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Cardiology - ABIM

EKG, TIMI, JVP

QuestionAnswer
a wave Max atrial contraction
c wave The beginning of ventricular systole and the closing of the tricuspid valve
x wave The nadir of ventricular systole, point of least pressure transmitted to JVP
v wave Maximum ventricular contraction, after which the tricuspid opens and diastole starts
y descent Ventricular diastole
How to calculate the beats a minute on an EKG? 300 divided by (# of large boxes between two R waves). 300, 150 100, 75
What is the length of the P-wave in seconds and boxes? 0.08 seconds 0.11 seconds, 2 to 3 small boxes
what is the length of the QRS wave in seconds and boxes? Normal is less than 0.12 seconds (three small boxes)
What is the length of a wide QRS in seconds and boxes? Wide is greater than 0.12 seconds ( wider than three small boxes)
What is the normal length of it PR interval? 0.12 tp 0.20 (3 to 5 small boxes)
What is a short PR interval? < 0.12 (<3 small boxes)
What is a long PR interval? >0.20 seconds (>5 boxes)
What is a normal QRS duration? <0.1 seconds (<3 small boxes)
Normal axis Positive in I and aVF
Normal variant axis Positive in I and II
Left axis deviation Positive in I
Right axis deviation positive in aVF
Name the components of the TIMI score T: troponin, CAD > = 50% stenosis, ST changes on EKG. I: >= 3 risk factors – diabetes, hypertension, hyperlipidemia, tobacco smoking, family history of early MI. M I: aspirin in the last seven days, age greater than 65, two episodes of angina in 24 hours
Name the categories for the TIMI score 0 to 2 points - low risk; 3 to 4 point – intermediate risk – gets heparin; 5 to 7 – high risk – gets heparin and eptifibatide
What axis deviation is associated with ostium primum ASD? Left axis deviation >-30, fixed S2, mitral regurg murmur
What axis deviation is associated with ostium secundum ASD? Right axis deviation >100
left atrial enlargement include... a widened (≥120 ms), M-shaped (notched) P wave (P mitrale) in one or more of the mitral leads (I, II, or aVL) or a deep negative component to the P wave in V1.
Criteria for left ventricular hypertrophy The sum of the deepest S wave in lead V1 or V2 and the tallest R wave in lead V5 or V6 is 35 mm or more; or The R wave in lead aVL is 11 mm or more.
Strain pattern on an EKG asymmetric ST-segment depression and T-wave inversion
What condition prolongs all EKG intervals? Hypothermia
J point elevation, Osborne wave Hypothermia on EKG
Criteria for posterior MI EKG changes in V1 to V3, with increased R – wave amplitude and duration. Often with evidence of inferior wall MI, with cue waves in leads II, III, and aVF.
Criteria for inferior MI ST segment elevation in the inferior leads (II, III, aVF)and reciprocal changes (ST dep) in I, aVL, V2
hypercalcemia on EKG Shortened QT interval, decreased initial portion of the T wave, prolongation of the PR interval, increase in QRS complex amplitude, nonspecific ST – T wave changes
A patient with pulmonary hypertension, 1/6 hole of systolic murmur at the left lower sternal border, toes with cyanosis and digital clubbing, hands normal. What is the diagnosis? Patient ductus with Eisenmenger syndrome
What to do for a patient with a patent foramen oval and cryptogenic stroke Aspirin
What to do for a patient with patent foramen oval with oxygen desaturation from a right to left shunt? Surgical closure of PFO
What to do for a patient with a thrombus trapped in the PFO? Surgical closure of PFO
What to do for patient with PFO and recurrent stroke? Warfarin
Hypocalcemia on EKG Prolongation of the QT interval
Criteria for accelerated atrioventricular rhythm on EKG Rate between 50 and 120, wide QRS that is regular
Criteria for left bundle branch block (1) QRS widening of at least 120 ms; (2) upright monophasic QRS complex in leads I and V6 (the QRS complex may also be notched); and (3) a predominantly negative QRS complex in lead V1. In the electrocardiogram shown, all three features are evident.
criteria for left posterior fascicular block neg QRS complexes - small r waves and deep S waves in leads I and aVL; positive tall R waves - qR complexes in leads II, III, and aVF; Pathologic right axis (>+90 degrees)
Criteria for junctional rhythm p wave in II is negative, 40 to 60 bpm
Criteria for accelerated junctional rhythm p wave in II is negative, 61 to 99 bpm
What changes on EKG do you see in hypokalemia? Appearance of U wave after the T wave, eventually replacing the T wave
Created by: christinapham