ECG Flashcards
what does the P wave represent
atrial depolarization that make the atria contract
What does QRS represent
Ventricular depolarization that make the ventricles contract
long PR interval means what?
longer means that the AV node interval is delayed…its holding on a little longer to fire off
Wide QRS means what
it is taking longer for the Ventricular depolarization - Bundle branch block
QT interval is what
ventricular repolarization time
Time is shown on what axis on the ECG
X axis
Big square on ECG is how many seconds
.2 seconds
Little square on ECG is how many seconds
.04 seconds
Lateral leads are represented on ECG where
Lead I and AVL, V5, V6
Inferior lead are represented on where on the ECG
Lead II, III, AVF
Anterior leads are represented on the ECG
V3, V4
Septal leads are represented where on ECG
V1, V2
V3r and V4r are for what
if they have electrical activity on R side
What am I
Sinus Rhythm
what am I
Sinus Bradycardia
What is the Rate
about 30
what am I
Artifact
QRS is regular…this is artifact
What am I
WPW
Wide QRS
short PR
problem with AV conduction - faster
What syndrome has fast AV conduction bc it extra wire that connects the atria and ventricles that bipasses the atrioventricular node -
Delta Waves (widening of QRS during the PR interval)
what am I ?
Up on the auto read…it may say consider acute STEMI
Early Repolarization
J point elevation
ST segment elevation
In adults this is concerning for heart ischemia
In healthy children this is a normal variant
Their heart is repolarizing before depolarization is over
Nike Swoosh instead of Tombstone - classic for early repolarization and it is normal
what am I
Sinus Rhythm with PAC
so you have to have a P wave
This P wave comes prematurely
P wave is a little different
What am I?
Sinus Pause
about 3.5 sec
What am I
SVT
side note- you can have p waves in SVT
this is narrow complex without p waves
what am I
Sinus Rhythm with PVC
Look at QRS
PVC can have a P wave
look at morphology
Different QRS morphology
It came in early
came from Ventricle
Broader and funny looking
what am I
Atrial Bigeminy
Find a sinus beat first
1st QRS of each couple has a P and QRS
They each have a twin
PAC - has a p wave…look in between QRS….it has a shoulder…its a p wave hiding in the T wave
so its coming from the Atria
Look at the morphology of QRS
PACs in the pattern of Bigeminy
1 sinus beat followed by a PAC
What am I?
2:1 Pseudo AV Block due to QT prolongation
There are more Ps then QRS - so some sort of AV nodal block
For every 2 P waves you have 1 QRS
2:1 Block
There is Long QT
its so long that it is preventing ventricular repolarization
The 2:1 AV block is a symptoms of QT prolongation
Their heart rate is super slow here
You give a B Blocker which will bring their heart rate up like magic!
what am I?
Monomorphic VT
Wide complex
What am I?
Artifact
It looks like Toursades but if you look…There are QRS that are marching through
What am I?
Torsades de Pointes
No QRS
same in all leads
ventricular fibrillation
what am I?
SVT
How are you going to treat?
Toursades de Pointes
Chest Compressions
Defibrilation
You can give magnesium but the mainstay here is chest compressions and early defibrillation
what am I?
Atrial Flutter
what am I?
How do we treat?
Atrial Fibrillation
What am I?
Toursades de Pointes
what am I
Ventricular vibrillation
Calculating rate on ECG by boxes
1 box=
2 box =
3
4
5
6
300
150
100
75
60
50
formula for calculating HR on ECG
300 divided by Number of Large boxes between QRS = HR
what am I
What is the rate
How do you treat
Sinus Bradycardia
48 bpm
Common, benign finding - because of high vagal tone
what am I
Rate?
How do you treat?
Sinus Rhythm
170
Normal finding ….can be up to 230 when irritable…should be transient
what am I?
NSR
What am I?
What am I?
Limb Lead Reversal
Abnormal P wave Axis - inverted in Lead I but normal in aVF
look in V6 - it looks right
Lead I and V6 should always be identical even if abnormal
What happened? R and L arm leads are placed incorrectly.
what am I?
How do you treat?
low right atrial rhythm
The p wave is upright in Lead I and inverted in aVF
Normal, benign variant at normal heart rates
what am I?
Bursts of Ectopic atrial tachycardia
(from irritable non-sinus focus in atrium)
If frequent, it can lead to tachycardia-induced cardiomyopathy
look at p waves in AvF …chaotic
ECG with Short PR interval
Delta Wave
Wide QRS
what am I
Wolff-Parkinson-White (WPW)
ECG with Long PR intervall
All P waves conduct to a QRS
What am I?
1st degree AV block
what am I?
Wolff-Parkinson-White (WPW)
Short PR interval
Slurred upstroke of QRS (Delta wave)
May be at risk for SVT- common and Preexcited atrial fibrillation -rare
What am I?
How do I treat?
1st degree AV block
Common benign finding (esp in teen athletes)
May progress to higher grade AV block if assoicated with myocarditis, neuromuscular disease
In Bundle branch block the QRS is > ___ms
120
What am I?
How to Treat?
Right ventricular conduction Delay
AKA: Incomplete R bundle branch block
common benign finding in childhood - possible association with ASD
what am I?
how do we treat?
RBBB
QRS >120 ms
Bunny ears
History of CHD - almost all have this
If no cardiac history - further workup…could be from myocarditis
What is this?
Treat?
LBBB
Rare in pedatrics
QRS >120ms
Dominant S wave in V1
Wide R wave in V6
we watch these …at risk for further cardiac later
measurment for prolonged QTc
Borderline - 450-460 ms
>460 is prolonged
The QT interval represents the time required for
Ventricular depolarization and repolarization
Bazett formula is used for what?
What is it?
QTc
= QT (sec) divided by square root of R-R (sec)
what am I?
Long QT syndrome
QTc = 540 ms
R atrial enlargement the P wave height is over ____ boxes
2.5
In pediatrics, the T wave abnormalities are more commonly associated with
Caridomyopathy
In adults - ischemic changes
What does the T wave do in V1 in a newborn
Upright as a newborn then inverted after one week of age.
T wave in V1 is inverted in adolescence….
Normal to invert after one week of age. if it remains inverted this is a normal variant
T wave in V5 and V6 should look how in all ages
Upright
After age 13, T-wave inversions (>1 mm depth) in >=2 leads (V2-V6) is normal or abnormal
may be abnormal
In Hypertrophic Cardiomyopathy, What is often seen on ECG with T waves
T wave inversions
what am I?
What are some pathologies to consider in pediatrics with other signs and symptoms?
1st Degree AV block
common in healthy asymptomatic adolescent due to high vagal tone
other pathologies: Lyme disease, myocarditis, neuromuscular disease
what am I
2nd degree AV block, Mobitz type 1
Wenckebach
Progressive PR prolongation, followed by a non-conducted P-wave
common during sleep and in athletic adolescens due to high vagal tone
Intermittent non-conducted P waves without preceding PR prolongation
2nd degree AV block, mobitz type 2
rare in pediatrics
what am I?
3rd degree (complete) AV block
P to QRS ratio >1
Steady R-R interval
When is 3rd degree (complete) AV block seen
Congenital heart disease
Heterotaxy syndrome
Myocarditis
neuromuscular disease
What am I?
Treat?
SVT
Adenosine via rapid IV push which halts conduction at AV node to terminate reentrant SVT
what am I
Ventricular Tachycardia
what am I
Treatment?
Left Posterior Fascicular VT (Belhassen VT)
Monomorphic tachycardia, wide complex, Left Superior Axis (QRS upright in I and down in aVF) with RBBB morphology
Highly responsive to Calcium channel blockers (Verapamil)
T-wave inversion in the inferior and/or lateral leads may warrant evaluation for
Cardiomyopathy
wide complex tachycardia should be considered what until proven otherwise
VT
what am I
Brugada syndrome
Coved ST segment elevation (>2 mm) in V1 and or V2 with T wave inversion
INherited disorer associated with risk of V-Fib and sudden cardiac death
May be associated with a sodium channelopathy (loss-of-function mutation in SCN5A gene)
