Cloned from: EKG uploaded

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signs of LAE
P-mitrale (notched P in I & II, greater than 0.12s, space btwn humps >0.04s), biphasic P where 2nd half is wide and deep (height-mm x width-sec = >0.3)
signs of RAE
P-pulmonale (teepee P >2.5mm in limb leads), biphasic P where first half is taller in V1 than in V6
P waves are normally positive in
I, II, & V4-V6
sign of IACD
biphasic P's in V1
wander atrial pacemaker WAP is a tachy form of...?
MAT
DDx of PR depression
(1) normal variant (must be <0.8mm)
(2) pericarditis
(3) atrial infarction
ECG signs of pericarditis
(1) tachy
(2) PR depresssion
(3) diffuse ST elevations (usu concave up, "scooped out")
(4) notching of terminal portion of QRS (esp in lateral precordial leads)
normal PR interval duration
0.12 to 0.20 seconds
where to measure PR interval
lead with widest P and widest QRS (or leada where you get the longest interval)
DDx for shortened PR
(1) retrograde junctional P wave
(2) Lown-Ganong-Levine syndrome
(3) Wolff-Parkinson-White
pattern of retrograde P waves
inverted P's in II, III, aVF
criteria for WPW
(1) shortened PR (<0.12s) with normal P
(2) wide QRS (>0.11s)
(3) delta waves (initial slurring of the QRS)
(4) ST-T changes
(5) association with paroxysmal tachycardias
DDX for tall R in V1
(1) RBBB
(2) posterior MI
(3) RVH
(4) WPW type A
(5) normal in adolescents and kids
ECG criteria for LVH
(1) (S in V1 or V2) + (R in V5 or V6) > 35mm
(2) any precordial >45mm
(3) R in aVL is >11mm
(4) R in I is >12mm
(5) R in aVF is >20mm
DDx for inc R:S in V1 or V2
(1) RVH
(2) RBBB
(3) post wall AMI
(4) WPW type A
(5) young kids and adolescents
things that add "strain" to RVH
concave downward ST that is depressed and a flipped assymetric T
major criteria for RVH
(1) P-pulmonale, aka RAE
(2) right axis deviation
(3) inc R:S in V1 and V2
(4) RVH strain pattern
(5) S1Q3T3 (I:S, III:q, III: flipped T)
ST depression is always pathological. What is the DDx?
(1) ischemia
(2) strain pattern
(3) BBB
(4) WPW
(5) resolving pericarditis
(6) CNS event
LVH with strain criteria
ST depression w downward concavity and a flipped/assymetric T in left precordials V4-6 and reciprocal changes on right precordials (ST elevation w upward concavity
In LVH is a diffuse J-point more indicative of strain or ischemia?
strain (DDx for diffuse J-point is early repol, LVH w strain, pericarditis, AMI)
DDx for tall, symmetric T waves
hyperkalemia (or other electrolyte abnormalities), ischemia, CNS events
very broad T waves
CNS events
pattern of normal T-waves
(1) upright in I, II, V3-6
(2) down in aVR
(3) ??? in rest of leads
LAH Criteria
(1) LAD from -30 to -90 {I:+, aVF:-, II:-}
(2) qR or R in I
(3) rS in III {maybe also II & aVF}
anteroseptal MI findings
(1) Q in V1
(2) RBBB
RBBB Criteria
(1) wide QRS {>0.12s}
(2) slurred S in I & V6
(3) RSR' in V1 {R' taller than R}
LBBB Criteria
(1) wide QRS {>0.12s}
(2) broad monomorphic R in I & V6 with no Q waves
(3) broad monomorphic S in V1 {may have small s}
LPH Criteria
(1) axis 90 to 180 {right quadrant, ie. I  is neg}
(2) s in I, q in III
(3) Exclusion of RAE and RVH
RAE (w biphasic P)
1st half of P in V1 is taller than 1st half of P in V6
most common cause of right axis
RVH
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