ECG

Question 1

Normal inversion of t wave in which lead

When is the t wave upright?

Answer 1

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

Question 2

ASD

ECG, CXR and clinical findings in a 5yo

Answer 2

Incomplete RBBB
ESM at upper LSE
CXR - cardiomeg (RV hypertrophy)
plethora
prominent PA
Fixed split S2

Question 3

p waves should be upright in which leads?

Answer 3

I and aVF

Question 4

Axis - which leads to look at?

Answer 4

I and aVF

Then to II

Question 5

Features of stills murmur on ECG, CXR, clinical exam

Answer 5

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

Question 6

ECG features L ventricular hypertrophy

Answer 6

Large R wave voltages in V5, V6
Deep S wave in V1
(note normal ranges change with age)

Question 7

4/6 pan systolic murmur at LSE

Normal ECG with ULN voltages in L leads

Answer 7

VSD (voltages due to L ventricule dilation which normalises over time)

Question 8

large vsd

Answer 8

2/6psm low pitches at LSE, 2/4 diastolic murmur at apex
cut - cardiomegaly, pulmonary plethora, hyper expanded lungs
ecg - rvh, lvh

Question 9

R and L ventricular hypertrophy on ecg

Answer 9

large q AND r wave voltages in v5, v6

Question 10

R ventricular hypertrophy

Answer 10

R wave dominance v1
S wave dominance V5, V6
upright t wave v1

Question 11

loud systolic murmur
mild cyanosis 88%
R V hypertrophy

Answer 11

TOF

Question 12

What do tall p waves indicate?

Answer 12

Right atrial dilatation/hypertrophy

Question 13

LONG bifid p wave in lead II

inverted p wave in V1

Answer 13

L atrial dilatation/hypertrophy

Question 14

Conditions that cause R atrial hypertrophy

Answer 14

Large ASD

Tricuspid regurgitation or stenosis

Question 15

Conditions that cause left atrial hypertrophy

Answer 15

Mitral regurgitation or stenosis
Large VSD or duct
Cardiomyopathy

Question 16

Causes of L axis

Answer 16

LVH esp with volume overload (large VSD)
LBBB (wide QRS)
Tricuspid atresia
AV canal defect

Question 17

When are deep q waves in young children normal vs red flags

Answer 17

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)

Question 18

R atrial enlargement

Answer 18

p wave hight >3mm

Question 19

L atrial enlargement

Answer 19

bifid p waves prolonged > 10ms (2.5 small squares)

Question 20

R ventricular hypertrophy

Answer 20

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

Question 21

L ventricular hypertrophy

Answer 21

R wave voltage >25mm

Severe - ST depression and T wave inversion in V6

Question 22

QTc interval - what is the bassett formula

What is normal range

Answer 22

QT (ms) / square root RR interval (ms)

Should be < .45sec

Should be measured only in lead 2 and V5

Question 23

Normal ST segment range (up or down)

Answer 23

Up to 1mm (except up to 2mm in V2-V4)

Caused by abnormal myocardium

• cardiomyopathy
• infarct
• severe hypertrophy