ECG

Question 1

ECG Paper

Answer 1

1 x large box, 5mm x 5mm = 0.2 seconds

1 x small box, 1mm = 0.04 seconds

Speed = 25mm/sec

5 x large boxes = 1 second

Question 2

Cath lab criteria

Answer 2

Chest pain/tightness lasting more than 20 mins & within last 9 hours

AND

ECG showing 2mm (male) or 1.5mm (female) in anterior leads (V2&3)

OR

1mm in any 2 contiguous leads showing same view of heart

Question 3

Not cath lab

Answer 3

Seizures that cannot be managed

Compromised airway that cannot be managed

Question 4

STEMI with ROSC post arrest

Question 5

Posterior STEMI

Answer 5

Back of the heart

MI symptoms & ST depression in V1-V3

V4, V5, V6 moved to patient’s back beneath scapula

STE in leads V4, 5, 6 (7, 8, 9)

0.5mm of STE = significant

Reciprocal ST depression in V1-3

Question 6

Right ventricular MI

Answer 6

Acute inferior MI

Question 7

ECG/MI - when not to give GTN

Answer 7

Inferior MI

RV involvement

Preload

Question 8

ECG - V4R

Answer 8

V4 to same spot on right side

Question 9

ECG - hyper/hypokalemia

Answer 9

Hypokalaemia - scooped shape in ST depression
Hyperkalaemia - tall and peaked T waves; wide and bizarre QRS

Question 10

ECG - PR interval

Answer 10

3 - 5 small boxes

0.12 - 0.20 seconds

Question 11

ECG - QRS interval

Answer 11

1.5 - 3 small boxes

0.08 - 0.12 seconds

Question 12

ECG - QT prolongation

Answer 12

Normal -

0.34 - 0.46 in women

0.34 - 0.44 in men

If T wave finished before midpoint between R-R interval QT is normal

Question 13

Broad Complex Tachycardia

Answer 13

VT or SVT with a conduction delay
Rapid HR
Broad QRS (>3 small boxes)
Regular rhythm

Question 14

Severe hyperkalaemia

Answer 14

Tall, peaked T waves
Wide and bizarre QRS complexes

Question 15

PVCs

Answer 15

Occasional broad complex generated by ventricles
Quad/tri/bi = PVC every 4/3/2 beats consistently
Ventricular couplets - 2 in a row
Non sustained VT - 3 or more vent beats >100bpm, lasting less than 30 seconds

Question 16

Paced Rhythm

Answer 16

Broad QRS complex with pacing spikes or arrows
Mimic diagnostic criteria of LBBB

Question 17

Wolff-Parkinson White

Answer 17

Tall R & inverted T in V1 - V3
Sinus with short PR
Slurred upstroke causing broad QRS
Additional electrical pathway between atria and ventricles causing additional impulses to trigger abnormal conduction

Question 18

Left Bundle

Question 19

Right Bundle

Question 20

First degree heart block

Question 21

Second degree heart block type 1

Question 22

Second degree heart block type 2

Question 23

Complete heart block

Question 24

Silent/atypical MI criteria

Question 25

Anterior leads

Question 26

Inferior leads

Question 27

Septal leads

Question 28

Paced rhythm/MI

Question 29

ECG NINE POINTS

Answer 29

Rate? A = V?
Reg?
P wave appearance? Uniform?
P before each QRS?
QRS after each P?
PR & QTc intervals normal & consistent?
QRS narrow or broad?
ST segment normal?
Where’s the pacemaker?

Question 30

ECG NINE POINT +

Answer 30

Review each lead systematically
P waves upright in I II and V2-V6?
No Q waves >0.4 wide in same leads
QRS & T same general direction in LL
ST segment start isoelectrically except in V1&V2 where it might be slightly elevated
T wave normally upright in I II & V3-V6
R wave progression in chest leads

Question 31

Modified Sgarbossa in LBBB