FLUTTER =

II P – V1 P                                                                                                    ...
LEFT ANTERIOR HEMIBLOCK = LA HEMI-

                                                                           QRS NORMAL ...
POSTERIOR MI = V1 RECIPROCALS = ST DEPRESSION T TALL = OFTEN = RIGHT CORONARY   ATHLETE HEART
OCCLUSION
                  ...
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44 Ecg Final

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44 Ecg Final

  1. 1. FLUTTER = II P – V1 P RHYTHM REGULAR SAW TOOTHED – BLOCK 2:1 3:1 4:1 etc – RA HTfy : P DURATION = NORMAL – P MAYBE RIGHT AXIS – ATRIAL BPM 250 – 350 – VENTICULAR BPM ½ 1/3 ¼ etc – CAROTID MASSAGE INCREASES BLOCK P 1ST POSRTION INCREASE AMPLITUDE LA HTfy : P DURATION = INCREASED – P 2ND PORTION INCREASED – P NO AXIS RV HTfy : RIGHT AXIS – V1 R – V6 S FIBRILATION : LV HTfy IREGULAR – ATRIAL BPM 350 – 500 – PRECORDIAL CRITERIA VENTRICULAR BPM VARIABLE – V5 OR V6 R + V1 OR V2 S > 35mm CAROTID MASSAGE MAY SLOW VENTRICULAR RATE V5 R > 26 mm – V6 R > 18 mm – V6 R > V5 R LIMB CRITERIA VL R > 13mm – VF R > 21 mm – I R > 14 mm – I R + III S > 25 mm MAT = MULTIFOCAL ATRIAL TACHYCARDIA REPOLARIZATION ABNORMALITIES IREGULAR – P 3 – MORE DIFFERENT MORPHOLOGIES – ST ASYMMETRIC DIPRESSION – T INVERSION : IN LEADS WITH TALL T = SIGNIFICANT HYPERTROPHY, VENTRICULAR DILATON, FAILURE BPM 100 – 200 OR LESS – CAROTIDMASSAGE NO EFFECT PAT = PAROXYSMAL ATRIAL TACHYCARDIA PSVT = PAROXISMIC SUPRAVENTRICULAR TACHYCARDIA REGULAR – BPM 100 – 200 – C RHYTHM REGULAR – P IF VISIBLE, RETROGRADE – BPM 150 – 200 – CAROTID MASSAGE SLOWS OR TERMINATES AROTID MASAGE NO EFFECT OR ONLY MILD SLOWING
  2. 2. LEFT ANTERIOR HEMIBLOCK = LA HEMI- QRS NORMAL DURATION – ST,T NO CHANGES – LEFT AXIS – NO OTHER CAUSES OF LEFT AXIS LEFT POSTERIOR HEMIBLOCK = LP HEMI- QRS NORMAL DURATION – ST, T NO CHANGES – RIGHT AXIS – NO OTHER CAUSES OF RIGHT AXIS BIFASCICULAR BLOCK RBBB + LA HEMI- = QRS >0.12 – V1,V2 RSR’ – LEFT AXIS RBBB + LP HEMI- = QRS >0.12 – V1,V2 RSR’ – RIGHT AXIS AV BLOCKS ST PREEXCITATION 1 DEGREE = PR > 0.2 SEC – P:QRS ND WPW = PR < 0.12 SEC – QRS > 0.12=WIDE – DELTA WAVES 2 DEGREE = PR > 0.2 SEC – NOT ALWAYS P:QRS LGL = PR < 0.12 – QRS NORMAL – 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 – AtFibril  VentFibril 3 DEGREE = COMPLETE BLOCK = AV DISSOCIATION = INDEPENDED Pacemakers MI = EXAM – ENZYMES – ECG T PEAK  T INVERSION -- ST ELEVATION -- Q WAVES Q WAVE CRITERIA >0.04 SEC – Q DEPTH => 1/3 R IN THE SAME COMPLEX MI NONQ CRITERIA = RIGHT BUNDLE BRANCH BLOCK = RBBB T INVERSION – ST DEPRESSION > 48 HOURS QRS > 0.12 – V1,V2 RSR’ = RABIT EAR – ST DEPRESSION – INFERIOR MI = T INVERSION – V5,V6,I,VL RECIPROCAL CHANGES II,III,VF – RIGHT CORONARY OR DESCENDING BRANCH – LBBB ANTERIOR, LEFT LATERAL LEADS RECIPROCALS QRS > 0.12 SEC – V5,V6,I,VL R BROAD OR NOTCHED – LATERAL MI = V5,V6,I,VL – OFTEN = LEFT CIRCUMFLEX OCLUSSION – ST DEPRESSION – T INVERSION – V1,V2 RECIPROCALS – INFERIOR RECIPROCALS LEFT AXIS MAYBE ANTERIOR MI = V1,…,V6 – OFTEN = LEFT ANTERIOR DESCENDING – INFERIOR RECIPROCALS
  3. 3. POSTERIOR MI = V1 RECIPROCALS = ST DEPRESSION T TALL = OFTEN = RIGHT CORONARY ATHLETE HEART OCCLUSION SINUS BRADYCARDIA – ST,T NONSPESIFIC CHANGES – ST ELEVATION = MI – PRINZMETAL ANGINA LV HTfy -- RV HTfy – RBBB INCOMPLETE – ST DEPRESSION = NONQ MI – TYPICAL EXERTIONAL ANGINA – POSSITIVE AV BLOCK 1ST DEGREE – OR WENCKENBACH AV BLOCK – SUPRAVENTRICULAR STRESS TEST TACHYCARDIA OCCASIONAL HYPERKALEMIA T PEAK, PR PROLONGATION, P FLAT, QRS WIDE  QRS + T MERGE TO SINE WAVE,  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 – U WAVE PERICARDITIS = ST,T DIFFUSE CHANGES – LOW VOLTAGE IF LARGE EFFUSION HOCM = LEFT AXIS – Q SEPTAL LEADS MYOCADITIS = CONDUCTION BLOCKS COPD = LOW VOLTAGE – RIGHT AXIS – R POOR PROGRESSION – RV HTfY , P PULMONALE – REPOLIRIZATION ABNORMALITIES ACUTE PULMONARY EMBOLISM = RBBB – I S – III Q – RV HTfy – ARRYTMIA = COMMON = SINUS TAVHYCARDIA OR ATRIAL FIBRILATION CNS DISEASE = T DIFFUSE INVERSION = WIDE AND DEEP -- U WAVES

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