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CVS > 9. ECG Common Abnormalilites > Flashcards

9. ECG Common Abnormalilites Flashcards

1
Q

What 2 things can abnormal rhythms be due to?

A

Abnormal pulse formation

Abnormal conduction

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2
Q

Where can supraventricular rhythms arise from?

A

Sinus node
Atrium
AV node

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3
Q

Do you get normal or abnormal ventricular depolarisation with supraventricular rhythms? What can be seen on the QRS complexes?

A

Normal ventricular depolarisation

Normal QRS complexes

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4
Q

What happens to the length of depolarisation in ventricular rhythms (ventricular ectopic beats)? What happens to the QRS complexes on an ECG?

A

Depolarisation takes longer, as not via usual His-purkinje system
Wide and bizarre QRS complexes

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5
Q

Give 2 examples of ventricular rhythms

A

Ventricular premature beats
Ventricular fibrillation
(Ventricular tachycardia)

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6
Q

What changes on an ECG depending on where the origin of the impulse is, which allows the diagnosis of an arrhythmia?

A

P wave and QRS complex

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7
Q

What is the rhythm strip on an ECG?

A

Lead II (sometimes also V1 and V5) best for looking at P waves

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8
Q

What is atrial fibrillation?

A

Multiple atrial foci making impulses chaotic

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9
Q

What is seen on an ECG in atrial fibrillation?

A

No P waves - wavy baseline

Narrow QRS complexes, irregularly irregular

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10
Q

What is heart block (AV conduction blocks)?

A

Delay/failure of conduction of impulses from atrium to ventricles via AV node and bundle of His

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11
Q

What are 2 causes of heart block?

A

Acute myocardial infarction (most common)

Degenerative changes

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12
Q

What happens in first degree heart block?

A

Atrioventricular conduction lengthened due to slow conduction in AV node and bundle of His

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13
Q

What is seen on an ECG in first degree heart block?

A

Normal P wave
PR interval prolonged (>5 small squares)
Normal QRS

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14
Q

What is seen on an ECG in Mobitz type 1 (Wenkebach) 2nd degree heart block?

A

Progressive lengthening of PR interval until one P is nor conducted, then cycle begins again

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15
Q

What is seen on an ECG in Mobitz type 2 second degree heart block?

A

PR interval normal

Sudden dropped QRS

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16
Q

Which type of second degree heart block has a high risk of progression to complete heart block?

A

Mobitz type 2

17
Q

What happens in third degree heart block?

A 
Atrial depolarisation normal
Impulses not conducted to ventricles
Ventricular pacemaker takes over
HR too slow to maintain BP and perfusion
Urgent pacemaker insertion required
18
Q

What is seen on an ECG in third degree heart block?

A

No relationship between P waves and QRS complexes
More P waves than QRS complexes
Wide QRS
HR slow 30-40bpm

19
Q

What is ventricular tachycardia?

A

Run of 3 or more consecutive ventricular ectopics. Is a broad complex tachycardia. If persists then is a dangerous rhythm, as high risk of VF need to shock to reset.

20
Q

What is ventricular fibrillation?

A

Abnormal ventricular depolarisation
Impulses from numerous ectopic sites in ventricular muscle
No coordinated contraction, ventricles quiver
No cardiac output - cardiac arrest

21
Q

What is seen on an ECG in VF?

A

Very rapid, irregular reading

22
Q

What changes are seen on an ECG in ischaemia and MI?

A

Need to look at PQRST in all 12 leads, changes seen in leads facing affected area
Leads facing affected area show ST segment depression, T wave inversion

23
Q

What are of the heart is most vulnerable in ischaemia and MI? Why?

A

Sub endocardial, as furthest from major coronary arteries

24
Q

When are ischaemic ECG usually seen?

A

During exercise (as flow through atherosclerosed coronary artery is usually during diastole, but diastole is shorter during exercise)

25
Q

What is am ST segment elevation myocardial infarction (STEMI)?

A

MI due to complete occlusion of lumen of coronary artery by thrombus. Muscle injury extends full thickness from endocardium to epicardium.

26
Q

What is seen on an ECG with an acute STEMI?

A

ST segment elevation in leads facing area affected

27
Q

What develops on an ECG following a STEMI that indicated necrosis?

A

Deep Q waves (more than 1 small square wide and 2 deep), ST segment elevation may still be present, or returned to normal

28
Q

What happens to the resting membrane potential in hyperkalaemia? What does this do to channel proteins and the heart?

A 
Less negative (more depolarised)
Inactivates dome voltage gated Na+ channels
Heart becomes less excitable leading to conduction problems
29
Q

What happens to the resting membrane potential in hypokalaemia? What affect does this have on the action potential?

A 
More negative (hyper polarised)
Longer ventricular action potential, increasing likelihood of early after depolarisations, leading to arrhythmia
30
Q

What is seen on an ECG in hyperkalaemia?

A

High T wave

Progressing to VF

31
Q

What is seen on an ECG in hypokalaemia?

A

Low T wave

Development of high U wave (wave that follows T wave)

CVS (14 decks)

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