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Anesthesiology > ECG > Flashcards

ECG Flashcards

1
Q

What are the ECG features of RBBB?

A
  • a QRS duration longer than 0.12 seconds
  • a secondary R wave (R’) in leads V1 and V2 (rsR’ or rSR’) with R’ usually taller than the initial R wave
  • secondary ST and T wave changes in leads V1 and V2
  • wide slurred S wave in leads I, V5, and V6
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2
Q

What are the ECG characteristics of LBBB?

A
  • a wide QRS complex (> 0.12 seconds)
  • broad R waves in leads I, V5, and V6 that are usually notched or slurred
  • secondary ST and T waves changes opposite in direction to the major QRS deflection (ie, ST depression and T wave inversion in leads I, V5, and V6)
  • ST elevation and upright T wave in leads V1 and V2
  • rS or QS complex in the right precordial leads
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3
Q
A

LBBB

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4
Q

How do LBBB and incomplete LBBB differ?

A

Incomplete LBBB has a similar morphology but the QRS duration is between 0.09 and 0.12 seconds as opposed to > 0.12 seconds in LBBB.

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5
Q

How does uncomplicated asymptomatic LBBB with normal LVEF affect long-term outcome after surgery?

A

Even uncomplicated asymptomatic LBBB with normal left ventricular ejection fraction is not benign. The presence of an isolated BBB denotes a high-risk patient subgroup that has a compromised long-term outcome.

In the perioperative period, while perioperative mortality is not directly attributable to cardiac complications in patients with LBBB, such patients may not tolerate the stress of perioperative noncardiac complications.

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6
Q
A

RBBB

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7
Q

What are the ECG features of WPW?

A

Short ( < 0.12 seconds) PR

Initial slurring of the QRS (delta-wave) resulting in an abnormally wide QRS (> 0.12 seconds)

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9
Q

ECG findings of a LAFB?

A

The criteria to diagnose a LAFB is as follows:

  • Left axis deviation of at least -450
  • The presence of a qR complex in lead I and a rS complex in lead III.
  • Usually a rS complex in lead II and aVF as well (not always).
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9
Q

What is a bifascicular block?

A

the combination of a right bundle branch block and a left anterior (or posterior) fascicular block.

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10
Q

What is the concern with a bifascicular block?

A

Progression to 3rd degree AV block

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11
Q
A

2nd degree AVB type I (Wenkebach)

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12
Q

Describe Mobitz Type II AV block.

A

AV node becomes completely refractory to conduction on an intermittent basis.

For example, three consecutive P waves may be followed by a QRS complex giving the ECG a normal appearance, then the fourth P wave may suddenly NOT be followed by a QRS complex.

The PR interval may be normal or prolonged, however it is constant in length, unlike in 2nd degree AV block Mobitz Type I (Wenkebach) in which the PR interval progressively lengthens until a P wave is not conducted.

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13
Q
A

2:1 AV block.

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14
Q

How should one assess 2:1 AV block ECG?

A

A general rule to remember is that if the PR interval of the conducted bead is prolonged AND the QRS complex is narrow, then it is most likely second degree type I AV nodal block (Wenkebach).

Alternatively, if the PR interval is normal and the QRS duration is prolonged (our patient), then it is most likely second degree type II AV block and a pacemaker is probably warrented.

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15
Q

How doe 2nd degree AV block respond to carotid sinus massage?

A

Only 2nd degree Type 1 would respond.

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16
Q

What is the physiological difference between Type I and Type 2 2nd degree AV blocks?

A

Second degree type I AV nodal block is an issue in the AV node itself which is subject to sympathetic and parasympathetic tone while second degree type II AV block is “infranodal” conduction disease of the His/Purkinje system, therefore altering AV nodal conduction would have no effect

17
Q

What type(s) of AV block should be paced?

A

2nd degree type II.

3rd degree.

19
Q

What ECG changes are seen in an acute inferior wall MI?

A

ST elevations in II, III, AVF

Reciprocal changes in I, AVL, V5, and V6

Note: if reciproval ST depressions are note present, consider alternative causes such as pericarditis.

20
Q

ECG findings of an acute anterior wall MI?

A

ST elevations in V3 and V4

Reciprocal ST segment depression in inferior leads (II, III, aVF

21
Q

ECG findings of an old anterior wall MI?

A

Q waves in V1 and V2 (or if there are little Rs as well “poor R wave progression”)

If present, persistant ST elevation in V1 and/or V2 may indicate ventricular aneursym.

21
Q

What are the ECG findings of a posterior wall MI?

A

1) ST segment depression (not elevation) in the septal and anterior precodial leads (V1 to V4). This occurs since these EKG leads will see the MI backwards (since the leads are placed anteriorly, but the MI is posterior).

2) The ratio of the R wave to the S wave in leads V1 or V2 is > 1.
3) ST elevation in the posterior leads of a posterior EKG (leads V7 to V9). Suspicion for a posterior MI must remain high, especially if inferior ST elevation is also present.
4) ST elevation in the inferior leads (II, III, and aVF) may be seen if an inferior MI is also present.

22
Q

What are the ECG findings in myocardial ischemia (not infarction)?

A

Myocardial ischemia (not infarction) has two distinct EKG findings:

1) ST segment depression (not elevation)

2) Symmetric T wave inversions

The lead in which these findings are seen will help to determine the area of myocardial ischemia.

23
Q

What vessel is involved in an anterior wall MI?

A

LAD

When the MI extends to the septal and lateral leads as well, it’s probably more proximal in the LAD or in the left main coronary artery.

24
Q

What vessel is involved?

A

Anterior wall MI involves the LAD

25
Q
A

Anterior STEMI

26
Q
A

Inferior STEMI

27
Q
A

Posterior MI

28
Q

What vessel is involved in an inferior wall MI?

A

RCA

29
Q

What vessel is involved in a posterior wall MI?

A

Posterior descending artery (a branch of the RCA in 80% of people.

30
Q

What are the septal ECG leads

A

Septal –> anterior

V1 –> V4

31
Q

What are the lateral ECG leads?

A

I, aVL, V5, V6

32
Q

What are the inferior leads?

A

II, III, avF

33
Q

What is the difference between multifocal atrial tachycardia and wandering atrial pacemaker?

A

The ventricular rate is > 100 for MAT and < 100 for WAP but they are otherwise the same physiologic/mechanistic entity.

34
Q

What are the ECG criteria for wandering atrial pacemaker/MAT?

A

at least 3 different p wave morphologies and a VR rate of 60 - 100 for WAP and >100 for MAT.

35
Q
A

multifocal atrial tachycardia

Anesthesiology (11 decks)

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