Chung's ECG Tut

Question 1

How does SVT appear on ECG?

Answer 1

140-180

Regular

Narrow complex

No p waves

Question 2

What are some treatment options for SVT?

Answer 2

Valsalva

Carotid massage

Adenosine

Question 3

What is the normal QTc for males and females?

Answer 3

Males: 440ms

Females: 480ms

Question 4

Outline the complete management of a patient with complete heart block who presents to ED

Answer 4

Admit to resus

Lie them with legs up

Administer 250ml of saline stat

Administer 0.6 to 3mg of atropine

And isoprenaline

Pacemaker

Question 5

How do you work out the degrees of axis deviation?

Answer 5

Make a vector of the amplitude of lead avF and I and determine the degree of the deviation from that

Question 6

What is the first line medical treatment of VT?

Answer 6

Amiodarone

Question 7

How does WPW appear on ECG?

Answer 7

Delta waves

Shortened PR interval

Question 8

What is the variation present in WPW ECGs? Why does it occur? What are the treatment implications?

Answer 8

The QRS complex can be narrow when there is orthodromic signal propagation - the signal travels down the normal path through the heart conduction system but then back through the accessory pathway. Treated with normal anti-arrhythmias

The QRS complex can also be wide when there is antidromic signal propagation - the signal travels down the accessory pathway first - slower signal propagation hence wide QRS - then back through the normal conduction system. This form can be treated with procainamide.

Question 9

What must you warm the patient about when giving adenosine? Why?

Answer 9

Their heart will stop so they’ll feel light headed for ~10s

It stops the heart for a short period but has a half life of 10s

Question 10

What are some common causes of R axis deviation?

Answer 10

RVH

Pulmonary hypertension

Question 11

What will the HR of someone in atrial flutter be? Why?

Answer 11

150

Most atrial flutter is due to a 2:1 block of transmission of atrial signal and the atrium has an intrinsic rate of 300bpm

Question 12

What is the difference between mobitz type I and II?

Answer 12

Mobitz Type I (Wenckebach) has progressive prolongation of the PR interval followed by a dropped beat

Mobitz Type II has random dropped beats

Question 13

What are the supraventricular arrhythmias?

Answer 13

SVT

AF

Atrial flutter

Question 14

What are the two L fascicles? What would destruction of each cause?

Answer 14

Left anterior fascicle - Left axis deviation

Left posterior fascicle - R axis deviation

Question 15

How does VT appear on ECG?

Answer 15

Wide complex tachycardia

Notches in the QRS representing P-waves

Question 16

What is the trick from determining axis deviation?

Answer 16

Look at lead I and III

If the QRS complexes are facing away from each other (leaving) then it’s L axis

If the QRS complexes are facing each other (reaching) then it’s R axis