Cardio - ECG Flashcards
What abnormalities can ECGs help us find?
Conductional abnormalities
Structural abnormalities
Perfusiom abnormalities
Why are the practical advantages to an ECG?
Relatively cheap and easy to undertake
Reproducible between people and centres
Quick turnaround on result / report
What are the electrodes?
The sticky tabs to put on the person in certain positions
What are the cables/wires?
Lead from the electrodes to the actual machine
What are the leads?
Measurement of electrical activity
How many leads are involved in an ECG?
12 in 12-lead ECG
How many cables are involved in a 12-lead ECG?
10
What is a vector?
Quantity that has both magnitude and direction
Typically represented by an arrow in the net direction of movement, whose size reflects the magnitude
What does a downward deflection like this represent?
Wave of excitation is moving towards the negative electrode
What does a upwards deflection like this mean?
Wave of excitation moves towards the positive electrodes
What does a deflection like this denote?
Wave of excitation is moving 45 degrees away from the negative electrode in either direction
What does a deflection like this denote?
Wave of excitation moves towards the positive electrode 45 degrees in each direction
What does a wave like this denote?
Isoelectric line represents no net change in voltage I.e. vectors are perpendicular to the lead
What does a width of a deflection denote?
Duration of the event
What does the steepness of the deflection denote?
Velocity of action potential
What phase does this electrical signal of the cardiac cycle represent?
Atrial systole - stimulates contraction of the atria
What phase does this electrical signal of the cardiac cycle represent?
Ventricles systole - Stimulates contraction of the ventricles
What phase does this electrical signal in the cardiac cycle represent?
Signifies relaxation of the ventricles
What cardiac vector does the P wave represent?
SAN (sinoatrial node)
Autorhythmic my oysters
Atrial depolarisation
What cardiac vector does the P-Q interval represent?
Represents a delay AVN depolarisation Isoelectric ECG Slow signal transduction Protective
What cardiac vector does this part of the cardiac cycle represent?
Bundle of His
Rapid conduction
Insulated
What cardiac vector does this part of the cardiac cycle represent?
Bundle branches
Septal depolarisation
What cardiac vector does this part of the cardiac cycle represent?
Purkinje fibres
Ventricular depolarisation
What cardiac vector does this part of the cardiac cycle represent?
Purkinje fibres (2) Late ventricular depolarisation
What cardiac vector does this part of the cardiac cycle represent?
Fully depolarised ventricles
Isoelectric line
What cardiac vector does this part of the ECG represent?
Ventricular repolarisation
What is the Rule of Ls?
Where do you put the electrodes for Lead I?
Right Arm (-) to Left Arm (+)
Where do you put the electrodes for Lead II?
Right arm (-) to left leg (+)
Where do you put the electrodes for Lead III?
Left arm (-) to Left leg (+)
What is the rule of reading for the leads?
Polarity for the leads is read left to right and top to bottom, just like English.
First electrode of each bipolar pair is the negative electrode
Where does the aVL lead go to and from?
Midpoint of lead II (-) to the left arm (+)
aVL = L = to the left arm
Where does the aVF attach to?
Midpoint of Lead I (-) to left leg (+)
aVF = F = to the floor AKA left leg
Where does the aVR attach to?
Midpoint of Lead III (-) to Right Arm (+)
aVR = R = to the right arm
Where is V1 placed?
Right sternal border in the 4th intercostal space
Where is V2 placed?
Left sternal border in the 4th intercostal space
Where is V3 placed?
Halfway between V2 and V4
Where is V5 placed?
Anterior axillary line at the level V4
Where is V4 placed?
Mid-clavicular line in the 5th intercostal space
Where is V6 placed?
Mid-axillary line at the level of V4
Which leads give you a lateral view of the heart?
Lead I
aVL
V5
V6
Which leads give you an inferior view of the heart?
Lead II
Lead III
aVF
What leads give you a septal view of the heart?
V1
V2
Which leads give you an anterior view of the heart?
V3
V4
Which leads represent the LCx (left circumflex artery)?
Lead I
aVL
V5
V6
Which leads represent the RCA (right coronary artery)?
Lead II
Lead III
aVF
Which leads represent LAD (left anterior descending artery)?
V1
V2
V3
V4
Which of the leads are bipolar?
Lead I
Lead II
Lead III
Which of the leads are unipolar?
Everything but Lead I, II, III
Which lead doesn’t give you a view of a heart or any of its coronary arteries?
aVR
Name the different parts of this ECG.
A = P-R interval B = PR segment C = QRS complex D = ST segment E = ST interval F = QT interval
Calculate the R-R interval.
0.6 - 1.2 s (0.52s)
Calculate the P-wave duration.
80ms
What is the P-R interval?
120 - 200 ms
Calculate the QRS duration.
< 120 ms
Calculate the QT interval.
420 ms
Calculate T-wave duration.
160 ms
Calculate the heart rate.
60-100 bpm
How do you calculate cardiac or QRS axis?
V
What is sinus rhythm? What are its features?
What is sinus arrhythmia?
What is sinus tachycardia?
What is sinus bradycardia?
What can normally cause bradycardia?
Medication or vagal stimulation
What can normally cause tachycardia?
Often a physiological response
When can sinus arrhythmia be normal?
R-R interval can normally vary with breathing cycle
What are the features of atrial fibrillation on an ECG?
What are the risks of atrial fibrillation?
Turbulent flow pattern increases clotting risk
Atria not necessary for cardiac cycle
How does the cardiac cycle carry on in atrial fibrillation?
Atria are not essential for cardiac cycle
What is atrial flutter?
Short circuit in the heart causes atria to pump rapidly
What are the features of atrial flutter on an ECG?
What is first degree heart block?
Electrical impulses still reach the ventricles but move slowly through the AVN so impulses are delayed
What are the features of first degree heart block on an ECG?
What is second degree heart block (Mobitz I)?
heart will skip beats in a regular pattern
Caused by a diseased AVN
What are the features of second degree heart block (Mobitz I)?
What is second degree heart block (Mobitz I) also called?
Wencknebach phenomenon
What are the features of second degree heart block (Mobitz II) on an ECG?
What are the consequences of second degree heart block (Mobitz II)?
Can rapidly deteriorate into third degree heart block
What are the features of third degree heart block?
What are the features of ventricular tachycardia on an ECG?
What are the risks of ventricular tachycardia ?
High risk of deteriorating into fibrillation (cardiac arrest)
However, is a shockable rhythm
What are the features of ventricular fibrillation on an ECG?
What are the risks of ventricular fibrillation?
Heart is unable to generate any output
Is cardiac arrest
However it is a shockable rhythm
What are the features of ST elevation on an ECG?
What causes an ST elevation?
Infarction (heart attack)
What are the features of ST depression on an ECG?
What causes ST depression?
Myocardial ischaemia