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Cards ECG

Cardiology

QuestionAnswer
Diffuse ST elevation in most leads, peaked T waves in V leads = pericarditis
Irregular irregular Atrial fibrillation; (if > 48 or chronic: anticoagulate)
ECG arrhythmia assoc w/COPD multifocal atrial tachy
LVH on ECG S in V1 + R in V5-V6 > 35; aVL (R) > 11; LAD; wide QRS; ST/TW changes
RVH on ECG RAD. R>S in V1 (R gets smaller V1 -> V6). S wave persists V5-V6. Wide QRS
tachy on ECG (regular/narrow) = sinus; atrial tachy or flutter; re-entrant (AVNRT/PSVT)(usu after p wave); give adenosine
tachy on ECG (irreg/narrow) = sinus tach w/PAC; MAT; A fib; atrial flutter w/variable block
tachy on ECG (regular/wide) = V-tach; SVT w/aberrancy (BBB); SVT w/WPW; pacemaker tachy
tachy on ECG (irreg/wide) = V-fib; torsades; irreg SVT w/aberrancy; irreg SVT w/WPW
RBBB on ECG RSR' in V1-V4. QRS wide (>.12). Slurred S wave at I, aVL, V5-V6. Biphasic QRS at I. STD & TWI
LBBB on ECG QRS >120; notched/slurred R in I, aVL, V5-V6; teepee (big pos R) V5-V6, no Q waves in same; ST & T usually opp direction of QRS (=ischemia) (occ QRS-T concordance); V1-V2: broad negative rS or QS
Hypercalcemia on ECG Shortened QT, Wide QRS, absent ST segment
Hypocalcemia on ECG Prolonged QT in II, V1, and V5, predisposition to V-tach
Hyperkalemia on ECG short QT, wide QRS, flat P wave, peaked T waves
Hypokalemia on ECG U waves, ST flattening, TWI, ST depression; areflexia, paralysis, ortho hypotension, ileus
Hypomagnesemia on ECG prolonged PR & QT, and wide QRS
Electrolyte imbalance: Shortened QT, Wide QRS, absent ST segment = hypercalcemia
Lyte imbalance: Prolonged QT in V1, II, and V5, predisposition to V-tach = hypocalcemia
Electrolyte imbalance: short QT, wide QRS, peaked T waves = Hyperkalemia
Electrolyte imbalance: U waves, ST flattening, TWI, ST depression; areflexia, paralysis, ortho hypotension, ileus = Hypokalemia
Antiarrhythmic: pos inotrope, neg chronotrope, decreases conduction velocity thru AV node = digoxin
Effects of CCB: Class IV, vasodilator; neg chronotrope, neg inotrope
Effects of beta blockers: Class II; neg chronotrope, neg inotrope
COPD on ECG Right axis deviation (RAD = RAD)
S1 Q3 TIII (Large S wave (I), ST depression (II), Q wave (III)) and TWI in V1-V4 = PE
Hypermagnesemia on ECG: wide QRS, long PR & QT
Short PR, wide QRS, Delta wave Wolf-parkinson-white; avoid Digoxin
Most common cause of tachyarrhythmia reentry; >1 pathway
Inferior STEMI reciprocates to which leads? AVL and I
Anterior STEMI reciprocates to which leads? Inferior leads (II, III, AVF)
Lateral STEMI reciprocates to which leads? Inferior leads (II, III, AVF)
What type of STEMI reciprocates to the anterior leads? None
Inferior MI: ECG correlation MOST COMMON MI. (II, III, aVF); RCA; left circumflex if left-dominant
Anterior MI: ECG correlation V1-V5; LAD
Lateral MI: ECG correlation I, aVL, V5-V6; Circumflex
Inferolateral MI: ECG correlation II, III, aVF, I, aVL; large RCA, or left-dominant Left circumflex
Septal / Posterior MI: ECG correlation Large R in V1-V2. Possible Q wave in V6. Do mirror test. LCx (or septal branch of LAD) or RCA
EKG changes, N/V, yellow-green visual disturbances = Digoxin toxicity (Hypokalemia will make worse)
Q waves in an MI usually develop within: 12-36 hours
MVP on ECG: often normal; ST depression or TWI in III & aVF
HCM on ECG = LVH, nonspecific ST-T abnormalities, deep septal Q waves in inferior leads, or tall narrow R waves in V1-V2
VSD on ECG LVH, RVH, atrial enlargement
ASD on ECG: RAD, rsR' pattern; RVH -> RBBB
PDA on ECG: LVH, LAH
Alcoholic with palpitations, arrhythmia = Atrial fibrillation (Holiday heart)
Kawasaki on ECG Peaked T waves, 1st degree block, STE or STD, QT prolongation
Mitral stenosis ECG P-mitrale: broad notched P wave
Acute infarct on ECG Q waves, ST elevation
Age-indeterminate infarct on ECG Q waves, ST at baseline, T wave inversion
Old infarct on ECG Q waves, ST at baseline, T wave upright
Anterolateral MI: ECG correlation Q waves in V5-V6 (and I, aVL). LCx > LAD
Idioventricular rhythm on ECG Usually 30-40 bpm. Slow V-tach. Atria failed or blocked
Anterior hemiblock is associated with: LAD. Normal-to-slightly wide QRS. Q1-S3 (assoc with MI, etc)
Posterior hemiblock is associated with: RAD. Normal-to-slightly wide QRS. S1-Q3.
Atrial enlargement is best seen in which lead VI. Right atrial enlargement: initial component larger. Left: terminal component larger.
Right atrial enlargement Initial part of P wave taller (with notching downslope). P>2.5mm in any limb lead. "P pulmonale"
Left atrial enlargement See VI (and II). Wide notched P wave >.12. Taller terminal point; notching upstroke. Large biphasic P wave with wide, negative terminal part. "P mitrale"
RVH may cause: extreme RAD (if V1 and aVF both very deflected)
LVH with strain on ECG Asymmetric ST depression / T wave inversion
Inherent rate of SA node 60-100
Inherent rate of atrial focus 60-80
Inherent rate of AVN / junction 40-60
Inherent rate of ventricles 20-40
Atrial escape beat 60-100. PR <.20. QRS <.12. QT <.44 (1/2 of RR). P waves present, pause, then different shape
Junctional escape beat 40-60. PR variable. QRS normal, QT normal. P waves inverted before, during, and after QRS
Ventricular escape beat 20-40. P waves absent. QRS wide, bizarre >.10. Potentially life threatening.
Wandering atrial pacemaker 60-100. P waves present, difference appearance. P to P differences. R to R differences.
Multifocal atrial tachycardia 100-200. Irregular. WAP, but faster
Paroxysmal atrial tachycardia 160-240. Regular. P waves regular (often inverted?). May be hidden in previous T wave
Paroxysmal SVT 150-250. Regular. P wave slurred in QRS
Atrial flutter 240-360 (atrial). Regular, sawtooth. Ventricular rate depends on block (2:1, 3:1). Danger: allow clots to form
A-fib 400-800 (atrial). P waves indistinguishable; irregular, charotic. Ventricular rate varies
Ischemia on ECG ST depression. TWI. Symmetric T waves (inverted) esp in V leads; often corresponds to angina
Injury on ECG ST elevation. Hyperacute T waves
Injury (STEMI) on ECG: ___ mm above baseline (limb) and ___ mm above baseline (chest leads) = acute damage. 1 mm limb leads; 2 mm in chest leads
Injury (STEMI) on ECG: J point .08 seconds to right of J point. Find in 2 leads facing same area
Infarct on ECG =necrosis. Significant Q wave (>1 mm wide and 1/3 of QRS height). Often see ST depression
Pericarditis on ECG Diffuse ST elevation in most leads (does not resolve, as MI does). PR depression. Peaked T waves (often above baseline) in V leads
Down-sloping (depressed) ST segment = specific for ischemia
Significant Q waves = >0.04 seconds (1 little box or 1/3 QRS height)
Created by: Abarnard