EKGs

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Name this condition: Paroxysmal Supraventricular Tachycardia
Name this condition: Atrial Flutter
Name this condition: Multifocal Atrial Tachycardia
Name this condition: Premature ventricular
Name this condition: Paroxysmal Atrial Tachycardia
Name this condition: Ventricular Tachycardia
Name this condition: Ventricular Fibrillation
Name this condition: Torsades de pointes
Name this condition: Accelerated Idioventriculare Rhythm
Name this condition: First Degree AV Block
Name this condition: Morbitz Type II
Name this condition: Third Degree AV Block
Name this condition: Right Bundle Branch Block
Name this condition: Left Bundle Branch Block
Name this condition: Left Anterior Hemiblock
Name this condition: Left Posterior Hemiblock
Name this condition: Wolf-Parkinson-White Syndrome
Name this condition: Lown-Ganong-Levine Syndrome
What does the PR interval measure: Start of atrial depolarization to the start of ventricular depolarization
What does the ST segment record: The time from the end of ventricular deploarization to the beginning of ventricular repolarization
What does the QT interval measure: The time from the start of ventricular deplarization to the end of ventricular repolarization
What leads make up the "anterior leads": V1-V2-V3-V4
What leads make up the "lateral leads": I, AVL, V5, V6
What leads make up the "inferior leads": II, III, AVF
What is the duration and amplitude of the P wave: Duration: <.12 seconds, Amplitude: 2.5mm or less
Where is the P wave normally biphasic: Lead III and V1
What is the duration of the PR interval: .12 to .2 seconds
What is the normal duration of the QT interval: .44-.86 seconds. (40% of normal cardiac cycle from 1 R wave to the next)
What is the normal duration of the QRS complex: .06 to .12 seconds
What does the term "R-wave progression" mean: The R wave get progressivel larger as you proceed across the precordial leads from V1 to V5
Deep S waves are normally seen in what precordial leads: Leads V1 and V2
What leads do you look at to identify the axis: Leads I and AVF
The QRS complexes of Lead I and AVF would appear how in left axis deviation: Lead I - Positive and Lead AVF - Negative
The QRS complexes of Lead I and AVF would appear how in right axis deviation: Lead I - Negative and Lead AVF-Positive
What leads do you look at to diagnose atrial enlargement: Leads II and V1
How is right atrial enlargement characterized: P wave larger than normal in lead II and large upright first portion of biphasic P wave in lead V1 (often caused by lung disease)
How is left atrial enlargement characterized: Widdened P wave in lead II with the second portion being at least one small block wide and the biphasic P wave of lead V1 showing the second portion of the P wave dipping below the baseline by at least one small block.
How is right ventricular hypertrophy recognized: Right axis deviation and the R wave is larger than the S wave in V1, whereas the S wave is larger than the R wave in V6
How do you recognize left ventricular hypertrophy: The R wave in V5 or V6 plus the S wave in V1 or V2 exceeds 35 mm and the R wave in AVL exceeds 13 mm.
What is normal sinus rhythm rate: 60-100
What rate do junctional pacemakers typically discharge at: 40-60
What rate do ventricular pacemeaker cells discharge at: 30-45
What rate do atrial pacemakers normally discharge at: 60-75
What non-disease related conditions may cause PSVT: Alcohol, coffee or sheer excitement
What can you manually do to slow or terminate PSVT: Carotid massage
True or False. Carotid massage increases block in A-flutter: TRUE
How can you distinguish a wandering atrial pacemaker from MAT: MAT has varying P wave shapes and a rate of 100-200 whereas a wandering atrial pacemaker has one P wave shape and a rate less than 100
How can MAT be distinguished from A-fib: MAT has easily identifiable P waves occurring before each QRS complex
When should you worry about PVCs: Frequent PVCs, a run of 3 or more PVCs, Multiform PVCs, PVCs falling on T waves
A run of 3 or more PVCs is called what: Ventricular tachycardia
A PVC falling on an elongated T wave can produce what: Torsades de pointes
Define bigeminy and trigeminy: Bigminy - ratio of one normal sinus beat to one PVC. Trigeminy-two normal sinus beats for every one PVC
What is sick sinus syndrome: Demonstrated by alternating periods of supraventricular tachycardia and bradycardia. Often there is a long pause after the SVT of greater than 4 seconds.
How is first-degree AV block identified: PR interval is longer than .2 seconds
How do you identify Mobitz Type I (Wenckebach): PR intervals get progressively longer until a QRS is dropped
How do you identify Mobitz Type II: The PR interval does not progressively lengthen but a QRS is suddenly dropped then the pattern repeats
How do you recognize third degree AV block: AV dissociation occurs with the P waves occurring at regular intervals and the QRS waves occurring at regular intervals
What are the criteria for right bundle branch block: Wide QRS complex, Rabit ears in V1 and V2 with ST segment depression and T wave inversion, reciprocal changes in V5, V6, I and AVL
What are the criteria for left bundle branch block: Wide QRS complex, Broad or notched R wave in V5, V6, I and AVL with ST segment depression and T wave inversion
What axis deviation results from a left anterior hemiblock: Left axis deviation
What axis deviation results from a left posterior hemiblock: Right axis deviation
What are the criteria for WPW syndrome: PR interval less than .12 seconds, Wide QRS, Delta waves
What are the criteria for Lown-Ganong-Levine Syndrome (LGL): PR interval less than .12 seconds, QRS normal, no delta wave
During an acute MI what 3 stages does an ECG evolve: T wave peaking followed by T wave inversion, ST segment elevation, Appearance of Q waves
How do the inverted T waves of an MI differ from ventricular hypertrophy: In an MI the the inverted T wave is symmetric whereas in ventricular hypertrophy it has a gentle downslope and rapid upslope
What does ST segment elevation represent: Injury
What does the appearance of Q waves indicate: Cell death has occurred and is diagnostic of MI
What characteristics confirm a pathologic Q wave: A duration greater than .04 seconds, the depth of the Q wave must be at least one third the height of the R wave
What might poor R wave progression indicate: Anterior infarction
What area of infarction develops with right coronary artery occlusion: Inferior infarction
Lateral wall infarction results from occlusion of what artery: Left Circumflex artery
Anterior infarctions are seen in what leads: Precordial leads
Tall R waves with ST segment depression in lead V1 indicate what: Posterior infarction
How do you distinguish rt. ventricular hypertrophy from a posterior infarction: Rt. ventricular hypertrophy has a large R wave in V1 like a posterior infarct but it also has rt. axis deviation.
What are the EKG signs for Angina: ST segment depression or T wave inversion
ST segment elevation may be seen in what two cardiac disease states: Transmural infarction or Prinzmetal's angina
ST segment depression may be seen in what two cardiac disease states: Angina or non-Q wave infarction
Peaked T waves througout all leads means what: Hyperkalemia
How does low calcium levels effect the QT interval: Prolongs it
How does high calcium levels effect the QT interval: Shortens it
How does digitalis effect the EKG: ST segment depression with flattening or inversion of T wave most prominent in leads with tall R waves
How does pericardial effusion effect the EKG reading: Low voltage in all leads
What is electrical alternans: The effusion allows the heart to rotate freely in the sac varying the electrical activity with each beat.
What are the EKG signs of pericarditis: ST segment elevation and T wave flattening or inversion often seen in far more leads that a localized infarction
What type of blocks are seen with myocarditis: Bundle branch blocks and hemiblocks
What are the EKG signs for an Acute Pulmonary Embolism: A large S wave in lead I, a deep Q wave in lead III and an inverted T wave in lead III (S1Q3T3)
Anterior infarctions result from blockage of what artery: Left anterior descending artery
Posterior infarctions result from what artery blockage: Rt. coronary artery or left circumflex artery
S1 heart sounds represent what and where do they fall on the EKG: Closure of the tricuspid and mitral valves during systole and correspond with the QRS
S2 heart sounds represent what and where do they fall on the EKG: Closure of the aortic and pulmonic semilunar valves and fall on the T wave
Where does the S3 heart sound occur: Sometime after S2
Where does the S4 heart sound occur and what does it represent: Falls on the P wave and represents atrial kick forcing blood into a stiffened ventricle
Name this condition: Atrial Fibrillation
Name this condition: Wenckebach
Name this condition: Ischemia
Name this condition: Myocardial Infarction

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