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58 terms


High lateral leads
Low lateral leads
V5, V6
Septal leads
V1, V2
Anterior leads
V3, V4
Inferior leads
Posterior leads
None! Check the RECIPROCAL waves of Anterior leads
Left axis deviation indicators
aVL positive, aVF negative
Right axis deviation indicators
aVL negative, aVF positive
No Man's Land Axis Deviation
R wave transition
In V1-V6, the QRS complex changes from predominately negative (QrS) to predominately positive (qRs) w/ the R/S ratio becoming >1. This usually occurs at V3 or V4
R atrial enlargement indicators
1. P in INFERIOR leads PEAKED (>2.5 mm); 2. UPWARD half of diphasic P in V1 is 2X larger than downward part
L atrial enlargement indicators
1. P waves in INFERIOR leads >120 ms & DOUBLE-peaked;
2. DOWNWARD part of diphasic P waves in V1 is 2X larger than upward part
P-wave indicators of mitral valve Dz (p-mitrale)
1. Camel-humped P in INFERIOR leads
2. BOTH L & R Atrial abnormality
RVH indicators
1. RAD ((aVL NEG, aVF POS)
2. R-progression in V1-V6 reversed;
3. In V1: R > 7mm or HT of R >Depth of S
1. DEEP S waves thru-out precordium
2. RAD
3. Delayed R-wave transition
LVH indicators
1. S in V1+ R in V5 >35 mm;
2. R in V5 >26 mm
3. R in Lead 1 >14 mm
4. ST depression and T inversion in LEFT precordial leads (V4-6) show LVH ischemia
LVH w/ diastolic overload indicators
LVH + tall, peaked T's & deep Q's in lateral leads
RBBB indicators
MaRRoW: (M is RsR' in V1 and W is rSr" in V6
QRS always >120 ms
1. RsR' in V1, V2, or V3 (Septal or Anterior)
2. DEEP/WIDE S in Lead (1 or) 2 & V6
3. T may be inverted in Septal (V1/V2) leads
LBBB indicators
WiLLiaM: (W is rSr' in V1 and M is RsR' in V6).
QRS always >120 ms
1. W is DEEP/WIDE (r)S(r') complex in V1;
2. M is TALL/WIDE R(s) in lead (1 or) 2 & V6
3. T wave is always opposite QRS.
Ischemia indicators
PEAKED T-waves or DEPRESSED ST in 2 contiguous leads
Injury/Infarction indicators
ELEVATED ST in 2 contiguous leads
MI & Post-MI indicators
ELEVATED ST & abnormal Q's in 2 contiguous leads, INVERTED T
Coronary occlusion associated w/ Anterior MI
Left Anterior Descending (LAD) = Anterior Interventricular
Coronary occlusion associated with Lateral MI
Coronary occlusion associated with Inferior MI
Right Coronary
Coronary occlusion associated with Posterior MI
(Distal) Right Coronary
Anterior MI Indicators
Peaked T, Altered ST in V1-V4 (Anterior or Septal leads)
Lateral or Antero-lateral MI Indicators
Peaked T, Altered ST in V3-V6, or I/AVL
Inferior MI Indicators
Peaked T, Altered ST in II, III, aVF (Inferior leads)
Posterior MI Indicators
ST DEPRESSION in anterior (V3, V4) (RECIPROCAL anterior ST elevation); TALL R in V1, V2 w/ no RAD
Mobitz type 1 (Wenkebach) appearance
PR interval gets longer until QRS drops
Mobitz type 2
Constant PR intervals w/ intermittently dropped QRS
Escape pacemaker indicators
Increased PR, altered P on delayed beats
Left Anterior Fascicular Block (Left Hemi-block)
1. Left axis deviation (-45 to -90 degrees) 2. Tiny Q's & Large R's in 1 & aVL
3. rS in inferior leads (II, III, aVF)
4. Delayed R wave transition. S wave in V5-V6
Left Posterior Fascicular Block indicators
RAD >100
2. Tiny R & Deep S in 1 & aVL
3. Tiny Q & Large R in inferior leads (II, III, aVF)
S1-Q3-T3 & Significance
Deep S in I
Tiny Q in III
Inverted T in III
Voila! Pulmonary Edema
Chronology MI Indicators
Peaked T waves-->
ST Depression -->
ST Elevation-->
Inverted T waves
A-Fib etiologies
High Atrial pressure from HTN, CHF, or VHD
A-Fib Indicators
Quivering or saw-tooth baseline
A-Flutter etiologies
High Atrial pressure from HTN, CHF, or VHD cause re-entry around a counter-clockwise path at Tricuspid valve
A-Flutter Indicators
Atrial rate 220-320, typically right at 300;
Sawtooth "flutter waves" in Inferior leads;
Normal QRS in 2:1, 4:1 other pattern
Jim's 2nd Law
A heart rate of exactly 150 is 2:1 A-flutter until proven otherwise (Look for flutter waves in Inferior leads)
How to prove a 300 bpm trace is 2:1 A-Flutter
Adenosine stops QRS for 6-10 sec; Now count the p waves. One/box = 300. See any flutter waves
2nd degree block, 2:1
A-Fib, Rapid Ventricle
3rd Degree AV block
Left Atrial Enlargement
2nd Degree Mobitz 1 (Wenkebach)
A-Fib, Slow Ventricles
A Flutter, 2:1
1st Degree AV Block
A Flutter, 4:1
Left Ventricular Hypertrophy
Left Atrial Enlargement
Right Atrial Enlargement
Right Ventricular Hypertrophy
V Tach