1. Axis, hypertrophy, BBB, MI Practice

3. S bradycardia
Nl axis (30)
Lbbb

5. Borderline LAD/ Nl axis (0 to -30)
LBBB

7. A fib
Nl axis (0)
LBBB

9. S brady
Nl axis
RBBB

11. Nl axis
RBBB

13. NSR
Almost 1 AVB (did you look?)
Nl axis (0)
RBBB

15. NSR
Nl axis
Atrial abnormality

17. NSR
RAD (150)
RVH
Atrial abnormality LAE =“terminal” (pt Lt) portion of P in V1 is biggest

19. NSR
Axis 90
Atrial abnormality
(RAE=V1 first portion is biggest (pt rt))

21. NSR
Nl Axis
LVH with strain
Atrial abnormality

23. Atrial fibrillation
Normal axis
LVH with strain

25. Nsr,
RAD
RVH

27. Probably NSR
Nl axis
LBBB

29. AF
Nl axis
LBBB

30. 80 year old woman with reports to ER with weakness and palpitations- intermittent rapid, no CP, SOB or NV. She takes ACE and aldactone for HTN. Recently she takes ibuprophen for a burn on her left arm yesterday. Denies abuse Exam 90, 150/90, 14, 2nd degree burn measuring 6cm in diameter on lateral surface of forearm has broken blisters. CV exam normal

32. Hyperkalemia

34. NSR
Extreme AD -90
RBBB
Possible OIWMI and acute LW ischemia

36. NSR at ~75
(Maybe borderline 1 AVB)
RBBB

37. 20 year old gives a Hx of intermittent fast regular palpitations that make her SOB. They last several seconds to a minute, once or twice weekly. A quick- thinking PA-S gets a 12 lead Ekg while she says she has the palpitations.

39. SVT
She quickly recovers a NSR so the PA-S gets another 12 lead

41. What should she tell the electrophysiologist when she calls to refer?
Did you see short PR interval and delta waves?
There are also T wave inversions in inferior and lateral leads and criteria for LVH with strain
Suspect WPW with SVT

43. S brady
Nl axis 0
LVH with strain
peaked Ts and ST elevations in V1-3, T wave inversions elsewhere so
Suspect anterior infarction

45. Acute PWMI

46. A 49 year old has sharp sternal chest pain 7/10 for 3 days, getting worse.
PMHx unremarkable ROS had a “cold” a week ago. Soc Hx negative for smoking, cocaine, other drugs. Fam Hx neg for CAD.
Exam : 100, 140/90, 18, T 101, obese, leaning forward in stretcher,
CV Rapid R, Reg R, S1, S2, no MRG, + friction rub

48. Pericarditis

50. Sinus at about 60 (with PAC 3rd)
P waves visible in leads 2 and V1 but look at PR interval
LAD
Possible RBBB
WPW did you recognize delta waves?

52. NSR
Nl axis
LVH with strain

54. 3 AVB but hard to tell because QRS complexes too fast
Probable atrial abnormality
Nl axis

56. SR
RAD Axis 150
RVH
“atrial abnormality” LAE

58. Ventricular fibrillation

60. Hypertrophy P in II is odd-
Rate ~ 100
Rhythm NSR
Axis Normal ~ + 30
Hypertrophy P in II is odd-
“atrial abnormality” or
LAE (terminal portion of P in V1)
LVH- high voltage

62. Rate > 100
Rhythm sinus tach
Axis Normal to right (ambiguous not on test)
Hypertrophy- RAE

64. Probable NSR
LAD -30
Probable LVH
OIWMI

66. Probable junctional escape
RAD 120
Old AWMI

68. NSR, Nl Axis
Atrial abnormality
ST elevation in anterior leads= AAWMI

70. LAD
RBBB
OIWMI

72. Sinus rhythm
Normal axis
ST elevations inferior leads- AIWMI
ST depressions elsewhere
No Q waves

74. NSR/ ST
Axis ~ 0
ST elevations in anterior leads + AAWMI
Also Q waves in anterior leads- old MI or current MI is evolving to QWMI
Q waves in inferior leads= possible OIWMI

76. SR with PAC
LAD
R or LBBB or conduction delay
ST elevation in lateral leads AVL mostly-ALWMI
ST depression in inferior leads
If there is ST elevation in one area, it can cause ST depression in others. “Reciprocal changes”

78. NSR with multifocal PVCs

80. 2nd degree AV block type 1
Wenkebok
The PR intervals increase, then there is a p wave without QRS

82. SVT
It is rate ~300, narrow complex QRS
P waves cannot be seen- possibly it is too fast and they are buried. In any case, we call it SVT.
In this strip, there are also delta waves. (They are not obvious enough for me to ask that on the test.)
Also, normal axis and LVH

84. SVT

86. Rate
Rhythm- SVT
Axis- normal

88. Rate ~60
Sinus dysrhythmia
RBBB
Short PR and slurred upstroke QRS “delta waves”= WPW syndrome
Q waves in inferior leads- OIWMI
What dysrhythmia might this person get?

90. V tach

92. V tach

94. V fib

96. Ventricular fibrillation

98. Ventricular fibrillation

100. SVT
Pause
Junctional tachycardia

102. Rate ~70
LBBB
LVH

107. Possible, subtle LAE
LVH with strain
Possible or incomplete LBBB (look at V4)

109. Rate ~ 75
NSR
Normal axis
No hypertrophy
No acute or old MI
Normal EKG

111. Sinus Brady with PACs
LAD
RBBB
Acute LWMI with reciprocal ST depression in inferior leads

113. Acute antero-Lateral WMI

115. 3 AVB