ECG Flashcards
What does a lead do?
Measures difference in potential at two points
Where does lead I go?
RA -ve to LA +ve
Where does lead II go?
RA -ve to LL +ve
Where does lead III go?
LA -ve to LL +ve
What does depolarisation towards the electrode cause?
Upward deflection in the ECG
What does depolarisation away from the electrode cause?
Downward deflection in the ECG
Which limb leads are bipolar?
Standard
Which limb leads are unipolar?
Augmented
What is the polarity of the augmented limb leads?
One positive electrode with the two others linked as negative
What is important to remember about aVR?
It is always inverted
Which plane do the chest leads work in?
Axial
How many electrodes are in a 12 lead ECG?
9
What does the ST segment correspond to?
Systole- ventricles contract
What does the TP segment correspond to?
Diastole- ventricles relax
What would be the next test to do in suspected intermittent rhythm disturbance?
Ambulatory ECG for 12 hours or 7 days
What would be the next test to do for stable angina?
Exercise ECG
Where should V1 be placed?
4th IC space, right sternal angle
Where should V2 be placed?
4th IC space, left sternal angle
Where should V3 be placed?
Halfway between V2 and V4
Where should V4 be placed?
Apex beat- 5th intercostal space midclavicular line
Where should V5 be placed?
Anterior axillary line
Where should V6 be placed?
Mid axillary line
How long does one large box correspond to?
0.2 secs
How long does one small box correspond to?
0.04 secs
What does the p wave represent?
Atrial depolarisation
What does the PR interval represent?
AV nodal delay
What does the QRS complex represent?
Ventricular depolarisation
What does the t wave represent?
Ventricular repolarisation
What does the QT segment correspond to?
Depolarisation and repolarisation of the ventricles
How long should the QT segment last?
0.36-0.44 secs
How long should the p wave last?
0.08-0.1 secs
How long should the PR interval be?
0.12-0.1 secs
How long should the QRS complex last?
<0.1 secs
How do you calculate the heart rate with a regular rhythm?
300/no of large squares between beats
How do you calculate the heart rate with an irregular rhythm?
The number of QRS complexes in 30 large squares and multiply by 10
What is step 1 of analysing an ECG?
Verify patient name and DOB
What is step 2 of analysing an ECG?
Check date and time ECG was taken
What is step 3 of analysing an ECG?
Check the calibration of the ECG paper
What is step 4 of analysing an ECG?
Determine the axis
What 7 things are involved in analysing the rhythm of an ECG?
Is electrical activity present? Is the rhythm regular or not? What is the heart rate? Are p waves present What is the PR interval? (normally 3-5 small squares) Is each p wave followed by a QRS? Is the QRS duration normal?
What is step 6 of analysing an ECG?
Look at individual leads for voltage criteria changes and ST/t wave changes
What suggests a normal ECG axis?
Complexes in lead I and II which are both positive
What suggests left axis deviation?
-30 to -90 degrees
What suggests right axis deviation?
+90 to +180 degrees
What can cause left axis deviation?
LVH, inferior MI, VT from LV focus, WPW sometimes
What can cause right axis deviation?
RVH, anterolateral MI, some WPW, PE
What lead changes suggest an inferior MI?
II, III, aVF
What lead changes suggest an anteroseptal MI?
V1-4
What lead changes suggest an anterolateral MI?
V4-6, aVL
What lead changes suggest a posterior MI?
tall R and and ST depression in V1-2
What artery is involved in an inferior MI?
Right coronary
Which artery is involved in an anteroseptal MI?
Left anterior descending
Which artery is involved in a posterior MI?
Circumflex
What can cause ST depression and inverted T waves in V5-6?
Digoxin effect
What can cause tall, tented T waves, widened QRS and absent p waves?
Hyperkalaemia
What can cause small T waves and prominent U waves?
Hypokalaemia
What can cause a short QT interval?
Hypercalcaemia
What can cause a long QT interval and small T waves?
Hypocalcaemia
What do both types of bundle branch block cause?
Delayed conduction and hence prolonged QRS
What can be seen on an ECG of right bundle branch block?
Inverted T waves in V1-3/4 and a deep wide S wave in V6
What can be seen on an ECG of left bundle branch block?
M pattern in V5, inverted T waves in I, aVL and V5-6
What are causes of right bundle branch block?
Isolated, PE, cor pulmonale
What can cause left bundle branch block?
IHD, hypertension, cardiomyopathy, idiopathic fibrosis