# UM Internal Medicine Clerkship - EKG Test

### 92 terms by peterdemaria

#### Study  only

Flashcards Flashcards

Scatter Scatter

Scatter Scatter

## Create a new folder

These flashcards will help prepare you for Dr. Esterson's EKG exam on the internal medicine clerkship.

.04 s

.20 s

5 small boxes

1 mm or .1 mV

1 mV
10 mm

### What formula can be used to calculate heart rate given the R-R interval? (assume regular rhythm)

300 / # large boxes in R-R interval
1500 / # small boxes in R-R interval

100 bpm

### How do you determine HR given an irregular rhythm?

Measure out 6 seconds (6 second rule). Count the # of complexes in 6 sec and multiply by 10.

### List 3 criteria for normal sinus rhythm.

1) Rate between 60-100
2) Every normal P wave followed by QRS
3) P wave upright in leads I and II, inverted in aVR.

### Length of normal PR interval =

.12 - .20 s (3 to 5 small boxes)

### Define PR interval

from ONSET of P wave to ONSET of QRS

<0.10 s

### Define QRS interval

from ONSET of QRS to END of QRS

### Define QT interval

from ONSET of QRS to END of T wave = systole

### List the FRONTAL leads

I, II, III, aVR, aVL, aVF

V1-6

### Lead I runs from the __ to the __.

Right arm to left arm.

### Lead II runs from the __ to the __.

Right arm to the left leg.

### Lead III runs from the __ to the __.

Left arm to the left leg.

Left arm

Left leg

Left leg

Unipolar

aVR, aVL, aVF

Right shoulder

Left shoulder

Left foot

+I

-aVR

+II

+aVF

+III

+aVL

+aVR

### What part of the heart do leads V5-6 "see" best?

lateral LV, precordial leads

-30 to +90

### Related to age <30, normal heart range = __

0 to +90 (even +105)

-30 to +90

leftward

-30 to -90

+90 to 180

+180 to -90

I, II, aVF

### Describe the QRS axes for a "normal" heart.

+ in I and II, either in aVF

### Describe the QRS axes for a "left" heart.

+ in I, - in II, - in aVF

### Describe the QRS axes for a "right" heart.

- in I, either in II, + in aVF

### Define "normal" P wave morphology.

I and II positive; aVR negative

II and V1

### Transition Zone: There is a progression of precordial R waves. Before V2, they should be (+/-) and (+/-) by V5.

Negative before V2
Positive at V5

### The ST segment is defined from the __ to the __.

J point to the beginning of the T wave.

### List 2 EKG findings that can progress to infarction.

- ST depression
- symmetric T wave inversion

### A positive EKG stress test will show __.

ST depression > 1 mm

Tall T wave

### What does the EKG show in the injury/acute period in the few hours following an MI?

ST elevation with tall T (tombstone)

### In the later stages following an MI, an EKG will show what changes?

Pathological Q waves. T returns upright and ST becomes normal.

Right coronary

Circumflex

### LVH should show ___ voltage.

Increased left voltage, due to increased mass

QT

< .44 s

### An ST elevation with a concave upwards slope suggests...

Early repolarization

### Describe the common case of early repolarization

A usually healthy male>female, athlete, with no symptoms

### What is the difference between an ST elevation in MI and pericarditis?

STEMIs are more regional whereas pericarditis is seen in all leads except aVR and isoelectric leads

### Describe the criteria for RBBB

- QRS elongation, >.12s
- R' in right precordial leads (V1)... R' is wider and taller than R wave
- Wide S in lateral leads
- Secondary ST-T changes (opposite direction)

### Describe the criteria for LBBB

- QRS elongation, >.12s
- absent Q waves in lateral leads (I, V5-6)
- broad R wave (I, V5-6)
- Secondary ST-T changes (opposite direction)

### Describe the criteria for LVH

- !!Increased QRS voltage
- ST-T "strain" changes in left sided leads
- Slight QRS elongation
- Abnormal Left axis deviation

LVH

RVH

>110 degrees

### What EKG findings are associated with HYPERKALEMIA?

- peaked T waves
- QRS prolongation (widenen T)
- P waves with long duration, low amplitude
- Increased PR interval
- P wave disappears
- QRS sine wave

### What is characteristic about the A fib EKG?

- No definite P shape can be determined
- Irregularly irregular P waves at 400-700 bpm
- Normal QRS at 100-180 bpm

### What is characteristic about the A flutter EKG?

- Saw tooth shape
- Normal QRS

### What is characteristic about PVCs: Premature Ventricular Complexes?

- Wider and different from sinus QRS
- Not preceded by premature P wave
- Significance depends on the clinical setting

### Define Ventricular tachycardia

- 3 or more PVCs
- abrupt onset and termination
- rate 140 - 200
- QRS >.14
- not preceded by P waves

### Describe Type I Second Degree AV Block

- Progressively lengthening PR interval, then a non-conducted P

### Describe Type II Second Degree AV Block

- PR interval is constant, followed by a non-conducted P
- bi/trifascicular block

### Describe Third Degree AV Block

- Regular PP and RR intervals, VARIABLE PR INTERVAL!
- Atrial rate > ventricular rate

Normal EKG

### "45 y.o supervisor with chest tightness and arm heaviness after foot surgery."

Subendocardial ischemia / ischemic ST depression

### What is necessary about Q waves to show necrosis?

There must be Q waves in 2 separate leads

Ischemic T wave

### "35 y.o. man presents with indigestion and chest fullness brought on by chili peppers and relieved by antacids."

Early repol - more common in young

"J notch"

Pericarditis

### What EKG changes should make you think pericarditis?

Diffuse ST elevations across multiple leads

RBBB - see RSR'

### "85 year old female undergoing preop evaluation prior to hip surgery. Anesthiologist is asking if a pacemaker is needed."

LBBB - remember mneumonic "WiLLiaM MaRRoW"
(looks like rabbit ears)

### How do you tell a RBBB from a LBBB?

R - M in v1 and W in v6
L - W in v1 and M in v6

acute STEMI

...

Example:

## Press Ctrl-0 to reset your zoom

### Please upgrade Flash or install Chrometo use Voice Recording.

For more help, see our troubleshooting page.

Create Set