Ecg Quiz 1s28o

EKG #1

1. What is the rhythm? a. V-Tach b. A-Fib c. A-flutter d. normal

EKG #1

1. What is the rhythm? a. V-Tach b. A-Fib c. A-flutter d. normal

Differential Diagnosis of Tachycardia Tachycardia Narrow Complex ST Regular

Irregular

SVT Atrial flutter A-fib A-flutter w/ variable conduction MAT

Wide Complex ST w/ BBB SVT w/ BBB

VT A-fib w/ BBB

A-fib w/ WPW VT

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EKG #2

1. What does this EKG represent? a. pericarditis b. myocarditis c. digitalis effect d. infero postero lateral wall ST-elevation MI

EKG #2

1. What does this EKG represent? a. pericarditis b. myocarditis c. digitalis effect d. infero postero lateral wall ST-elevation MI

Cardiac Location of Event

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EKG #3

1. What is the rhythm? a. V-Tach b. A-Fib c. A-flutter d. normal

EKG #3

1. What is the rhythm? a. V-Tach b. A-Fib c. A-flutter d. normal

Ventricular Tachycardia     

Rate 110 -250 bpm Wide complex (>0.12 – 3 small blocks) Regular AV dissociation Extreme Right Axis Deviation + Upright MCL-1

I

II

III MCL-1

EKG #4

1. What does this EKG represent? a. sinus bradycardia b. sinus tachycardia c. 2nd degree AV block d. complete heart block

EKG #4

1. What does this EKG represent? a. sinus bradycardia b. sinus tachycardia c. 2nd degree AV block d. complete heart block

Blocks  AV 

blocks

First degree block • PR interval fixed and > 0.2 sec



Second degree block, Mobitz type 1 • PR gradually lengthened, then drop QRS



Second degree block, Mobitz type 2 • PR fixed, but drop QRS randomly



Type 3 block • PR and QRS dissociated

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EKG #5

1. What does this EKG represent? a. V-fib b. left bundle branch block c. right bundle branch block d. normal

EKG #5

1. What does this EKG represent? a. V-fib b. left bundle branch block c. right bundle branch block d. normal

EKG #6

1. What does this EKG represent? a. V-fib b. left bundle branch block c. right bundle branch block d. normal

EKG #6

1. What does this EKG represent? a. V-fib b. left bundle branch block c. right bundle branch block d. normal

Bundle Branch Blocks 

Turn Signal Theory 1

2

3

LBBB

RBBB

EKG #7

1. What does this EKG represent? a. V-fib b. A-fib c. Supraventricular tachycardia d. normal

EKG #7

1. What does this EKG represent? a. V-fib b. A-fib c. Supraventricular tachycardia d. normal

Differential Diagnosis of Tachycardia Tachycardia Narrow Complex ST (HR < 150) Regular

Irregular

SVT (HR > 150) Atrial flutter (HR = 150) A-fib A-flutter w/ variable conduction MAT

Wide Complex ST w/ BBB SVT w/ BBB

VT A-fib w/ BBB

A-fib w/ WPW VT

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EKG #8 19 year old male with complaints of palpitations

1. What would you do next based on this EKG? a. Reassure and discharge b. Refer for electrophysiology study c. Begin a beta-blocker

EKG #8 19 year old male with complaints of dizziness and palpitations

1. What would you do next based on this EKG? a. Reassure and discharge b. Refer for electrophysiology study c. Begin a beta-blocker

EKG #9

1. The therapy of choice is: a. Thrombolytics b. Cath and PCI c. NSAIDs and Colchicine

EKG #9

1. The therapy of choice is: a. Thrombolytics b. Cath and PCI c. NSAIDs and Colchicine

Pericarditis  PR

segment depression, usually in lead II

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EKG #10

This patient is a 50 year old man who presented to the ED with chest tightness and is noted to be markedly hypotensive on exam. What is your therapy for BP restoration? A. Dopamine B. IVF bolus C. Balloon pump

EKG #10

This patient is a 50 year old man who presented to the ED with chest tightness and is noted to be markedly hypotensive on exam. What is your therapy for BP restoration? A. Dopamine B. IVF bolus C. Balloon pump

What about the right side? RV infarcts Occur in conjunction with inferior MIs  Move

V4 to the right side same location 

5th intercostal space anterior axillary 29

Acute MI with RV involvement

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Acute MI with RV involvement  IVF

to increase filling pressures  Inotropes to follow IVF loading  RV - VAD

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EKG #11

This patient is 40 year old woman with pleuritic chest pain and breathlessness. What is the diagnostic test of choice? a. Echo b. CTA c. CXR

EKG #11

This patient is 40 year old woman with pleuritic chest pain and breathlessness. What is the diagnostic test of choice? a. Echo b. CTA c. CXR

S1Q3T3 pattern is only second to D-dimer

EKG #12

1. What does this EKG represent? a. V-fib b. A-fib c. A-flutter d. V- tach

EKG #12

1. What does this EKG represent? a. V-fib b. A-fib c. A-flutter d. V- tach

EKG #13

1. What does this EKG represent? a. V-fib b. left bundle branch block c. right bundle branch block d. normal

EKG #13

1. What does this EKG represent? a. V-fib b. left bundle branch block c. right bundle branch block d. normal

EKG #14

1. What does this EKG represent? a. Pericarditis b. Myocardial infarction c. Early Repolarization

EKG #14

1. What does this EKG represent? a. Pericarditis b. Myocardial infarction c. Early Repolarization

Classic findings 1. J-point “notching”

2. Concave-up ST segment (smiley face) 3. ST segment elevation from baseline in V2-V5, typically <3mm 4. Large, symmetrically concordant T-waves in leads with STE

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Classic findings 1. J-point “notching”

2. Concave-up ST segment (smiley face) 3. ST segment elevation from baseline in V2-V5, typically <3mm 4. Large, symmetrically concordant T-waves in leads with STE

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Can we tease it out?  The

degree of ST segment elevation is thought to be indirectly proportional to the degree of sympathetic tone

 In

other words, the more relaxed the patient, the more pronounced the ST segment elevation (and vice versa)

 If

you truly want to test your patient, get their heart rate up and look at the ST segment 44

HR 64

HR 83

The ST segment is NOT fixed in pts w/ BER and changes from EKG to EKG and with the degree of sympathetic strain On the right, note the complete resolution of the ST elevation but maintenance of the J-point notching in V4

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