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Unit 12 (Tommy) > 12.3 Clinical Electrophysiology > Flashcards

12.3 Clinical Electrophysiology Flashcards

1
Q

Why is an electrocardiogram (ECG) good?

A
  • Cheap
  • Quick
  • Non-invasive
  • Can help diagnose cardiac and non-cardiac conditions
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2
Q

Draw a normal ECG

A
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3
Q

Where do the limb leads go?

Explain how lead I, II, III work

A
  • Right arm (RA)
  • Left arm (LA)
  • Right leg (RF)
  • Left leg (LF)

LEAD III goes Left arm to Right leg

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4
Q

Draw where the chest leads go

A
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5
Q

Explain the waves in an ECG and label the heart for where each section takes place

A
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6
Q

Explain how to read the timing of an ECG on the strip

A
  • The paper strip shows electrical activity over time-
    • 5 small squares 200ms
    • 5 big squares 1 second
    • One standard ECG strip- 10 seconds
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7
Q

Explain (diagram) the different areas on an ECG strip

A
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8
Q

Explain where the chest leads point to in the heart

A
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9
Q

Explain where on an ECG you would see areas of the heart

A
  • In the chest leads section
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10
Q

What do you check for in an ECG analysis?

A
  1. Check details
  2. Rate
  3. Rhythm
  4. Axis (refers to the overall electrical direction within the heart)
    • Towards an electrode is POSITIVE
    • Away from an electrode is NEGATIVE
  5. The alphabet (P, PR interval, QRS complexes, ST segment, T waves, QT interval)
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11
Q

How do you work out rate (heart) on an ECG strip?

A

Rate = Total number of R waves x 6 (on a standard 10sec strip)

Rate = 300 / number of large squares between R waves

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12
Q

What is a normal heart rate (too low/too high meaning)?

A

Normal heart rate = 60-100bpm

>100bpm = tachycardia

<60bpm = bradycardia

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13
Q

What do you check for in terms of rhythm on an ECG?

Atrial fibrillation & atrial flutter tell tell signs?

A
  • For it to be normal sinus rhythm
    • Normal looking P wave
    • Always followed by a QRS
    • In a regular fashion
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14
Q

What happens in atrial fibrillation? (ECG)

A
  • IRREGULARLY IRREGULAR QRS complexes
  • NO P waves (no SA node stimmulation)
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15
Q

What happens in atrial flutter? (ECG)

A

Can have different types of blocking e.g. 2:1 block (R waves 2 big squares apart), 3:1 block (R waves 3 big squares apart

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16
Q

Explain complete (third degree) AV block on an ECG

A

Atrioventricular block = Conduction (communication) between the atria and ventricles of the heart is impaired

  • Rate about 35bpm
  • Regular QRS complexes
  • There are p-waves BUT…
  • No relationship between p-waves and QRS complexes, more Ps than Qs
17
Q

What is first degree heart block?

A
  • The impulse is delayed at the AV node and PR interval >0.2seconds (same amount of time always) (regularly irregular)
18
Q

What is second degree heart block?

A

Mobitz Type 1

  • PR interval will become greater* and *greater* until there will be a *dropped QRS complex and there are two consecutive P waves, after which the pattern will restart
  • ​*Mobitz Type 2
  • PR and R to R intervals will remain consistent, but there will be “missing” QRS complexes (always come back in a pattern e.g. miss, seen, seen, miss, seen…)
  • Is more serious
19
Q

Explain what happens on an ECG in ventricular tachycardia (& show how it would be seen on an ECG)

A
  • Regular tachycardia, rate ~150bpm
  • Broad QRS complexes
  • No obvious preceding atrial activity
20
Q

What are the types of axis & show how they would be seen on an ECG (lead I & II)?

A
21
Q

Explain what is left axis deviation

A
  • Look at leads I, II, III
  • If lead I is positive, II is middling/negative and III negative, there is left axis deviation
  • The deflections are Leaving each other in Left axis deviation
22
Q

Explain right axis deviation

A
  • Lead I is more negative, and III is positive, it is right axis deviation
  • Lead I and Lead III are Reaching toward each other in Right axis
23
Q

What conditions can cause left axis deviation?

A
  1. Early conduction disease
  2. Myocardial Infarction
  3. Atrial Septal Defect
  4. Obesity
  5. Wolff-Parkinson White
24
Q

What conditions can cause right axis deviation?

A
  1. Myocardial Infarction
  2. RV strain-
    1. Pulmonary (COPD, PE, pulmonary hypertension
    2. Cardiac- RV cardiomyopathy, WPW
25
Q

What are the different types of P waves (abnormal)?

A
  • Normal
  • Right atrial enlargement (pulmonale) - big P wave
  • Left atrial enlargement (mitrale) - 2 P waves
26
Q

What could a prolonged PR interval mean?

A

1st degree heart block (if more that 0.2secs)

27
Q

How does a contraction of the heart take place? (impulse)

A
  1. The heart’s primary impulse generator is the sinoatrial (SA) node located in the right atrium.
  2. The impulse is carried through the cardiac muscle tissue of the atria.
  3. This causes the atria to contract.
  4. The impulse then travels through the network to the ventricles causing them to contract.
  5. The resulting action causes blood to be pumped through the body via connecting blood vessels.
28
Q

What is left bundle-branch block (LBBB) (&how is it seen on ECG)?

A
29
Q

What is right bundle-branch block? (RBBB)

A
30
Q

What abnormalities could be seen in the ST segment & what these could mean?

A
  • ELEVATION
    • Infarction
    • Pericarditis
  • DEPRESSION
    • Ischaemia
31
Q

What abnormalities can be seen in the T wave?

A
  • FLAT/PROLONGED T wave = LOW K+
  • PEAKED = High K+/early MI
  • INVERSION = Ischaemia
32
Q

Explain how the QT interval is measured

A
  • Is longer in women

Unit 12 (Tommy) (17 decks)

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