Cardio Flashcards
Which ECG leads monitor the inferior aspect of the heart?
II, III, aVF
Which ECG leads monitor the lateral aspect of the heart?
I, aVL, V5, V6
Which ECG leads monitor the anterior aspect of the heart?
V3, V4
Which ECG leads monitor the septal aspect of the heart?
V1, V2
What is the normal QRS axis?
-30 to +90
What is the range for Left axis deviation?
-30 to - 90
What is the range for right axis deviation?
+90 to +180
What is the usual cause of right axis deviation?
Right ventricular hypertrophy
What is the usual cause of left axis deviation?
Conduction defects
How do you work out the heart rate for regular rhythms?
300 / number of big boxes
1500 / number of small boxes
How do you work out the heart rate for irregular rhythms?
Count beats on rhythm strip and x6
What does the P wave represent?
Atrial depolarisation - combination of left and right
What does right atrial enlargement look like on an ECG?
Taller P wave >2.5mm
What does a P wave taller than >2.5mm suggest?
Right atrial enlargement
What does left atrial enlargement look like on an ECG?
Wider P wave >120ms (3 small squares)
May be M shaped - P. mitrale
What does a wide P wave >120ms suggest?
Left atrial enlargement
What is the PR interval?
Start of P wave until end of QRS
What does the PR interval represent?
Conduction through the AV node
What is the normal duration of a PR interval?
120-200ms
3-5 small squares
What does a PR interval >200ms suggest?
First degree heart block - delayed conduction through AV node
What do progressively increasing PR intervals suggest?
2nd degree heart block (Mobitz I) - not all atrial impulses reach vetricles
What does a PR interval <120ms suggest?
Wolff-Parkinson-White syndrome - accessory pathway allows early activation of the ventricle
What is the PR segment?
End of P wave until start of QRS
What does a normal PR segment look like?
Flat, isoelectric
What is PR segment depression suggestive of?
Pericarditis
What does the QRS complex represent?
Contraction of the ventricles
What does a normal QRS complex look like?
70-100ms wide
S wave <30mm deep
What does a narrow QRS complex (<70ms) suggest?
Originating supraventricularly - SAN, AVN, atria
Third degree Hid bundle heart block
What does a broad QRS (>100ms) suggest?
BBB, Hyperkalaemia, W-P-W syndrome, Hypothermia
How do you determine Left ventricular hypertrophy on an ECG?
S wave in V1 > 35mm
R wave in V5/6 > 35mm
What does a Q wave represent?
Left-to-right depolarisation of the interventricular septum
When is a Q wave pathological?
> 40ms wide
2mm deep or >25% depthy of QRS complex
Seen in leads V1-3
Absent in V5-6
What is the ST segment?
End of S wave until beginning of T wave
What does the ST segment represent?
Time between ventricular depolarisation and repolarisation
What is the J point?
Point between QRS and ST segment
What does ST elevation suggest?
Myocardial infarction - STEMI
Prinzmetal’s angina
Pericarditis
LBBB
What does ST depression suggest?
Right ventricular hypertrophy
RBBB
What does the T wave represent?
Ventricular repolarisation
What do abnormal T waves look like?
Symmetrical Tall Peaked Biphasic Inverted
What is the QT interval?
Start of Q wave until end of T wave
What does the QT interval represent?
Time for ventricular depolarisation and repolarisation
What is the relationship between QT interval and heart rate?
Inversely proportional
What is an atrial septal defect?
Connection between 2 atria
Explain the pathophysiology of an atrial septal defect
Slightly higher pressure in LA than RA
Blood shunts left –> right
Increased flow in right heart and lungs
Does atrial septal defect cause cyanosis?
No
What is a ventricular septal defect?
Connection between 2 ventricles
Explain the pathophysiology of ventricular septal defect
High pressure LV, low pressure RV
Blood shunts left–> right
Doest ventricular septal defect cause cyanosis?
No
What is a coarctation of the aorta?
Narrowing of the aorta at the sight of insertion of the ductus arteriosus
Does it cause cyanosis?
No
What is a congenital abnormality of the aortic valve?
Bicuspid aortic valve
What are the abnormalities in Tetralogy of Fallot?
- Pulmonary infundibular stenosis
- Overriding aorta
- Ventricular septal defect
- Right ventricular hypertrophy
Explain the pathophysiology of Fallot’s tetralogy
Stenosis of the RV outflow tract leads to the RV being at higher pressure than LV
Blood shunts Right –> left
(via VSD)
Does Fallot’s tetralogy cause cyanosis?
Yes
What is a patent ductus arteriosus?
Connection between aorta and pulmonary arteries
What is a patent foramen ovale?
Connection between left and right atria
What are the clinical signs of ASD?
Pulmonary flow murmur
Big pulmonary arteries and heart
What are the clinical signs of VSD?
Large - breathless, poor feeding, big heart, tachycardia
Small - v. loud systolic murmur
What are the clinical signs of Coarctation of the aorta?
Severe - collapse with heart failure
Mild - hypertension (particuarly right arm)
What are the clincial signs of patent ductus arteriosus?
Large - breathless, poor feeding
Small - asymptomatic
What are the clincial signs of patent foramen ovale?
No symptoms - normal health if no other abnormalities
What are th clincial signs of Fallot’s tetralogy?
BLUE - cyanosis
Which structural defects cause cyanosis?
Fallot’s tetralogy