ECG midterm

Question 1

ID point

Answer 1

Where the QRS turns downwards the last time

Question 2

Normal ID values (left+right)

Answer 2

V1 & V2 (right): ID < 40 ms

V5 & V6 (left): ID < 60 ms

*Fra start av QRS til ID point (siste peak)

Question 3

Incomplete bundle branch block

Answer 3

QRS characteristics of a BBB, but not pathologically wide (>0,12s)

Question 4

Extreme left deviation

Answer 4

More than -30*

Often LAH

Question 5

Extreme right deviation

Answer 5

More than 110*

Often LPH

Question 6

Lenegre syndrome

Answer 6

Type of bifascicular block

RBBB + LAH

Question 7

Bifascicular block

Answer 7

RBBB + LAH/LPH

Question 8

Trifascicular block

Answer 8

Bifascicular block + 1* AV block

Question 9

RBBB

Answer 9

• QRS > 0,12s
• “MoRRoW”: V1, Right, V6
• Wide S in lead I as well

Question 10

LBBB

Answer 10

• QRS > 0,12s
• “WiLLiaM”: V1, Left, V6
• rS or QS in V1-V4

Question 11

When consider BBB

Answer 11

When:

• QRS is wide
• Impulse of supraventricular origin
• and WPW excluded

Question 12

WPW

Answer 12

Wolff-Parkinson-White preexcitation syndrome

• Kent bundle
• δ wave (-> short PR, wide QRS)

Question 13

LGL

Answer 13

Lown-Ganong-Levine preexcitation syndrome

• James bundle (atrio-hisian)
• Short PR

Question 14

AVNRT

Answer 14

Atrioventricular nodal reentrant tachycardia

• Regular tachycardia ~140-280 bpm.
• QRS narrow (< 0,12s)
• QRS alternans – phasic variation in QRS amplitude
• P waves if visible exhibit retrograde conduction with P-wave inversion in leads II, III, aVF.

Question 15

AVRT antidromic

Answer 15

• HR: 200-300 bpm

- Wide QRS

Question 16

AVRT orthodromic

Answer 16

• HR: 200-300 bpm
• Narrow QRS (after wide QRS’s in WPW)
• QRS alternans - variation in amplitude
• T inversion common
• ST depression

Question 17

Hyperacute STEMI

Answer 17

• ST elevation
• Peaked T wave (=T en dome)

*Ischemia and lesion

Question 18

Acute STEMI

Answer 18

• ST elevation
• Inverse T
• Pathological Q
• Ischemia, lesion and necrosis

Question 19

Subacute STEMI

Answer 19

• Inverse T (coronary)
• Pathological Q (and/or reduction R)

*Ischemia and necrosis

Question 20

Definitive/ Old STEMI

Answer 20

• Pathological Q

* Necrosis

Question 21

Subendocardial lesion

Answer 21

• TP and PR elevation
• ST depression
• Pathological Q og R reduction

Question 22

Subepicardial/transmural lesion

Answer 22

• TP and PR depression
• ST elevation
• Pathological Q or QS

Question 23

Transitional zone shift

Answer 23

Normal: V3-V4
Right shift (V1-V2): Right ventricular hypertrophy
Left shift (V5-V6): Left ventricular hypertrophy

Question 24

Missing R-progression

Answer 24

“R-regression”

- Often necrosis (MI)

Question 25

P wave morphology not symmetrical in same lead

Answer 25

Multifocal

Question 26

Pre-excitation definition

Answer 26

PQ shorter than 0,12 s

Question 27

AV block definition

Answer 27

PQ longer than 0,2 s

Question 28

PQ interval time

Answer 28

0,12-0,2 s (3-5mm)

Question 29

LAH

Answer 29

Left anterior hemiblock | *Extreme left deviation (more than -30*)

Question 30

LPH

Answer 30

Left posterior hemiblock | *Extreme right deviation (more than 110*)

Question 31

Always isoelectric

Answer 31

TP segment

Question 32

Ascending ST segment

Answer 32

Can be normal

Question 33

Max normal deviation J-point

Answer 33

Up: 0,1 mV Down: 0,05 mV

Question 34

Escape beats vs premature contractions

Answer 34

Escape beats: comes after pause | Premature beats: comes too early, then pause

Question 35

Paroxysmal supraventricular tachycardia (PSVT)

Answer 35

- Sudden onset and termination - Rhythmic - HR: 150-250 bpm - No P wave - Can be terminated by carotid massage

Question 36

Atrial flutter

Answer 36

- F-waves (constant and rhythmic) - Regular ventricular rhythm - Functional AV block (2:1, 3:1, 4:1...)

Question 37

Atrial fibrillation

Answer 37

- Numerous impulse generation sites - Absolute arrhythmia - No P waves (small f-waves may be seen)

Question 38

MAT

Answer 38

Multifocal atrial tachycardia - P waves present! - Diff. sites of impulse generation, but do not fire simultaneously - Absolute arrhythmia * Compare to atrial fibrillation!

Question 39

Angina pectoris types

Answer 39

Classic: ST depression Prinzmetal: ST elevation Stable Unstable

Question 40

Atrial enlargement

Answer 40

Leads II and V1

Question 41

Right ventricular hypertrophy

Answer 41

- V1: R > S (R>7mm) - V6: S > R - Right deviation

Question 42

Anterior infarction

Answer 42

- V1-V4 | - Proximal LAD occlusion

Question 43

Lateral infarction

Answer 43

- I, aVL, V5 and V6 - High lateral: I and aVL - Circumflex occlusion

Question 44

Inferior infarction

Answer 44

- II, III and aVF | - Distal posterior descending

Question 45

Posterior infarction

Answer 45

- Mirror V1-V4 | - Branches posterior descending

Question 46

Septal infarction

Answer 46

- (V1), V2, V3, (V4) | - Septal branches (LAD or post desc)

Question 47

Anterolateral infarct

Answer 47

- I, aVL, V1-V5

Question 48

Extensive anterior infarct

Answer 48

I, aVL, V1-V6

Question 49

Posteroinferior infarct

Answer 49

- II, III, aVF | - Mirror V1-V4

Question 50

Sokolow criteria left ventricular hypertrophy

Answer 50

R in V5/V6 + S in V1/V2 > 35 mm

Question 51

Scoop-like ST

Answer 51

Digitalis toxicity

Question 52

Hypercalcemia

Answer 52

Shorter QT

Question 53

Hypocalcemia

Answer 53

Longer QT

Question 54

Hyperkalemia

Answer 54

Tented T

Question 55

Hypokalemia

Answer 55

- Flat T - U wave - ST depression

Question 56

Arythmogenic factors

Answer 56

HIS DEBS - Hypoxia - Ischemia + Irritability - Sympathetic stimulation - Drugs - Electrolyte disturbances - Bradycardia - Stretch

Question 57

AV dissociation

Answer 57

No correlation between P and QRS