ECG

Question 1

First Thing

Answer 1

Check patients name
DOB
Date of Investigation
Time of Investigation
Location

Question 2

Calibration

Answer 2

Check setting of 25mm/s

Ten Second strip

Question 3

Rate

Answer 3

Count intervals between R on Rhythm strip
Multiply by 6
60-100 normal

Question 4

Rhythm

Answer 4

Use piece of paper to check regular
Regular
Regularly irregular? = recurring features
Irregularly Irregular? = totally random

Question 5

Regularly Irregular

Answer 5

Sinus Arrhythmia = respiratory variation

2nd degree heart block

Question 6

Irregularly Irregular

Answer 6

Atrial Fibrillation = Absent P wave
Wandering atrial Pacemaker
Multifocal atrial tachycardia

Question 7

Axis

Answer 7

Look at 1,2,3
Normal = all up
Left = 1 and 2 leaving
Right = 1 and 2 reaching

Question 8

P waves

Answer 8

Atrial Abnormalities
Comment on presence
Absent = AF
Tall = Right Atrium enlargement (Corpulmonale)
Bifid = Left Atrium Enlargement = mitral stenosis
Flat = Hyperkalaemia

Question 9

PR interval

Answer 9

Maximum one large square
Normal is 3-5 small
anything more is Heart Block

Question 10

QRS comlex

Answer 10

Normal is 3 small squares = 120ms
Less than 100 is abnormal e.g. Atrial Flutter
More than 120 could be VT or BBB

Question 11

ST elevation

Answer 11

Sign of STEMI

Question 12

T Wave

Answer 12

Upright in all leads except aVR and V1
Tall tented T waves = Hyperkalaemia
Inverted = MI
Flattened = MI

Question 13

Further investigations

Answer 13

12 hr Troponin

serial ECGs

Question 14

anatomy of leads

Answer 14

LII - LI - SSA- ALL