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MBBS 3: Internal Medicine > Basic ECG > Flashcards

Basic ECG Flashcards

1
Q

What does a P wave indicate?

A

sinus rhythm

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2
Q

What does an ST interval indicate?

A

ischemia

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3
Q

What do the intervals indicate?

A
  1. heart rate
  2. heart blocks
  3. electrolytes
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4
Q

Calculating rate?

A

rate = 300/R-R interval in large squares
rate = 1500/R-R interval in small squares

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5
Q

Calculating rate in atrial fibrillation?

A
  1. use the rhythm strip count the number of QRS complexes in 10 seconds and multiply by 6
  2. give a range for the shortest distance between QRS and the longest
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6
Q

What does a normal sinus rhythm mean?

A
  1. P before every QRS (look lead II strip)
    AND
  2. Upright P wave in
    - I, II, aVF
    - Inverted P wave in aVR
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7
Q

Normal cardiac axis?

A

lead 1 - left thumb up
aVF - right thumb up
NB: Both are positive

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8
Q

Left axis deviation?

A

lead 1 positive - left thumb up
aVF negative - right thumb down

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9
Q

Right axis deviation?

A

lead 1 negative - left thumb down
aVF positive - right thumb up

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10
Q

What does QRS mean?

A

Q = if first NEGATIVE deflection
R = first POSITIVE deflection
S = second NEGATIVE deflection

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11
Q

What is a Q wave?

A

A Q wave is any negative deflection that
precedes an R wave
- The Q wave represents the normal left-to-right depolarisation of the interventricular septum

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12
Q

Pathological Q waves?

A

Q waves are considered pathological if:
1. > 40 ms (1 mm) wide
2. > 2 mm deep
3. > 25% of depth of QRS complex
4. Seen in leads V1-3
- Pathological Q waves usually indicate current or prior myocardial infarction

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13
Q

Where to locate lateral ischaemia?

A
  1. lead I
  2. lead aVL
  3. lead V5
  4. lead V6
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14
Q

Where to locate inferior ischemia on ECG?

A
  1. lead II
  2. lead III
  3. lead aVF
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15
Q

Where to locate septal ischaemia on ECG?

A
  1. lead aVR
  2. lead V1
  3. lead V2
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16
Q

Where to locate anterior ischameia?

A
  1. lead V4
  2. lead V3
17
Q

Signs of ischaemia on ECG?

A
  1. hyperactue T waves
  2. T wave inversions
  3. ST deviations (elevation or depression)
  4. deep Q waves
18
Q

Right bundle branch block?

A
  1. second and larger R-wave
  2. broad and deep S-wave
19
Q

Left bundle branch block?

A
  1. deep S-wave
  2. broad and clumsy R-wave
20
Q

Atrial fibrillation on ECG?

A
  1. narrow QRS
  2. irregular intervals
  3. undulating or flat P wave
21
Q

Atrial fibrillation management?

A
  1. Manage the UNDERLYING pathology (lung disease, heart failure, sepsis, etc)
  2. Consider Anticoagulation to prevent stroke
    - CHADs-2 VASC and HASBLED
  3. Consider Rate or Rhythm control
    - Beta Blocker, Calcium Channel Blocker, digoxin, amiodarone
  4. Likely get Echocardiogram
22
Q

If patient is unstable in arrythmias what should you do?

A

cardioversion

23
Q

Supraventricular tachycardia?

A
  1. TACHYCARDIC usually >150bpm
  2. No discernible P-waves
  3. REGULAR!! (should not vary much at all on continuous telemetry)
  4. NARROW!! (this is what makes it “supra” ventricular
24
Q

SVT management in stable patient?

A
  1. Vagal Maneuvers
  2. Adenosine (12mg, 12mg)
  3. Beta Blocker or Calcium Channel Blocker
  4. Direct Synchronized Cardioversion
24
Q

SVT features in an unstable patient?

A
  1. hypotensive
  2. altered mental status
  3. severe chest pain
  4. very short of breath
  5. syncope
24
Q

SVT management in unstable patient?

A

direct synchronized cardioversion

25
Q

Venricular fibrillation management?

A

dead patient - start ACLS
1. Immediately Start CPR
2. Immediately Apply the AED pads
3. Immediately defibrillate
4. 1 mg Adrenaline q3-5 min
5. continue until patient is out of Vfib

26
Q

Ventricular tachycardia treatment in stable patient?

A

Immediately apply AED pads
If available, amiodarone
Direct Synchronized Cardioversion

27
Q

Ventricular tachycardia treatment in an unstable patient?

A

direct synchronized cardioversion

28
Q

Features of unstable ventricular tachycardia?

A

hypotensive, altered mental status,
hypoxic, severe chest pain, syncope

29
Q

Pulseless patient in VT management?

A

Start ACLS
Immediate CPR
Immediate defibrillation
1 mg Adrenaline q3-5 min

30
Q

When to do cardioversion?

A

Afib, Aflutter, SVT, Vtach with pulse,
unstable Vtach but with pulse

31
Q

Who to do cardioversion on?

A

ANY patient with a PULSE!
- Hit the SYNCHRONIZE button on AED
- Avoids “R on T” phenomenon

32
Q

When to defibrillate?

A

Defibrillate = only TWO situations
1. PulseLESS VTach
2. Ventricular Fibrillation
- Do NOT hit the synchronize button on AED

MBBS 3: Internal Medicine (72 decks)

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