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SBM - Pathology > ECG > Flashcards

ECG Flashcards

1
Q

What’re the stages of assessing an ECG?

A
  1. Name and calibration (1 big box wide, 2 big boxes tall)
  2. Rate (ventricular then atrial)
  3. Rhythm - Space between QRS complexes regular? Sinus rhythm? P waves before QRS complexes? Prolonged PR interval? T waves normal? Any Abnormal U waves?
  4. Axis - R-wave progression
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2
Q

What’s the conducting pathway of the heart?

A

SAN / AVN / L. or R bundle branch / Pukinje fibers

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3
Q

What physiological delay happens at the AV node?

A

30ms to from SA to AV node

90ms delay before enting the penetrating portion of the AV bundle

40ms delay in the penetrating bundle

= 160ms delay in the AV network

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4
Q

What is Heart Block?

A

Electrical signal from the atrium to the ventircle is slowed or blocked

1st degree = signal delayed

2nd degree = signal is intermittently blocked

3rd degree = signal is always blocked

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5
Q

1st degree Heart Block

A

PR interval >5 little boxes

Young people

Rarely treated

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6
Q

2nd Degree Heart Block Type 1

A

Some P waves without QRS complex

Increased PR interval

No treatemnt

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7
Q

2nd Degree Heart Block - Type 2

A

PR interval stable

Bundle of His

High risk of 3rd degree block

Implant a pacemaker

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8
Q

Third Degree Heart Block

A

Atrial signals don’t arrive at the ventricles

Ventricles beat at their own pace

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9
Q

Atrial Fibrillation

A

Irregular QRS Complexes

(irratic or not visable P-waves)

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10
Q

Atrial Flutter

A

Sawtooth Appearance

300 BPM

Single re-entrant circuit in the right atrium

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11
Q

What drug can be used for Supraventricular Tachycardiacs

A

Adenosine

Activates specific ligand-gated K+ channels reducing exitability

Administered IV can cause transient HB at the AV node

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12
Q

What does the ECG have to show for the axis to be in the Northwest Territory?

A

Both I and II are negative

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13
Q

What’re some of the casues of Axis Deviation?

A

**Diaphragm pushing upwards **

Hypertrophy of one of the ventricles

Conduction Anomalies (axis moves towards undepolarised tissue)

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14
Q

Causes of Right Axis Deviation?

A

COPD / PE

Child or Tall Thin Person

Right Ventricular Hypertrophy

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15
Q

Causes of Left Axis Deviation?

A

Conduction pathologies

Obese person / pregnant

Artifical Cardiac Pacemaker

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16
Q

What is R-Wave progression?

A

V1 = Small R Wave (QRS complex negative)

V2, V3 = Zone of transition. The QRS is equally positive and negative

V6 = R Wave is dominant (QRS complex is Positive)

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17
Q

What can cause anomalies of R Wave progression?

A

Anterior Myocardial Infarction

LBBB

Wolff-Parkinson White Syndrome

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18
Q

What is Bundle Branch Block?

A

Conduction Pathology

One Bundle branch fails to conduct

That side of the heart is delayed in depolaristion (that side must be stimulated by the other)

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19
Q

What causes broad notched QRS Complexes?

A

Left Bundle Branch Block

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20
Q

What is Ischaemia? What signs are there on the ECG?

A

Relative lack of blood supply to tissues. Although there is no tissue infarct.

Causes ST depression on the ECG

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21
Q

What’re the signs of Acute Injury on an ECG?

A

ST Elevation

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22
Q

What sings would there be on an ECG of infarction?

A

Q-Waves

Potential Inverted T-waves

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23
Q

What’re the signs of Acute Coronary Syndrome on an ECG?

A

**ST elevation **

Receiprocal St depression

**Pathological Q waves **

T wave inversion

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24
Q

What’re pathological Q-waves?

A

Occur in an MI

Pathological Q waves lack R waves

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25
Q

What are normal Q-waves called?

A

Septal Q-waves

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26
Q

What leads supply the Septal Region of the Heart?

A

V1 + V2

27
Q

What leads supply to Anterior Section of the Heart?

A

V3 + V4

28
Q

What leads supply the inferior region of the heart?

A

aVF + II + III

29
Q

What leads supply the lateral region of the heart?

A

I + V5 + V6

30
Q

What artery supplies the anterior of the heat?

A

left anterior descending

31
Q

What artery supplies the lateral region of the heart?

A

Left Circumflex Artery

32
Q

What artery supplies the inferior of the heart?

A

Right dominant (90%) = Right Coronary Artery

Left dominant is supplied by the Left Circumflex

33
Q

What artery supplies the posterior region of the heart?

A

Posterior Descending Artery

34
Q

What artery supplies the SA & AV node?

A

Right Coronoary Artery

35
Q

Which region of an MI has a worse prognosis?

A

Anterior MI has a worse outcome than a Posterior MI

36
Q

What’s the prognosis of an MI (first and second time)?

A

First time = 1/3 die before discharge

Second time = > 50 die before discharge

37
Q

What’s the differential diagnosis of an MI?

A

**Bengin Early Repolarisation **

(normal varient in the young)

38
Q

Can T waves be depressed?

A

No

They can be inverted or negative! NOT inverted

39
Q

What can cause tenting of T-waves?

A

Hyperkalemia

40
Q

What can cause U waves?

A

Present in Hypokalaemia

41
Q

What is a Broad Complex Tachycardia?

A

Wide QRS complexes

42
Q

What’s a Supraventricular Tacycardia?

A

Arrhythmias that originate above the ventricles

43
Q

What’s Junctional Tacycardia?

A

AV node involvement

Can occur in junctional pacemakers

44
Q

Describe the image

A

Atrial Flutter with Carotid Sinus Pressure

45
Q

What’re the 3 scources of Arrhythmias?

A
  1. Re-Entry
  2. Enhanced Automaticity
  3. Triggered Activity
46
Q

What’re the symptoms of Long QT Syndrome?

A

Syncope & Sudden Death

47
Q

What is the mechainsm of Long QT Syndrome? (i.e what’s the also called?)

A

Torsades de pointes

A Polymorphic Ventricular Tachyarrhythmia

48
Q

How is Long QT Syndrome treated?

A

Pacemaker

Beta-blockers

Stop drug administration

49
Q
A

Torsades De Points

(Long QT syndrome)

50
Q

How long is a long QT?

A

Men > 440ms

Women > 460 ms

51
Q

What’s the basis of Atrial Flutter?

A

Re-entery arrhythmia

Typically the right atrium

52
Q

What is the basis of Fibrillation?

A

Abnormal automaticity of tissue in pulmonary veins

Re-entrant sources at posterior of left atrium

53
Q

What does Sinus Rhythm mean?

A

Normal heart rhythm

Electrical signals start in the SA node

P wave is followed by a QRS complex (fixed PR interval - <5 squares)

54
Q

What is sinus tachcardia?

A

Rate > 100 BPM

55
Q

What is Sinus Bradycardia?

A

< 60 BPM

56
Q

What two ways can atrial flutter occur?

A

Fixed degree block e.g a 3-to-1 block

Variable block e.g varies

57
Q

Secondary Degree Heart Block Type 1

A

Gradually increasing PR interval, the most prolonged one is not followed by a QRS complex.

58
Q

Second Degree Heart Block Type 2

A

PR interval is constant (either prolonged or normal)

Periodically there is no conduction between the atrium and the ventricle

59
Q

What do Tall P and bifid waves indicate?

A

P Pulomnale, P waves are Peaked (right atrium enlargement)

P Mitrale, P waves are Bifid and look like the letter M (mitral stenosis)

60
Q

Can you comment on the ST segment when LBBB is present?

A

NO!

61
Q

What’re the two emergency Shockable Rhythms?

A

**Ventricular Fibrillation **(trace all over the place)

**Ventricular Tachycardia **(regular contractions)

62
Q

What Rhythms are Non-Shockable?

A

Pulseless electrical activity

Asystole (no identifyable electrical activity)

P-wave asytole

63
Q

How can you determine if a person has a pacemaker or not from an ECG?

A

Pacing spikes are seen

If directly to the ventricle, then wide QRS complexes are seen.

SBM - Pathology (3 decks)

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