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ECG Practical Exam Reviewer

Practical Exam Answers (2016) B. Phase 2

 ST Segment – Starts at the end of S to the beginning of T
1. Atrial Repolarization  Represents phase 2 of ventricular repolarization
2. Phase 2 Related topics:
3. Lead III Phase 0
4. 60 BPM  QRS wave
5. ST Interval  Ventricular depolarization
6. aVF Phase 3
7. V6  T wave
8. Very tall t waves  Ventricular repolarization
9. 0.2 mv Phase 4
10. 1st degree AV Block  TP segment – starts at the end of T to the beginning of P
11. Phase 3
12. Hypokalemia Phase 0
13. QT Interval
14. PR segment
15. 0.16 – 0.17 sec
16. Lead II Phase 3
17. Lead II Phase 2
18. SP/DP
19. False elevated systolic BP
20. 90 mmHg

I. Analysis of answers
A. Atrial Repolarization
 There is no ECG wave for atrial repolarization C. Lead III
 It occurs together with ventricular repolarization  Left arm and left leg (+)
 Atrial repolarization wave (atrial T wave) is buried under the Related topics:
QRS complex/wave
Related topics: Three Bipolar Limb Leads
Lead I
P wave  Right arm and left arm (+)
 Atrial Depolarization Lead II
QRS complex  Right arm and left leg (+)
 Ventricular depolarization Einthoven’s triangle
 Q wave – Interventricular septum depolarization  Formed Lead I, Lead II,
 R wave – apical depolarization Lead III
 S wave – depolarization of the base of the ventricle  Lead II = Lead I + Lead III
T wave Electrodes
 Ventricular repolarization  Right arm – RED
U wave  Left arm – YELLOW
 Repolarization of papillary muscles  Right leg – BLACK
 Left leg – GREEN

**Right – Marcos (red) Patay (black)

**Left – Cory (yellow) Buhay (green)

Huey Javier, RN 1 of 4
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D. 60 BPM
Determination of Cardiac Rate for Regular Rhythm

Required: If asked for the formula

Easier way to count:

F. aVF
 Left leg (lower most portion of the heart – apex)
Related topics:
 aVR – active is the Right arm (uppermost right side of the
1 2 3 4 .5 heart)
 aVL – left electrode(left extremity lead)

G. V6
 Same level as V4 and V5 but located at the mid axillary line
Determination of Cardiac Rate for Irregular Rhythm:  Represents lateral left ventricle together with V5
Related topics: Landmark – Angle of Louis
Lead Position Representation
V1 4th ICS – LPSB Right side of heart
(right ventricle or
right bundle branch)
V2 4th ICS – RPSB Septum
V3 Between V2 & V4 Anterior Left
V4 5th ICS – LMCL Ventricle
(below the nips)
V5 Same level with V4
– LAAL Lateral Left
V6 Same level with V4 Ventricle
V5 – MAL
E. ST Interval Additional leads
 Starts at the end of S to the end of T V7 Same level with V5
V6 – PAL Posterior side of the
 Measures the whole period of latent repolarization
Related topics: V8 5th ICS - Left Heart
Midscapular Line
J point
 Marks the end of depolarization and start of repolarization
 Normally lies on the isoelectric line

[Physio A] ECG Practical 2 of 4

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H. Very tall T waves I. 0.2 mv

 Condition: Hyperkalemia  2 small boxes = 0.2mv
o Peaked T waves (same as QRS) (HyperTkalemia)

Related topics:
 Condition: Hypokalemia
o Prominent U wave (HypUkalemia)

J. 1st degree AV Block (Partial)

 Prolong PR segment or PR Interval
 Normal PR interval is 0.12 – 0.21

 Condition: Ventricular Hypertrophy

o Very tall R waves & Very deep S waves
o QRS interval is >0.10 sec

Related topics
2nd degree AV Block Type I (incomplete)
 Prolongation of PR interval until a drop beat
 Pinapatagal lang tapos mawawala din 

 Condition: Hypocalcemia
o Prolonged ST and QT intervals
 Condition: Hypercalcemia
o Shortened QT intervals

2nd degree AV block Type II (incomplete)

 PR intervals do not lengthen but there is a drop beat
 Walang pasabi bigla bigla ka nalang mawawala 

 Condition: Ischemia (iSTemia)

o ST depression

3rd degree AV block (complete)

 Condition: InfarcTion  Ventricle is independent of atrial activity
o ST elevation
o Peak T wave

[Physio A] ECG Practical 3 of 4

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K. PR Segment Mean Arterial Pressure

 AV nodal delay
Related topics:

QT Interval
 Ventricular muscle action potential or Ventricular muscle
depo and repo; electrical systole of the heart
PR Interval
 Duration of atrial depolarization + AV nodal delay
Atrial Muscle
 First to depolarize is the first to repolarize
Ventricular Muscle
 First to depolarize is the last to repolarize
AHA Updated Blood Pressure Categories 2017
L. Normal Values

M. Blood Pressure

Errors in Blood Pressure taking

According to Bates
Cause Effect
Cuffs that are too short and
narrow
Loose cuff Falsely high reading
Brachial artery is much below
the heart level
Crossing the legs Increased systolic blood
Exercise pressure
Cuffs that are long and wide
Tight cuff False low reading
Brachial artery is much above
the heart level
Slow or repetitive inflation of the False low systolic and high
BP cuff causes venous diastolic
congestion

[Physio A] ECG Practical 4 of 4

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