HOAG ECG TEST PAPER UPDATED QUESTIONS AND
ANSWERS GRADED A+
✔✔1st Degree Heart Block - ✔✔Prolonged PR Interval, greater that 0.20 seconds.
"R is far from P, you have a 1st degree"
✔✔2nd Degree Heart Block Type 1 (Wenckebach) - ✔✔Progressing lengthening of PRI
until a P wave is conducted with no QRS following it.
Rate: Normal
R to R interval is irregular due to dropped QRS
✔✔2nd Degree Heart Block Type 2 - ✔✔groups of complexes then a pause with one or
more P waves and no QRS following them. Regular P waves, QRS are dropped.
✔✔3rd Degree Block - ✔✔Complete heart block; regular, independent P waves (60-
100) and regular, independent QRS completes (20-40)
✔✔Left bundle branch block (LBBB) - ✔✔LV depolarization is delayed
Criteria:
- Wide QRS > 0.12
- Broad (+/- notched) R waves, ST depression & T-wave inversion in
I, aVL, V5, V6
- Broad S waves in V1, V2
- Left axis deviation may be present
✔✔Right bundle branch block (RBBB) - ✔✔Right ventricular depolarization is delayed
Criteria:
- Wide QRS
- RSR' in V1, V2 ("bunny ears") with ST depression and T wave inversion
- Late S waves in I, aVL, V5, V6 (reciprocal changes)
✔✔Premature Atrial Contraction (PAC) - ✔✔irregular heart rhythm characterized by
atrial contractions occurring before the expected time
✔✔Atrial Tachycardia - ✔✔Rate: 150-250 beats per minute
Regularity: regular
P-waves: may be upright or inverted will appear different from underlying rhythm
QRS-complex: Normal
PR interval- may be normal, shortened, or prolonged
✔✔Wandering Atrial Pacemaker - ✔✔Heart rate < 100bpm; occurs when atrium
generate consecutive action potentials that are all conducted to ventricles; must have
three distinctly different P wave morphologies and a ventricular rate of less than
100bpm
, ✔✔Atrial Fibrillation (A-Fib) - ✔✔an irregular and often very fast heart rate originating
from abnormal conduction in the atria; P waves: absent/non-discernable; PRI: n/a; QRS:
narrow
✔✔Atrial Flutter - ✔✔Sawtooth; normal rate; PRI: n/a; QRS: narrow. Abnormal
conduction circuit develops inside right atrium, allowing atria to beat at 250-300bpm;
more consistent and less chaotic than A-fib
✔✔paroxysmal atrial tachycardia (PAT) - ✔✔bursts of atrial contractions with little pause
between them;
✔✔Supraventricular Tachycardia (SVT) - ✔✔Episodes of abnormally fast/racing
heartbeat; 150-220bpm; indistinguishable P waves
✔✔normal sinus rhythm - ✔✔heart rhythm originating in the sinoatrial node with a rate
in patients at rest of 60 to 100 beats per minute
✔✔Sinus Tachycardia - ✔✔>100 (100-150)
normal sinus rhythm
✔✔Sinus Bradycardia - ✔✔<60
normal sinus rhythm
✔✔Sinus Arrhythmia - ✔✔A sinus rhythm in which the rate varies with respiration,
causing an irregular rhythm.
✔✔Sinus Arrest - ✔✔- SA node doesn't fire
- notice absence of P-wave for a complete cycle (a missed cycle)
✔✔QT Monitoring - ✔✔defaulted on "ON"; normal QT interval is 0.36-0.44; high limit is
500ms; QT and HR is inverse
✔✔QT - ✔✔Uncorrected QT
✔✔QTc - ✔✔QT corrected for heart rate
✔✔QTc HR - ✔✔HR used to calculate QTc
✔✔dQTc - ✔✔Delta QTC or the change in QTc from baseline
✔✔CANNOT ANALYZE QT - ✔✔Monitor will say this if QT morphology is too varied to
get an accurate measurement
✔✔When to discontinue QT monitoring - ✔✔1. Very flat T-wave;
ANSWERS GRADED A+
✔✔1st Degree Heart Block - ✔✔Prolonged PR Interval, greater that 0.20 seconds.
"R is far from P, you have a 1st degree"
✔✔2nd Degree Heart Block Type 1 (Wenckebach) - ✔✔Progressing lengthening of PRI
until a P wave is conducted with no QRS following it.
Rate: Normal
R to R interval is irregular due to dropped QRS
✔✔2nd Degree Heart Block Type 2 - ✔✔groups of complexes then a pause with one or
more P waves and no QRS following them. Regular P waves, QRS are dropped.
✔✔3rd Degree Block - ✔✔Complete heart block; regular, independent P waves (60-
100) and regular, independent QRS completes (20-40)
✔✔Left bundle branch block (LBBB) - ✔✔LV depolarization is delayed
Criteria:
- Wide QRS > 0.12
- Broad (+/- notched) R waves, ST depression & T-wave inversion in
I, aVL, V5, V6
- Broad S waves in V1, V2
- Left axis deviation may be present
✔✔Right bundle branch block (RBBB) - ✔✔Right ventricular depolarization is delayed
Criteria:
- Wide QRS
- RSR' in V1, V2 ("bunny ears") with ST depression and T wave inversion
- Late S waves in I, aVL, V5, V6 (reciprocal changes)
✔✔Premature Atrial Contraction (PAC) - ✔✔irregular heart rhythm characterized by
atrial contractions occurring before the expected time
✔✔Atrial Tachycardia - ✔✔Rate: 150-250 beats per minute
Regularity: regular
P-waves: may be upright or inverted will appear different from underlying rhythm
QRS-complex: Normal
PR interval- may be normal, shortened, or prolonged
✔✔Wandering Atrial Pacemaker - ✔✔Heart rate < 100bpm; occurs when atrium
generate consecutive action potentials that are all conducted to ventricles; must have
three distinctly different P wave morphologies and a ventricular rate of less than
100bpm
, ✔✔Atrial Fibrillation (A-Fib) - ✔✔an irregular and often very fast heart rate originating
from abnormal conduction in the atria; P waves: absent/non-discernable; PRI: n/a; QRS:
narrow
✔✔Atrial Flutter - ✔✔Sawtooth; normal rate; PRI: n/a; QRS: narrow. Abnormal
conduction circuit develops inside right atrium, allowing atria to beat at 250-300bpm;
more consistent and less chaotic than A-fib
✔✔paroxysmal atrial tachycardia (PAT) - ✔✔bursts of atrial contractions with little pause
between them;
✔✔Supraventricular Tachycardia (SVT) - ✔✔Episodes of abnormally fast/racing
heartbeat; 150-220bpm; indistinguishable P waves
✔✔normal sinus rhythm - ✔✔heart rhythm originating in the sinoatrial node with a rate
in patients at rest of 60 to 100 beats per minute
✔✔Sinus Tachycardia - ✔✔>100 (100-150)
normal sinus rhythm
✔✔Sinus Bradycardia - ✔✔<60
normal sinus rhythm
✔✔Sinus Arrhythmia - ✔✔A sinus rhythm in which the rate varies with respiration,
causing an irregular rhythm.
✔✔Sinus Arrest - ✔✔- SA node doesn't fire
- notice absence of P-wave for a complete cycle (a missed cycle)
✔✔QT Monitoring - ✔✔defaulted on "ON"; normal QT interval is 0.36-0.44; high limit is
500ms; QT and HR is inverse
✔✔QT - ✔✔Uncorrected QT
✔✔QTc - ✔✔QT corrected for heart rate
✔✔QTc HR - ✔✔HR used to calculate QTc
✔✔dQTc - ✔✔Delta QTC or the change in QTc from baseline
✔✔CANNOT ANALYZE QT - ✔✔Monitor will say this if QT morphology is too varied to
get an accurate measurement
✔✔When to discontinue QT monitoring - ✔✔1. Very flat T-wave;
