ECG Flashcards
Normal inversion of t wave in which lead
When is the t wave upright?
V1 is inverted between day 4 of life to 4yrs
Is upright until day 4 of life when pulmonary vascular pressure is high due to full of fluid, then decreases when fluid is replaced with air and this is when V1 becomes inverted
With RVH between day 4 to 4 yo t wave an be upright and this is ABNORMAL
ASD
ECG, CXR and clinical findings in a 5yo
Incomplete RBBB ESM at upper LSE CXR - cardiomeg (RV hypertrophy) plethora prominent PA Fixed split S2
p waves should be upright in which leads?
I and aVF
Axis - which leads to look at?
I and aVF
Then to II
Features of stills murmur on ECG, CXR, clinical exam
Normal precordium
2-3/6 vibratory ESM at upper and lower LSE
Murmurs Disappears when they sit up and extend their neck (quieter or disappears)
ECG - normal axis IRBBB
CXR - normal
ECG features L ventricular hypertrophy
Large R wave voltages in V5, V6
Deep S wave in V1
(note normal ranges change with age)
4/6 pan systolic murmur at LSE
Normal ECG with ULN voltages in L leads
VSD (voltages due to L ventricule dilation which normalises over time)
large vsd
2/6psm low pitches at LSE, 2/4 diastolic murmur at apex
cut - cardiomegaly, pulmonary plethora, hyper expanded lungs
ecg - rvh, lvh
R and L ventricular hypertrophy on ecg
large q AND r wave voltages in v5, v6
R ventricular hypertrophy
R wave dominance v1
S wave dominance V5, V6
upright t wave v1
loud systolic murmur
mild cyanosis 88%
R V hypertrophy
TOF
What do tall p waves indicate?
Right atrial dilatation/hypertrophy
LONG bifid p wave in lead II
inverted p wave in V1
L atrial dilatation/hypertrophy
Conditions that cause R atrial hypertrophy
Large ASD
Tricuspid regurgitation or stenosis
Conditions that cause left atrial hypertrophy
Mitral regurgitation or stenosis
Large VSD or duct
Cardiomyopathy
Causes of L axis
LVH esp with volume overload (large VSD)
LBBB (wide QRS)
Tricuspid atresia
AV canal defect
When are deep q waves in young children normal vs red flags
THIN deep q waves are normal in 1,2,3, avf, v5, v6
Red flag is BROAD q waves and q waves in V1 (anterior INFARCT, single ventricle, severe RVH, L-TGA)
R atrial enlargement
p wave hight >3mm
L atrial enlargement
bifid p waves prolonged > 10ms (2.5 small squares)
R ventricular hypertrophy
Tall R wave in V1 (>20mm)
Deep S wave in V6 (>7mm)
upright T wave in V1 (after day 4 of life - 5 yrs)
R axis deviation
L ventricular hypertrophy
R wave voltage >25mm
Severe - ST depression and T wave inversion in V6
QTc interval - what is the bassett formula
What is normal range
QT (ms) / square root RR interval (ms)
Should be < .45sec
Should be measured only in lead 2 and V5
Normal ST segment range (up or down)
Up to 1mm (except up to 2mm in V2-V4)
Caused by abnormal myocardium
- cardiomyopathy
- infarct
- severe hypertrophy
