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MD4003 > ECG > Flashcards

ECG Flashcards

1
Q

What are the small boxes equal to?

A

0.04sec

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2
Q

What are the big boxes equal to?

A

0.2sec

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3
Q

What is the rate of an ECG?

A

25mm/sec

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4
Q

Describe the appearance of an ECG with right bundle branch block?

A
  • Think: MaRRoW
  • V1 & V2 QRS complex widening
  • rsR’ in V1 & V2 (rabbit ears)
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5
Q

Describe the appearance of an ECG with left bundle branch block?

A
  • V1 looks like a “W”
  • V6 looks like an “M”
  • Think: WiLLiaM
  • Wide WRS complex
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6
Q

How do you work out the ECG axis?

A
  • Look for limb lead where QRS complex is equiphasic both + and - and/or small
  • The axis lies at 90o to this
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7
Q

What is the normal ECG axis?

A

-30o to +90o

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8
Q

Describe the appearance of an ECG in myocardial ischaemia?

A
  • ST depression/elevation

- T wave inversion

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9
Q

How do you work out if there is left ventricular hypertrophy through an ECG?

A

Sum of height of R wave in V5 & V6 + depth of S wave in lead V1 > 35mm

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10
Q

How do you work out if there is right ventricular hypertrophy through an ECG?

A
  • R wave in V1 greater than 7mm

- Right axis deviation S waves in V5-6

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11
Q

What is the treatment plan for an NSTEMI?

A
  • Aspirin
  • Anti-thrombin therapy
  • Coronary angiography within 9hrs
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12
Q

Describe the appearance of an ECG in myocardial infarction (STEMI)?

A
  • ST elevation (injury)
  • T wave elevation (ischaemia)
  • Pathological Q waves (dead tissue)
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13
Q

Describe what pathological Q waves are on an ECG?

A
  • Exceeds 0.04sec width

- >2mm depth (2 small squares)

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14
Q

List the 3 inferior ECG leads?

A
  1. II
  2. III
  3. AVF
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15
Q

List the 3 lateral ECG leads?

A
  1. V1-6
  2. I
  3. AVL
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16
Q

List the anteroseptal ECG leads?

A

V1-4

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17
Q

List the 3 anterolateral ECG leads?

A
  1. V3-6
  2. I
  3. AVL
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18
Q

What is the mnemonic for a pulmonary embolism on ECG?

A

S1 Q3 T3

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19
Q

What does S1 Q3 T3 stand for?

A
  • Large S wave in lead I
  • Q wave in lead III
  • Inverted T wave in lead III
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20
Q

How would hyperkalaemia appear on ECG?

A
  • Tall T wave
  • Prolonger PR interval
  • Widened QRS
  • Arrhythmias
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21
Q

How would hypokalaemia appear on ECG?

A
  • Flattened T wave
  • Depressed ST
  • Tall U waves
  • Prolonged QT
  • Arrhythmias
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22
Q

How would hypercalaemia appear on ECG?

A

Short QT interval

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23
Q

How would hypocalcaemia appear on ECG?

A
  • Long QT interval

- Small T waves

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24
Q

How would Digoxin affect an ECG?

A
  • Shortened QT interval
  • Down slopping ST depression
  • Arrhythmias
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25
Q

How do you work out the ventricular rate of an ECG?

A

300 ÷ number of big squares per R-R interval in lead II

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26
Q

What is the normal P wave size?

A
  • Height: <0.25mV

- Width: <0.11sec

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27
Q

What is the normal PR interval size?

A

120-200msec (3-5 small squares)

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28
Q

What is the normal QRS complex size?

A

<120msec (3 small squares)

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29
Q

Where is T wave inversion normal?

A
  • AVR

- V1

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30
Q

Describe the appearance of an ECG in ventricular fibrillation?

A
  • Highly irregular rythme
  • Unmeasurable rate
  • Absent P waves
  • No QRS
  • EKG tracings is a wavy line
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31
Q

What are the 2 shockable rhythms?

A
  1. Ventricular fibrillation

2. Ventricular tachycardia

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32
Q

What do you do for un-shockable rhythms?

A

Give adrenaline

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33
Q

Describe the appearance of an ECG in atrial fibrillation?

A
  • Irregular rhythm

- No P waves

34
Q

Describe the appearance of an ECG in atrial flutter?

A
  • Regular rhythm
  • Saw tooth appearance
  • Narrow complex tachycardia
35
Q

What drug stops parasympathetic activity?

A

Atropine

36
Q

Describe the appearance of an ECG superior ventricular tachycardia (SVT)?

A
  • No atrial activity (no P waves)
  • Palpations
  • Narrow QRS complex
  • Tachycardia
37
Q

What drug would you prescribe for SVT?

A

Adenosine

38
Q

Describe the 5 stages of MI seen on an ECG?

A
  1. Normal
  2. ST segment elevation
  3. Development of Q waves
  4. ST segment returns to baseline
  5. T waves become inverted
39
Q

Where on an ECG would an anterior infarction be seen?

A

V2-5

40
Q

Describe the appearance on an ECG posterior infarction?

A

Dominant R wave in lead V1 (upwards QRS complex)

41
Q

Describe 1st degree heart block on the ECG?

A

Wide PR interval

42
Q

Describe 2nd degree heart block (Mobitz I/ Wenckebach) on the ECG?

A

Gradual increase in PR interval, then missed beat (no QRS complex)

43
Q

Describe 2nd degree heart block (Mobitz II/ 2:1) on the ECG?

A

Alternating impulses not conducted by AVN, 2 P waves per QRS complex

44
Q

Describe 3rd degree heart block (AVN escape) on the ECG?

A
  • Complete dissociation between P and QRS

- Narrow QRS complex

45
Q

Describe 3rd degree heart block (ventricular escape) on the ECG?

A
  • Complete dissociation between P and QRS

- Wide QRS complex

46
Q

Patients with 1st/2nd degree heart block are often _______?

A

Asymptomatic

47
Q

What is the angle of left axis deviation?

A

-90o to -30o

48
Q

What is the angle of right axis deviation?

A

+120o to +90o

49
Q

What is the normal QT interval?

A

~300ms

50
Q

What is the normal ST segment?

A

0.25sec

51
Q

What 2 leads normally show the tallest QRS complex?

A

Lead II & AVR

52
Q

How is the P interval measured?

A

From the start of the P wave to the beginning of the QRS complex

53
Q

How is the QT interval measured?

A

From the beginning of the QRS complex to the end of the T wave

54
Q

What is a sign of left axis deviation?

A

Tallest QRS at AVL

55
Q

What can left axis deviation mean?

A

Left ventricular hypertrophy

56
Q

What is a sign of right axis deviation?

A

Tallest QRS at lead III or AVF

57
Q

What can right axis deviation mean?

A

Right ventricular hypertrophy

58
Q

What can hyperkalaemia cause on the ECG?

A

Tall peaked T wave

59
Q

What can cause a prolonged QTc?

A
  • Antiarrhythmic drugs
  • Heart failure
  • Inherited long QT syndrome
60
Q

What would the diagnosis be if there was a marked S-T elevation in leads V1-V4, and slight S-T elevation in l and aVL, this is the primary change, the S-T depression in ll, lll. aVF and V6 is a reciprocal change?

A

Acute antero-septal myocardial ischaemic damage

61
Q

What would the diagnosis be if there was marked S-T elevation in leads V1-V5?

A

Recent anterior myocardial infarction

62
Q

What would the diagnosis be if V1 had an RSR complex and the total QRS duration is 0.14 seconds?

A

Complete right bundle branch block

63
Q

What would the diagnosis be if the strip shows sinus rhythm followed by a pause, followed by sinus rhythm again?

A

Sinus rhythm with a single episode of sinus arrest

64
Q

What would the diagnosis be if the strip shows QRS complexes being continuously variable and unpredictable in amplitude , duration and frequency?

A

Ventricular fibrillation

65
Q

What is P mitrale?

A

When P is “M” bifid its from left atrial hypertrophy

66
Q

What is P pulmonale?

A

When P is peaked then its from right atrial hypertrophy

67
Q

What does an inverted Q wave mean?

A

Junctional rhythm, usually due to sinus pathology (P wave originating from the bottom of the atria’s)

68
Q

How can you quickly tell if the ECG axis is normal?

A

If there is a positive QRS complex in lead I and AVF

69
Q

How can you quickly tell if the ECG axis has possible left axis deviation?

A

If there is a positive QRS complex in lead I but a negative QRS complex in AVF (then go on to check if lead II is positive or negative to confirm)

70
Q

How can you quickly tell if the ECG axis has possible right axis deviation?

A

If there is a negative QRS complex in lead I but a positive QRS complex in AVF

71
Q

How can you quickly tell if the ECG axis has extreme axis deviation?

A

If there are negative QRS complexes in both leads I and AVF

72
Q

What should you always remember about the Bazett’s calculation?

A

Has to be calculated in seconds!!!

73
Q

What can happen when a prolonged QTc is not treated?

A

Polymorphic VT –> DEATH

74
Q

What artery/s supplies the anterior portion of the heart?

A

LAD

75
Q

What artery/s supplies the inferior portion of the heart?

A

RCA

76
Q

What artery/s supplies the lateral portion of the heart?

A

Left circumflex artery/ LAD

77
Q

What artery/s supplies the septal portion of the heart?

A

LAD

78
Q

What is the classification of a widespread STEMI?

A

When you have elevated ST segment in more than 2 places (anterior, inferior, lateral, septal etc)

79
Q

What does a flattened T wave suggest?

A

Ischaemic changes

80
Q

What are U waves?

A

Positive deflection after T wave and are not pathological

81
Q

What does pericarditis look like on an ECG?

A
  • PR depression

- Saddle-shaped ST interval

MD4003 (22 decks)

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