Characteristics ECG Flashcards
Sinus bradycardia
<60 bpm
Sinus tachycardia
> 100 bpm
Sinus arrthythmia
variations in heartrate during insp. (increases HR) and exp. (decreases HR).
Atrial premature beat
- Early P
- P- wave may “sit” on T- wave
- Narrow QRS
Ventricular premature beat
- No P- wave (or retrograde)
- Wide QRS
- Uni-/ multifocal
- Compensatory beat before next “normal” beat
- Bigeminy/ Trigeminy
Atrial tachycardia
- Continuous/ nonparoxysmal: 100- 150 bpm.
- Sudden/ paroxysomal: 150- 250 bpm.
Junctional (AV) premature beat
- no P (or retrograde) preciding QRS
- Shorter PR- interval
- QRS followed by compensatory pause
Supranodal: inverse P before QRS (II lead) except aVR where opposite
Mesonodal: no P- wave
Infranodal: QRS before inverse P
Ventricular tachycardia
- Sustained >30s, unsustained <30s.
- Nonparoxysmal/ paroxysmal
- Monomorphic/ polymorphic (i.e. Torsades de pointes: QRS amplitude fluctuates)
- Wide QRS
- AV dissociation (P i QRS, fusion beat)
- Ventricular escape < Accelerated ventricular rhythm < Tachycardia
Junctional tachycardia
- Nonparoxysmal = continuous, paroxysmal = sudden
- Escape rhythm < Accerlerated junctional rhythm < Tachycardia
Atrial Flutter
- 250- 300 bpm
- NO P- wave (f instead)
- Sawtoothed pattern (lead II, III)
- Common: 2:1 AV- block
2:1, 3:1, 4:1 block
Ventricular Flutter
> 200 bpm
- High amplitude sine wave- like pattern
- No P, QRS or T- waves
- F for f- waves
- No effecive ventricular activity
Atrial Fibrillation
- 350- 600 bpm.
- baseline appears flat
- NO TRUE P- waves
- irregular appearance of QRS in abs. of P- waves
- “wavelike” fronts
- irregular
Ventricular Fibrillation
- 120- 200 bpm.
- Fusion beats
- irregular
Wolf- Pakinson- White (WPW)
- Delta wave
- Short PR
- Widening of QRS due to delta wave
Lown- Ganong- Levine Syndrome (LGL)
- PR < 0,12s
- T- wave inversion
- no delta wave
RBBB
- wide QRS > 0,12s.
- V1,2: M cmpl. or notched R (RSR’)
- I, aVL, V6: wide, deep S
(ST depression and T- wave inversion might be seen)
LBBB
- wide QRS > 0,12s.
- I, aVL, V5, V6: slurred or notched R
- V1: wide, deep S
- lack of Q in V5 or V6
- rS or QS in V1-V4
Hyperacute MI
- NO Q
- ST- elevation –> “T- en dome” =ST- elevation merged with tall peaked T
- Increased T by amplitude and width (tall peaked T- waves)
Acute MI
- ST- elevation accompanied by T- inversion (symmetrical)
Subacute MI
- no ST
- path. Q
- Inverted deep T (coronary T).
Chronic/ Definitive/ Old MI
- Inverted/ upright T or nearly isoelectric
- deep path. Q
LAH
- Left deviation > -30*
- Normal QRS
- No ST or T changes
LPH
- Right deviation
- Normal QRS
- No ST or T changes
- Tall R in inferior leads
- Deep S in lateral leads
Bifasicular block
RBBB + LAH: QRS > 0,12s.
or
RBBB + LPH: QRS > 0,12s.
1st degree AV- BLOCK
PR > 0,12S.
All beats are conducted
RHYTHMIC
2nd degree AV- BLOCK
Mobitz type I
- Progressive prolongation of PR until one QRS is missed (usually 3rd or 4th)
- RR gets shorter
2nd degree AV- BLOCK
Mobitz type II
- PR constant
- QRS is dropped without PR prolongation
(after one P, no QRS) - RR constant
2nd degree AV- BLOCK
2:1
Every other P gets conducted (QRS dropped).
3rd degree AV- BLOCK
Complete block.
- No P get conducted
(P- waves marching across rhythm strip, no relation to QRS).
HIGH DEGREE AV- BLOCK
Consecutive P get blocked. Conduction sometimes. (Escape rhythm may start).
P- mitrale
Wide P- wave
P- pulmonale
Tall P- wave
Salve
Accerelation, but doesn’t last longer than 3 beats.
>3 beats = Tachycardia
Hyperkalemia
- tented T
- flat or missing P
- shorter QT
- atrial fibrillation
- PR prolongation
- QRS widening (may merge with T- wave)
Hypokalemia
- flat T
- ST- depression
- Long ST > 0,45s.
- arrhythmia or bradycardia
Hypercalcemia
Shortened QT
Hypocalcemia
Prologned QT
Subendocardial lesion
- TP, PR elevated
- ST depressed
Subepicardial/ Transmural lesion
- TP, PR depressed
- ST- elevated
- Coronary T- wave
Larger/ Transmural infarct
- path. Q
Smaller/ Subendocardial infarct
- path. Q
- R- reduction (unusually short R).
Anterior lead
V1-4
Inferior lead
II, III, aVF
Left lateral
I, aVL, V5-6
Right leads
avR, V1
Inferior infarction
II, III, aVF
Lateral infarction
I, aVL, V5-6
Anterior infarction
V1-6
- tall R
- ST- depression
- R > S
Posterior infarction
reciprocal changes in V1 (ST depression, tall R)
Mirror images of ant. infarc.
Ant. lateral infarction
I, aVL + most of/ all V1-6
Junctional escape beat
- after sinus arrest. NO P (may be retrograde before, after or during QRS)
Paroxysmal Supraventricular Tachycardia (PSVT)
- sudden onset, usually initiated by premature beat. Sudden termination.
- regular rhythm
- retrograde P may be seen in II, III
- V1: pseudo R’
- 150- 250 bpm
Multifocal Atrial Tachycardia (MAT)
- irregular rhythm
- there is a P- wave before each QRS
- 3 p- wave morphologies
- 100- 200 bpm.
Accelerated Idioventricular rhythm
…sometimes seen during acute infarct
- 50- 100 bpm.
- ventricular escape
- No P
- QRS is wide
- HR approx. 75 bpm.
Torsade de Pointes
- prologned QT
- QRS spiral around the baseline, changing axis and amplitude
Onset of TdP VT typically preceded by RR intervals: short (caused by extrasystole) - long (compensatory pause) - short
Atrial Pacemaker
Spike followed by a P and normal QRS.
Ventricular Pacemaker
Spike followed by wide QRS.
Abs. of P or retrograde P may be seen.
No- Q- wave infarction
- No Q
- T- wave inversion
- ST- depression
Apical Ballooning Syndrome
- T- inversion
- ST- elevation
Angina
- ST- depression
- T- inversion
AV- nodal reentrant tachycardia (AVNRT)
- Paroxysmal
- Regular tachycardia 140- 280 bpm
- QRS usually narrow
- ST depression may be seen
- P -wave if visible exhibitd rretrograde inversion with P- wave inversion in II, III, aVF
- P may be buried in the QRS, visible after QRS. Rarely visible before QRS.
Sick Sinus Syndrome
Multiple ECG abn. may be seen:
- sinus bradycardia
- sinus arrhythmia
- sinus arrest > 3s.
- atrial fibrillation with slow ventricular response
- bradycardia- tachycardia syndrome:
- -> alt. bradycardia with paroxysmal tachycardia often supraventricular.
Atrioventricular Reentry Tachycardia (AVRT): ORTHODROMIC CONDUCTION
- 200- 300 bpm
- P buried in QRS or retrograde
- QRS < 0,12s.
- T- wave inversion
- ST- segment depression
Atrioventricular Reentry Tachycardia (AVRT): ANTIDROMIC CONDUCTION
- 200- 300 bpm
- wide QRS
Right atrial hypertrophy
P- pulmonale
- increased amplitude of first portion of P
- no change in duration of P-wave (0,1 s.)
- possible right deviation of P- wave
Tallest P seen in aVF and II
Left atrial hypertrophy
P- mitrale
- increased amplitude of terminal portion of P- wave
- increased P- wave duration
- no significant axis deviation
- should drop > 1mm in V1
In lead II notched P
Right ventricular hypertrophy
- right axis deviation, greater than 100*
- ratio R- wave amplitude to S- wave is >1 in V1, and <1 in V6
Left ventricular hypertrophy
- R amplitude in V5 or V6 + amplitude of S in V1 or V2 >35mm
- R in V5 >26mm
- R in V6 >18mm
- R wave in V6 exceeds R- wave in V5
In limb leads:
- R wave in aVL >11mm
- R in aVF >20mm
- R in I >13mm
- R in I + S in III >25mm
Difference AV- BLOCK/ SA- BLOCK
AV- BLOCK: - no. P
- no QRS
SA- BLOCK: no P
Long QT syndrome (LQTS) type II
- prolonged QT (normal QT <0,44s)
Longest QT usually found in II, V5 or V6 - prominent U, might merge with T
Long QT syndrome (LQTS) type I
- prolongation of QT interval is caused by large T- waves with broad base
Brugada sign
Coved > 2 mm, descending ST- elevation, followed by a negative T in at least two leads out of V1, V2 and V3.
