EKG summary Flashcards
(24 cards)
P wave amplitude > 2.5 mm in at least one of the inferior leads allows you to diagnose what?
Right atrial enlargement
How do you diagnose left atrial enlargement?
1) 2nd portion of P wave incr. amplitude:
In V1, terminal P wave drops > 1 mm below baseline, and no axis deviation seen
OR
Incr. in duration:
2) terminal portion of P wave at least 1 small box (0.04 sec) in width in lead 2
What are the criteria for left ventricular hypertrophy (LVH)? (important)
1) R wave in V5 or V6 + S wave in V1 or V2 exceeds 35mm
2) R wave in aVL is 11mm
3) R wave in aVL + S wave in V3 exceeds 20mm in women and 28mm in men
4) LAD > ~15 degrees, but not useful diagnostic feature, & QRS may be slightly prolonged
What 2 leads do you need to look at for RVH?
V1 and V6
Which is normally due to afterload (pressure overload), hypertrophy or enlargement?
Hypertrophy
AFIB:
1) Does AFIB have true P waves?
2) Is QRS wide or narrow?
1) No
2) Narrow
Differentiate between the types of premature beats
How can you remember Mobitz type 2 second degree AV block?
“If some don’t get through, then you have a Mobitz 2”
List some main characteristics of right BBB
1) Wide QRS complex
2) RSR’ V1 and 2 (or just tall R waves)
3) Left lateral leads with late deep S wave
List the main characteristics of left BBB
1) Broad or notched R wave in left lateral leads
2) Deep S wave in leads over RV
3) May see Left Axis deviation
ST and T wave changes:
1) Where are they seen in RBBB?
2) What abt LBBB?
1) RBBB – in leads V1-3 (similar to LVH with repole abnormality)
2) LBBB- left lateral leads
List 3 main findings in WPW
1) Short PR interval
2) Delta wave
3) Wide QRS
Inferior MI: What does it involve? What leads is it seen in?
RCA or descending branch.
Leads: II, III, aVF
Anterior MI: What does it involve? What leads is it seen in?
Anterior IV branch (LAD) of LCA.
Leads: V1-6
Lateral MI: What does it involve? What leads is it seen in?
Left circumflex br. of LCA.
Leads: I, aVL, V5-6
Posterior MI: What does it involve? What leads is it seen in?
1) RCA; usually accompany inferior MI or less frequently lateral MI.
2) Reciprocal changes in the anterior leads V1-3 (ST depression, Tall R wave)
List the following groups of leads:
1) Anterior
2) Left lateral
3) Inferior
4) Right ventricular
1) V2, V3, V4
2) I, aVL, V5, V6
3) II, III, aVF
4) aVR, V1
Takotsubo cardiomyopathy and angina may both involve T wave inversion, but Takotsubo cardiomyopathy involves ST __________ and angina involves ST __________ (excluding Prinzmetal angina)
elevation; depression
RVH criteria are?
V1: R wave > S wave
V6: S wave > R wave
1) What is a normal PR interval?
2) How long is a normal QRS complex?
1) 3-5 small boxes
2) <3 small boxes
How do you tell QRS axis?
Lead 1 and aVF up = normal
Lead 1 up & aVF down = LAD
Lead 1 down & aVF up = RAD
Both leads down = extreme RAD
Summarize the AV conduction blocks
1) Type I: PR: QRS, rhythm is regular
2A) Type 2A (Wernicke’s): PR interval prolongs before it drops a QR complex. PR complex: QRS ratio is messed up.
-Narrow QRS. Rhythm is irregular
2B) Type 2B: QR complex gets dropped but PR interval is normal.
-Narrow QRS. Rhythm is irregular
3) Type 3: Extremely messed up (complete dissociation) but regular RR. Has a wide QRS
List the 9 steps of EKG analysis
1) Heart Rate
2) Intervals – PR, QRS, & QT intervals
3) Axis
4) Rhythm – 4 questions????
Are normal P waves present/normal?
Are QRS complex narrow or wide?
What is the Relationship of P waves & QRS complexes?
Is the rhythm regular or irregular?
5) Conduction blocks
-AV blocks
-BBB or hemiblocks
6) Preexcitation
7) Enlargement and hypertrophy
8) CAD
9) Other
