- Lead III + - aVF + - aVR + (extreme axis dev)

ECG Flashcards by Nihal Afsheen

Which leads show : Septal view of the heart

V1 + V2

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Which leads show lateral view of the heart?

I , AVL, V5, V6

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Which leads show an anterior view of the heart?

V3, V4

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Which leads show inferior view of the heart?

II, III and AVF

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Which lead is at 0 degrees

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Which lead is at 60 degrees?

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Which lead is at +90 degrees?

AvF

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Which lead is at +120 degrees?

III

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Which lead is at -150 degrees?

aVR

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ECG - 1 small square

1mm / 40 ms

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ECG : 1 large square

0.5cm / 200 ms

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How is the rate calculated?

QRS (over 10 secs) x 6 = HR Big squares between R-R / 300

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What is the definition of sinus rhythm?

Action potential originated from the SA node

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How is sinus rhythm seen on an ECG?

P waves up right: Lead II
Inverted P wavesin: Lead AVR
Each P waves looks the same in the same lead

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What is normal cardiac axis?

- Lead II
- aVF

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What is RAD in ECG?

Lead III +
aVF +
aVR + (extreme axis dev)

What is LAD in ECG?

- aVF
- Lead I

What is the definiton of cardiac axis?

Overall direction of electrical activity in the heart

What are the causes of L. axis deviation?

*Left bundle branch block
*Inferior MI
*Physiological } minor LAD in obese people

What is the definition of the PR interval?

atrial depolarisation and contraction

What is the ECG range of PR interval?

120 - 200m/s
3-5 small squares

What is the defintion of WPW syndrome?

Accessory pathway allows for conduction of electrical impulses into the ventricle at a site other than the AV node.

What are the ECG features of WPW syndrome?

Short P-R interval : <120 m/s, AV node usually delays impulse to allow the ventricles to complete contracting but this accessory pathway bypasses the AV node
Delta wave ‘slurred upstroke’ of the QRS complex

What is first degree heart block/

What is T1 mobitz - 2nd degree heart block?

* progressive lengthening of PR interval, * one non conducted P wave, next conducted beat has a shorter PR interval

What is 3rd degree Heart block? (3)

- No relationship between P wave and QRS complex Regular P waves - none are conducted by the AVN - Broad QRS - ectopic beats

What is the management of AV block?

1. 1st degree HB and Mobitz type 1 - usually do not require treatment as long as the patient is assymtpmatic 1. Mobitz type 2 and complete heart block (3rddegree) require permanent pacemaker

What is T2 mobitz - 2nd degree heart block?

R-R interval is constant occasional non conducted P wave - in variable or set ration

What is the pathophysiology behind LBBB?

1. Blocked L. bundle branch 2. Heart depolarised from Right bundle branch to left 3. Electrical activity travels from right to left 4. Tall R waves in lateral leads } Leads 1, V5,V6 5. Deep S waves in Right leads

What are the ECG features in LBBB?

* -Further deepn ’S’ wave in V1 } **‘W’** * -Further ‘R’ wave in V6} **‘M’** * T wave inversion in anterolateral leads and is 2nd to abnormal repolarisation

What is the pathophysiology of RBBB?

1. Left ventricle is activated as normal, impulse travels equally down the left and right bundles with 2. septum activated from left to right LV is activated as normal 3. so early part of QRS complex correlation to septal depolarisation is unchanged

What are the ECG features in RBBB?

1. V1 : RSR pattern 'M' 2. V4/V5 : 'W': broad S wave in V6

Bifascicular block RBBB + LAFB

R. Bundle branch block and left axis deviation

Bifascicular block RBBB + LPFB

R. Bundle branch block and right axis deviation

What is the defintion of QT interval?

Ventricular depolarisation and ventricular depolarisation Start of the QRS complex until the end of the T wave.

Definition of ST segement

normally flat as no electrical activity, ventricles are already depolarised

What is the function of the T wave?

- ventricular repolarisation, anything that affects depolarisation affects repolarisation - Check ; Orientation (upright/inverted), height * Normally inverted in - V2, II, III and AvF (inferior leads)

Where are T waves normally inverted?

Normally inverted in - V2, II, III and AvF (inferior leads)

What is the definition of Posterior STEMI?

Posterior STEMI - classically reciprocal changes in anterior leads >ST depression in V1, V2, V3 > Tall, broad R waves (30 secs) >Upright T waves