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Cardio > ECG > Flashcards

ECG Flashcards

1
Q

Notching of QRS complex in inferior leads may suggest

A

ASD-Crochetage sign

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2
Q

Low atrial rhythm may be seen in

A

Sinus venous ASD
Acute Amlodipine intoxication
Rare CHD

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3
Q

How to differentiate between high / mid/ low junctional rhythm

A

High-look like low atrial rhythm
Mid- no visible p waves(in QRS)
Low- After QRS; inverted p seen in inferior leads

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4
Q

How to identify low left atrial rhythm

A

P will be inverted in lateral leads also. L

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5
Q

If the PR interval is short in a low atrial rhythm it indicates

A

It probably arise from junction and not the low atrial tissue

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6
Q

Criteria for RVH in V1

A

R >7mm or R/S >1

V5/6—>7 mm deep S or R/S <1

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7
Q

RBBB and RVH

A

RAD(axis derived from first 60ms of QRS)
R/S ratio in Lead l is <0.5

In incomplete RBBB if R’is 10 mm or more it suggests RVH

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8
Q

Similarities of RVH and LPHB ecg

A
  1. RAD
  2. qR in Ld 3

But as c/c LPFB is rare, this diagnosis is generally not used.

RAE and changes in V1-3 and young age favors RVH
Young age more likely RVH and old age more likely LPFB
Not easy to differentiate with ECG alone

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9
Q

Repolarisation abn in RVH is seen in

A

V1-3, aVF and III

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10
Q

Criteria for impending MI in LBBB

A
  1. ST elevn >1mm in Rwaved leads(OR-25.2)
  2. ST elevn>5mm in S waved leads(odds ratio-4.3)
  3. ST depression 1mm or more in V1-3(OddsRatio-6)
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11
Q

Criteria for completed MI in LBBB

A
  1. Q in V6,I,aVL or II and aVF
  2. RV1 >3mm with QV6
  3. CABRERA sign- V3 or 4 , ascending limb of S wave will show notching(more than 50 msec duration
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12
Q

Sinoventricular conduction in Hyperkalemia means

A

P waves are absent but the impulses reach AV node

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13
Q

DD of 2:1 AV Block

A

Blocked premature P

Differentiated by the premature occurrence .
This is also a dd for Sinus pause

ie look 👀 for a premature p in 2:1 block and in Sinus pause- This is wrong. In sinus pause the p should be conducted. Non conducted premature p is correct

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14
Q

Exercise parameters suggesting significant MS

A

MeanPG15 or more.PCWP-25 or more.PASP more than 60

Dobutamine mean should be more than 18

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15
Q

—-% of Brugada will develop dangerous arrhythmias

A

25% can have life threatening arrhythmias

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16
Q

If PR is <90 ms it is .———-

A

Unlikely to be a conducted p wave. May be junctional (high)

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17
Q

Type of SA exit block which can be assessed in ECG

A

second DEGREE -In type 2 pp interval will be multiples of basic pp.; but not in Type 1

First Degree-will look normal

Third Degree-may be exit block or Sinus arrest

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18
Q

In wenkebach RR interval of pause is ———-

A

LESS than 2 previous RR

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19
Q

Cornel Voltage criteria for LVH

A

SV3 + RaVL > 28 in males & >20 in females

95% specificity 40% sensitivity

Cornell PRODUCT is best for LVH but tedious. So use Voltage

SVERaL-28/20 NoV um NoS um

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20
Q

Sokolow-Lyon index for LVH

A
  1. R in aVL 11 or more
    2.S in V1 or 2 plus R in V5or 6 is
    35 or more
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21
Q

Lateral wall MI pattern with Q in I & aVL s/o which WPW

A

Left lateral wall (Not left free wall?? which will include LL,LAL,LPL, LP)

IWMI pattern with Q in II,III,aVF s/o Posteroseptal pathways :::
Coronary Sinus type also will have IWMI pattern

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22
Q

De Winter sign

A

ST depression with Peaked T waves in precordial leads

It’s AWMI equivalent

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23
Q

In patients with RBBB ST depression during TMT is normal in

A

V1-4

ST depression in V4-6, II and aVF suggests CAD

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24
Q

qR in aVL indicates

A

LAHB

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25
Q

R peak time in aVL in LAHB

A

45 ms or more

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26
Q

LPHB mimics

A

LWMI due loss of R in lateral leads

LAHB mimics IWMI due to loss of R waves

Opposite leads will show qR pattern. ie LAHB shows qR in lateral leads while LPHB shows qR in inferior leads

LAHB - LAD; LPHB- RAD

This is in terms of R wave but in terms of Q its opposite pattern. I think better it is Q based.

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27
Q

Low voltage limb leads means

A

QRS amplitude <5 mm in each of the 3 standard limb leads I,II,& III

1mv = 10 mm

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28
Q

Low voltage of ALL LEADS means

A
  1. Low voltage limb leads &
  2. Average voltage in chest leads less than 10 mm

This is uncommon. Usually only limb leads are of low voltage

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29
Q

Low voltage QRS causes

A
  1. Fat, Fluid, Air
  2. Infiltration- RCMP(Amyloidosis,Sarcoidosis,Hemochromatosis, Myxedema -MASH)
  3. DCMP-loss of myocytes due to any reason
  4. CP, Scleroderma
  5. PERED- conditions with Peripheral or Pulm edema
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30
Q

Anterior fascicle supplies which area of LV

A

Upper and Lateral wall

Ie why small R waves in lateral leads and small Q in inferior leads in LPHB. ( reverse of LAHB)

The delayed activation of upper and lateral wall masks corresponding normal activation in infr wall in LAHB

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31
Q

Prolonged QTc

Abnormally prolonged QTc (ACC/AHA)

Highly abnormal QTc

A

> 440/470

> 470/480

> 500

32
Q

ECG doesn’t show any change in ………,pericarditis because…….

A

Uremic pericarditis doesn’t affect the epicardium

33
Q

Difference in ST/T in pericarditis and MI

A

ST segment elevation and T wave inversion DON’Toccur simultaneously in Pericarditis -Exceptions occur

34
Q

Differentiate ECG of pericarditis and early repolarisation

A

Only 50% of early repolarisation have ST elevation in limb leads

In pericarditis it is seen in most cases

35
Q

T inversion in inferolateral leads may be normal in

A

Black/African athletes

36
Q

Tall T waves definition

A

> 10 mm in chest leads

> 5 mm in limb leads

37
Q

ST elevation criteria in V2 and V3 in STEMI

A

2mm in males

1.5 mm in females

38
Q

VPCs arising at same site of origin may have different morphologies

A

True

Coupling interval of VPCs can affect the morphology

39
Q

Fixed coupled VPCs are usually considered

A

Reentrant

But not diagnostic of Ree try

Rarely Parasystole also appear fixed

40
Q

Fixed coupled VPCs mean

A

Variation less than or equal to 80 ms at Any cycle length

41
Q

ST/T ratio in early repolarisation

42
Q

PR segment depression is seen in

A
  1. Pericarditis

2. Atrial infarction

43
Q

If ECG sags or get elevated use the

A

Position control facility in the ECG machine

44
Q

If ECG baseline is thick(50-60Hz interference)

A

Electrical interference. Check loose connection etc ; other electronic equipment interference; change socket etc

45
Q

Highest voltage limb lead is

A

Ld 2

Ld2= Ld 1+Ld 3

46
Q

….. leads indicate the true voltage at the site of placement

A

Unipolar leads. Since negative electrode is connected to the central terminal which is zero

47
Q

Why unipolar limb leads are Augmented

A

Since the true voltage is relatively weak ,to be on par with other leads , they are augmented 1.5 times

48
Q

Why lead 1?axis is taken as zero

A

Arbitrarily. Need to convey to another person how the axis is

49
Q

ECG lead kept on midclavicular line

50
Q

Anterior/Posterior forces can be assessed from which precordial leads

51
Q

Right / Left forces can be assessed from which lead

52
Q

Normal resting myocardial cells have———charge outside and——-charge inside

A

Positive outside and Negative inside

53
Q

When can we see the repolarisation of atria

A

In extreme bradycardia we may see a negative wave after the QRS

54
Q

The anterior precordial leads are

A

V1&V2

Others are anterolateral or lateral

ie why negative P is not common in V3-6

55
Q

How to differentiate a normal negative deflection of P in V1

A

Negative deflection will be SMALLER than the positive component of right Atrial P in V1

56
Q

The part of ventricle to be first activated is the

A

SEPTUM

Septum is considered part of LV and is always activated from the LV side from Left bundle

ie L to R in normal cases

57
Q

The third vector of Ventricular depolarization activates ….

A

Basal and Posterior aspects of Ventricles.

So Vector directed Superiorly and Posteriorly.

So small s in V1( submerged in large S) &V6

58
Q

Normal duration of RA and LA depolarization

A

RA- ends in .02-.04 sec

LA- starts at 0.03 sec and ends in another.06 seconds

Idea not very clear in Pediatric cardiology by Santhosh kumar

59
Q

Is PR interval affected by Heart rate

A

Faster the heart rate , shorter the PR interval

60
Q

U wave amplitude is usually….of T wave

A

1/4th of T wave

61
Q

QT dispersion is

A

Difference in QT interval in different leads ( because of differences in depolarization and repolarisation in different parts of myocardium)

62
Q

Why beta blockers are useful in congenital long QT syndrome

A

Adrenergic stimulation precipitatesTorsades- Hence beta blockers are useful

63
Q

QRS duration is best measured in a lead with

A

Lower QRS amplitude- eg- limb leads, V1-2

The mechanical properties of stylet may falsely increase QRS duration when amplitude is high

64
Q

Bundle branch blocks cause wide QRS due to ………delay

A

TERMINAL delay

65
Q

Commonest cause of intraventricular conduction delay is

A

Ventricular enlargement ( takes more time for travel)- as in LVH

66
Q

In intraventricular conduction delay the qrs prolongation affects

A

Both initial and terminal portions

BBB-terminal

67
Q

Why second r wave is seen in anterior Chest leads(V1,2)

A
  1. The RVOT is just beneath the Sternum
  2. This one of the last portion to be depolarized

Hence second r wave

This is smaller than first R wave

68
Q

Sinus arrhythmia means RR interval variation is more than

A

120
160 ms according to some

ie 3-4 small divisions

69
Q

Early transition (V2) is seen in

70
Q

Low voltage QRS seen - think of

A
  1. Myocarditis- due to myocardial edema
  2. Emphysema
  3. Obesity
  4. Generalized edema etc
71
Q

Small q is normally seen in

A

I,aVL,aVF, II,III,V4-6

72
Q

Deep q in V4-6 indicates

A

Septal hypertrophy- which in turn indicates LV hypertrophy

Eg VSD with LVVO

Santhosh- Pediatric ECG

73
Q

Absence of q in V6 indicates

A
  1. Single Ventricle
  2. cTGA
  3. LBBB
  4. Mirror image dextrocardia
74
Q

Causes of ST depression

A
  1. Digoxin toxicity/ effect

2. Severe Anemia- possibly due to myocardial ischemia

75
Q

How to measure axis in BBB

A

Controversial

  1. RBBB- initial 80-100 ms ( ie only LV forces considered)
  2. LBBB and IVCD- entire QRS or initial 80-100 ms
76
Q

Short PR (<0.12s)with narrow QRS is seen in

A

LGL syndrome
Lown
Ganong
Levine

In the absence of tachycardia, it’s considered a benign variant

If tachy is present- no increase in mortality

All from Wiki

77
Q

Tall T wave definition

A

More than 2/3 rd preceding QRS

Normal T is 6 mm in limb leads and 10 mm in precordial leads

Santhosh- pediatric ECG

Cardio (36 decks)

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