Notes in Electrocardiogram (ECG/EKG)

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Published	10/13/2023	methodical approach to ECG interpretation:- R{{c1::ate}}- R{{c1::hythm}}- A{{c2::xis}}- I{{c2::ntervals}} (PR, QRS, QT)- M{{c3::orpholo…
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Published	10/13/2023	this ECG is {{c1::normal}}
Published	10/13/2023	{{c1::Sinus}} node is in RA and is internal cluster of {{c2::pacemaker}} cells*every cell in heart can conduct its own electric signal but this is the…
Published	10/19/2023	{{c1::electricity}} drives the pump function of the heart:- {{c2::P wave}} is right before {{c3::atrial}} contraction- {{c2::QRS complex}} occurs righ…
Published	10/13/2023	{{c1::limb}} leads (I, II, III, aVR, aVL, aVF) go on each limb and {{c1::precordial}} leads (V1-V6) go around heart on the surface of chest
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Published	10/13/2023	limb leads*leads: {{c2::I}}, {{c2::II}}, {{c2::III}}, {{c3::aVR}}, {{c3::aVL}}, {{c3::aVF}}- {{c1::bipolar}} leads: can detect electricity both from c…
Published	10/19/2023	precordial leads*leads: {{c2::V1}}, {{c2::V2}}, {{c2::V3}}, {{c2::V4}}, {{c2::V5}}, {{c2::V6}}- {{c1::unipolar}} leads: only detect signals coming fro…
Published	10/19/2023	3D electrical vector math- all 3D vectors can be broken into {{c1::x}}/{{c1::y}}/{{c1::z}} directional components → magnitude/direction for each axis …
Published	10/13/2023	ECG tracing and leads- positive (upward) deflections are {{c1::depolarizing}} forces directed TOWARD the lead or {{c2::repolarizing}} forces AWAY from…
Published	10/13/2023	Determining heart rate- use {{c2::rhythm strip}} and start with a {{c1::QRS complex}} that lines up with big box line→ memorize: 300-150-100-75-60*for…
Published	10/22/2023	Rhythm- regular: normal - {{c1::regularly irregular}}: clusters of irregularity that repeat*from PACs, PVCs, A-flutter- {{c2::irregularly irregul…
Published	10/19/2023	Sinus rhythm*4 requirements....- {{c1::P}} before every {{c2::QRS}}- {{c2::QRS}} before every {{c1::P}}- all P waves look the {{c3::same}}- norma…
Published	10/13/2023	Non-sinus rhythm*cardiac rhythms can originate from atrial locations other than the sinus node- {{c8::ectopic atrial}} rhythms have: P before eve…
Published	10/13/2023	{{c1::Sinus}} arrhythmia is not actually an arrhythmia, just a normal result of {{c2::respiratory}} variation*unequal time between heartbeats → m…
Published	10/13/2023	{{c1::arrhythmia}} is anything other than normal sinus rhythm→ {{c2::tachycardia}}: HR above normal→ {{c2::bradycardia}}: HR below normal *s…
Published	10/22/2023	(Ventricular) QRS Axis- normal axis: {{c2::+}} in I, {{c2::+}} in aVF- {{c3::right}} axis deviation: {{c1::-}} in I, {{c1::+}} in aVF*occurs in tall, …
Published	10/19/2023	Axis summary- leads {{c7::I}} and {{c7::aVF}} are used for both {{c2::P wave}} axis and {{c2::ventricular (QRS)}} axis→ normal for both P and QRS…
Published	10/19/2023	PR interval*something the machine is pretty good at measuring- represents {{c1::atrial}} depolarization and conduction through the pause at the {{c2::…
Published	10/19/2023	Heart block- {{c2::1st}} degree HB: prolonged PR (>{{c1::200}}ms) with 1:1 conduction - 2nd degree HB {{c7::Mobitz}} type 1 = Wenkebach: PR gr…
Published	10/13/2023	{{c1::stimulants}} (ex: methylphenidate) will not cause heart block because they will increase AV conduction and HR
Published	10/22/2023	heart block causes*most common = PR {{c7::prolongation}} (1st degree)- {{c1::congenital heart disease}}:→ {{c2::native}}: issues with conduction syste…
Published	10/13/2023	QRS complex- begins with firing of {{c1::AV}} node and spreads down bundle of His, R/L bundle branches, and into ventricular myocardium to trigger {{c…
Published	10/19/2023	QRS interval- issue with one of the bundle branches → R/L ventricular contractions are less coordinated → QRS becomes prolonged- can be due to {{c2::i…
Published	10/13/2023	Bundle branch block*entails some issue with conduction → shows up as split {{c1::QRSs}} out of phase- {{c7::right}} bundle branch block: → rSR' (…
Published	10/22/2023	QT interval*always calculate QTc yourself because machine measurement is wildly inaccurate- always use QTc (c = {{c1::corrected}}) to account for…
Published	10/13/2023	long QT syndrome- 3 types of genetic mutations → at risk for dangerous {{c1::arrhythmias}}- other causes: medications and {{c2::electrolyte}} abnormal…
Published	10/13/2023	medications causing QT prolongation- anti{{c1::arrhythmics}}: amiodarone, sotalol, procainamide, dofetilide- anti{{c2::microbials}}: levofloxacin, cip…
Published	10/13/2023	QT prolongation can lead to {{c1::Torsades de pointes}} (polymorphic ventricular tachycardia)
Published	10/13/2023	What are the rate, rhythm, and axis on this EKG?rate: {{c1::~70 (300 divided by # of boxes method)}}rhythm: {{c2::sinus rhythm (bc…
Published	10/19/2023	ECG abnormalities and what they entail{{c4::Left atrial enlargement}}: {{c5::bifid/biphasic P wave}} in lead II > 3 small boxes wide{{c6:…
Published	10/13/2023	{{c1::Unrepaired atrial septal defect}}: right heart enlargement, may see right atrial enlargement, right axis deviation{{c2::Primary pulmonary hypert…
Published	10/13/2023	P wave morphology*look in lead {{c2::II}}- normal: {{c1::small hump}}- RAE: {{c3::tall, spiky P wave >3 boxes}}- LAE: {{c4::bi-phasic/double-hump}}…
Published	10/19/2023	bundle branch block- look for bunny ears in QRS at {{c1::V1}} and {{c1::V2}} for right bundle branch block, {{c2::V5}} and {{c2::V6}} for left bu…
Published	10/13/2023	Left ventricular hypertrophy- tallest {{c6::S}}-wave amplitude in {{c1::V1/V2::two leads}} + tallest {{c7::R}}-wave amplitude in {{c2::V5/V6…
Published	10/19/2023	Right ventricular hypertrophy- {{c4::right}} axis deviation- dominant {{c2::R}} wave in {{c1::V1/V2::two leads}} (> 5mm tall or R>S)- normal {{c…
Published	10/13/2023	R wave progression- normal: gradual transition form all {{c1::negative}} to all {{c1::positive}} as you move from V1 to V6- abnormal: NOT gradual tran…
Published	10/16/2023	This CXR is c/w is {{c1::acute ST elevation myocardial infarction}}
Published	10/16/2023	For acute STEMI, look for local {{c1::ST elevation}} with reciprocal {{c2::ST depression}}- {{c1::ST elevation}} clustered to…
Published	10/22/2023	{{c2::Early repolarization}}: {{c1::‘fishhook’}} at J point and broad ST elevation*no {{c4::reciprocal}} depression like in acute STEMI{{c3::Acute per…
Published	10/16/2023	ST segments- normal = {{c1::flat}}- ST depression: {{c2::subendocardial ischemia}}- ST elevation: full-thickness {{c3::acute myocardial infa…
Published	10/16/2023	Depolarization and repolarization- QRS complex: {{c1::DE}}polarization ({{c2::+}} wave) from {{c3::AV node}} toward {{c4::apex}}- T wave: {{c1::RE}}po…
Published	10/19/2023	ischemia changes ST segmentsnormal heart muscle cells have ‘resting’ polarization of ~ -90mV→ {{c1::depolarization}} → LESS NEGATIVE (negative ions ru…
Published	10/19/2023	Mechanism of ST elevation*seen in {{c4::acute myocardial infarction}} (full thickness)- inability of injured cells to maintain normal {{c1::resting po…
Published	10/16/2023	Mechanism of ST depression*coronary arteries run along {{c1::outside}} of heart so first to infarct in the endocardium → {{c2::subendocardial ischemia…
Published	10/16/2023	ST segment- evaluate {{c2::J}} point relative to {{c5::PR}} interval to determine depression vs elevation- determine slope of {{c1::ST}} segment (upsl…
Published	10/16/2023	One month after an acute STEMI, ECG shows deep, wide inferior {{c1::Q}} waves in the same distribution as initial ST elevations → suggestive…
Published	10/16/2023	ECG progression after acute MI{{c1::Hyperacute T}} waves often present before symptoms or before care{{c2::ST elevation}} shows up almost immediately …
Published	10/16/2023	Pathologic Q waves- {{c1::small}} Q waves are normal in leads {{c2::I}}, {{c2::aVL}}, {{c3::V5}}, {{c3::V6}}*lead III is "free" so not a problem as lo…
Published	10/16/2023	{{c1::Anterolateral}} Q waves: old MI, different distribution- Q waves in V2, V3, V4 {{c2::Hyperacute}} T waves: acute ischemia vs hyperkalemia- …
Published	10/22/2023	Acute pericarditis on ECG- {{c1::diffuse}} ST {{c5::elevation}} (other than depression in aVR) (blue)*reciprocal ST depression +/- PR e…
Published	10/16/2023	ST elevation can be seen in... - acute {{c1::myocardial infarction}}- acute {{c1::pericarditis}}- early {{c3::repolarization}}
Published	10/22/2023	ST elevation - acute pericarditis- diffuse ST {{c2::elevation}} +/- PR depression*reciprocal ST {{c3::depression}} only in aVR, V1 - most common …
Published	10/16/2023	ST elevation - acute myocardial infarction- localized ST {{c1::elevation}} with localized reciprocal ST {{c1::depressions}}- no PR {{c2::depression}}-…
Published	10/16/2023	ST elevation - localizing the ischemia
Published	10/16/2023	ST elevation - early repolarization- non-{{c1::pathologic}} ST segment change- all upright T waves have {{c2::elevated}} ST segments- all negative T w…
Published	10/16/2023	PR depression specific to {{c1::acute pericarditis}}localized ST elevation specific to {{c2::myocardial infarction }}
Published	10/16/2023	{{c1::sinus tachycardia}} on ECG would not help differentiate between acute pericarditis and acute myocardial infarction
Published	10/19/2023	T wave inversions- can mean myocardial {{c1::ischemia}} (mechanism similar to ST segment changes), but NOT specific in isolationother causes:- {{c2::s…
Published	10/16/2023	tall peaked T waves- T waves more than 2/3 height of {{c2::QRS complex}}- could mean the following: → {{c1::acute MI}}→ {{c1::hyperkalemia}}→ {{c…
Published	10/22/2023	{{c4::Wolff-Parkinson-White}} pattern: - {{c5::accessory}} pathway of conduction: Bundle of Kent - treatment: {{c6::ablation}} to scar some …
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