Diagnosing from the ECG Flashcards
COPD
Generalized small complexes R axis RAH (P pulmonale) RVH RBBB
Pulmonary Embolism
Sinus tachycardia RVH RBBB S1 Q3 T3 Could have atrial arrhythmias
Mitral Stenosis
LAH if in sinus rhythm
AF is common
RVH
R axis
Mitral Incompetence
LAH if in sinus rhythm
AF common
LVH
RVH
Hyperkalaemia
Flat/absent P waves
Broadened QRS
Large peaked T waves
Arrhythmias
Hypokalaemia
Flat T waves Prominent U waves Prolonged QT 1st or 2nd degree block ST depression
Hypercalcaemia
Shortened QT
Flat T waves
Hypocalcaemia
Prolonged QT
Parts of a STEMI
Necrosis - pathological Q wave
Injury - ST elevation
Ischemia - inverted T wave
If T waves remain inverted 2 weeks after a STEMI
Suspect a myocardial aneurysm
Earliest sign of a MI
Giant peaked T waves
What leads show infarction of the RCA of circumflex artery?
Inferior leads (S2, S3, aVF)
What leads show infarction of the LAD?
Chest leads (V1-V6)
What leads show infarction of the 1st diagonal of the LAD?
High lateral leads (S1, aVL)
What causes sinus tachycardia?
Exercise Pregnancy Fever Anaemia Thyrotoxicosis CF Shock PE Alcohol Withdrawal
How can you unmask flutter waves?
Vagal stimulation
Adenosine
Treatment of Atrial Flutter
Electrical cardioversion
Radio-frequency catheter ablation
AVNRT is common in?
Young pts with structurally normal hearts
Rate of AVNRT
150-250 bpm
Type of drugs to be avoided if direction of conduction is reversed in AVRT
Drugs that inhibit AV condution such as Verapamil and Digoxin
What should be ruled out as a cause if AF is discovered?
Thyrotoxicosis
What steps should be taken to manage AF?
Prevent thrombo-embolic episodes
Control ventricular rate
Find treatable cause
Regain sinus rhythm
What rhythm has 3 or more ectopic atrial beats and P waves which vary in morphology?
Multifocal Atrial Tachycardia
What is the most common cause of MAT?
Obstructive airway disease
A scar from a previous MI is a common cause for which tachyarrhythmia?
Ventricular Tachycardia
Treatment of VT
Electrical cardioversion
Anti-arrhythmic drug such as Amiodarone or Lignocaine
Signs of VT
AV dissociation
QRS > 140ms
Electrial concordance
NW axis
Treatment of non-sustained VT
Prophylactic anti-arrhythmic drug or implantable defibrillator
Torades de Point is worsened with what type of drugs?
Anti-arrhythmic drugs
Treatment of Torsades de Point
Electrical cardioversion
Correct electrolyte disturbances esp. low Mg
Isoprenaline infusion or cardiac pacing
Treatment for VF
Adnvanced cardiac life support
electrical cardioversion
What should be excluded in pts with premature ventricular ectopic beats to ensure good prognosis?
Ischaemia and structural heart disease
What is a delta wave?
The initial slurred QRS deflection characteristic of WPW syndrome
Describe the AF pts with WPWS are prone to develop
Irregular, broad complex tachycardia with anterograde conduction
Name the regular, narrow tachyarrhythmias
Sinus tachycardia Ectopic atrial tachycardia Atrial flutter AVNRT AVRT
Name the Irregular, narrow tachyarrhythmias
AF
Atrial flutter with variable block
MAT
Name the regular, broad tachyarrhythmias
VT SVT with BBB SVT with aberrant conduction SVT with eccentric conduction Ventricular pacemaker
Name the Irregular, broad tachyarrhythmias
AF with BBB AF with aberrant conduction AF with eccentric conduction Multifocal ventricular rhythm Torsades de Point
Extrinsic causes of sinus bradycardia
Drugs
Hypothyroidism
Cholestatic jaundice
Intrinsic causes of sinus bradycardia
SSS
Ischaemic heart disease
In what condition will exersice or atropine have no effect on the heart rate
Sick Sinus Syndrome
Causes of 1st degree block
Fit Beta-blockers RF Myocarditis Ischaemia
What heart block is the PR interval progressively lengthened until a beat is dropped?
2nd degree - Mobitz 1
Mobitz 1 is commonly observed after?
Inferior MI
Who would require pacing in Mobitz 1?
Symptomatic elderly pts with structural heart disese
Why is a pacemaker indicated in Mobitz 2?
It often progresses to 3rd degree block
If the QRS complex is narrow in complete block, where does the escape rhythm originate?
The AV junction