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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

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24
Q

What is the axis of the AVL

A

-30

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25
Q

What is the axis of leads 1 2 and 3

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

What is the axis of AVR

A

-150

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27
Q

What is the axis of AVF

A

90

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28
Q

What are the possible causes of a left axis deviation

A

L anterior hemiblock
Inferior MI

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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
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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

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31
Q

What are supraventricular causes of wide QRS complexes

A

Right or left BBB or hypothermia

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32
Q

What are the ventricular causes of wide QRS complexes

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

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36
Q

What does a bifascicular block look like

A

RBBB + Left axis (L ant hemi-block)

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37
Q

What does a trifascicular block look like

A

RBBB + left axis + Mobitz 2

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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

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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

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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

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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

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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

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43
Q

What are the possible causes of ST segment depression 4

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

What are the causes of an ST segment elevation 3

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

In which leads is it normal to have inverted T waves

A

AVR, Lead 3 and V1

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45
Q

What are the causes of a peaked T wave 2

A

Hyperacute MI or Hyperkalemia

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45
Q

How can you distinguish strain from LVH

A

combination of ST ↓, T neg in V1 or V6

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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 6

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

What causes an inverted U wave 3

A

Heart disease
Hyperthyroidism
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

What are the criteria for a sinus bradycardia

A

All the QRS are preceded by a p and the HR is less than 60

54
Q

In which lead is the p wave biphasic

A

V1

55
Q

What is the general size of a normal p wave

A

3 block high and 3 blocks long

56
Q

What is a junctional escape

A

Junctional Escape refers to a type of heart rhythm originating from the junctional area (AV node)

57
Q

What are the 3 criteria for a junctional escape

A
  1. Bradycardia 40-60
  2. Narrow QRS complexes
  3. Retrograde P waves
58
Q

What is a retrograde P wave

A

It is an atrial contraction that is conducted in the opposite pathway to the normal contractions

59
Q

What does a retrograde p wave look like

A

In Lead 2 it is negative and is positive in AVr

60
Q

What is the normal PR interval

A

It is 3-5 blocks 120-200ms

61
Q

What causes a shortened PR interval

A

WPW

62
Q

What are the 3 criteria for WPW

A

Broad QRS
Shortened PR interval
Delta waves

63
Q

What causes prolonged constant PR interval

A

First degree heart block

64
Q

What are the 3 criteria for a first degree heart block

A
  1. Prolonged PR
    2.PR interval is constant
  2. Each P wave has a QRS
65
Q

What causes PR interval becomes progressively longer until p-wave
is not followed by QRS (‘dropped beat’)

A

Second degree heart block type 1

66
Q

Which type of heartblock causes grouped beats

A

Second degree mobitz type 1

67
Q

What is the difference between a mobitz type 1 and a type 2

A

In a type 2 the PR interval is fixed and there is just an occasional dropped QRS

68
Q

What is a second decree heart block with a 2:1 conduction

A

This is where the PR interval ifs fixed but every second P wave is not followed by a QRS

69
Q

What are the 2 criteria of a 3rd degree heart block

A
  1. There is no relationship between the P and the QRS
  2. The ventricular rate is regular
70
Q

What is the normal length of a QRS segment

A

Less than 120ms thus 3 small blocks

71
Q

What is considered left axis deviation

A

Less than -30

72
Q

What is considered right axis deviation

A

More than 90

73
Q

How to identify a left bundle branch block

A

There is an W present in V1 and M in V6

74
Q

How is a right bundle branch block identified

A

M pattern in V1 and a W in V6

75
Q

What are the 5 possible differentials for a RBB

A
  1. Pulmonary hypertension
  2. IHD
  3. Conduction system fibrosis
    4.Cardiomyopathy
  4. Congenital heart disease
76
Q

What are the 3 main criteria of left ventricular hypertrophy with strain pattern

A
  1. Tall QRS
  2. Inverted T waves
  3. LAD
77
Q

What are the 3 criteria for RVH

A
  1. Dominant r wave in V1
  2. RAD
  3. T wave abnormalities in V1 and 2
78
Q

What are the 2 criteria for spotting a PVC

A
  1. Narrow complexes with P waves
  2. Wide complex without a p wave
79
Q

Where is the normal location of the ST segment

A

On the isoelectric line

80
Q

What is considered abnormal depression or elevation of the ST segment

A

1 block on the normal leads and 2 on the limb leads

81
Q

What does ST elevation or depression mean

A

MI

82
Q

Which 4 leads look at the lateral aspect of the heart

A

Lead 1, aVL,V5 and V6

83
Q

What are the 3 leads that look at the inferior segmant of the heart

A

Lead 2,3, and aVF

84
Q

What are the 2 septal leads

A

V1 and 2

85
Q

Which 2 leads look at the anterior segment of the heart

A

V3 and 4

86
Q

What are the 4 criteria for a pericarditis

A
  1. Sinus tachycardia
  2. Prolonged PR in lead 1 and 2
  3. ST segment elevation
  4. No Q waves
87
Q

What are the 2 criteria for a STEMI

A
  1. ST elevations
  2. Q waves
88
Q

What is the normal height of a T wave

A

In the limb leads it is less than 5 mm and in the chest leads it is less than 10mm

89
Q

What are the primary causes of large T waves

A

1.Hyperkalaemia
2. Hyperacute STEMI

90
Q

What causes a flat T wave

A

It is a nonspecific finding that can show signs of ischemia or electrolyte imbalances

91
Q

Where is a t wave inversion normal

A

V1 and lead 3

92
Q

What causes a biphasic T wave

A

Hypokalemia

93
Q

What is the normal range for QT interval

A

440ms for men and 460 for women

94
Q

What are the acquired causes of long QT interval

A
  1. Low on electrolytes like calcium, k or Mg
    2 Medications: Psychiatric and antibiotics and antihistamines
95
Q

What is the cause of a left axis deviation 2

A
  1. Left anterior hemiblock
  2. Inferior MI
95
Q

What does one small block represent

A

40 ms

96
Q

What does a large spiked p wave indicate

A

Right artrial enlarement

97
Q

What does a double peaked p wave mean

A

Left atrial enlargement

98
Q

What is a pathological q wave and what does it indicate

A

A q wave present in V1-3 that is wider than 40ms and higher than 2mm and more than 25% of the r waves

99
Q

What does a pathological Q wave indicate

A

Damaged or dead myocardium normally from a previous infarct

100
Q

What is a ventricular pacemaker and when does it occur

A

This is when there is a 3rd degree heart block and so there is no connection between the atria and ventricles and so the ventricles need to take over contraction initiation

101
Q

What are the 4 criteria for a ventricular pacemaker from the purkinje fibers

A
  1. Rate is 15-40
  2. Narrow QRS
  3. The QRS have bizarre shapes
  4. There is no connection between the P and the QRS
102
Q

What is the main 2 criteria that are used to diagnose a high infranodal pacemaker

A
  1. No p QRS relationship
  2. The rate is 40-60
103
Q

What is a common misdiagnosis in the presents of an artificial pacemaker

A

A pseudo LBBB with an axis of -60 to -90 and negative complexes in V6

104
Q

What is the difference between a monomorphic and a polymorphic ventricular tachy

A

A polymorphic arises from 2 or more origins or reentry circuits

105
Q

What are the 5 differencials for a regular narrow complex tachy

A
  1. Sinus tachy
  2. Atrial tachy
  3. Atrioventricular nodal reentry tachy
  4. Atrioventricular reentry tachy
  5. Atrial flutter
106
Q

What is the differential for an irregular narrow tachy

A

A fib

107
Q

What is the differential for a wide tachy

A

V tach

108
Q

Which are the best leads for P waves

A

2 and V1

109
Q

Which are the best leads for PR interval

A

2 and V1

110
Q

Which are the best leads for QRS

A

V1 and 6 and Lead2

111
Q

Which are the best leads for ST segment

A

V3 and 4 and lead 2

112
Q

Which are the best leads for T waves

A

V2 3 and lead 2

113
Q

Which are the best leads for QT interval

A

Lead 2 V5 and V6

114
Q

What is the best wave for T wave abnormalities

A

V2 and 3 and lead 2

115
Q
A

Semester 6 (23 decks)

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