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MD4003 OSCEs > ECG > Flashcards

ECG Flashcards

1
Q

Normal length of PR interval?

A

120-200 ms

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2
Q

Define PR interval

A

Start of P to start of Q wave

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3
Q

Normal length of QRS interval?

A

120ms

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4
Q

Define QT interval

A

Start of Q to end of T

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5
Q

Define ST segment

A

End of S to start of T wave

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6
Q

Define QRS

A

Start of Q to end of S

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7
Q

Large square =

A

5mm = 200ms (0.2s)

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8
Q

Small square =

A

1mm = 40ms (0.04s)

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9
Q

Which limb leads look at:
Left lateral heart?
Inf heart?
Right atrium?

A

Left lateral heart: I, II and VL
Inf heart: III and VF
Right atrium: VR

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10
Q

Normal cardiac axis?

A

-30 to +90

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11
Q

Left/right axis deviation?

A

Right: +90 to -90
Left: -30 to -90

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12
Q

Presentation and cause of first degree heart block?

A

Presentation: Consistent prolonged PR internval
Cause: CAD, acute rheumatic carditis, digoxin toxicity or electrolyte disturbances

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13
Q

Presentations and cause of second degree heart block?

A 
Cause: Intermittent failure of excitation to pass through the AV node or bundle of His.
Presentations:
1. Mobitz type 2 phenomenon
2. Wenckebach
3. 2:1 or 3:1 conduction
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14
Q

What is Mobitz type 2 heart block?

A

2nd degree heart block

Most beat conducted with constant PR interval, with occasional absent ventricular contraction following atrial contraction

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15
Q

What is Wenckebach heart block?

A

2nd degree heart block

Progressive lengthening of PR interval with then failure conduction of atrial beat. Following by short conducted PR interval etc etc

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16
Q

What is “2:1 or 3:1 conduction” heart block?

A

2nd degree heart block

Alternate conducted and non-conducted atrial beats
Ratio is the number of conduction P to QRS waves

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17
Q

Cause and presentation of third degree (complete) heart block?

A

Atrial contraction is normal but no beats are conducted to the ventricles.
Ventricles are then excited by a slow “escape mechanism” from a depolarising focus within the ventricular muscle
P wave and QRS complex rate= DIFFERENT and UNRELATED

Cause:
(Acute) MI phenomenon
(Chronic) Fibrosis around Bundle of His

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18
Q

Characteristics of a normal sinus rhythm?

A
  1. Regular rhythm at a rate of 60-100 bpm
  2. Each QRS complex is preceded by a normal P wave.
  3. Normal P wave axis: P waves should be upright in leads I and II, inverted in aVR.
  4. The PR interval remains constant.
  5. QRS complexes are < 120 ms wide (unless a co-existent interventricular conduction delay is present).
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19
Q

Sign of RBBB

A

Lead V1, RSR pattern

Wide QRS in V6 with deep S waves

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20
Q

Sign of LBBB

A

V6 borad complex with notched top (“M”)

With corresponding “W” is V1

T wave inversion is lateral leads (I, VL, V5 and V6)

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21
Q

The septum is depolarised from..

A

left to right

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22
Q

3 types of supraventricular rhythms

A

Sinus
Atrial
Junctional

The depolarisation wave spreads to the ventricles in the normal way via the Bundle of His. Hence normal QRS (or narrow)

23
Q

QRS complexes in ventricular rhythms?

A

Wide as depolarisation spread in ventricles is abnormal

24
Q

Categorises of abnormal rhythms (both ventricular and supraventricular)?

A

Bradycardias
Extrasystoles
Tachycardias
Fibrillations

25
Meaning of paroxysmal?
Occurs intermittently
26
What is AV block?
When atrial rate is greater than 200bpm so AV nodes prevents all P waves being conducted. This is a protective mechanism due a functioning AV nodes (hence different to 2nd degree heart block)
27
Appearance of atrial flutter
Saw toothered | Not all P waves followed by QRS (due to AV block)
28
Appearance of atrial flutter?
Atrial rate greater than 250bpm No p wave baseline (Often no T waves but in fact 2:1 block)
29
Arrhythmia identified i lead with..
most visible p waves
30
Presentation of junctional (nodal) tachycardia?
No p waves Normal QRS shape Fast rate
31
Presentation of ventricular tachycardia?
Abnormal and wide QRS complexes in all 12 leads | Due to abnormal pathway spread through ventricular muscle
32
Atrial fibrillation appearance?
No p waves Irregular QRS complexes (but normal shape) and baseline
33
ECG presentation of ventricular fibrillation?
No identifiable QRS complexes and disorganised ECG
34
Presentation of wolff-parkinson-white syndrome?
Short PR Slurred upstroke in QRS complex Can cause paroxysmal tachycardia
35
Causes of peaked p wave?
Right atrial hypertrophy (e.g. due to tricuspid valve stenosis or pulmonary hypertension in PE)
36
Cause of bifid p wave?
Left atrial hypertrophy (e.g. due to mitral valve stenosis)
37
What and where is the normal transition point?
When R wave equal S wave Normally at V3 and V4. (Pathology: Clockwise rotation when at V5 or V6 due to pulmonary hypertension)
38
Q waves presentation is an MI
Width: More than 1 small square (0.04s) Depth: Greater than 2mm
39
Normal T wave inversion in which leads?
VR and V1 | sometimes III and V2
40
T wave inversion induced by...
``` Normality Ischaemia Ventricular hypertrophy Abnormal IV conduction i.e. BBB Digoxin treatment ```
41
Peaked t waves means..
hyperkalaemia | Flat and prolonged in hypokalaemia
42
Normal callibration
10mm/mV | 25mm/s
43
Causes for irregular rhythm?
AF 2nd degree heart block Ectopy (vent= broad, atrial=narrow)
44
P waves abnormality in right atrial hypertrophy
Peaked p waves
45
P waves abnormality in left atrial hypertrophy
Bifid p waves
46
3 types of heart block
1st degree = PR > 200ms consistently 2nd degree: TYPE 1= PR gets progressively longer TYPE 2= PR consistent with intermittent loss of conduction so absent QRS complex 3rd degree: Complete dissociation between P waves and QRS complexes. PR interval inconsistent
47
``` Degrees of: Normal LAD RAD Extreme axis ```
Normal: -30 to +90 LAD: -30 to -90 RAD: +90 to 180 Extreme axis: 180 to -90
48
Type finding of LBBB and RBBB
RBBB = MaRRoW LBBB= WiLLiaM
49
QT interval means
Ventricular depolarisation and repolations | So start of QRS to end of T
50
Was is Bazetts equation
Qtc = QT/root of RR Needs to be in seconds
51
Normal QTc?
Between 380-420ms
52
``` Which leads are: Inferior? septal? Anterior? Lateral? ```
Inferior? II, III, AVF septal? V1, V2 Anterior? V3, V4 Lateral? I, AVL
53
ECG findings in PE
Tachycardia Right ventricular hypertrophy S1Q3T3
54
Signs of a pathological Q waves
more than 0.04s wide | More then 2mm deeo

MD4003 OSCEs (19 decks)

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