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Data Interpretation > ECG > Flashcards

ECG Flashcards

1
Q

Inferior leads

A

Lead 2,3 and aVF

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2
Q

Lateral leads

A

1, aVL, aVR, V5-6

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3
Q

Septal leads

A

V1, V2

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4
Q

Anterior leads

A

V3-V4

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5
Q

Order of reading ECG

A
  1. Patient details
  2. Heart rate
  3. Heart rhythm
  4. Cardiac axis
  5. P waves
  6. PR interval
  7. QRS complex
  8. ST segment
  9. T waves
  10. U waves
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6
Q

Normal heart rate and how to measure

A

60 to 100bpm
300 / RR interval (big squares)
If irregular - no of complexes on rhythm strip (6 secs = 30 boxes) x 10

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7
Q

Assessing heart rhythm

A

Regularly regular
Irregularly irregular

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8
Q

Cardiac axis

A

Leaving - left axis deviation (leads 1+2)
Arriving - right axis deviation

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9
Q

P wave assessment

A

Present
Followed by QRS
Duration, direction, shape
Sawtooth =flutter
Chaotic = fibrillation

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10
Q

PR interval assessment

A

Prolonged = more than 200ms (1 large square)
Shortened = less than 120ms (3 small boxes)

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11
Q

Delta wave

A

Wolff-Parkinson syndrome if occurs with tachycardia
Slurred upstroke of R wave

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12
Q

QRS complex assessment

A
  1. Width - broad if >120ms (3 small squares)
  2. Height - tall if >5mm (1 large square) in limbs and >10mm (2 large squares) in chest
  3. Delta wave
  4. Pathological q wave- >25% of size of R wave />2mm in height (2 small squares) + > 40ms in width (1 small squares) in V1-V3
  5. R/S waves - S>R until V3/4
  6. J point (looks like ST elevation)
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13
Q

ST segment

A

Elevation - >1mm (1 small square) in 2+ contiguous limb leads or >2mm (2 small squares) in 2+ chest leads
Depression - > 0.5mm (half small square) in 2+ contiguous leads

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14
Q

T waves

A

Tall - >5mm (1 large square) in limbs and >10mm (2 large squares) in chest
Inverted - normal in V1 and 3
Biphasic
Flattened

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15
Q

U wave

A

Rare
>0.5 (half small square) deflection after t wave
In V2/3

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16
Q

First degree heart block

A

Fixed prolonged PR interval

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17
Q

Second degree heart block

A

Mobitz type 1/ Wenckebach phenomenon - progressive prolonging of PR interval followed by absence of QRS

Mobitz type 2- constant PR interval, absent QRS every 3 to 4 waves (3:1 or 4:1)

Acute MI / chronic heart disease

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18
Q

Third degree heart block

A

No relationship between p waves and QRS complexes - more p waves than QRS
Right axis deviation
Variable PR intervals

MI
Fibrosis
Consider pacemaker

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19
Q

Right bundle branch block

A

Normal PR interval
Broad QRS (>120s)
Second R wave (slow depolarisation on RHS) (R1)
MaRroW
V1 - M shape - +ve R, -ve S, +ve R1
V6 - W shape - -ve R, +ve S, -ve R1
Wide slurred S wave in lateral leads

20
Q

Left bundle branch block

A

Normal PR interval
Broad QRS
WilLiaM
Dominant S wave in V1
Broad monophonic R wave in lat leads
Absence of q waves in lat leads
Prolonged R wave in lateral leads

21
Q

Sinus rhythm

A

One p wave per QRS
Constant PR interval

22
Q

Causes of BBB

A

Aortic stenosis
MI

23
Q

Sinus tachycardia

A

Exercise
Dear
Pain
Haemorrhage
Thyrotoxicosis

24
Q

Sinus bradycardia

A

Athletic training
Fainting
Hypothermia
Myxoedema
Immediately after MI

25
Q

Locations of rhythm abnormality

A

SAN
AVN (nodal/junctional)
Ventricular muscle

26
Q

Supraventricular rhythms

A

Rhythm that originates outside of ventricles and spreads in normal manner
Can be atrial or nodal
Normal QRS

27
Q

Atrial escape

A

SAN node does not start depolarisation
Another part of atrium does
Abnormal p wave
Normal QRS
Normal beats after abnormal one

28
Q

Nodal escape

A

No p waves
Normal QRS
Bradycardic

29
Q

Ventricular escape

A

Seen in complete heart block / one offs
SAN and junctional escape fails
No p wave
Normal rhythm afterwards

30
Q

Accelerated idioventricular rhythm

A

Ventricular rhythm but not bradycardic - normal rhythm
Benign

31
Q

Extrasystoles

A

Similar to escape rhythms
But beat occurs earlier rather than later than expected

32
Q

Junctional extrasystole

A

absent / misplaced p wave
As depolarisation travels to atria and ventricle at same time
Normal QRS

33
Q

Atrial extrasystole

A

Normal beat but earlier than expected

34
Q

Tachycardia

A

Either atrium or AVN depolarising too quickly
Look at p wave to discover origin
If intermittent = paroxysmal

35
Q

Atrial tachycardia

A

p waves superimposed on the t waves of preceding beat
QRS normal
AVN limit is 200bpm - if atrial depolarisation faster - AV block
But block has sinus rhythm (no tachycardia)

36
Q

Atrial flutter

A

Rate > 250bpm
Saw tooth p waves
Associated with block

37
Q

Nodal tachycardia

A

P waves very close to QRS or no p waves
QRS normal
Carotid sinus pressure - stimulate AVN and SAN - no effect on ventricular tachycardias

38
Q

Ventricular tachycardia

A

Broad QRS
Difficult to identify t waves
No p waves
Regular QRS
similar to BBB
If just had MI - VT

39
Q

Atrial fibrillation

A

No p waves
Irregularly irregular
Tachycardia

40
Q

Ventricular fibrillation

A

No discernable pattern
Very likely to lose consciousness
Urgent defibrillation

41
Q

Wolff-Parkinson-White syndrome

A

Accessory pathway from atria to ventricles on LHS (bundle of kent)
Pre-excitation of ventricles
Risk of sudden death if paroxysmal tachycardia - loop of depolarisation / re-entry circuit
R axis deviation
Short PR and QRS
Delta wave
If tachycardic = no p waves

42
Q

Pacemaker

A

Occasional p waves not related to QRS
QRS preceeded by spike
Broad QRS as depolarisation is ventricular in origin

43
Q

Ectopic beats

A

Unexpected p waves (atrial) or QRS (ventricular)

44
Q

Atrial ectopics

A

Abnormal or no p wave
Normal QRS
Benign

45
Q

Ventricular ectopics

A

Widened QRS
Irregularly irregular pulse
Benign
Predispose to VT

46
Q

Hyperkalaemia

A

Peaked t wave
Wide/flat p waves
Bradycardia
Conduction blocks
QRS widening

47
Q

Hypokalaemia

A

Tall p wave
Prolonged PR interval
ST depression
T wave flattening/inversion
U waves
Long QT interval due to fusion of T and U waves

Data Interpretation (1 decks)

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