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