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Year 1 CVS > Abnormal ECGs > Flashcards

Abnormal ECGs Flashcards

1
Q

What happens to an ECG in AF?

A

No p wave- just a fluctuating baseline
Pulse and heart rate irregularly irregular because AVN only conducts some atrial depolarisations when not in refractory period.
QRST normal but irregularly irregular

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2
Q

List the different types of heart block.

A

First degree
Second degree- Mobitz type 1 and Moritz type 2
Third degree or complete (Ventricular escape rhythm needed)

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3
Q

What is ventricular fibrillation and how does it appear on ECG tracing?

A

VF is abnormal, chaotic, fast depolarisation of the ventricles that arise from multiple ventricular foci. This gives an uncoordinated contraction that leads to quivering ventricles incapable of producing a cardiac output.
Cardiac arrest.

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4
Q

What ECG changes happen in acute MI?

A

ST elevation

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5
Q

Which ECG changes remain in patients with a history of MI?

A

Pathological Q waves

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6
Q

What happens to ECGs in ischaemia of the heart?

A

ST depression

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7
Q

Outline ECG changes that are seen in hypokalaemia.

A

Low T <3.5mmol/L
U waves <3mmol/L
St deression in <2.5mmol/L

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8
Q

What pacemaker taking over would invert a P wave?

A

AVN

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9
Q

Why is lead II a good strip?

A

Often the rhythm strip

Good p wave exposure

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10
Q

Why is lead II a good strip?

A

Often the rhythm strip (V1, V5 may also be used)

Good p wave exposure

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11
Q

Why are escape rhythms slower?

A

The SAN node is the fastest

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12
Q

Why are escape rhythms slower?

A

The SAN node is the fastest pacemaker of the heart so anything replacing it will be slower

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13
Q

Normal QRS with a prolonged PR interval (>5small squares) is….. and is caused by slow conduction in the…. and ….

A

First degree heart block

AVN and bundle of His

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14
Q

What is Moritz type 1 heart block and what other names does it go by?

A

Progressive lengthening of PR interval until one P wave does not conduct and make a QRS.
Wenkenbach phenonmenon in 2nd degree heart block

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15
Q

Second degree heart block Mobitz type 2 has what features on ECG

A

PR interval normal

Dropped QRS complexes

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16
Q

Why is Mobitz type 2 a concern?

A

High risk for progressing to complete heart block.

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17
Q

What is complete heart block?

A

Third degree heart block
Normal P wave but not conducted to ventricle
Ventricular pacemaker takes over- slow rate of QRSs and normally wide
No link between P and QRS

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18
Q

How do you treat this degree heart block?

A

Pacemaker urgently needed

HR too slow to maintain BP and perfusion (cardiogenic shock risk)

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19
Q

What is complete heart block?

A

Third degree heart block
Normal P wave but not conducted to ventricle
Ventricular pacemaker takes over- slow rate of QRSs and normally wide
No link between P and QRS
P-P interval constant and faster than Q-Q interval which are also constant

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20
Q

What is a ventricular ectopic?

A

Ectopic foci in the ventricle (foci is an origin of an impulse)

21
Q

A run on 3 or more ventricular ectopics is called ….

A

Ventricular tachycardia

22
Q

What do QRS look like in VT?

A

Wide - ventricular ectopic not conducted by fast His Purkinje system

23
Q

A run on 3 or more consecutive ventricular ectopics is called ….

A

Ventricular tachycardia

24
Q

Why is VT a dangerous rhythm?

A

Risk VF

25
Q

Are all leads affected in MI or cardiac ischaemia?

A

No just the leads facing affected myocardium

26
Q

Which leads are affected by a Right coronary artery occlusion?

A

Right ventricle affected so Inferor facing leads detect change
II, aVF, III

27
Q

Which leads are affected by a Right coronary artery occlusion?

A

Right ventricle affected so Inferior facing leads detect change
II, aVF, III

28
Q

V2 V3 and V4 would be affected in an MI involving which coronary artery?

A

Left anterior descending

Anterior heart affected

29
Q

Which artery being occluded would affect the lateral side of the heart? Which leads would show changes?

A

Left coronary artery

V6, V5 aVL and I

30
Q

Which area of myocardium is hardest to perfuse?

A

Endocardium is furthest from coronary arteries

31
Q

Which area of myocardium is hardest to perfuse?

A

Endocardium is furthest from coronary arteries so is most vulnerable to ischaemia

32
Q

Are iscahemic changes always seen on ECG if the heart has iscaemia?

A

No sometimes the heart only gets ischameic in exercise when the HR increases and systolic time is reduced. The coronary arteries flow in diastole so shorter time to perfuse a heart muscle that needs more oxygen.. ischaemia shown in exercise but not rest.

33
Q

ST depression and T wave inversion are signs of …

why do you get them?

A

Ischaemia

Abnormal currents in repolarisation

34
Q

When do you see ST elevation?

A

During acute occlusion of a coronary artery lumen by a thrombus.
Full thickness muscle injury

35
Q

Hours after an MI what do ECGs look like?

A

ST elevation
Lower R wave
Pathological Q wave

36
Q

1-2 days post MI the ECG shows?

A

T wave inversion

Deeper Q wave

37
Q

ST normalisation with T wave inversion is seen …… post MI

A

days

38
Q

What do Pathological Q waves indicate?

A

Muscle necrosis

39
Q

How do you know if a Q wave is pathological?

A

> 1 small sq wide

>2 small sq deep or more than 0.25 the night of the following R

40
Q

What are the signs of hyperkalaemia on ECG other than high T?

A 
Prolonged PR
St depressed
Atrial standstill
IV block
VF
41
Q

When assessing an ECG what do you comment on?

A 
rhythm 
rate
PR interval 
QRS int
QT int
P wave
QRS description 
ST segment position
T wave 
Axis
42
Q

What is cardiac axis?

A

Average over all direction of depolarisation spread in ventricles. Normal -30-90 degrees

43
Q

What can give a left axis deviation?

A

Problem with LBB
Inferior MI
LVH

44
Q

RVH shift cardiac axis to the….

A

right

45
Q

How do we check if cardiac axis has changed?

A

Compare is QRS is upright in which leads

46
Q

QRS upright in lead I but inverted in III and aVF

A

left deviation of cardiac axis

47
Q

right axis deviation look like what ?

A

aVF and lead III are upright QRS but lead I is inverted

48
Q

How do you remember right and left deviations?

A

compare avF and Lead I
QRS Leave each other (point in opposite directions) Left
QRS reach together (point toward each other) Right

Year 1 CVS (15 decks)

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