EKG 2 etiologies & criteria

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CircadianHomunculus
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228197
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EKG 2 etiologies & criteria
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2013-07-28 23:11:25
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EKG
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EKG 2
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  1. What are the causes of RBBB?
    • Idiopathic degenerative conduction system disease
    • Ischemic heart disease
    • Cardiomyopathy
    • Massive pulmonary embolus
    • Right ventricular hypertrophy 
    • Normal variant
  2. What are the etiologies of right axis deviation (RAD)?
    • Right ventricular hypertrophy (most common)
    • Extensive lateral and apical MI
    • WPW
    • LPFB
    • Massive pulmonary embolism
    • Pulmonary hypertension
    • RBBB
  3. What is the ECG criteria for RBBB?
    • QRS >0.12 (any lead)
    • RSR' or RR' in V1-V3 (any one or more)
    • Wide (slur) S wave in V4-V6 (any one or more)
    • ST depression in V1 and V2
    • Inverted T wave in V1 and V2 (discordance)
  4. What are the causes of LBBB?
    • Idiopathic degenerative conduction system disease
    • CAD/ischemic heart disease
    • Dilated Cardiomyopathy
    • Aortic stenosis
    • HTN/left ventricular hypertrophy
    • Hyperkalemia
    • Myocardial infarction
    • Normal variant (less often than RBBB)
  5. What is the ECG criteria for LBBB?
    • QRS >0.12 (any lead)
    • High voltage S waves in V1-V3 (any one or more)
    • Tall R/ RR' waves in V4-V6, I and aVL (any one or more)
    • Slurred notch in any of the above (vice true RSR')
    • ST depression in V5, V6, I and aVL
    • Inverted T wave in V5, V6, I and aVL (discordance)
  6. What are the etiologies of left axis deviation (LAD)?
    • LAFB
    • Inferior MI
    • WPW
    • COPD
    • Hypertension/ LVH
    • LBBB
    • Mechanical shift (pregnancy, ascites, adb mass)
  7. What can an ECG containing a LBBB NOT be evaluated for?
    • Ischemia/infarction
    • Ventricular hypertrophy
    • ST/T wave changes (except concordance)
  8. What are causes of LAFB (hemiblock)?
    • Acute MI (up to 4%)
    • Hypertension
    • Aortic stenosis
    • Dilated cardiomyopathy
    • Consider LAD as source
  9. What is the criteria for LAFB?
    • LAD (usually marked)
    • Normal/slightly widened QRS (<0.12)
    • S wave larger than R wave in II, III, aVF
    • qR or R wave in lead I
    • rS wave in lead III (prob II and aVF)
    • Q1S3
  10. What are causes of LPFB (hemiblock)?
    • Rare
    • Acute MI (up to 4%)
    • Consider RCA as source
  11. What is the criteria for LPFB?
    • RAD
    • Normal/slightly widened QRS (<0.12)
    • q wave in lead III
    • s wave in lead I
    • S1Q3
  12. What are the etiologies for LAE?
    • Valvular heart disease (MS, MR, AS, AR)
    • LVH
    • Hypertropic cardiomyopathy (HCM/HOCM)
    • HTN
  13. What is the criteria for LAE (p-mitrale)?
    • Notched P wave in any lead (lead II): >0.11 wide or peaks >0.04 apart
    • Biphasic P in V1: terminal portion of P wave ≥1mm deep and ≥0.04 wide (P terminal force)
  14. What are the etiologies of RAE?
    • Valvular heart disease (TS, PS, MR, MS)
    • COPD
    • Pulmonary hypertension
    • Pulmonary embolism
  15. What is the criteria for RAE (p-pulmonale)?
    • Tall, peaking P wave (any lead): ≥2.5 mm
    • Most prominent in leads I, II, aVF
    • Biphasic P in V1 with initial force > terminal force
  16. What are the etiologies for LVH?
    • Hypertension
    • Valvular heart disease (AS, AR, MR, HCM)
    • Coarctation of the aorta
    • Patent ductus arteriosus
    • Acromegaly
  17. What can cause a false positive for LVH?
    • thin chest wall
    • S/P radical mastectomy
    • LBBB
    • acute MI
    • LAFB
    • WPW
  18. What is the Scott criteria for LVH?
    • Normal duration QRS (<0.12)
    • Sum of S in V1 or V2 + R in V5 or V6 > 35mm (use deepest in V1/V2 and tallest in V5/V6)
  19. What is the Estes criteria for LVH?
    • 1. R/S in limb lead >20mm; S in V1, V2 or V3 of 25mm or more; R in V4, V5 or V6 of 25mm or more (3)
    • 2. Any ST shift (w/o digitalis) (3); Typical "strain" ST-T (w/ dig) in V5, V6, aVL (1)
    • 3. LAD -15° or more (2)
    • 4. QRS interval 0.09 sec or more (1)
    • 5. Intrinsicoid deflection in V5-6 of ≥0.04 sec (1)
    • 6. P terminal force in V1 >0.04 (3)

    **score of 4 LVH likely; score of 5+ LVH**
  20. What is the Cornell voltage/duration criteria for LVH?
    • Voltage: R aVL + S V3 >20mm (F), >25mm (M)
    • Duration: Cornell voltage X QRS during in ms
  21. What are the etiologies of RVH?
    • COPD
    • Pulmonary HTN
    • Valvular disease (MS, MR, TR, PS)
    • Pulmonary embolism
    • Chronic left heart failure
    • ASD, VSD
    • Tetralogy of Fallot
  22. What is the criteria for RVH?
    • RAD (must have!)
    • Normal QRS duration
    • Reversal of R wave progression
    • May have strain pattern in V1, V2
    • Must NOT have BBB
  23. What makes a Q wave "significant"?
    • Greater than 1 box in width (longer than 0.04 sec)
    • OR larger than 1/3 of the R wave
  24. What are the causes of ST depression?
    • Ischemia
    • Hypothermia
    • Hypokalemia
    • Tachycardia
    • Subendocardial infarct
    • Reciprocal ST elevation
    • Ventricular hypertrophy
    • BBB
    • Digitalis
  25. What makes an ST segment elevation significant?
    • Exceeds 1mm in a limb lead
    • Or 2mm in a precordial lead
  26. What are the causes of ST elevation?
    • Infarction
    • Vasospastic (prinzmetal's angina)
    • Pericarditis
    • Early repolarization
    • **measure 2mm beyond QRS, significant w/ 1mm (limb lead) 2mm (chest lead)**
  27. What causes tall, peak T waves?
    • hyperkalemia: generalized
    • infarction: localized
  28. What can cause inverted (discordant) T waves?
    • evolving infarction
    • chronic pericarditis
    • conduction block
    • ventricular block
    • ventricular hypertrophy
    • acute cerebral disease
  29. What conditions can cause large U waves to appear on ECG, following the T wave?
    • electrolyte abnormality (hypokalemia)
    • severe CAD
    • drug effects
  30. What are the causes for pericarditis?
    • Idiopathic
    • Viral infx (MOST COMMON!)- coxsackie virus
    • Bacterial infx (TB)
    • Immunologic conditions (SLE)
    • MI (dressler's syndrome)
    • Trauma to the heart
    • Uremia
    • Malignancy
    • Side effect of meds
    • Radiation induced
    • Aortic dissection
    • Tetracyclines
  31. What are the most common physical findings of pulmonary embolism?
    • tachypnea
    • tachycardia
    • anxiety
  32. What are the causes of myocardial ischemia?
    • not enough blood
    • atherosclerosis
    • vasospasm
    • thrombosis
    • embolism
  33. In what conditions do T waves usually appear abnormal?
    • ventricular hypertrophy
    • LBBB
    • chronic pericarditis
    • electrolyte abnormality

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