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Sports and Exercise Medicine iBSc > Cardiology in Sport > Flashcards

Cardiology in Sport Flashcards

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Sports Trivia flashcards
1
Q

Interpreting ECG

A

Start at rhythm strip (III)- is there a P wave, followed by a QRS
What is PR interval
Is it followed by normal QT interval and any ST changes
What is sinus rhythm
Number of big squares R wave has

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2
Q

R wave and LVH

A

If more than 5 big squares, suggestive of LVH

OR if biggest S wave + biggest R wave bigger than 7 big squares

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3
Q

R wave + athletes

A

R wave>5 big squares common in athletes

Rarely coincides with their acc being LVH at eco

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4
Q

Isolated Sokolow-Lyon voltage criterion for LVH

A

Common in male athletes and does not warrant further investigation

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5
Q

Early repolarisation pattern accompanied by concave ST segment elevation

A

Identified in 25-40% of highly trained athletes

More common in males, black athletes and those with sinus bradycardia

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6
Q

T wave inversion in people with chest pain

A

Think MI

But can be other causes

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7
Q

Bi-phasic T wave inversion in leads V3

A

Would be considered abnormal ECG and not due to exercise in white athlete

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8
Q

Black athletes + T wave inversion

A

Higher in prevalence

Thought to be more physiological

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9
Q

Many inverted T waves

A

Regardless of ethnicity, start thinking about myopathic process, and generally an inherited cardiac myopathy- one of most common is hypertrophic cardiomyopathy

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10
Q

TWI in leads V1-4 present in what percentage of black athletes

A

12-13%

Usually preceded by J-point and convex ST segment elevation

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11
Q

ESC criteria deem any TWI beyond … as abnormal

A

V1

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12
Q

If preceding ST segment to TWI is …, suggestive of pathology

A

Depressed

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13
Q

ST segment depression

A

Should always be considered pathological

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14
Q

Pathological Q wave

A

Shouldn’t have this regardless of how much you exercise
Height + length make it pathological
Should be less than a quarter of the R wave

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15
Q

Prevalence of Q waves in athletes

A

0.7% vs controls 1.2%

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16
Q

Measurement pathological Q wave

A

> 0.4mV deep in any lead except III, aVR

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17
Q

QT interval

A

Measured rom beginning of Q wave to end of T wave

Has to be corrected for HR using Bazett formula

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18
Q

Bazzett Formula

A

QTc=QT/(square root of RR)

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19
Q

When should QT interval be measured

A

During peak plasma concentration of a QT-prolonging medication

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20
Q

QTc abnormal in males

A

> 440ms

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21
Q

QTc abnormal in females

A

> 460ms

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22
Q

QTc interval affected by

A 
Diurnal variations
Drugs
Clinical history + familial evaluation
U waves
Subtle T wave changes
HR
Repolarization abnormalities
Decreased K+
Decreased Mg2+
Decreased Ca2+
Increased Ca2+
23
Q

Problems with measuring QT interval in athletes

A

Slow HR
Sinus arrhythmia
Slightly wide QRS complexes
T-U complexes

24
Q

U waves

A

Common in athletes
Always follow your T wave
Can interfere with measurement of T wave
Are <50% of the height of the preceding T wave

25
Q

Measuring QT

A

Summit of T wave to isometric line across that angle

26
Q

Probability of long QT syndrome factors that give points on ECG

A 
QTC>480- 3 points
QTC 460-479- 2 points
QTC 450-9 (males)- 1 point
QTC >480ms at 4th min of recovery from ETT- 1 point
Torsades de pointes- 2
T wave alternans- 1
>3 leads notched T waves-1
Bradycardia for age- 0.5
Syncope with stress-2
Syncope without stress-1
Congenital deafness- 0.5
Family history with definite LQTS- 1
Unexplained sudden death in 1st degree fam member <30
27
Q

Probability of long QT criterion- <1 point

A

Low probability

28
Q

Probability of long QT criterion- 1.5-3 points

A

Intermediate probability

29
Q

Probability of long QT criterion- >3.5 points

A

High probability

30
Q

Problems with ESC 2010 criteria for QTC

A

17-32% false positives in white athletes

30-40% false positives in black athletes

31
Q

Problems with Seattle criteria 2013 WTC

A

4-9% white athletes false positive

16% black athletes false positive

32
Q

Over half the people failing ESC and Seattle criteria had following abnormalities

A 
Left or right atrial enlargement
Left or right axis deviation
RVH
Complete RBBB or LBBB
RVH with concomitant right axis deviation
33
Q

Refined 2014 QTC criteria

A

2.1% false positives white athletes

10% false positives black athletes

34
Q

Left Axis Deviation

A

Lead 1 pointing up (leaving page)

Lead III pointing down (leaving page)

35
Q

Right Axis Deviation

A

Lead I pointing down

Lead III up (returning)

36
Q

Left atrial enlargement

A

Negative potion of P wave in lead V1>0.1mV in depth and >40ms in duration

37
Q

Right atrial enlargement

A

P wave amplitude >2.5mm in leads II, III or aVF

38
Q

RVH

A

Sum of R in V1 + S in V5 (or V6)>10mm

39
Q

Sudden cardiac death causes percentage- cardiomyopathy

A

41%

40
Q

Sudden cardiac death causes percentage- congenital and anatomic abnormalities

A

26%

41
Q

Sudden cardiac death causes percentage- electric disorders

A

10%

42
Q

Sudden cardiac death causes percentage- idiopathic hypertrophy

A

8%

43
Q

Sudden cardiac death causes percentage- acquired disorders

A

8%

44
Q

Sudden cardiac death causes percentage- valvular disorders

A

6%

45
Q

Sudden cardiac death causes percentage- coronary artery disease

A

1%

46
Q

Sudden cardiac death % below 17 (including)

A

65%

59% in high school

47
Q

ATWI

A

In adult, white, asymptomatic individuals deemed normal if limited to V1-V2
Beyond V2 rare and should be investigated
Preceded by J point depression or ST segment depression should also be investigated further

48
Q

ST depression

A

Rare

V bad

49
Q

Hypokalaemia early changes

A

Flattening or inversion of T waves
Prominent U waves
ST segment depression
Prolonged QT interval

50
Q

Hypokalaemia late changes

A

Prolonged PR interval
Decreased QRS voltage
Widened QRS
Ventricular arrhythmia

51
Q

Slow HR

A

Increased vagal tone
Reduced intrinsic sinus pacemaker rate
Reverses on detraining

52
Q

Slow HR- more likely to exhibit

A

Sinus bradycardia
Junctional rhythm
1st degree heart block
Mobitz type 1

53
Q

Mobitz type II and 3rd degree HB are

A

Rare

Further investigation

Sports and Exercise Medicine iBSc (13 decks)

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