Name the ECG Leads & Vectors:

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Name the waves:

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+60 degrees

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-30 to +90 degrees. Leads aVL thru aVF.

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Beyond -30 degrees or beyond aVL.

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ECG voltage criteria for determining LVH whereby S wave of V1 + R wave of V5 or V6 = >35mm = 90% probability of LVH.

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1. T wave inversion & ST segment depression in V5 & V6
2. May also present as ST segment elevation in leadsV1 & V2
3. Chronic condition seen sometimes in LVH.

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1. High amplitude R waves
2. Prolonged Ventricular Activation Time (prolonged first segment of the r wave)
3. Loss of qrs and ST wave concordance
4. ST segment depression

1. R wave greater than 7mm and/or
2. Wave amplitude R>S
3. RV Strain Pattern - ST segment depression with deep T wave inversion.

1. P waves >2.5mm in inferior leads
2. Cardiac axis towards aVF
3. P waves are of normal duration <2mm

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1. Hyperacute T waves
2. ST elevation
3. Terminal qrs alterations
4. T wave inversion
5. Patholigical Q waves

Onset: 20-30 minutes

Resolution: days to weeks

What are the 2 clasical changes seen on an EKG in NSTEMI and Unstable Angina?

1. ST segment depression
2. T wave inversion in leads w/ dominant R wave

Note: Both changes can manifest on the same lead.  See below for each example:

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True or False

EKG changes seen in unstable angine and NSTEMI are identical.

True or False:

T waves in Leads V1 & V2 can have positive or negative deflections in normal adults.

True

1. Intracranial Pathology
2. Persistent Juvenile Pattern
3. Digitalis Tx
4. Metabolic
1. Hypokalemia
2. Hypocalemia
3. Hypomagnesemia

Downsloping "reverse tick sign" ST segment.

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1. Normal P waves seen in inferior leads
2. Normal PR interval
3. Normal narrow qrs complex (supraventricular origin)
4. HR ≥100bpm

1. HR 100-140bpm
2. Regular, narrow complex
3. Negative  P waves in inferior leads
4. Shortened PR interval (<0.12sec)
5. P waves which may occur before, after or coincident (hidden) the qrs complex

1. HR >100bpm
2. Abnormal P wave morphology (variable P wave axis)
3. Prolonged PR interval

1. Irregularly irregular rhythm (irregular p waves with irregular qrs rhythm)
2. No identifiable P waves
3. f waves - atrial depolarization from multiple foci occuring at 400-700bpm

1. Saw-tooth pattern - represents a continuous anti-clockwise re-entry loop of current within the right atria discharging into the left atrium at approx 300pbm
2. qrs complexs occur at a fixed atrial conduction ratio (atrial flutter w/ 2:1 conduction = 1 qrs/2 flutter waves)

1. HR >140pbm (may also also occur 130-140)
2. Psuedo s waves in inferior leads- represent atrial depolizaation post vent depolarization
3. Psuedo r waves in aVR or V1 - same as above
4. Normal qrs complexes
5. Typically paraxysmal attacks with normal resting EKG (young women)

1. Broad complex qrs >0.12sec
2. HR commonly 140-200bpm (can be as low as 100bpm)
3. Tends to be monotonously regular with monomorphic appearance and ≥3 consecutive qrs complexes
4. AV dissociation

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1. capture beats
2. fusion qrs complex
3. dissociated p waves 

The EKG below is of a patient in VT. What is the type of AV dissociation in this EKG?

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The EKG below is of a patient in VT. What is the type of AV dissociation in this EKG?

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The EKG below is of a patient in VT. What is the type of AV dissociation in this EKG?

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True or False

Ectopic beats occur before the expected Sinus beat

True or False

The qrs complex of an atrial ectopic beat is prolonged

True or False

The qrs complex is prolonged in a ventricular ectopic beat.

True or False

Only in atrial ecoptic beat is there a pause of the p wave.

True or False

An escape beat occurs before the next expected sinus beat.

False

Escape beats occur after an expected sinus beat and represent an automatistic foci in the atrium which fires off when the SA node fails to fire within th expected time frame. See below:

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Choose one:

First degree AV block

1. Prolonged PR interval
2. Intermittent failure of p wave conduction
3. Complete failure of p wave transmission

Choose one:

2nd degree AV block

1. Prolonged PR interval
2. Intermittent failure of p wave conduction
3. Complete failure of p wave transmission

2 - 

Intermittent failure of p wave conduction

Mobitz types I & II below to what category of AV Block?

1. 1st dregee
2. 2nd degree
3. 3rd degree

True or False:

In 2° AV Block, Mobitz Type II, there is a progressive prolongation of PR intervals prior to failure of p wave transmission.

True or False:

In 2° AV Block, Mobitz Type II there are prolonged but constant PR intervals prior to p wave transmission failure.

3rd degree AV Block

Note: There is complete AV dissociation and thus ventricular foci will take over.

1. qrs ≥0.12sec
2. Slurred s wave in V6
3. Possible rSR pattern in V1
4. Positive qrs in V1

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RBBB

However, do not rely on this diagnostic tool alone.  Many times the notch is much less pronounced or may be fused. RBBB EKG criteria should be:

1. Positive V1
2. Prolonged qrs complex >0.12sec
3. Slurred s wave following r wave in V6

Name the top 3 causes of RBBB?

1. Diseases causing chronic R Ventricular pressure such as 1° Pulmonary HTN; Cor Pulmonale and Acute Pulm Embolism. Etiology; - compression of the RBB proximal to the endocardium
2. LAD infarction. (LAD supplies the RBB)
3. Myocarditis

1. Current flow reversal of septal depolarization
2. Delayed depolarization of the L Vent.

1. qrs ≥0.12sec
2. Broad R waves in I and V6 (may be notched).
3. Broad deep S waves in V1-V3

1. LAD Infarction
2. HTN
3. Myocarditis
4. Cardiomyopathy
5. Aortic Valve diseases

True or False:

The left anterior descending (LAD) artery supplies the Left and Right bundle branches.

True or False:

An Anterior MI can result in either LBBB or RBBB.

True or False:

The RBB has a longer refactory period than the LBB.

1. A delta wave between p and r waves
2. Short PR interval
3. Broad qrs complex
4. Paroxysmal attacks of tachycardia in young healthy females