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ACSM > ECG > Flashcards

ECG Flashcards

1
Q

Combien de mm entre les lignes du papier et combien de temps cela représente?

A

-1 mm entre chaque petite ligne;
-5 mm entre les lignes épaisses;

Sur l’axe des x:
-Chaque boîte de 1 mm = 40 ms (0,04s);
-5 petites boîtes = 200 ms (0,2 s).

Sur l’axe des y:
-Chaque boîte de 1 mm = 0,1 mV;
-10 boîtes de 1 mm = 1 mV.

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2
Q

Durées normales des ondes et des segments:

A

-P: <= 120 ms (0,12 s);
-Intervalle PR: 120-200 ms (0,12-0,20 s);
-QRS: < 100 ms (0,10 s) (2,5 petites boîtes);
-Intervalle QT: < 440 ms (0,44 s).

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3
Q

Fréquences cardiaques à l’ECG:

A

-300
-150
-100
-75
-60
-50

Chaque petite boîte représente environ 3 bpm.

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4
Q

Qu’est-ce qu’un « SA nodal reentrant tachycardia »?

A

Abnormal current that spins rapidly around in the area of the SA node, resulting in fast HR.
-P wave appears normal since the depolarizations come from the SA node;
-Sudden onset and sudden cessation.

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5
Q

What is a sinus pause

A

A delay before the appearance of a P wave;

May be caused by failure of the SA node to depolarize or SA « block » which does not permit the depolarization to escape from the SA node.

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6
Q

What is a premature atrial complex?

A

Early (premature) beat, arising from somewhere above the ventricules other than the SA node (ex: in the atria or the AV junction).

Starts in an ectopic focus in the atria or AV junction. Appearance of the P wave will differ from the sinus P waves and will take a different amount of time to travel through the atria (PR interval will differ).

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7
Q

What is atrial bigeminy/trigeminy/quadrageminy?

A

Situation wherein every second/3rd/4th beat is a premature atrial complex.

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8
Q

What is atrioventricular reetrant tachycardia?

A

Abnormal current that spins rapidly around in the area of the AV node. The P waves are usually not seen or are negative and follow the QRS complex.

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9
Q

Quel est le rythme intrinsèque d’un foyer jonctionnel?

A

40-60 bpm

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10
Q

Quelle est la particularité du « Wandering Atrial Pacemaker and Multifocal Atrial Tachycardia »?

A

The P waves differ in appearence.
A commonly accepted critereon is the presence of 3 or more different P wave morphologies.

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11
Q

What is called the occurence of two/three premature ventricular complexes?

A

Ventricular couplet.

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12
Q

What is a string of three or more ventricular couplets called?

A

V-Tach

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13
Q

Différence entre TVNS et TVS?

A

-TVNS: Séquences de TV durant moins de 30 secondes;
-TVS: Séquences de TV durant plus de 30 secondes.

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14
Q

Que sont les torsades de pointe?

A

Subclass of polymorphic V-Tach in which the polarity of the QRS complexes repetitively shifts.
The cause may be reversible (ex: electrolyte abnormalities and certain medication effects).

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15
Q

Dans quel cas est-ce qu’une ESV est particulièrement dangereuse?

A

When a premature ventricular complex falls on the T wave of the preceding beat, it is much more likely to lead to a serious arythmia, such as V-Tach or V-Fib.

Called « R-on-T PVCs ».

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16
Q

What is a ventricular escape rythm?

A

Usually seen in situations when higher pacemakers (SA node, AV node) have failed to depolarize the ventricles.

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17
Q

Qu’est-ce qu’un bloc AV de 1er degré?

A

Delay in the conduction of depolarization from the atria to the ventricles. PR intervals are consistently long (>= 200 ms), but all of the depolarizations reach the ventricles.

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18
Q

Que sont les blocs AV de 2e degrés?

A

Some P waves are followed by a QRS complex, but some are not. Two major types exist: Mobitz type I (aka Wenckebach) and Mobitz type II.

Mobitz type I: progressive lengthening of the PR interval, culminating in a P wave that does not conduct down to the ventricles and therefore is not followed by a QRS complex.
-The missing QRS causes a break in the rhythm that leads to a characteristic appearence of groupes of P-QRS-Ts with spaces in between.

Mobitz type II: multiple P waves per QRS complex. It may occur occasionnally or be persistant for long periods of time. Many types depending of the number of P waves apprearing before a QRS is conducted (ex: 2:1, 3:1, 4:1, etc.).

19
Q

What is AV dissociation?

A

The atria and ventricles are functionning independently (like a 3rd degree block), but the ventricle rate is faster than the atrial rate.
-Benign type of AV dissociation often occurs when the supraventricular (usually sinus) rate has slowed and a lower pacemaker (junctional or idioventricular) begins to pace the ventricles;
-Condition is typically transicent (when the atrial rate increases, the ventricles are captured).

20
Q

Dérivations des membres et précordiales:

A

Dérivations des membres: I, II , III, aVF, aVR, aVL.
Dérivations précordiales: V1, V2, V3, V4, V5, V6.

21
Q

À quels endroits se retrouvent les dérivations I, II et III + leurs pôles?

A

I: LA (+ - ) –> RA (-)
II: LL (+) –> RA (-).
III: LL (+) –> LA (+ -).

22
Q

Inferior leads:

A

II, III, aVF

23
Q

Septal leads:

A

V1, V2

24
Q

Lateral leads:

A

I, aVL, V5, V6

25
Q

Anterior leads:

A

V3, V4.

26
Q

Placement des électrodes:

A

-RA: right arm (ou mid-clav);
-LA: left arm (ou mid-clav);
-RL: right leg (ou entre RA et LA car ground);
-LL: left leg (ligne mi-claviculaire le plus bas possible);
-V1: 4e espace intercostal à droite du sternum;
-V2: 4e espace intercostal à G au sternum;
-V3: Entre V2 et V4;
-V4: 5e espace intercostal ligne mid-claviculaire G;
-V5: Ligne axillaire antérieure G au même niveau que V4;
-V6: Ligne mi-axillaire au même niveau que V4 et V5.

27
Q

Dans quel plan sont les dérivations des membres?

A

Plan frontal.

28
Q

Dans quel plan sont les dérivations précordiales?

A

Plan transverse

29
Q

Où regarde aVR?

A

Seule dérivation à droite.

30
Q

Apparence d’une onde P si hypertrophie oreillette D vs G?

A

Si hypertrophie OD: abnormally tall and often pointy (« peaked ») P wave typically found in lead II (>= 0,25 mV ou 2,5 mm).

Si hypertrophie OG: enlarged P wave often with a notch in the middle, typically seen in lead II.
-The first part of this wide P wave represents the normal electrical activity of the RA (because the RA begins to depolarize before the LA). The enlarged atrium then takes longer to depolarize, therefore, the latter part of the P wave lengthens, resulting in abnormally long P wave (>= 120 ms).

31
Q

Apparence d’une hypertrophie VD sur l’ECG?

A

Abnormally large R wave in V1.

32
Q

Apparence + détermination d’une hypertrophie VG sur l’ECG?

A

V1 et V2: petite onde R avec grosse onde S;
V5 et V6: grosse onde R.

Additionner la hauteur de l’onde R dans V5 ou V6 avec l’onde S en V1. Si >= 35 mm (3,5 mV) = HVG.

33
Q

Apparence BBD sur l’ECG:

A

RsR’ en V1 et V2 et un S en V5 et V6 (in the absence of RBBB the left chest leads usually do not have s waves).

Putting these series of events together, the classic RBBB pattern consists of wide QRS complexes with rSR’ in leads V1 and V2 and a qRs in leads V5 and V6 with a longer than normal S wave.

Oreilles de lapin.

34
Q

Apparence BBG sur l’ECG:

A

R wave in leads V5 and V6 and a Q wave in leads V1 and V2. Creation of a wide R wave in the left chest leads. Notched R wave and long QRS (> 120 ms)

Chapeau de cowboy.

35
Q

What is an incomplete bundle branch block?

A

QRS longer than 100 ms but shorter than 120 ms.

36
Q

What is a complete bundle branch block:

A

QRS longer than 120 ms.

37
Q

What is a hemi block?

A

The left bundle branche has two fascicles. When one of these fascicles functions normally and the other does not, it is called a fascicular block or hemiblock. Failure of one of the fascicles only mildly prolongs the QRS duration; a more significant effect is a shift of the axis.

38
Q

What is a bifascicular block?

A

One of the fascicles of the left branch + right branch block.

39
Q

How can digitalis affect an ECG?

A

Excessive digitalis can cause a variety of arrhythmias and types of heart block, but even normal doses commonly result in characteristic and often shallow « U-shaped » depression of the ST-segment. This is known as digitalis effect. It complicates ECG interpretation because ST-segment depressions due to digitalis can be difficult or impossible to distinguish from ST changes due to ischemia.

40
Q

How can pericarditis affect an ECG?

A

Pericarditis results in ST-segment elevations that may initially appear similar to those of STEMI. However, the ST elevations of pericarditis differ in several ways from those of an acute infarct.
Given the fact that the pericardium surrounds the heart, pericarditis typically results in ST elevations in all leads except aVR. Their evolution is much slower, and there is no development of Q waves.

41
Q

How does hypocalcemia and hypercalcemia affect an ECG?

A

Hypocalcemia: prolongs the QT interval (long QT);
Hypercalcemia: decreases the QT interval (short QT).

42
Q

How can hyperkalemia affect an ECG?

A

-Appearance of tall, peaked T waves;
-As serum potassium levels continue to rise, the T waves remain tall and peaked, and an unusual rhythm develops, This appears to be an idioventricular rhythm but is actually a sinoventricular rhythm.

43
Q

What are the 3 features of Wolff-Parkinson-White?

A
  1. Short PR interval;
  2. Wide QRS;
  3. Delta wave.

ACSM (3 decks)

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