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ECG > Basics > Flashcards

Basics Flashcards

1
Q

Name the Anterior leads of the ECG

A
  • V2
  • V3
  • V4
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2
Q

Name the left lateral leads of the ECG

A
  • Lead 1
  • AVL
  • V5
  • V6
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3
Q

Name the inferior leads of the ECG

A
  • aVF
  • Lead 2
  • Lead 3
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4
Q

Name the right ventricular leads of the ECG

A
  • aVR

- V1

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5
Q

what is the difference between hypertrophy and enlargement of the heart?

A

Hypertrophy: Increase in muscle mass usually due to pressure overload like in systemic HTN or aortic stenosis.

Enlargement: Dilatation of a particular chamber usually due to volume overload like in aortic insufficiency or mitral insufficiency.

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6
Q

What is the normal axis of :

  • QRS complex
  • P wave
  • T wave?
A

QRS = 0 to +90 ( +90 to - 30).
P wave = 0 to 70
T wave = 50 to 60

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7
Q

What is the normal duration and amplitude of a P wave ?

A

Duration: less than 0.12 second (3 small boxes)
Amplitude: Not exceed 2.5 mm ( 2.5 small boxes)

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8
Q

Which leads you should look at first when assessing QRS axis ?

A

Leads 1 and aVF.

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9
Q

Which leads you should look at first when assessing atrial enlargement?

A

P waves at lead 2 and lead V1

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10
Q

How to diagnose right atrial enlargement in ECG?

A

1- Presence of P waves with an amplitude exceeding 2.5 mm (2.5 small boxes) in at lease one of the inferior leads : lead 2, lead 3, and aVF.
2- No change in the duration of the P wave.
3- Possible right axis deviation of the P wave.

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11
Q

How to diagnose left atrial enlargement in an ECG?

A

1- Terminal (left atrial) portion of the P wave should drop (negative) at least 1 mm (1 small box) below the isoelectric line in lead V1.
2- The terminal portion of the P wave should be at least 1 small box (0.04 sec) in width.
3. No significant axis deviation is seen becuase left atrium is normally electrically dominant.

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12
Q

What does the electrocardiographic picture of left atrial enlargement called? and why?

A

P mitrale because mitral valve disease is a common cause of the left atrial enlargement.

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13
Q

What does the electrocardiographic picture of right atrial enlargement called? and why?

A

P Pulmonale because severe lung disease is the most common cause of right atrial enlargement.

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14
Q

How to diagnose Right ventricular hypertrophy in ECG ?

A

In limb leads:

  • Right axis deviation is present. With QRS axis exceeding +100.

In precordial leads:

  • V1 : R wave is larger than S wave.
  • V6: S wave is larger than R wave.
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15
Q

How to diagnose left ventricular hypertrophy in ECG ?

A

Precordial leads:
- R wave amplitude in V5 OR V6 + S wave amplitude in lead V1 OR V2 > 35 mm.

  • R wave amplitude in V5 > 26 mm.
  • R wave amplitude in V6 > 20 mm
  • R wave amplitude in V6 > R wave amplitude in V5

Limb leads:

  • R wave amplitude in aVL > 11 mm
  • R wave amplitude in aVF > 20 mm
  • R wave amplitude in lead I > 13 mm
  • R wave amplitude in lead 1 + S wave amplitude in lead III > 25 mm.
  • R wave amplitude in aVL + S wave amplitude in V3 > 20 mm in Female / 28 mm in males.
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16
Q

What is the Most common cause of right ventricular hypertrophy ?

A
  1. Pulmonary disease.

2. Congenital heart disease.

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17
Q

What is the most common cause of left ventricular hypertrophy?

A
  1. Systemic hypertension.

2. Valvular disease.

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18
Q

What are the secondary repolarization abnormalities of ventricular hypertrophy?

A
  • Downsloping ST segment depression.
  • T-wave inversion.

Right ventricular repolarization abnormalities:
Leads V1 and V2

Left ventricular repolarization abnormalities:
Leads I, aVL, V5 and V6.

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19
Q

What are the causes / factors causing arrhythmias ?

A

HIS DEBS :

Hypoxia
Iscemia and Irritability
Sympathetic Stimulation.

Drugs
Electrolyte Distrubances.
Bradycardia
Stretch : Hypertrophy / enlargement

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20
Q

What is the most common rhythm disturbance seen in early stages of an acute myocardial infarction?

A

Sinus bradycardia

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21
Q

What is the definition of ectopic rhythms?

A

Ectopic rhythms are abnormal rhythms that arise from elsewhere than the sinus node.

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22
Q

What is an AV dissociation?

A

It is a lack of correlation between the P wave and a QRS complexes.

(The atria and the ventricles depolarize and contract independently of each other).

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23
Q

What are the 4 questions that you should ask yourself when assessing an ECG rhythm ?

A
  1. Are normal P waves present?
  2. Are the QRS complexes narrow or wide?
  3. What is the relationship between the P wave and the QRS complexes?
  4. Is the rhythm regular or irregular ?
24
Q

What are the 5 sustained supra-ventricular arrhythmias ?

A
  1. Paroxysmal supra-ventricular tachycardia (PSVT) / AV nodal reentrant tachycardia.
  2. Atrial flutter
  3. Atrial fibrillation.
  4. Multifocal atrial tachycardia (MAT).
  5. Paroxysmal atrial tachycardia (PAT) / ectopic atrial tachycardia.
25
Q

How to treat Paroxysmal Supra- Ventricular Tachycardia?

A
  • Carotid massage
  • Adenosine ( short acting AV nodal blocking agent) ( contraindicated in bronchospastic lung disease)
  • Second line: beta-blockers, Calcium channel blockers.
  • Rarely, electrical cardioversion
26
Q

When do you see a (Saw-toothed pattern) in ECG ?

A

P waves in Atrial flutter

27
Q

What are the common conditions associated with atrial flutter ?

A
  • HTN
  • Obesity
  • DM
  • Electrolyte imbalances
  • Alcohol intoxication
  • Drug abuse ; Cocaine and amphetamines
  • Pulmonary disease
  • Thyrotoxicosis
  • Cardiac conditions : congenital or acquired.
28
Q

What is the key in identifying atrial fibrillation in an ECG ?

A

Irregularly irregular appearance of QRS complexes in the absence of discrete P waves is the key to identify atrial fibrillation.

29
Q

How to make the diagnosis of Multifocal Atrial Tachycardia (MAT) in ECG ?

A

Irregular rhythm
+
Easily identifiable P wave occurring before each QRS complex.
+
You need to identify at least 3 different P-wave morphologies.

30
Q

How to differentiate between Paroxysmal Atrial Tachycardia (PAT) and Paroxysmal Supra-ventricular Tachycardia (PSVT) ?

A

PAT :
- warm up or cool down period
- Carotid massage has no effect on PAT ( may slow it mildly).
PSVT:
- carotid massage will slow or terminate it.

31
Q

What are the rules of malignancy in Premature Ventricular Contraction PVCs ?

“Rules that could increase the risk of triggering ventricular tachycardia, ventricular fibrillation and death”.

A
  1. Frequent PVCs
  2. Runs of consecutive PVCs, especially three or more in a row.
  3. Multiform PVCs in which the PVC vary in their site of origin and hence in their appearance.
  4. PVCs falling on the T wave of the previous beat (R-on-T phenomenon “
  5. Any PVC occurring in the setting of an acute myocardial infarction.
32
Q

What is the definition of ventricular tachycardia?

A

A run of 3 or more consecutive premature ventricular contractions PVCs.

33
Q

Which types of arrhythmias are considered Emergency?

A
  • Ventricular tachycardia.
  • Ventricular fibrillation.
  • Torsade de pointes
34
Q

What is Torsade de Pointes ? In an ECG ?

A

Meaning: Twisting of the point.

It is a unique form of ventricular tachycardia that is usually seen in patients with prolonged QT intervals.

35
Q

What is Ashman Phenomenon in ECG ?

A

A wide, aberrantly conducted supraventricular beat occurring after a QRS complex that is preceded by a long pause.

36
Q

How to diagnose a First- Degree AV block ?

A

Prolonged PR interval : > 0.2 seconds

37
Q

What are the types of conduction blocks?

A
  1. Sinus node block
  2. AV block:
    - First-Degree AV block.
    - Second-Degree AV block:
    • Mobitz type 1 second degree AV block (Wenckebach block).
    • Mobitz type 2 second-degree AV block.
      • Third-Degree AV block (Complete heart block).
  3. Bundle branch block.
38
Q

How to diagnose Mobitz type 1 second degree AV block (Wenckebach block) ?

A

It requires the progressive lengthening of each successive PR interval until one P wave fails to conduct through the AV node and is therefore not followed by a QRS complex.

39
Q

How to diagnose Mobitz type 2 second degree AV block?

A

It requires the presence of a dropped beat without progressive lengthening of the PR interval.

40
Q

How to diagnose third degree AV block?

A

It requires the presence of AV dissociation in which the ventricular rate is slower than the sinus or atrial rate.

41
Q

What are the 3 stages that occur in an ECG during myocardial infarction?

A
  1. T-wave peaking followed by T-wave inversion.
  2. ST - segment elevation.
  3. The appearance of new Q waves.
42
Q

Which ECG sign is the most reliable sign of a true myocardial infarction ?

A

ST- segment elevation

43
Q

What are the indications of a persistent ST-segment elevation in an ECG ?

A

Ventricular aneurysm

44
Q

Where does a normal Q wave usually seen ?

A
  • Left lateral leads : I , aVL, V5 & V6

- Inferior leads : II, III “most common” & aVF.

45
Q

What are the criteria of a signifcant Q wave (pathological Q wave) ?

A
  1. The Q wave must be greater than 0.04 seconds in duration.
  2. The depth of Q wave must be at least one-third the hieght of the R wave in the same QRS complex.

EXCEPT lead aVR

46
Q

Name the blood supply of the heart

A
  1. Right coronary artery + it’s descending branch: runs between the right atrium and the right ventricle and then swings around to the posterioe surface of the heart. It gives a descending branch that supplies the AV node.
  2. Left main artery:
    a- Left Anterior Descending LAD : supplies anterior wall of the heart and interventricular septum.

b- Left circumflex artery: runs between the left atrium and left ventricle and supplies the lateral wall of the left ventricle.

47
Q

What are the criteria of a non-Q-wave infarctions ?

A
  • T wave inversion

- ST segement depression.

48
Q

How to distinguish between angina and Non-Q-wave myocardial infarction ?

A

Angina :

  • ST segment depression usually return to baseline shortly after the attack has subsided.
  • Cardiac enzymes not elevated.

Non-Q-wave myocardial infarction:

  • ST segment remain down for at least 24 hours.
  • elevated cardiac enzymes.
49
Q

What are the Changes that occur on an ECG in hyperkalemia?

A
  1. Peaked T waves.
  2. PR prolongation and P-wave flattening.
  3. QRS widening.

Ultimately, the QRS complexes and T waves merge to form a sine wave, and ventricular fibrillation may develop.

50
Q

What are the changes that occur in an ECG in hypokalemia?

A
  1. ST segment depression
  2. Flattening of the T wave with prolongation of the QT interval
  3. U wave appearance.
51
Q

What are the ECG changes occur in calcium disorders?

A

In Hypocalcemia: QT interval prolongation. (Associated with the lethal arrhythmia, ventricular tachycardia: Torsade de pointes”.

In hypercalcemiq : QT interval shortening.

52
Q

What are the ECG changes associated with therapeutic blood levels of Digitalis ?

A
  • ST segment depression
  • T wave flattening or inversion.
  • Most prominent in leads with tall R waves.
  • It’s normal and predictable.
53
Q

What are the ECG changes associated with toxic blood levels of Digitalis ?

A
  • Sinus node suppression
  • Conduction blocks
  • Tachyarrhythmias
  • Combinations :
    Paroxysmal Atrial Tachycardia (PAT) with 2nd degree AV block is the most common characteristic rhythm disturbance of digitalis intoxication.
54
Q

Name the medications that prolong the QT interval.

A
  1. Anti arrhythmic agents:
    - Sotalol
    - Quinidine
    - Procainamide
    - Disopyramide
    - Amiodarone
    - Dofetilide
    - Dronedarone
  2. Antibiotics:
    - Macrolides: erythromycin, clarithromycin, azithromycin.
    - Fluoroquinolones: Levofloxacin and Ciprofloxacin.
  3. Antifungal: Ketoconazole.
  4. Nonsedating antihistamine: astemizole, terfenadine.
  5. Psychotropic drugs
    - Antipsychotic: Haloperidol, Phenothiazines
    - Tricyclic antidepressants: amitriptyline.
    - SSRI: citalopram and fluoxetine.
  6. Gastrointestinal meds
  7. Antineoplastic agents
  8. Diuretics
55
Q

What are the ECG features of acute pericarditis and how to differentiate it from myocardial infarction?

A

Acute pericarditis:

  1. ST segment elevation
  2. T wave flattening or inversion.

In acute pericarditis:

  1. ST segment & T wave changes are diffused, involving more leads.
  2. ST segment is saddle shaped.
  3. T wave in inversion occur only after the ST segment have returned to baseline.
  4. No Q waves
  5. PR interval is depressed sometimes.

In MI :

  1. ST segment and T wavs changes are localized.
  2. T wave inversion usually precedes normalization of ST segment
56
Q

What are the ECG changes that occur in Acute pulmonary embolism?

A

In massive PE:

  1. Right ventricular hypertrophy with repolarization changes
  2. Right bundle branch block
  3. Large S wave in lead I + Deep Q wave in lead III (S1Q3 pattern).
  4. T wave in lead III may be inverted
  5. Arrhythmia: sinus tachycardia and atrial fibrillation.

Q waves in acute PE are generally limited to lead III.

In non-massive PE : normal ECG usually , may show sinus tachycardia.

57
Q

What is the 11 step method for reading ECGs ?

A
  1. Standardization
  2. Heart rate.
  3. Intervals
  4. Axis
  5. Rythm:
    • Are there normal P wave prsent?
    • Are the QRS complexs wide or narrow?
    • What is the relation between the P wave and the QRS complexes ?
    • Is the rythm regular or irregular ?
  6. Atrioventricular (AV) block
  7. Bundle branch block or hemiblock
  8. Pre-excitation.
  9. Enlargement or hypertrophy.
  10. Coronary artery disease.
  11. Utter confusion.

ECG (1 decks)

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