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EKG fast interpretation

  • Ddx by rate, rhythm, axis, waves, intervals

    • Rate:
      • Tachy: sinus tach, afib, aflutter, WPW (delta wave), SVT, MAT
      • Wide tachy: vtach (regular), afib with WPW (irregular), torsades, vfib
      • Brady: sinus brady, SSS, 1st deg heart block (long PR), Wenkebach (progressive PR prolongation, dropped beat), Mobitz II (dropped beat), 3rd deg heart block (regular, P-QRS dissociation), escape rhythm (regular, no P waves)
      • Wide brady: ventricular escape rhythm
    • Rhythm:
      • tachy irregular: afib (narrow), afib with WPW (wide), afib with SSS (tachy-brady), MAT (multiple P morphologies), vfib, torsades
      • brady irregular: Wenkebach (progressive PR prolongation, dropped beat), Mobitz II (dropped beat), afib with SSS (tachy-brady)
      • narrow irregular: PAC, afib, aflutter, Wenkebach, Mobitz II, afib with SSS (tachy-brady), MAT (multiple P morphologies)
      • wide irregular: PVC, afib with WPW, vfib, torsades
    • Axis:
      • normal: QRS upright in I and aVF
      • left hypertrophy: QRS upright in I, down in aVF
      • right hypertrophy: QRS down in I
    • Waves and Intervals:
      • P waves: atrial enlargement (double humps in II, V1)
      • PR interval: 1st deg heart block, WPW (short PR, delta wave)
      • Q waves: normal in III, pathologic if 1/3 of QRS
      • QRS wide: PVC, hyperkalemia, afib with WPW, torsades, vfib, bundle branch block, pacer, AIVR
      • QRS: RBBB (V1 M, V6 W), LBBB (V1 W, V6 M)
      • ST: STEMI, NSTEMI, pericarditis
      • T: hyperkalemia (tall T), hypokalemia (U wave after T), MI (T inversions in V1-6)
      • QT: QTc prolongation (QT longer than 1/2 of RR)

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