Gary's EKG Heart
Terms
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- Standardization
- Should be standardized to 10 mm, if not, must adjust vertical measurements
- Heart Rate
-
Method 1: Count 300, 150, 75, 60, 50, 42
Method 2: Divide 300 by number of boxes between R waves - Rhythm
-
P for each QRS
Regular sinus rhythm: 60-100
Sinus Tachycardia: >100
Sinus Bradycardia: <60 - PR Interval
-
Normal: .12 to .20 seconds
1st Degree block: > .20
WPW: <.12, Wide QRS, and Delta Wave - QRS Width
-
Normal: < or = .10 sec
Incomplete BBB: .11 sec
Complete BBB: > or = .12 sec
LBBB: big QS (-V1)
RBBB: rabbit ears (+V1) - QT Interval (Normal)
- Normal: HR 70, QT .40; HR 100, QT .35-.36
- QT Interval (Abnormal)
-
Shortening of QT:
Digitalis (scooping of sT seg in leads with tall R's)
Hyperkalemia (peaked T waves)
Hypercalcemia
Lengthening of QT:
Procainamide, Quinidine
Hypokalemia (U waves)
Hypocalcemia - Axis
-
Method 1: Axis is 90 deg to smalles QRS complex, if -, then go to - end of the perpendicular axis, not the reference lead
Method 2: Axis is plotted, net voltage in lead I on X axis, net voltage in aVf on -Y axis
Normal Axis: -30 to +100 degrees
If axis is < or = -45 deg and QRS <.12: LAH
If axis is > or = 20 deg and QRS <.12 (must rule out RVH): LPH - Axis Interpretation
-
I aVf Quadrant/Disease
+ + RLQ – Normal
- - ULQ – Extreme Derivation
- + LLQ – RAD
+ - Look at Lead II:
+ = URQ (Normal)
- = URZ - LAD -
Hypertrophy (limb leads)
Right Atrial Enlargement - 1. P wave > or = 2.5 mm tall
-
Hypertrophy (limb leads)
Left Atrial Enlargement -
1. P wave > or = .12 seconds wide
2. P mitral
3. P in V1 Neg component >.04 sedonds or > or = 1 mm depth -
Hypertrophy (limb leads)
Right Ventricular Hypertrophy -
1. Right Axis Deviation - must have this
2. R>s in V1
Strain (upside-down backwards checkmark) -
Hypertrophy (limb leads)
Left Ventricular Hypertrophy -
(must rule out young person)
1. R in V5 or V6 plus S in V1 is >35mm
2. R in aVL is >13mm
Strain - can't have strain without hypertrophy - Subendocardial
- Non-Q waves
-
SUBENDOCARDIAL
Ischemia or Angina - Transient ST segment depressions (goes away with treatment)
-
SUBENDOCARDIAL
Infarction -
1. ST depressions
2. +/- T wave inversions
3. No Q waves - Transmural Acute
- Q waves
-
TRANSMURAL ACUTE
Ischemia or angina -
Transient ST segment elevations
Prinzmetal's -
TRANSMURAL ACUTE
Infarction -
1. ST elevations **Key**
2. Q waves (> or = .04 sec or > 1/3 height QRS)
3. Hyperacute T waves -
TRANSMURAL ACUTE
Evolving -
1. Must have Q waves
2. ST back to baseline
3. Inversion of T waves -
TRANSMURAL ACUTE
Resolving -
1. T waves back to normal
2. +/- Q wave disappearance - Locations
-
Inferior = II, III, aVf
Anterior = V2-V5
Septal =V1
Lateral =V6, I, aVL
Posterior = Reciprocal in V1 and V2 - Baseline
- Between P and QRS
- CHF
-
Small limb leads
Tall V leads
Poor R waves - Pericarditis
- ST elevations everywhere
- V2 and V3, something to keep in mind...
- V2 and V3 are largest amplitudes and thus 1 square of elevations is ok
- High HR
- Tachycardia
- Low HR
- Bradycardia
- PR > .20
- 1st degree block
- PR < .12
-
WPW
Wide QRS and delta wave - QRS </= .12
-
Left posterior hemiblock, RAD
or
Right posterior hemiblock, LAD - QRS = .11
- Incomplete BBB
- QRS>/= .12
- Complete BBB
-
QRS >/= .12
Big QS (-V1) -
LBBB
Can't read MI with LBBB -
QRS >/= .12
Rabbit Ears (+V1) - RBBB
-
QRS >/= .12
PR < .12 and Delta - WPW
-
QT Shortening
Scooping of ST in leads with tall R's - Digitalis
- QT Shortening, Peaked T waves
-
Hyperkalemia
Hypercalcemia - QT Lengthening
- Procainanide, Quinidine, Hypocalcemia
-
QT Lengthening
U waves - Hypokalemia
-
Axis: RAD (90 to 180)
R > S in V1 - RVH
-
Axis: RAD (90 to 180)
Axis >/= 120
QRS .12 - Left Posterior Hemiblock
-
Axis: LAD (-90 to -30)
Axis </= -45
QRS < .12 - Left Anterior Hemiblock
- P wave >/= 2.5 mm
- RAE
-
P wave >/= .12 sec
P mitral
P in V1 negative
(2 of 3) - LAE
-
RAD - must have
R > S in V1
Strain - upside down checkmark or T waves not symmetrical - RVH
-
R in V5 or V6 plus S in V1 >35 mm
R in aVL is >13 mm
Strain - upsidedown checkmark or T waves not symmetrical - LVH
- Transient ST segment depressions, goes away with treatment. Non-Q wave
- Subendocardial Ischemia
-
ST depressions
+/- T wave inversions
Non Q wave - Subendocardial Infarction
-
Transient ST segment elevations
Q waves
Goes awaywith treatment -
Transmural Acute Ischemia
Printzmetal's -
Transient ST segment elevations
Q waves
Does not go away with tx - Transmural Acute Ischemia
-
ST elevations
Q waves >/=.04 sec or 1/3 ht QRS
Hyperacute T waves - Transmural Acute Infarction
-
ST back to baseline
Inversion of T waves
Q waves - Transmural Acute Evolving Infarction
-
T waves back to normal
+/- Q wave disappearance - Transmural Acute Resolving Infarction