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44 Ecg Final
1. FLUTTER =
II P â V1 P RHYTHM REGULAR SAW TOOTHED â BLOCK 2:1 3:1 4:1 etc â
RA HTfy : P DURATION = NORMAL â P MAYBE RIGHT AXIS â ATRIAL BPM 250 â 350 â VENTICULAR BPM Âœ 1/3 ÂŒ etc â CAROTID MASSAGE INCREASES
BLOCK
P 1ST POSRTION INCREASE AMPLITUDE
LA HTfy : P DURATION = INCREASED â P 2ND PORTION INCREASED â
P NO AXIS
RV HTfy : RIGHT AXIS â V1 R â V6 S FIBRILATION :
LV HTfy IREGULAR â ATRIAL BPM 350 â 500 â
PRECORDIAL CRITERIA
VENTRICULAR BPM VARIABLE â
V5 OR V6 R + V1 OR V2 S > 35mm CAROTID MASSAGE MAY SLOW VENTRICULAR RATE
V5 R > 26 mm â V6 R > 18 mm â V6 R > V5 R
LIMB CRITERIA
VL R > 13mm â VF R > 21 mm â I R > 14 mm â
I R + III S > 25 mm
MAT = MULTIFOCAL ATRIAL TACHYCARDIA
REPOLARIZATION ABNORMALITIES
IREGULAR â P 3 â MORE DIFFERENT MORPHOLOGIES â
ST ASYMMETRIC DIPRESSION â T INVERSION : IN LEADS WITH TALL T = SIGNIFICANT HYPERTROPHY, VENTRICULAR DILATON, FAILURE
BPM 100 â 200 OR LESS â CAROTIDMASSAGE NO EFFECT
PAT = PAROXYSMAL ATRIAL TACHYCARDIA
PSVT = PAROXISMIC SUPRAVENTRICULAR TACHYCARDIA
REGULAR â BPM 100 â 200 â C
RHYTHM REGULAR â P IF VISIBLE, RETROGRADE â BPM 150 â 200 â CAROTID MASSAGE
SLOWS OR TERMINATES AROTID MASAGE NO EFFECT OR ONLY MILD SLOWING
2. LEFT ANTERIOR HEMIBLOCK = LA HEMI-
QRS NORMAL DURATION â ST,T NO CHANGES â LEFT AXIS â
NO OTHER CAUSES OF LEFT AXIS
LEFT POSTERIOR HEMIBLOCK = LP HEMI-
QRS NORMAL DURATION â ST, T NO CHANGES â RIGHT AXIS â
NO OTHER CAUSES OF RIGHT AXIS
BIFASCICULAR BLOCK
RBBB + LA HEMI- = QRS >0.12 â V1,V2 RSRâ â LEFT AXIS
RBBB + LP HEMI- = QRS >0.12 â V1,V2 RSRâ â RIGHT AXIS
AV BLOCKS
ST PREEXCITATION
1 DEGREE = PR > 0.2 SEC â P:QRS
ND
WPW = PR < 0.12 SEC â QRS > 0.12=WIDE â DELTA WAVES
2 DEGREE = PR > 0.2 SEC â NOT ALWAYS P:QRS
LGL = PR < 0.12 â QRS NORMAL â NO DELTA WAVES
MOBITZ I =WENCKENBACH = PR PROGRESSIVE PROLONGATION UNTIL QRS IS DROPPED
COMMON ACOMPANING ARRYTHMIAS =
MOBITZ II = PR NO PROLONGATION - QRS ARE DROPPED
RD PSVT WITH NARROW QRS â AtFibril ï VentFibril
3 DEGREE = COMPLETE BLOCK = AV DISSOCIATION = INDEPENDED Pacemakers
MI = EXAM â ENZYMES â ECG
T PEAK ï T INVERSION -- ST ELEVATION -- Q WAVES
Q WAVE CRITERIA
>0.04 SEC â Q DEPTH => 1/3 R IN THE SAME COMPLEX
MI NONQ CRITERIA =
RIGHT BUNDLE BRANCH BLOCK = RBBB T INVERSION â ST DEPRESSION > 48 HOURS
QRS > 0.12 â V1,V2 RSRâ = RABIT EAR â ST DEPRESSION â INFERIOR MI =
T INVERSION â V5,V6,I,VL RECIPROCAL CHANGES II,III,VF â RIGHT CORONARY OR DESCENDING BRANCH â
LBBB ANTERIOR, LEFT LATERAL LEADS RECIPROCALS
QRS > 0.12 SEC â V5,V6,I,VL R BROAD OR NOTCHED â LATERAL MI =
V5,V6,I,VL â OFTEN = LEFT CIRCUMFLEX OCLUSSION â
ST DEPRESSION â T INVERSION â V1,V2 RECIPROCALS â
INFERIOR RECIPROCALS
LEFT AXIS MAYBE
ANTERIOR MI = V1,âŠ,V6 â OFTEN = LEFT ANTERIOR DESCENDING â INFERIOR RECIPROCALS
3. POSTERIOR MI = V1 RECIPROCALS = ST DEPRESSION T TALL = OFTEN = RIGHT CORONARY ATHLETE HEART
OCCLUSION
SINUS BRADYCARDIA â ST,T NONSPESIFIC CHANGES â
ST ELEVATION = MI â PRINZMETAL ANGINA
LV HTfy -- RV HTfy â RBBB INCOMPLETE â
ST DEPRESSION = NONQ MI â TYPICAL EXERTIONAL ANGINA â POSSITIVE
AV BLOCK 1ST DEGREE â OR WENCKENBACH AV BLOCK â SUPRAVENTRICULAR
STRESS TEST
TACHYCARDIA OCCASIONAL
HYPERKALEMIA
T PEAK, PR PROLONGATION, P FLAT,
QRS WIDE ï QRS + T MERGE TO SINE WAVE, ï Vent Fibril
HYPOKALEMIA =
ST DEPRESSION, T FLAT, U WAVES
HYPOCALCEMIA = QT PROLONGATION
HYPERCALCEMIA = QT SHORT
HYPOTHERMIA = OSBORNE WAVE
DIGITALIS
THERAPEUTIC LEVELS = ST,T CHANGES IN LEADS WITH TALL R
TOXI LEVELS = TACHYARRYTHMIAS, CONDUCTION BLOCKS, PAT + BLOCK = MOST
COMMON
SOTALOL, QUINIDINE, PROCAINAMIDE, AMIODARONE, TRICYCLICS,
QUINOLONES, PHENOTHIAZINES, ERYTHROMYCIN, SOME ANTISTAMINES,
ANTIFUNGALS = QT PROLONGATION â U WAVE
PERICARDITIS =
ST,T DIFFUSE CHANGES â LOW VOLTAGE IF LARGE EFFUSION
HOCM = LEFT AXIS â Q SEPTAL LEADS
MYOCADITIS = CONDUCTION BLOCKS
COPD =
LOW VOLTAGE â RIGHT AXIS â R POOR PROGRESSION â
RV HTfY , P PULMONALE â REPOLIRIZATION ABNORMALITIES
ACUTE PULMONARY EMBOLISM =
RBBB â I S â III Q â RV HTfy â
ARRYTMIA = COMMON = SINUS TAVHYCARDIA OR ATRIAL FIBRILATION
CNS DISEASE =
T DIFFUSE INVERSION = WIDE AND DEEP -- U WAVES