Lec 2-3 EKG Images Flashcards Preview

Cardio Exam 2 > Lec 2-3 EKG Images > Flashcards

Flashcards in Lec 2-3 EKG Images Deck (75):
1

What type of rhythm is this?

 

Sinus arrhythmia = non-pathological variation with respiration = looks irregular in bunches

 

2

What type of rhythm is this?

premature atrial contraction = early QRS complex originated by abnormal P wave followed by compensatory pause; but QRS complex itself looks normal

3

What type of rhythm is this?

premature ventricular contraction

4

Is this sinus rhythm? What is it?

No! because P waves present and regular but not upright in I/II

since P wave = problem is not with atria,
must be problem with where focus is [atrial rhythm/tachycardia with focus coming from somewhere else], or heart just not where its supposed to be [dextrocardia] OR you put leads in the wrong dir [inverted right and left]

5

What causes this rhythm?

 

dextrocardia

 

inverted P wave in I, decreasing amplitude from V1 to V6 [opposite what you’d expect = muscle mass decreasing toward left]

6

What causes this rhythm?

p wave inverted 1, 2 but normal progression of QRS so unlikely to be dextrocardia

III + aVF = good; aVL should have been upright but its not; aVR should have been negative but its not

--> you accidentally switched L and R 

7

Sinus or non-sinus? Normal, brady, or tachy?

sinus bradycardia

8

What rate? Sinus or non? Normal brady or tachy?

sinus tachycardia

9

What axis?

right axis deviation à V1 negative, AVF positive

10

What axis?

 

left axis deviation à V1 positive, AVF negative

11

What axis?

left axis deviation

12

What causes this type of axis?

left anterior fascicular block

13

What causes this?

left bundle branch block = broad QRS, looking down in V1

14

What causes this?

right bundle branch block = broad QRS, looking up in V1

15

What causes this?

right bundle branch block = broad QRS, looking up in V1

16

What causes this?

left bundle branch block = broad QRS, looking down in V1

17

What rhythm is this?

right BBB à broad QRS, rabbit ears, upright V1

18

What rhythm is this?

WPW à short PR, delta wave on upstroke of QRS, broad QRS

19

What rhythm is this?

posterior wall infarct --> huge positive R in V1, prominent Q waves in leads II and III [inferior leads]

20

What rhythm?

LVH

21

What rhythm?

RVH with right axis deviation

22

What rhythm is this?

Wolf parkinson white = WPW

23

What rhythm is this?

wolf parkinson white = WPW

24

What rhythm is this?

Wolf Parkinson White = WPW

25

What rhythm is this?

Right bundle branch block

26

What does this rhythm suggest?

posterior infarct

27

What does this rhythm suggest?

left ventricular hypertrophy

28

What does this rhythm suggest?

right ventricular hypertrophy

29

Which leads correspond to inferior wall? septal wall? anterior wall? anteroseptal wall? lateral wall?

inferior = leads II, III, aVF

septal = V1 and V2

anterior = V3 and V4

anteroseptal = V1, V2, V3, V4

lateral = I, aVL, V5, V6 [I/aVL = high lateral; V5/V6 = anterolateral]

30

What does this rhythm show?

diffuse subendocardial ischemia = ST depressions and T wave inversions

31

What does this rhythm show? Which specific leads/signs?

anterolateral and inferior ischemia

 

T inversion and ST depression on II, III, aVF --> inferior ischemia

ST depression on V4, V5, V6 --> anterolateral ischemia

32

What stage of MI is this?

 

[hyperacute, fully resolved, resolution, or chronic stabilized]

resolution phase

 

because you see:

- Q wave

- inverted T wave

- no ST elevation

33

What stage of MI is this?

 

[hyperacute, fully resolved, resolution, or chronic stabilized]

chronic stabilized 

because you see

- Q wave

- upright T wave

- no ST elevation

34

What stage MI is this?

 

[hyperacute, fully resolved, resolution, or chronic stabilized]

hyperacute phase

this is because:

- huge ST elevation

- hyperacute tall T wave

- no Q wave yet

35

What stage MI is this?

 

[hyperacute, fully resolved, resolution, or chronic stabilized]

fully evolved phase

this is because:

- ST elevation

- start to see Q wave formation

- start to see T wave inversion

36

What pathology does this rhythm show? what phase?

anterior wall MI

hyperacute phase since T waves and STs still up

ST elevation in V3, V4, V5, V6

37

What does this EKG show?

 

If a patient presents with new onset of this type of EKG and chest pain what is the diagnosis?

this shows LBBB = wide QRS, QRS down in V1, rabbit ears notched/slurred in V5, V6

 

pt with new onset LBBB and acute chest pain = acute STEMI MI

this is an acute anterior wall MI

38

What does this EKG show?

 

 

Inferior wall MI

ST elevation in V2, V3, aVF

hyperacute phase

reciprocal ST depression/T wave inversion in 1 and aVL substantiate STEMI

39

What does this EKG show?

inferior and RV infarction --> RCA infarct

 

ST elevation in 2, 3, aVF [hyperacute] and in V4%, V5R, V6R

 

40

What does this EKG show?

inferior wall/posterior MI

II, III, aVF ST elevation = inferior wall MI

I and aVL ST depression = reciprocal changes

V1/V2 ST depression --> mirror image of posterior wall -> may signify posterior wall MI

41

What does this EKG show?

 

age-indeterminant inferior wall MI

- III, avF show Q wave = inferior infarction

42

What does this EKG show?

atrial fibrillation

 

-  irregularly irregular R-R interval b/c some P waves transmitted down and some aren't

- fibrillatory waves rather than discrete P waves

43

What does this EKG show?

multifocal atrial tachycardia

 

- atrial tachycardia with 3 or more different P wave morphologies

- irregularly irregular rhythm

44

What does this EKG show?

multifocal atrial tachycardia

 

- atrial tachycardia with > 3 different P wave morphologies

- irregularly irregular rhythm

- rate > 100 bpm

45

What does this EKG show? How should you treat?

supraventricular tachycardia

 

Give adenosine

46

What type of rhythm is this?

supraventricular tachycardia = SVT

47

What type of rhythm is this?

sinus tachycardia

 

P before every WRS and upright in 1 and 2 and inverted in aVR

48

What type of rhythm does this EKG show?

typical atrial flutter

- sometimes 1 or 2 or 3 p waves between each QRS

- irregularly irregular QRS 

- saw tooth pattern P-waves

- typical means upright in II, III, aVF

- distinguish from AFib: clear p wave activity

49

What type of rhythm does this EKG show?

typical atrial flutter

- fast sawtooth p waves

- a few P waves for each QRS

- typical b/c upright in II, III, aVF

50

What type of rhythm does this EKG show?

atypical atrial flutter

- sawtooth p waves

- very distinctive p waves

- atypical = down in II, III, aVF

51

Match each of the following rhythm strips with the following types of rhythms:

 

- multi-focal atrial tachycardia [MAT]

- atrial fibrillation

- atrial flutter

- atrial tachycardia

- AVNRT/AVRT [SVT]

- sinus tachycardia

1 = sinus tachycardia

2 = AVNRT/AVRT = SVT

3 = atrial fibrillation

4 = atrial flutter

5 = atrial tachycardia

6 = multi-focal atrial tacycardia [MAT]

52

What type of rhythm is this?

 

Treatment?

ventricular tachycardia

= fast wide QRS complexes

Treat: synchronized cardioversion

53

What is this rhythm?

ventricular tachycardia with fusion and capture beats mean VT

 

AV dissociation = no real association betwen P and QRS

capture beat = in middle of VT a p wave able to capture a narrow normal QRS

fusion beat = QRS in between supraventricular and ventricular beats

 

54

What rhythm is this? How do you treat?

Ventricular fibrillation

- chaotic irregular deflections

- no P waves or QRS or T

 

treat by defibrillations [not cardioversion]

55

What rhythm is this? How should you treat?

This is a fake fibrillation = an artifact on exam

Not fib because its regular [in fib = irregular] not flutter b/c don't have classic sawtooth pattern in II, III, aVF

 

don't do fibrillation!!

56

What rhythm is this? How should you treat?

This is torsade de pointes

 

treat with IV magnesium

57

What rhythm is this? How do you treat?

WPW with AFib

- broad complex tachycardia

-  irregularly irregular means not VT or VF --> must be AFib

- broad coming down accessory path

- WPW since broad QRS + delta complex pre-excitation = slurred QRS upstroke

Treat = procainamide or pronesta and synchronize cardiovert

58

What does this EKG show?

first degree AV block

- prolonged PR

- each P followed by QRS

- usually constant PR interval

59

What does this EKG show?

Mobitz type I 2nd degree EKG block [wenkebach]

- lots of p waves and irregularly irregular QRS = "group" beating

- progressive prolongation of PR until P fails to conduct

60

What does this EKG show?

second degree AV block mobitz type 2

more dangerous than type 1

lots of extra P waves

3 or more extra p waves for every QRS

no group beating like in wenkebach

61

What does this EKG show?

complete heart block

 

p waves show no relation to the QRS complexes

62

What does this EKG show?

sinus pause = longer than 2 seconds of no sinus activity = 10 big boxes

63

What does this EKG show?

electronic pacemaker spikes = artificially induced electronic stimuli that pace pts rhythm cause a blip or spike on the waveform

64

What is this patient's most likely K level


A)4.5
B)5.0
C)5.5
D)6.5
E)8.5
 

mostly likely has 6.5

- peaked T waves mean K . 5.5

- loss of p waves mean K > 6.5

- but if 8.5 would have had wider QRS

65

Identify 3 ECG findings inidicative of possible hyperkalemia? Give what med?

- peaked T waves

- first degree AV block

- wide QRS

 

give IV calcium

66

What caused this EKG pattern?

hypokalemia = promiment U waves in V2/V3

67

What likely caused this EKG pattern?

acute pericarditis 

= diffuse ST elevation, concave upwards, PR depression in V3

- may be tachycardic

68

What EKG finding is this?

electrical alternans

= QRS axis or amplitude alternates between beats

may be due to pericarditis or tamponade with fluid surrounding heart

69

What caused this EKG finding

Pulmonary embolism

 

S1Q3T3 pattern

- prominent S wave in lead I

- Q wave and inverted T wave in lead III

- sinus tachycardia

- T wave inversion in V1-V3

70

What caused this EKG finding?

digoxin effect = reverse tick/check sign = sagging ST

71

What kind of rhythm is this?

 

What is dysfunctioning here?

sinus bradycardia

 

represents dysfunction at SA node

72

What kind of rhythm is this?

 

What is dysfunctioning?

Sinus tachycardia

 

this is dysfunctional SA node

73

What kind of rhythm is this?

 

What causes this?

Supraventricular tachycardia

narrow QRS, fast, P waves not super distinct

reflects reentry through AV node

74

What does this rhythm show?

premature ventricular contractions

 

wide QRS from ventricles; two different shaped PVC means multiple ectopic foci

75