259.2 📚 國考版

259.2.0.1 必背 — Systematic Approach

  1. Standardization
  2. Rate
  3. Rhythm
  4. Axis
  5. Intervals (PR, QRS, QTc)
  6. Waves
  7. Chambers
  8. Ischemia / injury / infarction
  9. Special (WPW, channelopathy, electrolytes, drugs)

259.2.0.2 必背 — Normal Values

  • Rate 60-100
  • PR 120-200 ms
  • QRS < 100 ms
  • QTc < 440 men / < 460 women
  • Axis -30° to +90°

259.2.0.3 必背 — STEMI Criteria

  • ≥ 1 mm in ≥ 2 contiguous leads OR
  • ≥ 2 mm V2-V3 men; ≥ 1.5 mm V2-V3 women

259.2.0.4 必背 — MI Localization

Leads Region Artery
V1-V4 Anterior LAD
V5-V6, I, aVL Lateral LCx / diagonal
II, III, aVF Inferior RCA (80%) or LCx (20%)
V4R Right ventricle Proximal RCA
Posterior (V1-V2 reciprocal) Posterior LCx / RCA

259.2.0.5 必背 — Hypertrophy Criteria

  • LVH: Sokolow-Lyon S(V1) + R(V5/V6) ≥ 35 mm; or Cornell R(aVL) + S(V3) > 28 (M) / 20 (F)
  • LAE: P > 120 ms or P mitrale (bifid II)
  • RAE: P > 2.5 mm II (P pulmonale)

259.2.0.6 必背 — BBB

  • RBBB: QRS > 120, rSR’ V1, slurred S in V6
  • LBBB: QRS > 120, notched R V6, QS or rS V1
  • LAFB: left axis -45° to -90°
  • LPFB: right axis +90° to +180° (exclude RVH first)

259.2.0.7 必背 — AV Blocks

  • 1°: PR > 200
  • Mobitz I: progressive PR → dropped beat (benign)
  • Mobitz II: constant PR + dropped beats (often need pacemaker)
  • 3°: AV dissociation

259.2.0.8 必背 — WPW

  • Short PR + delta wave + wide QRS (pre-excitation)
  • Risk of SVT + AF with rapid conduction
  • Avoid AV nodal blockers in AF + WPW

259.2.0.9 必背 — Hyperkalemia Progression

  • Peaked T → flattened P → wide QRS → sine wave → asystole

259.2.0.10 必背 — Pericarditis

  • Diffuse ST elevation (concave) + PR depression (most leads, except aVR + V1)
  • vs STEMI: regional ST elevation + reciprocal changes

259.2.0.11 必背 — Pulmonary Embolism

  • S1Q3T3 + sinus tachycardia + RBBB + RAD + T-wave inversion V1-V3
  • Most common: sinus tachycardia alone

259.2.0.12 必背 — Long QT (Acquired)

  • Drugs: macrolides, FQ, antifungals, TCAs, citalopram, methadone, ondansetron
  • Electrolyte: hypoK, hypoMg, hypoCa
  • Risk: torsades de pointes
  • Treatment: stop drug + correct electrolytes + Mg IV for torsades

259.2.0.13 必背 — Sgarbossa Criteria (LBBB + Suspected MI)

  • Concordant ST elevation ≥ 1 mm: 5 points
  • Concordant ST depression ≥ 1 mm V1-V3: 3 points
  • Discordant ST elevation ≥ 5 mm: 2 points
  • ≥ 3 points = likely STEMI

259.2.0.14 必背 — Brugada Type 1

  • Coved ST elevation V1-V3
  • Risk of SCD
  • ICD if symptomatic or family hx SCD