EKG Stuff

Question 1

• What should be done on physical exam:
  1. ) Check jugulars for?
  2. ) Palpate carotids with patient?
  3. ) Pulses?
  4. ) Palpate apex for?
  5. ) Palpate upper abdomen for?
  6. ) Listen UR? UL? LR? Apex?

Answer 1

• A and V waves
• Supine
• Brachial and dorsalis pedis
• LV dilation/hypertrophy
• RV
• Aortic, pulmonic, tricuspid, mitral

Question 2

• Murmurs:
• Systolic murmurs? (5) Shapes? Ebstein related to?
• Diastolic murmurs? (4)
• S3: Type of gallop? Rhythm? Due to? Patho?
• S4: Type of gallop? Rhythm? Due to? Patho?

Answer 2

• AS/PS (diamond); MR/TR Holosytic; MVP; click and then comes on; TR
• AR/PR; MS/TS
• Ventricular; Kentucky; HF; Sudden stop in ventricular filling
• Atrial; Tennessee; LVH; Occurs just after atrial contraction

Question 3

• RV leads? LV Leads?
• R axis deviation? Left?
• RA/LA enlargement?
• RBBB?
• LBBB?
• Left anterior/posterior hemiblock?
• Anteroseptal? Anterior? Anterolateral? Inferior?
• Acute pericarditis?
• ST elevation? Depression? T inversion? Long QT?

Answer 3

• V1/V2; V5/V6
• 90-180 lead 1 negative, 2 positive; -90 - -30; lead 2 positive, 1 negative
• Lead 2 and V1
• Wide QRS; upright V1/V2
• Wide QRS; inverted T in V5/V6
• Anterior = Lead 1 positive, 2 negative; Post = opposite
• V1-V2; V3-V4; V5-V6; 1,2, AvF
• ST elevations in all
• Injury; Ischemia/ subendo infarct; Ischemia/LVH/LBBB; Electrolyte/drug imbalance

Question 4

• Evolving MI? (4)
• Lateral Wall?
• Transmural vs. Subendocardial?
• Hypercalcemia? Hypo?
• Hypokalemia? Hyperkalemia?
• Junctional rhythm?
• Atrial tachy? Cause?

Answer 4

• Peaked T, T inversion, ST elevation, Q
• 1, AVL, V5, V6
• Entire wall thickness; ST elevation with Q; Inner layer, ST depression and no Q waves
• Hyper = Short QT; Hypo = Long QT
• Hyper = Tall peaked T, Broad QRS; Sine wave pattern; hypo = Long QT with inverted T
• Regular QRS with no P
• Normal QRS, Bimodal P waves; reentry

Question 5

• PRI is?
• A- fib treatment?
• A flutter treatment?
• Defibrillator with primary v tach? Secondary?
• Sudden cardiac death: Percent of mortality? Percent resucitated? Must be within? General pop.?

Answer 5

• Conduction from AV, Bundle of His, Bundles and Purkinjes
• 5 c’s
• similar to a fib but ablation is VERY successful
• Low EF or inducible VT needs defib; cardiac arrest due to v fib or v tach
• 15%; 1/3; 5 minutes; most effected