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Cardiology Review Questions:

12- lead EKG- cardiac depolarization and repolarization from 12 different sites on
the body surface

Lead I records from the left at a coordinate of 0o.

Lead II records from the foot at a coordinate of 60o.

Lead III records from the foot at a coordinate of 120o.

Lead aVR records from the right shoulder at a coordinate of -150o.

Lead aVL records from the left shoulder at a coordinate of -30o.

Lead aVF recordsdirectly from the feet below at a coordinate of 90o.

There are 6 chest leads- electrodes positioned horizontally around the 4-5th interspaces on
the left-anterior hemithorax:

Leads V1 and V2 record the current flux over the right ventricle directly.

Leads V3 and V4 record directly the electrical activities of the ventricular septum and the
anterior wall of the left ventricle.
Leads V5 and V6 record the current flow generated by the left ventricle directly.

In sinus rhythm when the SA node is the pacemaker, the mean direction of atrial
depolarization (the P wave axis) points downward and to the left, in the general direction of
lead II within a coordinate between 15o and 75o and away from lead aVR.

On this count the P wave is always positive in lead II and always negative in lead aVR during
sinus rhythm. Conversely, a P wave that is positive in lead II and negative in lead aVR
indicates normal P wave axis and sinus rhythm.

PR interval extends from the beginning of the P wave to the beginning of the QRS.
Normal range is 120 – 200 ms (3 to 5 1-mm-divisions) and no longer.

Normal HR: 60-100 beat/min


It is only necessary to examine the QRS complexes in leads I and II to determine whether
the QRS axis in normal or deviated to the left or the right; a precise calculation of the QRS
axis is not required in clinical interpretation of the ECG.

QRS axis is between -30o and -90o or deviated to the left (left axis deviation or LAD) if the
QRS is positive in lead I but negative in lead II.

QRS axis is between +90o and +150o or deviated to the right (right axis deviation or RAD) if
the QRS is negative in lead I but positive in lead II.

Anytime a patient is pulseless you are code blue and remember that 2 different
types of rhythm- shockable and non-shockable
Shockable rhythm are V-tach and V-fib- CPR- shock before medication
Non-shockable: asystole, and pulseless electrical activity- Drugs- IV 1 mg
epinephrine
V-fib will not have a pulse
v-tach may have pulse

The ECG sign of subendocardial ischemia is ST segment depression (A). Depression is


reversible if ischemia is only transient but depression persists if ischemia is severe enough to
produce infarction.

Signs of anterior MI (grey area), territory supplied by the left anterior descending coronary
artery (LAD), are seen in V1 to V4.
Signs of lateral MI (grey area), territory supplied by the left circumflex coronary artery (LC),
are seen in leads I, aVL, V5 and V6.
Signs of inferior MI (grey area), territory supplied by the right coronary artery (RCA), are
seen in leads II, III, and aVF.
Synchronized cardioversion: non-emergency- patients with an arrhythmia with a
pulse
Non-synchronized cardioversion: pts with an arrhythmia but no pulse

MVP- pregnant- increase in intravascular volume- mild-systolic click with mild


systolic murmur
MI-tight, pressure, midline sub-sternal chest pain
Whats the first thing you do to increase survival? First step management: aspirin-
increase in survival you can also get EKG
ST elevation? Necrosis- Window for T-PA- 3 hours
ST- depression? Then occlusion, ischemia

If pt given streptokinase before then if given again- immune rxn


Severe respiratory disease such as COPD: multifocal atrial tachycardia

Gastroenterology: Gallbladder
Cholelithiasis:

Acute otitis media:


Proximity of the middle ear and adjacent mastoid to the middle and posterior
cranial fossa
Middle ear fluid and inflammation of the mucosa that lines the middle ear space
Infection caused by obstruction of Eustachian tube, which results in fluid retention
and suppuration of retained secretions

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