EKG

Question 1

Axis Measurements:

• Normal
• LAD: pathologic and non pathologic
• RAD

Answer 1

NL: 0 to 90
LAD pathologic: < -30
LAD non-path: 0 to -30
RAD: >90

Question 2

I and AVF

• Nl
• LAD
• RAD

Answer 2

Nl: both up
LAD: I up, AVF down
* look at lead II: if positive or iso, then non pathologic, if negative, pathologic
RAD: I down, AVF up

Question 3

Chart to remember to calculate axis

Answer 3

I: 90
II: -30
III: 30
AVR: -60
AVL: 60
AVF: 0

Question 4

Electrical movement in heart

Answer 4

• Bundle of His to R and L sides

- Left splits into L anterior and L posterior fascicles

Question 5

Bundle Branch Block

- Overview

Answer 5

• must have wide QRS (=> 120 ms)
• V1 and V2: what it is
• I and V6: what it ain’t

Question 6

Right BBB

Answer 6

• Bunny in V1 (rabbit in V1 is right)

- I and V6: leaning L/slurred S

Question 7

Left BBB

Answer 7

• Bunny in I and V6

- V1: leaning L/slurred S

Question 8

How to find fascicular blocks

Answer 8

• Anterior: Q wave in I and AVL but no Q in II, III, AVF
• Posterior: Q wave in II, III, AVF but no Q in I and AVL
• must be pure
• First look at II and AVL: if both + or - Q, no fascicular block, if one has Q and other does not, look for a block

Question 9

Definition of MI on EKG

Answer 9

• ST elevation in two contiguous leads in a family
  AND
• reciprocal changes in two separate contiguous leads in a family (ST depression or T wave inversion)

Question 10

Definition of ischemia on EKG

Answer 10

• ST depression
• T wave inversion
• NO other signs of MI

Question 11

In what circumstance should you place V4 on the right side of the body and why

Answer 11

• Inferior wall MI (esp if signs of CHF)
• Very likely if have inferior wall MI will also have RV infarct (1 mm ST elevation on right side).
• Tx = more fluid

Question 12

Pathologic Q wave definition

Answer 12

• =>0.04 sec and 1/4 height of QRS

Question 13

What does PR elevation throughout indicate?

Answer 13

Pericarditis

Question 14

What does a posterior MI look like?

Answer 14

V2: very tall R wave and scooped S

Question 15

In what situation can you not call a MI on a EKG?

Answer 15

LBBB

Question 16

RAE

Answer 16

• Peaked P wave in II and V1
• Usually dt pulm issues, mitral issues
• “P pulmonale”

Question 17

LAE

Answer 17

• Lead II: broad and m-shaped p wave

- V1: biphasic or inverted P-wave

Question 18

BAE

Answer 18

features of both LAE and RAE

Question 19

LVH

Answer 19

• AVL R wave >11
• V1 S + V5/V6 R >35
• Does not require LAD
• Often dt HTN

Question 20

RVH

Answer 20

• V1, V2, V3 Large R wave (esp compared to V4-V6)
• RAD required
• AVR R wave >5
• V1 R wave >7

Question 21

Normal R wave progression

Answer 21

increases from V1-V4 where it peaks, then slight decrease from V4-V6

Question 22

What is special about V1

Answer 22

should not have a T wave or will have upside down T wave

Question 23

How to tell if correct arm placement of leads?

Answer 23

QRS in I + QRS in III = QRS II

Question 24

What does “possible anterior infarct” on the EKG mean

Answer 24

poor R wave progression

Question 25

Pulmonary embolism on EKG

Answer 25

S1Q3T3 I: deep S III: Q wave and flipped T

Question 26

Bat wing

Answer 26

- deep inverted T waves - SAH - Usually in V leads, can be anywhere

Question 27

Hyperkalemia

Answer 27

peaked T-waves with a point | - think renal failure

Question 28

WPW

Answer 28

- Delta wave on QRS - can lead to SVT - "heart raced, feel better now"

Question 29

Prolonged QTc

Answer 29

- T wave > 2 big box from QRS - Usually dt hypocalcemia or meds - R on T = torsades - "fainted, feel better now"

Question 30

Short QTc

Answer 30

- can lead to vtach - often hypercalcemia - "felt woozy"

Question 31

Hypertrophic cardiomyopathy

Answer 31

- weekend warriors - Deep Q, Tall R, deep flipped T in lateral leads - Usually also LVH

Question 32

Burgada syndrome

Answer 32

- "shark fin syndrome" - T wave in V1 or V2 - Na ion channelopathy - leads to vtach and vfib

Question 33

Arrythmogenic RV dysplagia/cardiomyopathy

Answer 33

- "almost passed out, ok now" | - V1 and V2 ST seg epsilon wave, looks like a nipple

Question 34

Electrical alternans

Answer 34

- Extreme SOB | - cardiac tamponade

Question 35

Wellen sign

Answer 35

- "ZZ top" - "Chest pain but ok now" - EKG findings normally when not in pain - May be one on a QRS but not the next one... - Associated with proximal LAD lesions

Question 36

Hyperacute T wave

Answer 36

- Broad and asymmetrical (vs. peaked from hyperkalemia) | - Percursor to MI

Question 37

What to look at on AVR

Answer 37

- PR elevations: pericarditis - ST seg elevation: L. main obstruction - RR': TCA poisoning (also will prob be tachycardia and wide QRS) - ST seg elevation with tachycardia: re-entrant phenomena