Atrial Enlargment

1. Right: V1 - P waves amplitude exceeds 1.5 mm in inferior leads

II - > 2.5 mm in
2. Left: V1 – amplitude of negative part of P wave > 1 mm below isoelectric line, P wave duration >1 mm
II – biphasic > 120 msec

Ventricular Hypertrophy
1. Right:
a. R Axis deviation w/ QRS exceeding + 100
b. R wave > S wave in V1 S wave > R wave in V6
2. Left:
a. R wave in V 5 + V6 S Wave in V1 + V2 exceed 35
b. R wave in aVL exceeds 13

R in AVL + S in V3 > 28 mm in men or 20 mm in women

1. Left:
a. > 20 limb leads
b. S in V1 / V2 > 30 or R in V5 V6 > 30

Supraventricular Arrhythmias Rate:

PSVT – regular P waves are retrograde if visible 150-250 Carotid Massage slows or terminates

Atrial Flutter
Rate
PSVT 150-250 Regular
P waves are retrograde if visible
Tx: carotid massage
Flutter 250-350 Regular, saw tooth
2:1, 3:1, 4:1 block – with fractioned ventricular rate
Fibrillation 350-500 Irregular, undulating baseline
Carotid massage may work
Without baseline – irregularly irregular QRS complexes
Mat 100-200 or <100 Irregular
3 P wave morphologies
Carotid massage doesn’t work
PAT 100-200 Regular
Warm up period in automatic form

VT PSVT
Clinical History Diseased Heart Healthy
Carotid Massage Responsive
Cannon – A waves Present Absent
AV dissociation Present Absent
Fusion beats Present Absent
QRS deflection May differ

Fast + Narrow
1. PSVT
Sick Sinus Syndrome – alternating brady cardia + SVT normal QRS no P wave = junctional
Fucked up QRS = Ventricular escape
AV Blocks
1. First Degree
a. PR interval > 0.2 seconds
2. Second Degree
 a. Morbitz Type I – prolongation of PR until QRS is dropped
b. Morbitz Type II – QRS dropped without prolongation of PR Interval
3. Third Degree
a. Complete AV dissociation

RBBB
1. RSR – rabbit ears in V1 + V2 w/ ST segment depression
2. Reciprocal changes in V5, V6, I, aVL ( Wide S in V1 + V6)
3. Wide QRS > 0.12 seconds

LBBB
1. L axis deviation
2. Broad / Notched R wave w/ prolonged upstroke in left lateral leads, St depression + T wave inversion
3. Reciprocal changes in V1 + V2 Deep S waves
4. QRS complex wide > 0.12 seconds

WPW
1. PR interval < 0.12 seconds
2. Wide QRS complex
3. Delta wave
4. WPW + accessory pathway  Vfib

LGL Syndrome
1. PR interval < 0.12 seconds
2. Normal QRS width
3. No delta wave

MI
Anterior = V2, V3 V4 LAD + reciprocal changes in inferior leads
Inferior = II, III, aVF RCA + reciprocal changes in anterior + left lateral leads
Left lateral leads: I, AVL, V5, V6 LCX + reciprocal changes in inferior leads
Right Leads, AVR, V1
Posterior V1 St depression, tall R wave – R coronary artery

J point elevation

1. T wave peaks  inverts

2. St elevates
a. Differential: J point elevation, acute pericarditis, myocarditis, hyper K+, E, Brugada, Hypothermia
3. Q waves – greater than 0.04 seconds in duration Depth > 1/3 height of the R wave
a. May signify an old MI
4. J point elevation

Hypothermia – Osbourne waves

Dignoxin – ST segment depression + Wenckebach block + paroxysomal a tach w/ 2:1 block
Electrical alterans – QRS complex shifts subtle
HOCM – Q waves
Pericardial effusion – decreased voltage

PE
1. RVH
2. RBBB
3. Large S ave in lead 1 + deep Q wave in lead 3 T wave inversion in lead 3
 1. Data Gathering
a. Standardization
b. Heart Rate – if irregular heart rate, count up QRS complexes – EKG overall = 10 seconds
c. Intervals – use lead II
i. PR = start of P to start of QR
ii. QT = start of Q to end of T
iii. QRS = start of Q to end of S)
d. QRS Axis – 30 to 90 = normal axis
2. Diagnoses
a. Rhythm
i. P waves
ii. QRS wide or narrow
iii. Relationship between P + QRS complexes
iv. Rhythm Regular or Irregular
3. R wave progression – V1 – V6 – it should become more and more positive
4. AV Block
5. Bundle branch block – if QRS is wide
6. Prexcitation
7. Enlargement Hypertrophy
8. Coronary Artery Disease

Turn off stray lights, optimize room lighting, view images in order

Patient Data (name history #, age, sex, old films)

Routine Technique: AP/PA, exposure, rotation, supine or erect

Trachea: midline or deviated, caliber, mass

Lungs: abnormal shadowing or lucency

Pulmonary vessels: artery or vein enlargement

Hila: masses, lymphadenopathy

Heart: thorax: heart width > 2:1 ? Cardiac configuration?

Mediastinal contour: width? mass?

Pleura: effusion, thickening, calcification

Bones: lesions or fractures

Soft tissues: don’t miss a mastectomy

ICU Films: identify tubes first and look for pneumothorax

Six causes of air bronchograms are; lung consolidation,
pulmonary edema, nonobstructive pulmonary atelectasis,
severe interstitial disease, neoplasm, and normal expiration.