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CVS > CVS 7 ECG > Flashcards

CVS 7 ECG Flashcards

1
Q

What colours are the limb electrodes?

A

Ride Your Green Bike

RA - Red
LA - Yellow
LL - Green
RL - Black

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2
Q

Where are the 6 chest electrodes placed?

A

V1- 4th intercostal space to right of sternum
V2- 4th ICS to left of sternum
V3- halfway between V2+V4
V4- 5th ICS at the midclavicular line
V5- level with V4 at the left anterior axillary line
V6 - level with V4+5 at left mid axillary line
(directly under midpoint of armpit)

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3
Q

Location of V1 electrode

A

4th intercostal space to right of sternum

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4
Q

Location of V2 electrode

A

4th intercostal space to left of sternum

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5
Q

Location of V3 electrode

A

Halfway between V2 + V4

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6
Q

Location of V4 electrode

A

5th intercostal space at midclavicular line

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7
Q

Location of V5

A

Level with V4 at left anterior axillary line

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8
Q

Location of V6 electrode

A

Level with V4+5 at left mid axillary line
(Directly under midpoint of armpit)

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9
Q

How do the ECG leads work?

A

Each lead is a representation of a measurement of the change in mV in 2 electrodes
Signal for each of the 12 leads represents change over time
Each lead represents specific part of the heart

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10
Q

What does 1 small square on an ECG represent?

A

0.04 seconds (40ms)

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11
Q

What does 1 large square on an ECG represent?

A

0.20 seconds

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12
Q

What is 1 second on an ECG?

A

5 large squares

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13
Q

How should you approach an ECG?

A

Correct patient?
Rate- 10 second strip - QRS waves x 6 = HR
Rhythm
Axis
Intervals

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14
Q

What gives you lead I?

A

Difference between RA + LA

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15
Q

What gives you lead II?

A

Difference between RA + LL

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16
Q

What gives you lead III?

A

Difference between LA + LL

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17
Q

What are the augmented leads?

A

avR
avF
avL

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18
Q

What type of wave is generated if signal is going directly - to + ?

A

Strong upwards deflection

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19
Q

What type of wave is generated if signal is going partially - to + ?

A

Small upwards deflection

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20
Q

What type of wave is generated if signal is going perpendicular - to + ?

A

Biphasing
Positive and negative

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21
Q

What type of wave is generated if signal is going away at an angle - to + ?

A

Small downward deflection

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22
Q

What type of wave is generated if signal is going directly away - to + ?

A

Strong downwards deflection

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23
Q

Anterior/septal leads
What artery is affected?

A

Septum V1+V2
Anterior V3+V4
Left anterior descending artery

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24
Q

Lateral leads
What artery is affected?

A

I
avL
V5
V6

L - lateral
1+5+6=12 L is the 12th letter of the alphabet

Left circumflex or left anterior descending

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25
Q

Inferior leads
What artery is affected?

A

Lead II
Lead III
avF

INF
N - 2 vertical lines&raquo_space; lead II
IN - 3 vertical lines&raquo_space; lead II
F&raquo_space; avF

Right coronary artery or left circumflex

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26
Q

What is the axis of the ECG?

A

Top right - to bottom left +

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27
Q

What is sinus rhythm?

A

Regular spacing with same QRS and P waves before

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28
Q

What is sinus arrhythmia?

A

Irregular spacing between QRS with a p wave before QRS

29
Q

Describe atrial fibrillation

A

Irregular irregular
Irregular spacing with no p wave
Atria quiver rather than properly contracting

30
Q

Length of a normal PR interval

A

0.12-0.2 seconds

31
Q

What are the colours of the chest electrodes?

A

Ride Your Great Big Brown Pony
Red
Yellow
Green
Brown
Black
Purple

32
Q

Left side of the heart leads

A

Lead I
avL

33
Q

What is sinus bradycardia?

A

Sinus rhythm with <60bpm

34
Q

What is sinus tachycardia?

A

Sinus rhythm with >100bpm

35
Q

How to calculate heart rate from ECG with regular rhythm?

A

300/no. of large boxes between complexes

36
Q

How to calculate rhythm of ECG with irregular rhythm?

A

No. of QRS complexes in 10 seconds x 6

37
Q

What are wider QRS waves associated with?

A

Abnormal ventricular depolarisations

38
Q

What are longer PR intervals indicative of?
What length is long?

A

slow conduction from atria to ventricles
1st degree branch block
Ischaemic heart disease
Hypokalaemia
>0.2 seconds

39
Q

What are shorter PR intervals indicative of?
What length is short?

A

Wolf-Parkinson-White (delta wave seen)
<0.12seconds

40
Q

What factors affect the amplitude of deflection?

A
  • Size + speed of muscle changing potential
  • Direction of wave activity towards electrode
41
Q

What structures compose the specialised conducting system of the heart?

A

SAN
AVN
Bundle of His
Right + left bundle branches
Purkinje fibres

42
Q

What is avL being the greatest positive lead indicative of?

A

Left axis deviation

43
Q

What is lead III being the greatest positive lead indicative of?

A

Right axis deviation

44
Q

How do you confirm left axis deviation?

A

avL - greatest positive lead
Leads II,III + avF - negative

45
Q

How do you confirm right axis deviation?

A

avF - most positive lead
Lead I + avL - negative

46
Q

What is seen in Wolf-Parkinson-White syndrome?

A

Delta wave
Short PR interval

47
Q

What are the characteristics of first degree heart block?
Causes

A

Consistently prolonged PR interval
> 5 small squares
QRS complex follows

Causes - ischaemic heart disease
hypokalaemia

48
Q

What is characteristics of Mobitz Type 1 (second degree heart block)?

A

Progressive lengthening of PR interval
1 QRS wave drops
Cycle repeats

49
Q

What is characteristic of Mobitz Type 2 (second degree heart block)??

A

PR interval normal
Sudden non conduction of beat
Dropped QRS

50
Q

What causes complete heart block?

A
  • normal atrial depolarisation but impulses not conducted to ventricle
  • ventricular pacemaker takes over
51
Q

What is characteristic of third degree heart block?

A

Very slow rate 30-40bpm&raquo_space; BP can’t be maintained
Wide QRS complex
No relationship between P wave and QRS complex

52
Q

What is seen in right bundle branch block?

A

Bunny rabbit ears in V1
QRS prolonged >3 small squares

53
Q

How do you find the 4th intercostal space?

A

Find the sternal angle - slight dip in between manubrium + body of sternum
- this give you the 2nd ICS, count down to the 4th

54
Q

Describe the cardiac conduction pathway and deflections

A
  • depolarisation towards the electrode = upwards deflection (when
    impulse is travelling down the septum, this gives the upwards part of
    QRS complex
  • depolarisation away from the electrode = downwards deflection
    (impulse travelling up ventricles giving downwards part of QRS complex
  • repolarisation towards electrode = downward deflection
  • repolarisation away from electrode = upward deflection
55
Q

how can you look at an ECG orderly to determine if it is normal

A
  1. calculate the heart rate
  2. is the rhythm regular or irregular (mark them out with peaks of QRS complex and slide across to match it up if unsure
  3. are there P waves - this suggests atrial activity
  4. are there QRS complexes - this suggests ventricular activity
  5. is each P wave followed by a QRS complex and is each QRS complex preceded by a P wave
  6. measure the intervals of
    PR, QRS and QT
56
Q

Change in ECG following a STEMI

A

1- normal ECG
2- hyper acute T wave
3- ST elevation
4- deeper Q wave inverted T wave
5- improved ST elevation
6- Q wave persists + T wave normalises

57
Q

What is a STEM?

A

Full thickness myocardial infarction
ST elevation myocardial infarction

58
Q

What is an NSTEMI?

A

Partial thickness myocardial infarction
Non ST elevation myocardial infarction

59
Q

What is seen on the ECG of a NSTEMI?

A

Depressed ST segment
Inverted T wave

60
Q

ECG of atrial flutter

A

Sawtooth pattern in inferior leads

61
Q

ECG in hypokalaemia

A

First sign - T wave inversion
ST depression
Prominent U wave

62
Q

ECG in hyperkalaemia

A

Peaked T waves
P waves flattening
PR prolongation
Wide QRS complex

63
Q

What features are seen on an ECG with ectopic beats?

A

Atrial ectopic - early abnormally shaped P wave
**Atrioventricular junctional ectopic ** - inverted P wave
Ventricular ectopics - broad QRS complex

64
Q

Causes of heart block

A

Fibrosis
Ischaemia

65
Q

ECG of 2:1 block

A

For every 2 P waves
There is only 1 QRS complex

66
Q

How do you determine if an ECG is in sinus rhythm?

A

If each P wave is followed by a QRS complex

67
Q

Describe Torsades de Pointes

A

Polymorphic ventricular tachycardia
QRS complex all look different
Long QT interval

68
Q

Most common cause of left axis deviation

A

Defects in conduction system

69
Q

Most common cause of right axis deviation

A

Right ventricular hypertrophy

CVS (22 decks)

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