Chapter·PhysiologyECG interpretation

ECG basics and lead placementDownloads

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Sample Questions

1

A 28-year-old male presents with sharp, stabbing chest pain that worsens when lying flat and improves when sitting forward. He reports a recent viral upper respiratory infection 2 weeks ago. On examination, a friction rub is heard on auscultation. His vital signs are stable. An ECG is most likely to show which of the following findings in this patient?

ADiffuse, concave ST-segment elevations

BPeaked T waves and ST-segment elevations in leads V1-V6

CSawtooth-appearance of P waves

DS waves in lead I, Q waves in lead III, and inverted T waves in lead III

EAlternating high and low amplitude QRS complexes

2

A 58-year-old man comes to the emergency department for complaints of crushing chest pain for 4 hours. He was shoveling snow outside when the pain started. It is rated 7/10 and radiates to his left arm. An electrocardiogram (ECG) demonstrates ST-segment elevation in leads V2-4. He subsequently undergoes percutaneous coronary intervention (PCI) and is discharged with aspirin, clopidogrel, carvedilol, atorvastatin, and lisinopril. Five days later, the patient is brought to the emergency department by his wife with complaints of dizziness. He reports lightheadedness and palpitations for the past 2 hours but otherwise feels fine. His temperature is 99.7°F (37.6°C), blood pressure is 95/55 mmHg, pulse is 105/min, and respirations are 17/min. A pulmonary artery catheter is performed and demonstrates an increase in oxygen concentration at the pulmonary artery. What finding would you expect in this patient?

AWidespread ST-segment elevations

BHarsh, loud, holosystolic murmur at the lower left sternal border

CPulseless electrical activity

DDrop of systolic blood pressure by 20 mmHg during inspiration

ENormal findings

3

A cardiologist is studying how a new virus that infects the heart affects the electrical conduction system of the cardiac myocytes. He decides to obtain electrocardiograms on patients with this disease in order to see how the wave patterns and durations change over time. While studying these records, he asks a medical student who is working with him to interpret the traces. Specifically, he asks her to identify the part that represents initial ventricular depolarization. Which of the following characteristics is most consistent with this feature of the electrocardiogram?

AElevated in patients with full thickness ischemic injury of the heart

BBecomes peaked in states of hyperkalemia

CBecomes prominent in states of hypokalemia

DNormal duration defined as less than 120 milliseconds

ENormal duration defined as less than 200 milliseconds

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