IVCD (Exam #2)

Question 1

What does the initial portion of the P wave represent?

Answer 1

RIGHT atrial depolarization

Question 2

What does the terminal portion of the P wave represent?

Answer 2

LEFT atrial depolarization

Question 3

What are the two criteria for RAE (__ OR __)?

Answer 3

• P wave amplitude is 2.5+ mm tall
  OR
• Initial portion of P wave in V1 is larger than the terminal portion (if biphasic)

Question 4

What are the two criteria for LAE (__ OR __)?

Answer 4

• P wave duration is 0.10+ seconds
  OR
• Terminal portion of P wave in V1 is negative with a duration of 0.04+ seconds AND depth of 1+ mm (both one small block)

Question 5

What is the most common characteristic of RVH seen in the limb leads?

Answer 5

RAD

Question 6

A normal R wave progression involves what?

Answer 6

Increase in size from V1 to V6

Question 7

What is the progression of conduction (hint: 3 steps)?

Answer 7

AV node → Bundle of His → LBB or RBB

Question 8

What are the three fascicles of the LBB?

Answer 8

• Septal fascicle
• L Anterior fascicle
• L Posterior fascicle

Question 9

What is the primary criteria for a BBB?

Answer 9

WIDE QRS of 0.12+ seconds

Question 10

What is an Incomplete BBB?

Answer 10

NORMAL QRS interval with an RR’ configuration

Question 11

What is the criteria for RBBB (__ AND __OR __)?

Answer 11

• Wide QRS of 0.12+ seconds AND…
• M-shaped RR’ in V1 or V2
  OR
• Wide S wave in Lead I or V5 or V6

Question 12

What is the criteria for LBBB (__ AND __)?

Answer 12

• Wide QRS of 0.12+ seconds AND…

- Wide R wave in Lead I or V5 or V6

Question 13

What CANNOT be dx in the setting of a BBB?

Answer 13

Hypertrophy (LVH or RVH)

Question 14

For the possible M-shaped RR’ in V1 or V2 seen with RBBB, what does the R’ represent?

Answer 14

R’ is the the delayed RV depolarization

- LV depolarized normally (R)

Question 15

With a LBBB, what is generally the shape of the R waves?

Answer 15

Tall (can be notched or flattened)

Question 16

What is the criteria for STRONG LAD?

Answer 16

R wave in aVL > R wave in I

Question 17

What is the criteria for STRONG RAD?

Answer 17

R wave in III > R wave in aVF

Question 18

What is the key to detecting a Hemiblock/Fascicular Block?

Answer 18

Change in QRS axis but QRS duration is NORMAL

Question 19

What is the criteria for an LAHB (4?)

Answer 19

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

Question 20

What is the criteria for an LPHB (4?)

Answer 20

• Strong RAD
• Deep S waves in Lead I
• Tall R waves in Lead III
• NORMAL QRS duration

Question 21

What is a Bi-Fascicular Block?

Answer 21

RBBB + LAHB/LPHB

Question 22

What is a Non-Specific IVCD?

Answer 22

Prolonged/Wide QRS duration with NO LBBB/RBBB features

Question 23

What is the primary criteria for a Pre-Excitation Syndrome, and what are the two examples?

Answer 23

Short PR interval (<0.12 seconds)

• Wolff-Parkinson-White (WPW) Syndrome
• Lown-Ganong-Levine (LGL) Syndrome

Question 24

What are the three criteria for Wolff-Parkinson-White (WPW) Syndrome?

Answer 24

• Short PR interval of <0.12 seconds
• Wide QRS complex of 0.12+ seconds
• Delta waves (“slurred” upstroke of R wave)

Question 25

What are the three criteria for Lown-Ganong-Levine (LGL) Syndrome?

Answer 25

• Short PR interval of <0.12 seconds
• Normal QRS complex of <0.12 seconds
• NO delta waves

Question 26

What condition involves James fibers?

Answer 26

Lown-Ganong-Levine (LGL) Syndrome

Question 27

What other RBBB criteria may be present involving the QRS complex and T wave?

Answer 27

Terminal portion of QRS and T wave are oriented opposite directions