ECG Flashcards
Tall P [Pulmonale ]
> 2.5 BOX IN LEAD II
Causes of RA hypertrophy
* Pulmonary hypertension
* CorPulmonale
-tricuspid stenosis
-congenital heart disease
biphasic P wave (P mitrale)
in lead II
means left atrial enlargement
cause:
mitral stenosis
mitral regurgotation
hypertension
first degree heart block
PR > 5 box
causes:
normal in athletes
IHD
rheumatic fever **
cardiomyopathy
AV node blocking drugs ( beta blocker,CCB,digoxin)
second degree heart block: Mobitz type 1:Wenckebach phenomenon
progressive prolongation of PR, QRS drop
-causes: Not of much significance
second degree heart block:Mobitz type II
no PR prolonged but QRS dropped
3rd degree heart block
no relationship btw P and QRS
Cause
-Congenital
Acquired:
Degeneration
AMI I
nflammatory Drugs
CF:Slow pulse(25-50/min)
Pulse not varying with exercise
Canon waves in JVP
Adam-Stokes attacks
TREATMENT:
CHB in Acute MI-
Inf wall MI less serious-atropine Ant wall MI-Pacemaker
Chronic CHB
Symptomatic patients-Pacemaker
Stokes Adam Attacks
Sudden loss of consciousness without warning
Convulsion if prolonged
Pallor & death like appearance during the attack
Reappearance of pulse &consciousness spont; flushing
Causes:
Complete heart block Mobitz type II Heart Block Sick Sinus Syndrome
Wolf-Parkinson-White Syndrome
PR shorten
delta wave
QRS prolonged
-accesory pathway,genetic
RVH
R:S ratio in V1 >1
Deep S waves in V6
Sloping of ST segment is strain pattern due to RVH
RVH causes
MS Cor pulmonale
LVH
sokolow+ Lyon criteria
S of V1 + R of V5 OR V6 >35mm (7 big box)
can have ST-T :Strain pattern
cause:
hypertension
aortic stenosis
aortic regurgitation
cardiomyopathy
coarctation of aorta
RBBB
QRS > 3 BOXES
RSR IN V1 (BUNNY EARS)
S WAVE > 1 BOX IN V6
CAUSE:
normal variant
IHD
Cardiomyopathy
LBBB
QRS>3 BOX
V1:DEEP,BROAD S WITH ST ELEVATION
V6: BROAD,NOTCHED R ,ST DEPRESSION
CAUSE:
FIBROSIS
IHD
HTN
CARDIOMYOPATHY
ST DEPRESSION
MORE THAN HALF SMALL SQUARE IN 2 CONTIGUOUS LEADS
NSTEMI
U WAVE
HYPOKALEMIA
ST ELEVATION
ST ELEV ATION > 1 SQUARE AT J POINT ATLEAST 2 CONTIGOUS LEADS
STEMI
T WAVE PEAKED
PEAKED IN MORE THAN 1 LEAD
HYPERKALAEMIA
INVERTED T
INVERSION IN MORE THAN 2 CONTIGOUS LEADS EXCEPT AVR & V1
NSTEMI
WITH ST ELEVATION IN STEMI
Sinus Tachycardia
regular,narrow QRS,rate>100bpm
causes: TACH FEVER
Tamponade/ Thyrotoxicosis
Anemia
CHF
Hypotension
Fever
Excrutiating pain
Volume depletion
Exercise
Rx (Theo, Dopa, Epi, etc)
supraventricular tachycardia
- barely visible/buried p wave
-regular
-narrow QRS complex
rate> 100bpm
treatment:
Vagal manoeuvres (carotid massage)
Intravenous adenosine ( 6 mg IV ) or verapamil,
AV nodal blockers (β-blockers or calcium channel blockers)
Immediate DC cardioversion is the treatment of choice for all haemodynamically unstable tachycardias.
atrial fibrillation
irregularly
no P wave
narrow QRS
FIBRILLATORY WAVES
Causes
ØCoronary artery disease ØValvular heart disease ØHypertension ØThyrotoxicosis
ØAlcohol
ØPulmonary embolism
Complications
ØPrecipitate CF
ØRisk of thromboembolism
AF CLINICAL FEATURES N TREATMENT
Clinical features:
Palpitation, breathlessness and fatigue Irregularly irregular pulse
Apex Pulse deficit of > 10 / min (HR-PR) Absent ‘a’ wave in JVP
Changing intensity of S1 apex
Rate control Control VR : Digoxin, βblockers,Verapamil
Rhythm control-Revert to Normal Sinus Rythm : Amiodarone / DC cardioversion ( after 48 hrs of anticoagulation)
Treat the underlying cause
Anticoagulation if >2 CHADSVAS stroke risk: Warfarin with target INR of 2-3 Aspirin : If age < 65 yrs / If warfarin is contraindicated
Atrial Flutter
ØAtrial rate 250 to 350/min ØVariable AV block
ØECG saw tooth appearance
If persists longer converts to AF
Cause:organic heart disease- pericarditis, COPD, dig toxicity, AMI
Treatment :Conversion to sinus rhythm- DC shock 25 to 50 joules or
atrial overdrive pacing
OR
ventricular rate reduction by beta blockers, verapamil
Ventricular Premature Beat
- Complexses - Unifocal / Multifocal
- Couplet / Triplet – ectopic beats
Bigeminy / Trigeminy / Quadrigeminy - Prevalence increases with age; in people with normal
heart- disappear with exercise - mostly asymptomatic / palpitation
- Pulse - irregular
- Aetiology : CAD, HF, Digoxin toxicity, MVP, Escape
beat
Ventricular Tachycardia
regular,broad QRS, RATE>100bpm
x p wave
Unstable patients with monomorphic VT should be immediately treated with synchronized direct current (DC) cardioversion
Unstable polymorphic VT-defibrillation
In stable patients with monomorphic VT and normal left ventricular function-(IV) procainamide, amiodarone, sotalol, or lidocaine
Torsades De Pointes
Type of V.Tachycardia
Changing QRS amplitude.
Appearance of twist around isoelectric line
ventricular fibrillation
EXTREME IRREGULAR
ABSENT P WAVE
BROAD QRS
CAUSES:IHD,DILATED CARDIOMYOPATHY
Sinus bradycardia
REGULAR
RATE < 60bpm
p wave preceeds every QRS
young athletes
meds: BETA BLOCKERS
hypothyroidusm
VASOVAGAL REACTION
HYPOTHERMIA
