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ECG > ECG > Flashcards

ECG Flashcards

1
Q

significance of axis deviation include: RAD could signify _____________ while LAD could signify ___________.

A

pulmonary embolism; conduction defect

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2
Q

pulmonary conditions and congenital heart problems cause:

a. right ventricular hypertrophy
b. left ventricular hypertrophy

A

a. right ventricular hypertrophy

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3
Q

which interval signifies time taken for conduction to travel from SA node to ventricles?

A

PR interval

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4
Q

interferance with normal conduction of depolarization leads to

A

heart block

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5
Q

If depolarization originates in SA node and reaches ventricles but there is a delay in the conduction somewhere. this is known as _____________ characterized by prolonged _______.

A

first degree heart block. characterized by prolonged PR interval. PR>5 small squares

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6
Q

when one or more conductions fail to reach the ventricles. this is known as ______________ heart block

A

second degree

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7
Q

progressive lengthening of PR interval then 1 P wave with no proceeding QRS

A

second degree heart block. MOBITZ type 1.
Usually benign and asymptomatic
also known as wenkebach.
# of QRS waves= # of P waves-1

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8
Q

constant PR interval with occasional drop of QRS is known as

A

second degree heart block MOBITZ type 2

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9
Q

which is more common type of second degree heart block? which is more dangerous? why?…
a/MOBITZ 1
b/MOBITZ 2

A

MOBITZ 1 is more common but MOBITZ 2 is more dangerous as it carries risk of becoming third degree heart block or cardiac arrest

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10
Q

normal contraction from atria but no conduction to ventricles. complete heart block. P wave and QRS disassociation. these are known as

A

third degree heart block.

high risk of cardiac arrest! needs pacemaker(mobitz 2 needs pacemaker as well)

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11
Q

there is an escape rhythm in which type of heart block?

A

third degree.

the QRS complexes are also abnormally shaped as there is abnormal spread of depolarization from a ventricular focus.

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12
Q

causes of third degree heart block?

A

most common: fibrosis around bundle of His
Acutely: due to MI
could also be caused by block of both bundle branches

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13
Q

time taken for depolarization to spread from interventricular septum to furthest parts of ventricles is the

A

QRS complex

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14
Q

QRS is considered prolonged if it is more than ________ squares. What are the two conditions causing prolonged QRS?

A

three small squares.

  1. Bundle branch blocks
  2. Depolarization beginning in ventricles
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15
Q

if QRS is prolonged and the rhythm is

  1. sinus(P wave present and normal PR)
  2. not sinus
A
  1. bundle branch block

2. depolarization beginning in ventricles

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16
Q

which bundle branch block PATTERN (normal QRS duration) could be present in normal people? what does this same one indicate if QRS is prolonged?

A

right. problem with right side of the heart.

NOTE: left never happens in healthy ppl. always indicates heart disease(usually left ventricle.)

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17
Q

which BBB is associated with inverted T wave

A

left. the inversion is usually seen in the lateral leads.

NOTE: BBB are important to point out soon since they make interpretation of the ECG hard

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18
Q

which BBB is best seen on V1 vs V6?

A

V1:right
V6: left

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19
Q

how to recognize LBBB?

A

M(widened and notched QRS) pattern on V6. this could also appear on other leads like 1,2,V5
NOTE: W is hardly seen on V1; it is sinus! t inversion could be present.

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20
Q

which type of heart block(1,2,3) ALWAYS indicated a conducting tissue disease? is it more often fibrotic or ischemic

A

type 3. often fibrotic

need pacemaker

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21
Q

think about an atrial septal defect with ________ bundle branch block

A

right. it has no specific treatment

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22
Q

think about aortic stenosis with _BBB

A

left bundle branch block

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23
Q

think about ischemic disease with _BBB

A

left bundle branch block

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24
Q

patient has recently had severe chest pain. what could LBBB indicate?

A

acute myocardial infarction

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25
Q

think about left ventricular hypertrophy and its causes with

A

left axis deviation

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26
Q

what could left axis deviation and right bundle branch block indicate?

A

severe conducting tissue disease. pacemaker is needed if symptoms suggest intermittent complete heartblock

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27
Q

Changes in sinus rhythm seen in younger ppl due to respiration is called

A

sinus arrhythmia

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28
Q

QRS in supraventricular arrhythmia is ________ while in ventricular it is _________.

A

normal(narrow). abnormal(wide and abnormal shape) t wave is also abnormal in the latter one

29
Q

frequencies of depolarization:
SA:
atrial/nodal:
ventricular:

A

70 bpm. 50. 30

30
Q

if p wave is present but abnormal in an escape beat, this is

A

atrial escape?

31
Q

which escape beat happens in complete heart block?

A

ventricular. there are multiple p waves and then an abnormal QRS complex with an abnormal t wave

32
Q

atropine is a positive or negative? ionotrope or chronotrope?

A

positive chronotrope(increases heart rate)

33
Q

which type of escape beat happens in third degree heart block?

A

ventricular.

34
Q

atrial rate of >250/min is called

A

atrial flutter. there is no flat baseline between the p waves and often called sawtooth

35
Q

narrow complex tachycardia of 125-150/min and atrial flutter should make u think of

A

2:1 block.

36
Q

QRS rate is irregular in..

a. atrial flutter
b. atrial fibrillation

A

b

37
Q

QRS is wide and abnormal in which type of tachycardia?

A

ventricular..usually t waves disappear in tachycardias

38
Q

wide complex tachycardia is treated by _________ while narrow complex is treated by _______.

A

lidocaine. adenosine

39
Q

peaked P wave:

broad and bifid p wave:

A
  1. right atrial hypertrophy

2. left atrial hypertrophy

40
Q

what can right atrial hypertrophy indicate? 2 things

A
  1. tricuspid valve stenosis

2. pulmonary hypertension

41
Q

what can left atrial hypertrophy indicate/

A

mitral valve stenosis

42
Q

when V1 becomes upright, (R>S), this indicates

A

right ventricular hypertrophy. S becomes deep on V6

43
Q

if ECG of a person suspected of pulmonary embolism shows normal pattern, what is the approach?

A

give anti coagulant. do not ignore it

44
Q

what to look for in pulmonary embolism regarding the following:

  1. p wave
  2. axis
  3. V1
  4. V6
  5. transition point on chest leads
  6. Q wave
A
  1. peaked p wave(atrial hypertrophy)
  2. right axis deviation: deep S on lead 1
  3. tall R in V1
  4. persistent and deep S in lead V6
  5. transition point shift to the left(v5,v5)
  6. Q wave appears in lead III: resembling inferior infarction
45
Q

can there be pulmonary embolism without any wave abnormalities?

A

yes. patient could present with only sinus tachycardia

46
Q

what changes are expected to be found in V1 and V6 in left ventricular hypertrophy? are these changes enough to diagnose LVH?

A

V1: deep S wave(also in V2)
V6: tall R wave. (also in V5)
NO…

47
Q

what 2 changes are associated with significant LVH?

A
  1. left axis deviation(lead II)

2. inverted t wave in the left leads: II,VL,V5,V6

48
Q

When is an ST segment elevation seen? 2 occasions.

A

seen in acute MYOCARDIAL injury

  1. infarction
  2. pericarditis
    note: with the former, the specific leads show which part is infarcted, with pericarditis most leads will show ST elevation since pericarditis is not focal.
49
Q

when is a horizontal ST segment depression seen? what about sloped depression?

A
  1. ischemia(there will be upright T wave) and exercise

2. sloping is the characteristic effect of digoxin, a drug given for atrial fibrillation, flutter, and heart failure

50
Q

which leads have a normal inverted t wave?

A

VR, V1. maybe III and V2. V3 in some black people

51
Q

count the conditions that can cause inverted t wave. (almost everything)

A
  1. ischemia
  2. BBB
  3. ventricular hypertrophy
  4. digoxin effect
  5. normal
52
Q

what is the first abnormality seen after an MI? what changed follow?

A

ST segment elevation. this returns back to normal in 24-48 hrs. Q wave appearance and t wave inversion. these don’t return to normal

53
Q

if an infarction is not full thickness, it doesn’t produce a window thus there is no _ wave. however what change is still prominent? what is this type of infarction called?

A

q wave. t wave inversion will still happen. this is called a NSTEMI or subendothelial infarction.

54
Q

t wave inversion, sloping ST depression, narrow QRS is seen in

A

digoxin effect

55
Q

which plasma electrolyte level doesn’t affect the ECG out of the 4 main ones?

A

Sodium unlike potassium, calcium, magnesium.

56
Q

high levels of potassium and magnesium show as

A

PEAKED T WAVE with ST disappearance. maybe prolonged QRS.

57
Q

low levels of potassium and magnesium show as

A

flat t wave with appearance of a small hump at the end of ‘t wave’ called a u wave

58
Q

high levels of calcium show as while high levels as

A

short QT interval; long QT

59
Q

one small square is 1 mm. in width this means _____ and in height it means _______

A

width: 0.04 seconds.
height: 0.1 mv

60
Q

if there’s atrial fibrillation. what clue could tell us it’s due to digoxin?

A

sloping ST depression

61
Q

in which type of extrasystole is there p wave but it is abnormal

A

atrial

62
Q

what would an inverted p wave in most leads indicate?

A

an atrial focus is controlling the heart. atrial ectopic beat

63
Q

tall p wave exists in normality. when is it actually significant?

A

tall p wave indicates right atrial hypertrophy. when there is also right ventricular hypertrophy

64
Q

what does a bifid p wave in the presence of left ventricular hypertrophy indicate

A

mitral valve stenosis. but this is rare

65
Q

RAD is often seen in healthy ppl. when is it significant?

A

when there is right ventricular hypertrophy. also if the patient has had Previous MI

66
Q

what does RAD in a person with previous MI indicate

A

left posterior hemiblock

67
Q

criteria for LVH include V1/V2 and V5/V6 >35 mm or 7 large squares. this is only significant if what other ecg change is seen

A

when there is also inverted t wave in the left lateral leads

68
Q

what is the hallmark of a fully developed STEMI?

A

Q waves. reminder that q waves can be seen in normal individuals in the lateral and inferior leads.

ECG (2 decks)

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