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Semester 6 > ECG > Flashcards

ECG Flashcards

1
Q

What is the normal speed of an ECG strip

A

25mm/sec

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2
Q

What does one small block represent

A

40ms or 0.04 secs

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3
Q

What does a big block represent

A

200ms

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4
Q

How do you calculate the heart rate

A

You count the number of QRS complexes in the rhythm strip and then multiply by 6

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5
Q

What is the other method for calculating the heart rate using the big blocks

A

You count the number of big blocks and then divide by the 300

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6
Q

What is the formula for the max sinus rhythm

A

220- age of the patient

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7
Q

Which are the normally negative leads on an ECG

A

AVR, V1 and V2

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8
Q

Which area of the heart does Lead 1 AVL and V5 and 6

A

Lateral side of the heart

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9
Q

What does the leads 2 3 and AVF look at

A

Inferior side of the heart

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10
Q

Which leads look at the anterior area of the heart

A

V1 2 3 4

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11
Q

Which leads look at the septum of the heart

A

V1 and V2

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12
Q

How do you know that a P wave is originating in the SA node

A

In the inferior leads 2 3 and AVF the P waves are positive and then in the AVR it is negative

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13
Q

Which 2 waves are used to check the morphology of a P wave

A

2 and V1

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14
Q

What are the general measures of a P wave

A

Smaller than 2.5 mm and less than 0.12sec

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15
Q

How do you know that a patient has P pulmonale or RA enlargement

A

Increased more than 2.5mm [2.5 small blocks] in lead 2. There will also be a biphasic p wave in V1 with the positive portion being larger

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16
Q

How do you know that a patient has P mitralle or LA enlargement

A

Increased more than 2.5mm [2.5 small blocks] in lead 2. There will also be a biphasic p wave in V1 with the negative portion being larger

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17
Q

What does the PR segment represent

A

This is the depolarisation of the atria and the delay of the AV node

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18
Q

What is a normal PR segment length

A

3-5 small blocks or 120 - 200msec

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19
Q

What are you worried about when there is shortening of PR segment

A

Pre excitation problems like WPW and Ectopic focuses near the AV node

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20
Q

What are the concerns when there is the lengthening of the PR segment

A

Heart blocks

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21
Q

What is the normal length of a QRS complex

A

105ms or less and not above 120ms

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22
Q

What are the 4 things that we look at in a QRS complex

A
  1. Axis
  2. Width
  3. Height
  4. Presents of a pathological Q waves
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23
Q

What is the normal range for the axis

A

90 to -30

24
Q

What is the axis of the AVL

A

-30

25
Q

What is the axis of leads 1 2 and 3

A
  1. 0
  2. 60
  3. 120
26
Q

What is the axis of AVR

A

-150

27
Q

What is the axis of AVF

A

90

28
Q

What are the possible causes of a left axis deviation

A
  1. Left Ventricular Hypertrophy
  2. Left Bundle Branch Block
  3. Inferior Myocardial Infarction
  4. Left Anterior Fascicular Block
  5. Wolff-Parkinson-White (WPW)
  6. Congenital Heart Disease
29
Q

What are the causes of a right axis deviation

A
  1. Right Ventricular Hypertrophy
  2. Right Bundle Branch Block
  3. Lateral Myocardial Infarction
  4. Cor Pulmonale
  5. Left Posterior Fascicular Block
  6. Wolff-Parkinson-White (
  7. Normal in Children and Young Adults
30
Q

What does supraventricular mean

A

It tells the impulse originates from above the ventricles, but the QRS is widened due to abnormal conduction through the ventricle

31
Q

What are supraventricular causes of wide QRS complexes

A

Right or left BBB or hypothermia

32
Q

What are the ventricular causes of wide QRS complexes

A
  1. Ventricular ectopics
  2. Pre excitation
  3. Ventricular Pacemaker
33
Q

What are the 3 criteria for a RBBB

A
  1. Tall slurred R waves in V1
  2. Deep slurred S waves in V6 and Lead 1
  3. Inverted T waves in V1-3
34
Q

What are the 3 criteria in a LBBB

A
  1. Negative QRS complexes in the septal leads V1-3
  2. M shaped R waves in V6
  3. T wave inversion in V5 and 6
35
Q

What causes a hemiblock

A

Occurs when there is a blockage or delay in one of the two main branches of the left bundle branch of the heart’s conduction system

36
Q

What does a bifascicular block look like

A

RBBB + Left axis (L ant hemi-block)

37
Q

What does a trifascicular block look like

A

RBBB + left axis + Mobitz 2

38
Q

How to diagnose LVH with the cornell criteria

A

Add the R waves in AVL + S wave in V3
If it is over 28 mm in male and 20 in female then it is pathological

39
Q

What are the criteria for RVH

A

Tall R wave in V1 (must have this criteria plus at least 1 of the other 3)
1. T wave inversion in V1-3
2. Right axis
3. P pulmonale

40
Q

What is the normal Q waves

A

A normal Q wave is the negative deflection that precedes a the positive of an R wave

41
Q

What are the 3 criteria for a pathological Q wave

A

Width of more than 1 block
Deeper than 3 blocks
More than 25% of the R wave

42
Q

What does a pathological Q wave indicate

A

It indicates an infarct but for it to indicate a infarct then there must be pathological Q waves in more than 2 leads

43
Q

What are the possible causes of ST segment depression

A
  1. Myocardial ischemia
  2. NSTEMI
  3. Posterior infarct
  4. Digoxin (Nike tick sign in V4-6)
43
Q

What are the causes of an ST segment elevation

A
  1. Acute MI
  2. Pericarditis
  3. Ventricular aneurysms
44
Q

In which leads is it normal to have inverted T waves

A

AVR, Lead 3 and V1

45
Q

What are the causes of a peaked T wave

A

Hyperacute MI or Hyperkalemia

45
Q

What are the possible causes of of flattened T wave

A
  1. Ischemia
  2. Myocarditis
  3. Pericarditis
  4. Hypercalcaemia
46
Q

Where are U waves normally seen and what are their normal size

A

The normal size is less than 0.5 mm and are best seen in lead V2 and 3

47
Q

What are the usual causes of U waves

A

Anything that slows the heart rate

48
Q

What are things that cause U waves

A
  1. Bradycardia
  2. Severe hypokalemia
  3. Hypothermia
  4. LVH
  5. Hypocalaemia
  6. Digoxin
49
Q

What causes an inverted U wave

A

Heart disease
1. Coronary arterey diesease
2. Valvular disease
3. Cardiomegally
4. Hyperthyroidism
5 Raised ICP

50
Q

What is the normal length of a QT interval

A

Under 440 in males and 460 in females

51
Q

What causes a prolonged QT interval

A

Congental abnormalies
Hypo K Mg or Ca
Drugs
Ischemia and infarction

52
Q

What causes a shortened QT interval

A

Hypercalcemia

53
Q
A

Semester 6 (14 decks)

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