EKG

Question 1

Right Atrial Hypertrophy

Answer 1

peaked tall P wave in lead II

Question 2

Left Atrial Hypertrophy

Answer 2

Biphasic P wave in lead V1 with large terminal portion

Question 3

right vent hypertrophy

Answer 3

large R wave in V1
deep S wave in V5 V6
Right axis deviation

Question 4

left ventricle hypertrophy

Answer 4

tall R waves in V5 V6
deep S wave in V1
can have left axis deviation

Question 5

Right bundle branch block

Answer 5

Prolonged QRS in all leads
rabbit ears in V1
wide S wave in I V5 and V6

Question 6

Left Bundle Branch Block

Answer 6

Prolonged QRS in all leads
Large and wide R wave in I, AvL, V5 and V6
deep S wave in II, III, aVF, V1-V3

Question 7

Atrial Flutter

Answer 7

sawtooth flutter waves
almost always due to underlying heart disease
can be seen with pulmonary embolus and digoxin tox

Question 8

atrial fib

Answer 8

no organized P waves only shimmering baseline
irregular ventricular rhythms usually rapid 160-180
normal QRS width
mcc RHD, HTN, IHD
Tx: if unstable shock if stable use CaCB to control Vent rate

Question 9

Vent Tach

Answer 9

three or more ectopic beats in a row
wide QRS
rate over 100
emergency

Question 10

Multifocal Atrial Tach

Answer 10

P waves have different shapes, multiple sites of atrial depolarization
PR intervals vary
artral rate high
Usually indicates underlying pathology ie COPD, CHF, Sepsis, drug tox

Question 11

Supraventricuar Tachycardia

Answer 11

Regular rapid atrial rhythm
P wave hard to see, may be buried in preceding T waves
QRS normal width
mcc normal heart, sometimes seen in assoc with MI,RHD, pericarditis, mitral valve polapse
2/2 reentry of depolarization
sx in elderly or those with heart disease: syncope, pulmonary edema, ischemia,

Question 12

Premature atrial contractions

Answer 12

Ectopic P wave sooner than expected
P wave has different shape , originates from site other than sinus node
usually benign, may trigger other atrial arrhythmias

Question 13

Premature Ventricular Contractions

Answer 13

impulses arise prematurely 
occurs before next expected sinus beat 
no preceding P wave
wide QRS
MCC - stress, alcohol, caffeine, ischemic heart disease, acute MI, CHF

Question 14

1st degree AV block

Answer 14

elongated PR interval
slower than normal atrial impulse
generally benign

Question 15

2nd degree type 1 AV block

Answer 15

progressive prolongation of PR interval until dropped QRS
Wenckebach
mcc: acute inferior MI, digitalis tox, myocarditis, cardiac surgery, RHD

Question 16

2nd degree Type II

Answer 16

Constant PR interval then dropped QRS
QRS may be narrow or wide depending on if bundle branch block is present
mcc - cardiomyopathy, acute anterospetal MI

Question 17

3rd degree complete heart block

Answer 17

random PR interval, dont match
atrial and ventricular depolarizations are independent of each other
P waves and QRS have no consistent relation to each other
QRS can be narrow or wide
MCC - acute MI, drug effect

Question 18

Junctional Escape Rhythm

Answer 18

Rte typically 40-60 bpm, may be 60-100
MC regular rhythm
absent or inverted P waves
normal QRS

Question 19

Ventricular Escape Rhythm

Answer 19

Very wide QRS

HR less than 40 BPM

Question 20

Torsades de Pointes

Answer 20

• prolonged QT segment
• initiated by a short-long-short interval of QT segment
• the ventricles depolarize in a circular fashion resulting in QRS complexes with a continuously turning heart axis around the baseline
• Following the short-long-short the QRS is wide and fast