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EKG > Final Exam > Flashcards

Final Exam Flashcards

1
Q

What is the criteria for RAE?

A

P wave amplitude > 2.5 in lead II
OR
Biphasic P wave in V1 with initial portion > terminal portion

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2
Q

What is the criteria for LAE?

A

P wave duration > 0.10s in lead II
OR
Terminal portion of the P wave in V1 is negative and can fit 1 small box

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3
Q

What is the criteria for RVH?

A

RAD
R wave > S wave in V1/2
S wave > R wave in V5/6

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4
Q

What is the criteria for LVH?

A

S wave in V1/2 + R wave in V5/6 > 35 mm
R wave in aVL > 11
R wave in lead I + S wave in lead III > 25

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5
Q

Does the R or L bundle branch divide into separate fascicles?

A

LBB

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6
Q

What is seen on EKG in the presence of RBBB?

A

QRS > 0.12s and M shaped RR’ in V1/2
OR
Wide S wave in Leads I and V5/6
The ST-T waves normally appear in the opposite direction of the terminal portion of the QRS

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7
Q

What is seen on EKG in the presence of LBBB?

A

QRS > 0.12s and Wide R wave in Leads I and V5/6

Deep S wave in Leads V1-3

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8
Q

What is seen on EKG in the presence of Left Anterior Fascicle (LAFB) or Left Anterior Hemiblock (LAHB)?

A

Normal QRS duration
Strong LAD
Tall R waves in Lead I
Deep S waves in Lead III

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9
Q

What is seen on EKG in the presence of Left Posterior Fascicle (LPFB) or Left Posterior Hemiblock (LPHB)?

A

Normal QRS duration
Strong RAD
Tall R waves in Lead III
Deep S waves in lead I

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10
Q

What is seen on EKG in the presence of Wolff-Parkinson-White (WPW): Bundle of Kent?

A

PR interval < 0.12s
Wide QRS complexes
Delta wave seen in some leads

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11
Q

What is seen on EKG in the presence of Lown-Ganong-Levine (LGL): James fibers?

A

PR interval < 0.12s
Normal QRS complexes
Absence of Delta wave

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12
Q

What is the normal amplitude and duration of P waves?

A
  1. 06s-0.10s

0. 5-2.5mm

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13
Q

What is the normal duration of QRS complexes?

A

0.06-0.12s

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14
Q

What is the normal amplitude and duration of q waves?

A

Amplitude is <25% of the R wave

< 0.04s

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15
Q

____ is due to lack of O2 to myocardium

Reversible; no permanent damage.

A

Ischemia

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16
Q

What is seen on EKG in the presence of ischemia?

A

T wave inversion (due to delayed repolarization)
Symmetrical, peaked T waves
ST segment depression

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17
Q

____ is due to more prolonged ischemia

Onset of cellular damage, but without necrosis.

A

Injury

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18
Q

What is seen on EKG in the presence of injury?

A

ST elevation in leads facing injury (due to incomplete depolarization)

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19
Q

____ causes death of injured myocardial cells, is

irreversible, and release of enzymes into circulation?

A

Infarct

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20
Q

What enzymes does infarct release into circulation?

A

Troponin
Ck-MB
Myoglobin

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21
Q

What is seen on EKG in the presence of infarct?

A

Enlarging or new Q waves

  • 0.04s duration
  • At least 1/3 the height of R wave in same QRS complex AND
  • Present in 2 or more contiguous leads
22
Q

Depolarization normally proceeds in what direction?The conduction system is within what tissue?

A

Endocardial to epicardial

Subendocardial tissue

23
Q

Repolarization normally proceeds in what direction? The conduction system is within what tissue?

A

Epicardial to endocardial

Epicardial surface

24
Q

How does transmural ischemia affect repolarization?

A

Repolarization takes longer and reverses direction (becomes endocardial to epicardial)

25
Q

How does the abnormal repolarization caused by transmural ischemia appear on EKG?

A

T wave inversions in leads overlying ischemic regions

Symmetrical T waves

26
Q

When is ST segment depression considered significant?

A

> 1 mm below baseline measured 0.04s to right of J point, in 2 or more contiguous leads

27
Q

When is ST elevation considered significant?

A

> 1 mm above baseline measured 0.04s to right of J point, in 2 or more contiguous leads

28
Q

How does pericarditis appear on EKG?

A

Diffuse ST segment elevation

29
Q

Which leads view the anterior portion of the heart?

A

Leads V2-V4

30
Q

Which leads view the inferior portion of the heart?

A

Leads II, III, aVF

31
Q

Which leads view the lateral portion of the heart?

A

Leads I, aVL, V5, V6

32
Q

What is seen on EKG in the presence of an anterior MI?

A

ST segment elevation
T wave inversion
Pathologic Q waves in V1-V4

33
Q

What is seen on EKG in the presence of a lateral MI?

A

ST segment elevation
T wave inversion
Pathologic Q waves in lead I, aVL, V5-6

34
Q

What is seen on EKG in the presence of an inferior MI?

A

ST segment elevation
T wave inversion
Pathologic Q waves in leads II, III, and aVF

35
Q

What generally indicates prior “healed/old” infarction?

A

Q wave in the absence of ST segment and T wave abnormality

36
Q

what should give you a high degree of suspicion for a posterior MI?

A

ST segment depression in V1-3

37
Q

Which leads view the septal portion of the heart?

A

V1, V2

38
Q

What is seen on EKG in the presence of a benign repolarization?

A

Benign Early Repolarization

39
Q

What is seen on EKG in the presence of a pulmonary embolism?

A

Large S wave in lead I, deep Q wave and inverted T wave in lead III

40
Q

Delayed repolarization which puts pt at risk of what?

A

V. fib and Torsades de Pointes

41
Q

What is seen on EKG in the presence of hyperkalemia?

A

Tall, peaked T waves
Flattened P waves
1st degree AV heart block
Widened QRS complexes

42
Q

What is seen on EKG in the presence of hypokalemia?

A

Appearance of U waves
Flattening of T waves
ST segment depression

43
Q

What is seen on EKG in the presence of hypercalemia?

A

Shorter ST segment and shorter QT interval

44
Q

What is seen on EKG in the presence of hypo K+, Ca2+, Mg2+?

A

Prolongation of QT interval (risk of ventricular tachycardia or Torsades de Pointes)

45
Q

When may you see electrical alternans?

A

Large pericardial effusion

46
Q

What is seen on EKG in the presence of digoxin at therapeutic levels?

A

“Dig effect”

Shortened QT interval

47
Q

What electrolyte abnormality should you be concerned for with toxic digoxin blood levels?

A

Hypokalemia

48
Q

What is the most characteristic rhythm disturbance seen with toxic digoxin levels?

A

PAT with 2nd degree AV block

49
Q

What types of drugs can prolong the QTI and put pts at risk for V. tach and TdP?

A

Anti-arrhythmics
TCAs
Phenothiazines
Macrolides

50
Q

What is seen on EKG in the presence of hypothermia?

A

All intervals are prolonged (PRI, QRS, QTI)
ST segment elevation with an abrupt ascent at the J point, then plunge back to the baseline (“Osborn waves”)
May see muscle artifact

EKG (2 decks)

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