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STP 1st year exams > ECG > Flashcards

ECG Flashcards

1
Q

Causes of non-ischaemic sudden cardiac death:

A

Hypertrophic cardiomyopathy

Arrythmogenic RV cardiomyopathy

Brugarda syndrome

Long QT syndrome

Short QT syndrome

Early repolarisation syndrome

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2
Q

What is hypertrophic cardiomyopathy?

A

Condition where heart muscle becomes thickened

Caused by mutations in genes encoding sarcomeric proteins = myocardial disarray

Increased risk of VT/VF

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3
Q

Hypertrophic cardiomyopathy ECG features:

A

LVH + strain pattern

Deep, narrow (“dagger-like”) Q waves in lateral and inferior leads

Apical HCM = Gaint T wave inversion (asymmetrical)

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4
Q

What is arrhythmogenic right ventricular cardiomyopathy?

A

Mutations that cause desmosomal abnormality = causes fibrofatty replacement of RV muscle

(can also include LV muscle)

can trip into VT/VF

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5
Q

Arrhythmogenic right ventricular cardiomyopathy ECG features:

A

RBBB

Inverted T waves V1-3

Slurred S waves or epsilon waves V1-V3

Inferior/lateral T wave inversion = shows LV involvement

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6
Q

What is Brugada syndrome?

A

Sodium ion channel abnormality in RV epicardium

SCD due to fast polymorphic VT during rest/sleep

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7
Q

Brugada syndrome ECG features:

A

Type 1 = Coved ST elevation with T wave inversion V1/2

Type 2 = Saddleback ST elevation with positive T wave V1/2

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8
Q

Brugada sign can be hidden:

A

Diagnosis recommends moving V1/2 electrodes up to 2nd and 3rd intercostal spaces

Can also be revealed by…
* Na channel blockers
* Fever
* Beta blockers
* Tricyclic antidepressants
* Alcohol toxicity
* Cocaine toxicity

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9
Q

Ajmaline challenge:

A

Used to check for Brugada syndrome

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10
Q

What is long QT syndrome?

A

Inherited ion channel abnormality

Prolonged or delayed ventricular repolarisation

Increased risk of lethal ventricular arrhythmias

Females ≥460ms

Males ≥450ms

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11
Q

QTc (ms) =

A

QT (ms) divided by square root of RR (s)

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12
Q

Triggers for cardiac events in Long QT type 1

A

vigorous exercise - swimming/diving

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13
Q

Triggers for cardiac events in Long QT type 2

A

Auditory stimuli – alarm clock, phone, door bell, ambulance siren, door slam – esp on waking Emotional stress, anger

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14
Q

Triggers for cardiac events in Long QT type 3

A

Sleep or rest without arousal

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15
Q

What is short QT syndrome?

A

<340ms QT interval

Inherited

May cause AF, ventricular arrhythmias, SCD

Other causes of short QT: digoxin toxicity, hypercalcaemia

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16
Q

What is early repolarisation syndrome?

A

early repolarisation is usually benign - occasionally a marker for sudden cardiac death

ST elevation + J waves

J wave = slurred or notched

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17
Q

Causes of Left Ventricular Hypertrophy…

A

Hypertension

Aortic stenosis

Coarctation of the aorta

Cardiomyopathies

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18
Q

LVH ECG:

A

S wave in V1 + R wave in V5 or V6 >3.5mV

R wave in aVL ≥ 1.1mV

T wave inversion and ST depression in I, aVL, V5 and V6

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19
Q

Voltage for LVH may be present in the absence of LVH if:

A

Thin build

Young patient

No ST changes will be seen

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20
Q

Causes of Right Ventricular Hypertrophy …

A

Chronic obstructive pulmonary disease

diopathic pulmonary hypertension

Pulmonary stenosis

Complex congenital heart disease

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21
Q

RVH ECG:

A

R wave in V1 + S wave in V5 or V6 ≥1.1mV (11mm)

Dominant R wave in V1

S wave in V6

Right axis deviation

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22
Q

Left atrial abnormality (enlargement) causes…

A

Any disease of the LV which impairs function

LVH

Cardiomyopathy

Mitral valve disease

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23
Q

Left atrial abnormality (enlargement) ECG:

A

P mitrale (broad P)

Lead II = Wide, notched (bifid) P waves (≥3mm)

V1 = Negative component of P wave has a width and depth of 1 mm or more (and is bigger than the initial positive deflection)

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24
Q

Right atrial abnormality (enlargement) ECG:

A

P Pulmonale (tall peaked P)

Lead II = P wave height ≥ 2.5 mm

V1 = Tall upright initial P wave deflection
≥1.5mm

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25
Q

Right atrial abnormality (enlargement) causes…

A

Pulmonary hypertension

RVH

Cardiomyopathy

Tricuspid stenosis or regurgitation

Congenital heart disease (e.g. Ebstein’s anomaly)

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26
Q

What is dilated cardiomyopathy?

A

All chambers dilated

Poor LV function

Can lead to HF

Multiple causes: familial, viral, alcoholic

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27
Q

Dilated cardiomyopathy

A

No specific ECG findings although ECG is usually very abnormal

LBBB common

Combination of LBBB & RAD

ST / T wave changes common

AF and VPBs common

LA abnormality (enlargement)

Combination of low voltage QRS in limb leads & high voltage QRS in chest leads

28
Q

What is restrictive cardiomyopathy?

A

Eg cardiac amyloidosis (Thick heart walls but not LVH)
* Rare
* Several forms
* Infiltrative process
* Usually systemic: multi-organ
* Initially LV diastolic dysfunction

29
Q

Restrictive Cardiomyopathy: Amyloidosis ECG features

A

Low voltage of all waveforms, particularly limb leads ≥ 5 mm

Marked LAD

QS waves in V1-3 (simulating anteroseptal MI)

Prolonged AV conduction time

T wave inversion

30
Q

Atrial Septal Defect ECG

A

RBBB pattern

rsR’ in V1 + RAD = secundum ASD

rsR’ in V1 + LAD = primum ASD

Can have Crochetage sign (notch at peak of R wave in inferior leads)

31
Q

Subarachnoid haemorrhage ECG

A

Widespread deep T wave inversion

Can mimic ACS ecg

32
Q

Stroke ECG

A

widespread T wave inversion

long QTc

33
Q

Muscular dystrophy

A

Deep lateral Q waves

Dominant R in V1

Conduction abnormalities/ventricular arrhythmias are common

34
Q

What is Friedreich’s Ataxia?

A

an autosomal-recessive genetic disease that causes difficulty walking, a loss of coordination in the arms and legs, and impaired speech that worsens over time

patients can develop hypertrophic cardiomyopathy

35
Q

Friedreich’s Ataxia ECG

A

ST depression and T wave inversion common

36
Q

Dextrocardia

A

Heart is in the right side of the chest and points to the right

negative P, QRS and T waves in lead I

QRS negative & gets smaller from V1 to V6

Normal R wave progression with right-sided chest leads

37
Q

There are only 2 possible causes of a negative P wave and a negative QRS in lead I…

A

Dextrocardia

Transposal of right and left arm connections

QRS progression in chest leads is normal with transposed arm connections

38
Q

Potential massive Pulmonary Embolism ECG characteristics:

A

S1, Q3, T3 = large S wave in I, large Q wave in III, T wave inversion in III

Sinus tachycardia

T wave inversion in right chest leads

Right axis deviation

Transient RBBB

ST elevation in V1

39
Q

Acute Pericarditis ECG

A

Inflammation of the pericardium

1st Stage
 Widespread concave upwards ST elevation
(due to epicardial injury)
 PR segment depression

2nd Stage
 ST segment elevation resolves
 Widespread T wave inversion develops

After several weeks, ECG is usually normal

40
Q

If significant pericardial effusion develops, ECG will show…

A

Low voltage waveforms

Electrical alternans (alternate beats vary dramatically in size or axis as the heart swings in the pericardial fluid)

41
Q

Non-ischaemic chest pain ECGs:

A

Pulmonary embolism:
* S1Q3T3 pattern
* T wave inversion V1-V3
* Sinus tachycardia

Pericarditis:
* Concave upwards ST↑
* ST ↑ < 5mm
* ST↑ widespread
* No pathological q waves

42
Q

Myocarditis ECG findings:

A

No ECG abnormality specific for myocarditis

Most common finding in acute myocarditis is diffuse T wave changes (particularly inverted T waves)

ST elevation, ventricular arrhythmias and heart block may be found

43
Q

Myocarditis:

A

May mimic acute MI clinically and electrocardiographically

MRI shows myocardial inflammation

Myocarditis and pericarditis often co-exist

44
Q

unipolar pacing =

A

big spikes

45
Q

Long QT syndrome types:

A

1 = run (exercise)

2 = boo (stimulant)

3 = zzz (sleep)

46
Q

bipolar pacing =

A

small spikes

47
Q

hypokalaemia =

A

T wave inversion + ST depression
U wave

48
Q

hyperkaleamia =

A

T wave peaked9
P wave flat
PR interval prolonged
wide QRS complex

49
Q

Pulmonary embolism =

A

DVT migrates to lungs

S1 Q3 T3

tachycardia

Right ventricular strain pattern (T wave inversion anterior + inferior leads)

RAD

RAE (P pulmonale)

RBBB

50
Q

LVH =

A

LAD

Deep S waves in V1
Tall R waves in V5/6

R wave in lead V5/6 + S wave in V1 = >35mm
R wave in lead all >11mm
Any R wave >25mm

Strain pattern

51
Q

Causes of LVH

A

Hypertension
aortic stenosis
mitral regurgitation
coarctation of the aorta
HCM

52
Q

RVH =

A

RAD

Dominant R wave in V1
Dominant S wave in V5/6

Right ventricular strain pattern - T wave inversion/ST depression in anterior and inferior leads

53
Q

Causes of RAD

A

RVH

RV strain (pulmonary embolism)

COPD

Dextrocardia

54
Q

Causes of LAD

A

LVH

LBBB

ASD

55
Q

Chest leads swapped

A

abnormal R wave progression

56
Q

V5/6 too medial

A

S waves

57
Q

Swapping the black lead with another

A

flat lines

58
Q

V4-V6 too low

A

4th should be in 5th intercostal space and 5/6 should be horizontal

if too low there will be low R wave amplitude

59
Q

V1/2 too high

A

V1 looks like aVR

V2 looks like aVL

RSR

negative P waves

60
Q

hypothyroidism =

A

Brady

T wave inversion

low voltages

61
Q

hyperthyroidism =

A

tachy

AF common

RBBB/LAFB (RBBB +LAD)

62
Q

left anterior fascicle block

A

LAD with no other cause

S wave in V6

no LBBB

no Q waves

63
Q

left posterior fascicular block

A

RAD with no other cause

64
Q

broad QRS tachycardia =

A

VT unless proven otherwise

65
Q
A

STP 1st year exams (4 decks)

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