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Question 1

What would you see in left axis deviation?

Answer 1

Both lead III AND II are negative.

Lead I is positive.

Question 2

All leads should be positive in I, II and III.

What would you see if there was right axis deviation?

Answer 2

Lead I is negative

Lead II and III are positive

Question 3

What would you see in first degree block?

Answer 3

The R is far from P (prolonged PR interval)

Question 4

What would you see in 2nd degree block: Wenckebach

Answer 4

Longer longer longer drop!

Progressive lengthening of the PR interval and then failure or conduction of the QRS complex.

The PR interval is longest before the QRS drop and shortest after it.

Question 5

What would you see in Mobitz Type 2?

Answer 5

‘If some P’s just don’t go through then you have a ….’

Some QRS’s are dropped randomly.

There can be a pattern of ratio conduction I.e 3 atrial beats to 1 qrs = 3.1 ratio

Question 6

What would 3rd degree show?

Answer 6

‘If the p’s and q’s just don’t agree then you have a third degree’

A complete disassociation between atrial beats and ventricle beats.

Question 7

What would you see in LBBB?

Answer 7

Predominantly negative Qrs in V1 and positive strong R in V6.

It is best seen in V6:

• where there is a widened qrs
• a notched top of an R wave or a positive qrs resembling an M shape ‘bunny ears’

Question 8

What would you see in Rbbb?

Answer 8

It is best seen in V1 where there is an RsR pattern or M shape

Question 9

What would you see in a Stemi

Answer 9

1mm+ ST elevation in 2 or more adjacent leads.

Reciprocal changes can be seen such as depression and t wave inversion in electrically opposite leads

Question 10

What extra to do if anterior stemi is suspected

Answer 10

Do a posterior ecg to gain V7, v8 and v9 views

Question 11

How to treat a stemi and LBBB

Answer 11

Manage ABCs
I’ve morphine in left arm
Oxygen if spo2 below 94%
GTN (glyceryl trinitrate)
Aspirin
Iv paracetamol left arm
Entonox If pain not controlled
Ondansetron if needed

Transfer to cath lab for coronary angiography then primary percutaneous coronary intervention eg. Stent placement (Presentation must be within 12 hours of onset of symptoms)

Question 12

What would you see in benign early repolarisation (high take off)

Answer 12

Widespread st elevation that is most prominent in v2-v5.

A notched irregular J point ‘a fish hook’ that is best seen in V4. /\,

There will be no reciprocal st depression except in aVR.

Question 13

What would you see in pericarditis?

Answer 13

Widespread ST elevation
and PR depression throughout most limb leads and v2-v6

The degree of elevation is usually 0.5-1mm

S+s include tachycardia due to pain.
Assess for pericardial rub, tachypneoa, tachyc and fever.

Question 14

When do to a v4r

Answer 14

If there’s inferior elevation to check for right ventricular involvement