ECG Flashcards
What is sinus bradycardia ?
<60BPM
What is sinus tachycardia?
> 100BPM
What part of ECG shows atrial depolarisation?
P wave
What part of the ECG shows ventricle depolarisation?
QRS compelx
What are the four limb ECG and where are they on the body?
Red (AVR) on the right arm
Yellow (AVL) on the left arm
Green (AVF) on the right leg
Black is neutral on right leg
What creates lead 1?
AVR to AVL
What creates lead 2?
AVR to AVF
What creates lead 3?
aVL to AVF
What are the chest electrode placement positions?
1 – 4th Intercostal Space, Rt. Sternal Edge.
V2 – 4th Intercostal Space, Lt. Sternal Edge.
V3 – Midway between V2 & V4.
V4 - 5th Intercostal Space, Mid Clavicular.
V5 – Midway between V4 & V6.
V6 – 5th Intercostal space, Mid Axillary.
What are leads 2,3 and AVF looking at?
Inferior view of the heart
What are V1 and V2 looking at?
Septal view of the heart
Anterior
What are V3 and V4 looking at?
anterior wall
What are lead 1 and AVL looking at?
Superior lateral view of the heart
What are V5 and V6 looking at?
Inferior lateral view of the heart
What do you initially comment on when looking at ECG?
Patient name and DOB
Date of ECG and indication
Quality of ECG and if its 12 lead
Scale
What is the system that should be used when looking ECG?
Rate ? Rhythm ? P wave ? PR interval ? (AV conduction time). QRS Complex interval ? QT interval ? (Ventricular contraction time).
What does one small box horizontally represent?
0.04s
What does one large box horizontally represent?
0.20s
What does one large box vertically represent?
0.5mv
When looking at rhythm strip what are you trying to identify?
Clear P wave
QRS regular or irregular
Is the QRS narrow or broad
What is the normal length of a P wave?
0.11s just less than 3 small squares
What does absent P wave indicate?
AF or nodal rhythm
What is the PR interval?
P wave to start of QRS complex
What is normal size of PR interval?
0.12-0.2
3-5 small squares
What does a short PR interval indicate?
Wolff Parkinson syndrome –> abnormal fast heart rate or it can be normal
What does long Pr interval indicate?
AV block –>1st 2nd or 3rd degree
What is normal ORS size?
3 small squares
0.12s
What does ST depression indicate?
NStemi
Ischaemia
What does ST elevation indicate?
Stemi
Infarction
What does a peaked T wave indicate?
Hyperkalaemia or normal for young man
What does a inverted/biphasic T wave indicate?
Previous infarct/ ischaemia
Hypokalaemia
Bundle branch block
Wolf Parkinson White syndrome
What does a small T wave indicate?
Hypokalaemia
What are the characteristics of atrial fibrillation ECG?
Irregular Baseline.
Unable to distinguish P waves.
Irregular and narrow QRS complexes.
Normal T Waves.
What are the characteristics of atrial flutter in a ECG?
Difficult to distinguish P and T waves.
Narrow QRS.
No flat baseline between P waves.
Giving a saw toothed appearance
What are the characteristics of ventricle fibrillation in a ECG?
No P Waves.
A rhythm of ventricular origin with rapid, bizarre and wide QRS ( ventricle when wide QRS)
No identifiable T wave
Can you see the P wave and QRS complex in ventricular fibrillation?
No
What are the characteristics of asytole?
Rhythm - Flat absence of all ventricular activity.
Rate - 0 Beats per minute.
P Wave – None.
No QRS Complexes
What is a pulseless electrical activity?
Ventricular Activity. Still electrical activity but pump not working IE. QRS complexes. No Major Circulation. PATIENT HAS NO PULSE. Non shockable but correctable Normal Sinus Rhythm – Pulseless.
What are the 4 H’s and 4 T’s reversible causes of cardiac arrest?
Hypovolemia
Hypoxia
Hyper/hypokalemia
Hypothermia
Tablets/toxins cocaine overdose Cardiac Tamponade Thrombosis Trauma Tension pneumothorax
What is the treatment for PEA?
Adrenaline and CPR
Not shockable
Is asystole shockable?
Yes
What is the PR interval a indication of?
It represents the time taken for electrical activity to move between the atria and ventricles.
Atrial contraction time
What is the QT interval a indication of?
Ventricle contraction time
It represents the time taken for the ventricles to depolarise and then repolarise.
In normal cardic axis what is the most positive and negative?
Lead 2 most positive
AvR most negative
what causes right axis deviation?
Right ventricle hypertrophy
Great electrical current from the right side of the heart
What affect does right axis deviation have on the ECG?
Lead 1 negative and AVL negative
Lead 3 and AvF more positive
In who can right axis deviation on a ECG be normal?
Very tall patients
What is the cause of left axis deviation?
Conduction defect
What is the ECG change of left axis deviation?
Lead 3 negative and AvF negative
Lead 1 and AvL are positive
When is Left axis deviation significant?
When lead 2 is also negative
What does a increase PR interval indicate?
Heart block
What can a reduce PR interaval indicate?
Wolf parkinson white syndrome
What would a QRS shorter than 0.12 seconds (3 small squares) indicate?
The complex is supraventricular in origion
What would a QRS greater than 0.12 seconds (3 small squares) indicate?
The complex is ventricle in origin
What is the structure of the QRS in ventricle tachycardia and what does this indicate?
Regular Bizarre wide QRS which indicate origin in ventricle
What is the cause of ventricular tachycardia?
Direct damage to the myocardium secondary to MI or cardiomyopathy
What is the treatment for ventricular tachycardia?
Pace maker or defibrillator
Stable patient= give 300 mg Iv of amiodarone in first hour then 900mg IV/24hrs
What is the immediate treatment of VF (cardiac arrest)
Defibrillation
What is the rate rhythm and character of VF?
Rate = >300 Rhythm= irregular Character = No P, QRS complex
What do you need to do immediately for patient who is asystole?
CPR
Are AvL and AVf facing each other or away each other in left axis deviation?
Facing away from other
Are AvL and AVf facing each other or away each other in right axis deviation?
Facing towards each other
Describe the Pr interval in 1st degree heart block
fixed prolonged PR interval (>200 ms)
Describe second degree heart block type 1?
If the PR interval slowly increases then there is a dropped QRS complex
Describe second degree heart block type 2?
If the PR interval is fixed but there are dropped beats, t
Describe third degree heart block?
If the P waves and QRS complexes are completely unrelated