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CP3 Medicine > Cardiology - ECG > Flashcards

Cardiology - ECG Flashcards

1
Q

Which part of the ECG is always down

A

Q

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2
Q

Which part of the ECG is always up

A

R

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3
Q

What part of the ECG represents dead myocardium

A

Q waves

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4
Q

Determining the rate - ECG

A

300/no’ large squares

How many QRS in 10s

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5
Q

Determining the rhythm ECG

A

Sinus - Each P wave = followed by QRS

Constant PR interval

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6
Q

Normal cardiac axis

A

I + II = +ve

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7
Q

RAD

A

I negative

III positive

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8
Q

LAD

A

II + III negative

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9
Q

P wave appearance RAH

A

Peaked/tall

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10
Q

P wave appearance LAH

A

Notched/broad

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11
Q

Def PR interval

A

Time from beginning of P wave to beginning of QRS

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12
Q

Normal range PR interval

A

0.12 - 0.2
Or
3-5 small squares

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13
Q

What does prolonged PR interval indicate

A

1st degree heart block

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14
Q

What does a wide QRS indicate

A

Bundle branch block

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15
Q

Tall R waves in V1 indicate

A

RVH

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16
Q

Tall R waves V6 indicate

A

LVH

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17
Q

2 conditions –> ST elevation (2)

A

MI

Pericarditis

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18
Q

2 conditions –> ST depression

A

Ischaemia

Digoxin

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19
Q

In what leads is T wave inversion considered normal

A

aVR
III
V1/2

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20
Q

Where can Q waves be normal

A

I
VL
V5/6

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21
Q

Def QT interval

A

From beginning of QRS to end of T wave

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22
Q

Normal value QT interval

A

<0.45 s

Or 2 large squares

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23
Q

What is a sinus rhythm

A

When electrical activity starts in SAN

Hence P wave

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24
Q

What is a normal axis

A

-30 –> +90

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25
Q

Conditions –> R axis deviation (10)

A 
Infancy 
PE
Cor pulmonale 
ASD seculum 
rvh
RBBB 
L post hemiblock 
Dextrocardia
LV ectopic rhythm 
Congenital heart disease
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26
Q

Conditions –> L axis deviation (7)

A 
L ant hemi block
LVH
WPW syndrome 
RV ectopic beats 
Mechanical shift
Normal 
ASD primum
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27
Q

Hyperkalaemia ECG

A

Tall tented T waves

More PQT waves

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28
Q

Hypokalaemia ECG

A

Flatter T waves

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29
Q

Def bradycardia

A

<40-60bpm

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30
Q

Def tachycardia

A

> 120 bpm

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31
Q

Def S wave

A

Any deflection below baseline following R wave

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32
Q

Narrow QRS complexes originate from

A

Above AVN

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33
Q

Wide QRS complexes are often x in origin

A

Ventricular

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34
Q

examples of conditions –> T wave inversion

A

Ischaemia
Ventricular hypertrophy BBBB
Digoxin - sloped ST segments

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35
Q

What is meant be: ST segment should be isoelectric

A

The same level apart between the T wave and the next P wave

36
Q

J point

A

Between end of QRS complex and start of T wave

37
Q

What is re-entry tachycardia

A

Impulse –> depolarisation twice in a row at faster rate than norm
= 180-200bpm

38
Q

Why does re-entry tachycardia occur

A

Nodal re-entry pathways within AVN

39
Q

What is WPW syndrome

A

Accessory pathway allows electrical signal from ventricles to enter atria –> earlier than norm contraction
–> repeated stim of AVN

40
Q

What is sinus arrhythmia

A

HR varies between 40-120

Due to irreg discharge SAN

41
Q

Most common cause sinus arrhythmia

A

Breathing

Due to fluctuations in vagal tone

42
Q

What is Atrial ectopic?

A

Premature discharge of ectopic atrial focus

43
Q

Appearance ECG atrial ectopic

A

P wave shape different

Occurs early before next P wave due

44
Q

What are supraventricular ectopics

A

Ectopic beats originating in AVN or atria

45
Q

What do patients with atrial ectopics complain of

A

Skipped beat or irreg pulse

46
Q

What condition can atrial ectopics lead to

A

AF

47
Q

Causes AF

A 
use PIRATES
PE
IHD/Idopathic 
Rheumatic valve disease 
Anaemia/alcohol/age
Thyroid (hyper)
Elevated BP 
Sleep apnoea/sepsis
48
Q

ECG appearance AF

A

Irreg baseline
no P waves
Irreg QRS rate

49
Q

How many atrial contractions /min in AF

A

450-600

50
Q

What is atrial flutter

A

Atrial rate >250 and no flat baseline between P waves

51
Q

Appearance ECG atrial flutter

A

Saw toothed baseline

52
Q

diff between AF and atrial flutter

A

Similar than in both - normal coordination of atria is lost

But in flutter, there is some element of synchronicity

53
Q

Appearance ventricular ectopic ECG

A

Broad QRS
Possible inverted P waves
Bigeminy

54
Q

Appearance ventricular tachycardia ECG

A

Broad abnormal QRS in all 12 leads
HR > 100bpm
Torsades de Pointes

55
Q

In VT which signs indicate immediate electrical cardioversion (4)

A

BP <90mmHg
Chest pain
HF
Rate >150

56
Q

In VT, in abscence of signs indicating ECV, what Mx should be done

A

300mg loading dose amiodarone over 30 mins

57
Q

What is VF?

A

Individual mm fibres can’t contract independently, hence = fibrillating –> no cardiac output

58
Q

VF ECG appearance

A

No QRS

ECG totally disorganised

59
Q

What is branch block?

A

Depolarisation reaches septum normally (norm pR interval)

But abnormal condition through L/R bundle branches of his –> Wide QRS

60
Q

Right bundle branch block

A 
IV septum depolarised from Left normal 
Hence R wave V1 + small Q V6 
Later R depolarisation --> 2nd R wave 
Excitation LV --> S wave V1 + R in V6 
RV depolarises after L --> R' V1 and deep S wave
61
Q

Which lead is RBBB best seen in?

A

V1
MarroW - M shape V1
W shape V6

62
Q

Left bundle branch block

A

Septum depolarises from R–>L
Hence Q wave V1 R wave V6
RV depol before LV –> small R V1 and S in V6
Subsequent LV depol –> S wave V1 + S wave V6
Also assoc w/ T wave inversion Lateral leads

63
Q

Which lead is LBBB best seen in?

A

V6
WilliaM - W shape V1
M shape V6

64
Q

If LBBB is asymp - what condition should be considered

A

Aortic stenosis

65
Q

If LBBB is associated with chest pain, what condition should be considered

A

acute MI

66
Q

What is a hemiblock?

A

LB divides into ant and posterior fascicles

= hemi block if 1 fasicle blocked

67
Q

Left anterior block - ECG changes

A

Upward + leftward directoin
Hence LAD >-45’
Rs complex lead III

68
Q

Left posterior block - ECG changes

A

Bulk depolarisation downward and to right
RAD +>120
S wave I
q wave III

69
Q

Why does QRS not widen in hemiblocks

A

Because other fascile is intact

70
Q

Causes hemiblocks (4)

A

Acute MI
Coronary aa disease
HTN
Congenital heart disease + cardiomyopathies

71
Q

What is the voltage criteria for LVH?

A

Combined height R wave in V5/6 + depth S wave V1 should not exceed 25mm

72
Q

What is heart block

A

Abnormal conduction from SAN to ventricles

73
Q

PR interval 1st degree heart block

A

> 0.22s

74
Q

What is 1st deg heartblock

A

Each wave SAN depolarisation = spread to ventricles

But = delay somewhere along pathway

75
Q

What can 1st degree heart block indicate? (4)

A

CAD
Acute rheumatic fever
Electrolyte disturbance
Digoxin toxicity

76
Q

What is Sinoatrial block?

A

SAN depolarises as normal, but fails to rad atria

77
Q

ECG appearance Sinoatrial block

A

P wave fails to appeare in expected place
Hence no QRS
Subsequent P waves in norm place

78
Q

2nd degree heart block

A

Excitation intermittently fails to pass through AVN/bundle of his

79
Q

What are the 3 types of 2nd degree heart block

A

Mobitz II
Wenckebach/Mobitz I
2:1/3:1

80
Q

Mobitz II phenomenon

A

Constant PR interval
Sometimes = atrial contraction w/ no ventric contraction
Most P followed by QRS
Occasionally, P not followed by QRS

81
Q

Wenckebach phenomenon

A

Progressive PR lengthening until atrial beat is not conudcted - no QRS
Then cycle repeats

82
Q

2:1 or 3:1 conduction

A

2x or 3x as many waves as QRS complexes

83
Q

What is complete/3rd degree heart block

A

Atrial contraction normal

No beats conducted to ventricles

84
Q

Complete heart block - ECG appearance

A

P waves dissoc from QRS

Wide QRS - escape rhytm

85
Q

What is AV dissociation

A

If escape rhythm from AV junction or ventricles occurs during sinus brady C

86
Q

AV dissociation ECG appearance

A

QRS slightly higher than P wave rate

CP3 Medicine (29 decks)

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