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Flashcards in EKG Deck (32)
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1

What are the steps of EKG interpretation?

1. Rate
2. Intervals
3. Axis
4. Rhythm
5. Hypertrophy
6. Infarction / Ischemia
7. Other

2

How do you determine rate?

Measure R-R intervals or count the # of complexes and multiply by 6

3

How do you measure rate using the RR interval?

use the 300 – 150 – 100 – 75 – 60 – 50 - 40

4

What are the intervals we measure?

PR, QRS, Qtc

5

What is the normal PR interval?

0.12 - 0.20 seconds

6

What does one "itty-bitty" box count for? what about one big box?

itty-bitty box = 0.04 seconds
big box = 0.20 seconds

7

What is the normal QRS interval?

0.06 - 0.10 seconds

8

What is the normal QTc interval?

0.30 - 0.46 seconds or as long as the Qt interval is less than half the preceding R-R interval

9

What is normal axis?

between -30 and 90

10

Where is the axis if lead I is positive and lead II is positive?

Normal axis! -30 to -90

11

Where is the axis if lead I is positive and lead II is negative?

left axis deviation! -30 to 270

12

Where is the axis if lead I is negative and lead II is positive?

right axis deviation! 90 to 150

13

Where is the axis if lead I is negative and lead II is negative?

no mans land! 150 to 270

14

PR interval more than 0.20 seconds with 1:1 conduction

1st degree AV block

15

PR interval lengthens followed by completely blocked P wave

2nd degree AV block type 1

16

PR interval stays the same, P waves are intermittently blocked

2nd degree AV block, type 2

17

P waves are completely blocked, QRS originates independently

3rd degree AV block

18

Right atrial hypertrophy

Either:
P wave in any limb lead is more than 2.5 mm
P wave in V1 is biphasic and the initial portion is the largest

19

Left atrial hypertrophy

Either:
P wave in lead II is notched with > 0.04 sec between peaks
P wave in V1 is biphasic and the terminal portion is the largest with usually a negative deflection

20

Right ventricular hypertrophy

Right axis deviation AND R wave in V1 is more than 7mm tall

21

Left ventricular hypertrophy

Cornell criteria: R wave in aVL + S in V3 = > 24 in men or > 20 in women
Any R + S in precordial leas >45mm
R wave in V5 more than 26mm
R wave in aVL at least 12 mm (most specific)

22

Ischemia

T waves biphasic with or without ST depression

23

LBBB

QRS greater than or equal to 0.12 sec
Broad R waves in I, V5 and V6
- ST depression and T wave inversion in these leads
-large S wave in V1/V2
-possible left axis shift

24

Does having LBBB affect any other diagnosis?

hypertrophy and infarct

25

RBBB

QRS equal to or more than 0.12 sec
rsR' in V1 and V2, typically second R larger

26

Diffuse Upward Concave ST segment elevation except for aVR with no reciprocal ST depressions

pericarditis

27

Tall, narrow, peaked T wave with possible QT shortening

K+ = 5.5 - 6.5 mEq/L

28

flattened wide P waves, widened QRS

K+ = 6.5 - 7.5 mEq/L

29

Loss of P waves, very wide QRS, VT, VF, asystole

K+ > 7.5 mEq/L

30

Prominent U waves, flat T waves, big P waves

hypokalemia