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YEAR 3 OSCE > ECG > Flashcards

ECG Flashcards

1
Q

What is your system to reading ECGs? (8)

A
  1. patient symptoms
  2. demographics
    - name, age and DOB, date, time
  3. calibrated at 25mm/s and 1mV (1 millivolt)
  4. rhythm - p wave = sinus, piece of paper measure between r waves
  5. rate
  6. axis - leads I, II, III, AVL and AVF
  7. QRS and p wave
  8. ST segments
  9. others QTc
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2
Q

How many mm/s is a whole strip?

A

25 mm/s

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3
Q

how many m/s and s is 1 large square?

A

0.2s or 200ms

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4
Q

How many m/s or s is 1 small square?

A

0.04 s or 40ms

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5
Q

Where do you start reading the PR interval from?

A

the beginning of the p wave to the beginning of the q wave

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6
Q

How long should the PR interval be?

A

120-220 ms

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7
Q

What is standard rates?

A

R-R interval Heart rate (bpm)

1 300

2 150

3 100

4 75

5 60

6 50

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8
Q

What do leads I, II and VL look at?

A

left lateral surface of the heart

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9
Q

What do leads III and VF look at?

A

the inferior surface

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10
Q

What does lead VR look at?

A

right atrium

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11
Q

Where do leads V1-6 look at the heart?

A

they look at the heart from the horizontal plane

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12
Q

Rhythm strip - what is it

A

whichever lead shows the p wave most clearly usually lead II

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13
Q

What are the deflection in VR and II usually?

A

VR - downwards

II - upwards

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14
Q

What deflection are leads I, II and III associated with and why?

A

upwards deflection

  • depolarising waves is spreading towards these leads
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15
Q

what is right axis deviation?

A

deflection in lead I becomes negative

deflection in lead III become more positive

right ventricle becomes hypertrophied

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16
Q

normal axis

A

lead I, II and III all positive deflections

lead II with most positive deflection

17
Q

left axis deviation

A

lead I - small positive deflection

lead II - negative deflection

lead III - negative deflection

left ventricle is hypertrophied

18
Q

What is first degree heart block?

A

PR interval is prolonged

  • delay somewhere along the conduction pathway
  • sign of coronary artery disease, acute rheumatic carditis, digoxin toxicity or electrolyte disturbance
19
Q

What is second degree heart block?

A

excitation completely fails to pass through the AV node or bundle of His.

This occurs intermittently

20
Q

What is seen in Mobitz type I/ Wenebach second degree heart block?

A
  • progressive lengthening of the PR interval
  • failure of conduction of an atrial beat
  • followed by a conducted beat with a shorter PR interval
  • this cycle repeats
21
Q

What is seen in Mobitz type II?

A
  • PR interval is constant
  • occasionally there is one p wave without ventricular depolarisation
  • one p wave is not followed by a QRS complex
22
Q

What is third degree heart block?

A

this is complete heart block

  • atrial contract is normal
  • nothing gets to ventricles
  • on ecg QRS complexes are abnormally shaped
  • transient MI
  • chronic due to fibrosis around the bundle of His
23
Q

What is right bundle branch block?

A
  • V1 lead
  • see a RSR pattern

think Marrow

24
Q

Left bundle branch blcok

A

Willaim

  • v6 lead - M
  • v1 lead - W
  • braod QRS
25
Q

What is supra ventricular/atrial tachycardia?

A
  • p waves are superimposed on the T waves of the preceding beats
  • QRS intervals are short
  • QRS are the same shape
26
Q

What is an atrial flutter?

A

atrial rate is greater than 250/min

  • pawave - saw tooth appearance
  • four p waves per QRS
  • ventricular activity is perfectly regular
27
Q

What is ventricular tachycardia?

A

no p waves

  • regular QRS
  • broad QRS
  • no t waves
28
Q

Atrial fibrillation

A
  • no p waves
  • irregular QRS complexes
  • normal shaped QRS
29
Q

Ventricular fibrillation?

A
  • no QRS

- loss of consciousness

30
Q

Pacemaker

A
  • occasional P waves visible
  • p waves not related to QRS complex
  • spike before QRS complex - pacemaker stimulus
  • broad QRS
31
Q

ST elevation

A
  • acute myocardial injury

ANTERIOR DAMAGE

-V leads

INFERIOR DAMAGE

  • leads III and VF

LATERAL DAMAGE

  • leads I, II, VL

YEAR 3 OSCE (38 decks)

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