Cardiology “Dig Effect”

EKG Changes in Hypokalemia

Delta wave (blurring of the R wave)

EKG Changes in Hyperkalemia © Andrea Cormier
Delta wave of WPW syndrome

Jugular Venous Pulsations

Right Ventricular Hypertrophy (RVH) Bundle Branch Blocks
• QRS < 0.12 seconds, R/S ratio > 1 in V1, R/S ratio < 1 in V5 and
V1 V2
V6, R > 7 mm in V1
• right axis deviation (RAD) (> 90º)
• asymmetric ST segment depression and T wave inversion
in V1 and V2 (RV strain pattern)
Left Ventricular Hypertrophy (LVH) RBBB
• S in V1 or V2 + R in V5 or V6 > 35 mm Clinical Approach to Arrhythmias
• S in V1 or V2 or R in V5 or V6 > 25 mm V6
• R in aVL > 11 mm (most sensitive criterion) Mobitz Type I
• R in I + S in III > 25 mm V1
• left axis deviation (LAD) (> –30º) with slightly widened QRS
• asymmetric ST segment depression and T wave inversion
(LV strain) leads I, aVL, V4-6
• left atrial enlargement (LAE) Atrial Flutter
Right Atrial Enlargement(RAE) (P Pulmonale)
• P wave > 2.5 mm (in height) in leads II, III or aVF
Left Atrial Enlargement (LAE) (P Mitrale)
• P wave duration > 0.11s best seen in leads I, II, aVL, V4-V6
LBBB
• large, biphasic P wave in V1 with deep terminal component that is
at least one square wide (0.04 sec) and one square deep (1 mm) Atrial Fibrillation
• notched P with interpeak interval > 0.04 seconds in I, II or aVL

Areas of Infarction/Ischemia (right dominant anatomy)

Paroxysmal
Usual Involved Vessel Infarct Area Leads Supraventricular
Toronto Notes 2006 – Editors: Carolyn Shiau and Andrew Toren

Toronto Notes 2006 – Editors: Carolyn Shiau and Andrew Toren

Tachycardia
left anterior descending (LAD) anteroseptal V1, V2
anterior V3, V4
anterolateral I, aVL, V3-V6 Ventricular
extensive anterior I, aVL, V1 - V6 Tachycardia
right coronary artery (RCA) inferior II, III, aVF
right ventricle V4R (V5R and V6R) (right sided chest leads)
posterior in the company of inf. MI V1 and V2 (prominent R waves)
circumflex lateral* I, aVL, V5, V6 Ventricular
Isolated posterior MI Fibrillation
*often no ECG changes because small infarcts and lateral wall is late in the depolarization (QRS complex)

Torsades de
Pointes

Acute Recent Old

days (avg. 3-5) weeks-months (avg. 2-6 months) months-years (avg. > 6 months)
ST segment elevation T wave inversion Just significant Qs
ECG changes with Infarction