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CRRAB I Final > EKG Hypertrophy & Ischemia/Infarct > Flashcards

EKG Hypertrophy & Ischemia/Infarct Flashcards

1
Q

What do you see for right atrial hypertrophy?

A

RAE (right atrial enlargement)

-Characterized by the tall (>2.5 mm) P waves in leads II, III, aVF

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2
Q

What do you see for left atrial hypertrophy?

A
  • Increased P wave duration in Lead II

- Large negative component to P wave in lead V1

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3
Q

Where does the vector point?

A

Hypertrophied side

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4
Q

What do you see in RVH?

A
  • RAD (negative in I, positive in aVF - around +150 deg)
  • R > S wave in V1
  • S wave persists in V5 and V6 (larger/pronounced here)
  • Right precordial lead (V1-V3) ST depression
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5
Q

What do you see in LVH?

A
  • S wave depth in V1/2 + R wave height in V5/6 > 35 mm

- LVH t-wave inverted

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6
Q

What should you scan all leads for with ischemia/infarct?

A
  • Q waves
  • Inverted T waves
  • ST segment elevation or depression
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7
Q

What does ST elevation indicate?

A

Acute ischemia

MI

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8
Q

What does an ST elevation + significant Q waves indicate?

A

Acute or recent infarct

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9
Q

What does persistent ST depression represent?

A

“Subendothelial infarction”

-Shallow infarct just beneath the endocardium lining the L ventricle

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10
Q

Where will you see STe elevation in an inferior MI?

A

Lead II, III and aVF

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11
Q

What will you see in the EKG of Myocardial Infarction - Necrosis?

A
  • Pathological Q wave
  • -1 mm wide (.04 sec) or is a Q wave at least 1/3 the amplitude of the QRS complex
  • Note leads where pathologic Q’s are present (Omit AVR) to determine infarct location and identify the vessel involved
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12
Q

What can happen with old infarcts?

A

-Pathologic Q waves remain for life

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13
Q

What can you use to determine infarction location and identify the vessel involved?

A

-Note leads where the pathologic Qs are present (Omit AVR)

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14
Q

What artery is occluded?

  • Q waves in V2, V3, V4
  • ST depression in II, III, aVF
A
  • Acute/hyperacute anterior wall MI
  • Reciprocal ST depressions
  • Proximal Left Anterior Descending (LAD) occlusion
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15
Q

Whats is going on?
ST elevation in V1, V2, V3, V4, V5
Q waves in V1, V2, V3

A

Acute anterior wall myocardial infarction (MI) ST-elevation (STEMI), consistent with proximal left anterior descending (LAD) occlusion

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16
Q

Whats going on?
ST elevation V2-V5, associated with T wave inversion
Q waves in V2-V3
T waves: II, III, aVF

A

Evolving anteroseptal myocardial infarction secondary to cocaine.
-Occlusion of large left anterior descending (LAD) artery that wraps around base of heart

17
Q

What’s going on?
Q waves: V2-3
ST elevation: V2-V5, I, aVL
ST depression - III

A

Acute anterior wall ST elevation MI (STEMI)

-Occlusion of proximal left anterior descending coronary artery

18
Q

What does aVR normally look like?

A

Upside down

19
Q

What is going on?

  • QRS > 0.12
  • RSR’ in V1 and V2 (bunny ears)
  • Large R wave in V3 combined with average S wave in V5
A
  • Right Bundle Branch Block (RBBB)

- Possible LVH

20
Q

What if you have Q waves without any ST elevation?

A

Old infarct

21
Q

What are the lateral leads?

A

Lead I and aVL

22
Q

What are the anterior leads?

A

V1-V4

23
Q

What’s going on?

  • QRS > .12
  • Broad notched R wave in V5 and V6
  • V2 and V3 with S and S’ (looks like upside down R and R’ bunny ears)
A

-Left Bundle Branch Block (LBBB)

24
Q

What is this?

PR

A

WPW (Wolf Parkinson White)

25
Q
  • S wave in V1 very large

- R wave in V5 very large

A

…if they are >35 mm then we have LVH (left ventricular hypertrophy)

26
Q
  • Flipped T waves on V1-4

- Q waves III, V1, V2

A

Ischemia - anterolateral

27
Q

What is occluded:

-ST elevation in II, III, aVF

A

Inferior MI

-RCA (right coronary artery) likely occluded

28
Q
  • Elevated ST segments all over.
  • Pathologic Q waves in V2, V3
  • ST depression absent
  • aVR only site not showing injury
A

Pericarditis!!

-Affects entire heart

CRRAB I Final (21 decks)

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