Cardiology ECGs

Question 1

ECG features of WPW

Answer 1

Short PR
Wide QRS with slurred upstroke delta wave
LAD with R accessory pathway
RAD with L accessory pathway

Question 2

Congenital causes of prolonged QT

Answer 2

Jervell-Lange-Nielsen syndrome
Romano-Ward syndrome

Question 3

Causes of prolonged QT

Answer 3

Hypocalcaemia
Hypokalaemia
Hypomagnasaemia
hypothermia
Acute MI
Myocarditis
SaH

Question 4

Drug causes of prolonged QT

Answer 4

Amiodarone, sotalol
Quinidine, procainamide, disopyramide
TCA
fluoxetine
chloroquine
terfenadine
erythromycin

Question 5

ECG hypokalaemia

Answer 5

U waves
Small/absent T waves
Prolonged PR interval
ST depression
Long QT

Question 6

Causes of LBBB

Answer 6

MI
hypertension
aortic stenosis
cardiomyopathy
Idiopathic fibrosis, digoxin, hyperkalaemia

Question 7

ECG features of digoxin

Answer 7

Down-sloping ST depression
Flattened/inverted T waves
Short QT interval
Arrhythmias (AV block, bradycardia)

Question 8

Causes of RBBB

Answer 8

Normal variant
RVH
Cor pulmonale
PE
MI
ASD
Cardiomyopathy or myocarditis

Question 9

Anteroseptal MI

Answer 9

V1-V4
LAD artery

Question 10

Inferior mI

Answer 10

II, III, aVF
Right coronary

Question 11

Anterolateral MI

Answer 11

V1-6, I, aVL
Proximal LAD

Question 12

Lateral MI

Answer 12

I, aVL, +/- V5-6
Left circumflex

Question 13

Posterior MI

Answer 13

Changes in V1-3
Left circumflex and right coronary
Reciprocal changes of STEMI

Question 14

Reciprocal changes of posterior STEMI

Answer 14

Horizontal ST depression
Tall, broad R waves
Upright T waves
Dominant R wave in V2

Question 15

Causes of peaked T waves

Answer 15

Hyperkalaemia
MI

Question 16

Causes of inverted T waves

Answer 16

MI
Digoxin toxicirt
SaH
Arrhythmogenic RV cardiomyopathy
PE (S1Q3T3)
Brugada syndrome

Question 17

ECG hypothermia

Answer 17

Bradycardia
J wave (small hump after QRS)
First degree heart block
Long QT interval
Atrial and ventricular arrhythmias

Question 18

ECG ST depression

Answer 18

Secondary to abnormal QRS
Ischaemia
Digoxin
Hypokalaemia
Syndrome X

Question 19

Causes of prolonged PR interval

Answer 19

idiopathic
ischaemic heart disease
digoxin toxicity
hypokalaemia
rheumatic fever
aortic root pathology
Lyme disease
sarcoidosis
myotonic dystrophy

Question 20

Causes of short PR interval

Answer 20

WPW

Question 21

Causes of left axis deviation

Answer 21

left anterior hemiblock
left bundle branch block
inferior myocardial infarction
Wolff-Parkinson-White syndrome - right-sided accessory pathway
hyperkalaemia
congenital: ostium primum ASD, tricuspid atresia
minor LAD in obese people

Question 22

Causes of RAD

Answer 22

right ventricular hypertrophy
left posterior hemiblock
lateral myocardial infarction
chronic lung disease → cor pulmonale
pulmonary embolism
ostium secundum ASD
Wolff-Parkinson-White syndrome* - left-sided accessory pathway
normal in infant < 1 years old
minor RAD in tall people

Question 23

Normal ECG variants in an athlete

Answer 23

sinus bradycardia
junctional rhythm
first degree heart block
Mobitz type 1 (Wenckebach phenomenon

Question 24

Causes of ST elevation

Answer 24

myocardial infarction
pericarditis/myocarditis
normal variant - ‘high take-off’
left ventricular aneurysm
Prinzmetal’s angina (coronary artery spasm)
Takotsubo cardiomyopathy
rare: subarachnoid haemorrhage

Question 25

STEMI criteria

Answer 25

≥ 2 contiguous leads of: 2.5 mm ST elevation in leads V2-3 in men under 40 years, or ≥ 2.0 mm (i.e ≥ 2 small squares) ST elevation in leads V2-3 in men over 40 years 1.5 mm ST elevation in V2-3 in women 1 mm ST elevation in other leads new LBBB

Question 26

ECG changes acute pericarditis

Answer 26

Saddle shaped ST elevation PR depression (most specific)

Question 27

Arrhythmogenic right ventricular cardiomyopathy

Answer 27

ECG abnormalities in V1-3, typically T wave inversion. An epsilon wave is found in about 50% of those with ARV - this is best described as a terminal notch in the QRS complex

Question 28

Brugada syndrome

Answer 28

convex ST segment elevation > 2mm in > 1 of V1-V3 followed by a negative T wave partial right bundle branch block the ECG changes may be more apparent following the administration of flecainide or ajmaline - this is the investigation of choice in suspected cases of Brugada syndrome

Question 29

HOCM ECG findings

Answer 29

left ventricular hypertrophy non-specific ST segment and T-wave abnormalities, progressive T wave inversion may be seen deep Q waves atrial fibrillation may occasionally be seen