repolarization which is happening during a T wave

Hypokalemia ECG findings?

T wave flattened U wave develops At risk for Torsades “Tiny bumps after a QRS complex“ lower and lower the K then the wider and wider the QRS

Hypocalcemia ECG findings?

QT interval lengthens (Torsades risk)

Hypercalcemia ECG findings?

QT interval shortens

Digitalis Effects on ECG finding?

Gradual downward curve of the ST segment "Reverse check" or "Reverse tick" signs from digoxin effect

Pacemaker ECG findings?

Can see pacing “spike” on ECG first spike is atria depolarization second is ventricularr