ECG

Question 1

when would you see a J wave?

Answer 1

a notch in S wave

• seen in hypothermia and hypercalcaemia

Question 2

at what pulse do you have sinus bradycardia?

and sinus tachycardia?

Answer 2

<60bpm

<100bpm

Question 3

what type of MI:

if you have ST elevation in leads II, III and aVF?

due to which coronary artery?

Answer 3

inferior

RCA or LCx

Question 4

what type of MI:

if you have ST elevation in leads V1-V4?

• what coronary artery is affected?

Answer 4

• anterior/septal MI

- LAD

Question 5

what type of MI:

of you have ST elevation in leads I, aVL and V5, V6?

• what coronary artery s affected?

Answer 5

lateral MI

• LCx or diagonal of LAD

Question 6

HEART BLOCK (1st degree)

• what happens to PR interval?
• P:QRS ratio?

Answer 6

• prolonged

- 1:1

Question 7

HEART BLOCK

(2nd degree - Mobitz I)

• what happens to PR interval?
• what is this phenomenon called?

Answer 7

• PR interval gets longer and longer until a QRS is missed

- wenckebach phenomenon

Question 8

HEART BLOCK

(2nd degree - Mobitz II)

• what happens to PR interval?
• dangerous rhythm - can lead to?

Answer 8

• PR interval is the same !!
  BUT QRS is regularly missed.
• complete heart block

Question 9

HEART BLOCK

(2nd degree - 2:1 block)

• what happens to PR interval?
• P:QRS ratio?

Answer 9

• PR interval is the same but 2 P waves for every QRS

- 2:1

Question 10

RBBB

• what happens to V1 and V6?

Answer 10

MaRRoW

V1 = M 
V6 = W

Question 11

LBBB

• what happens to V1 and V6?

Answer 11

WiLLiaM

V1 = W
V6 = M

Question 12

when is T wave inversion normal?

abnormal?

Answer 12

black patients and children

in LBBB and RBBB

Question 13

what do you see on an ECG for atrial flutter?

Answer 13

Saw tooth pattern of loads of P waves for every QRS - as AVN can’t conduct all.

Question 14

A 65-year-old man calls an ambulance as he has central crushing chest pain that radiates to his left arm and jaw. As he arrives at the emergency department his heart rate is found to be 50/min. An ECG is performed which shows ST elevation and bradycardia with a 1st-degree heart block.

Given the history, which of the following are the leads will most likely show the ST elevation?

V1-V4
II, III, aVF
I, aVL, V5,V6

Answer 14

II, III, aVF

The patient has presented 1st-degree heart block following his MI and so we can work out that his MI has most likely affected the inferior leads (right coronary arteries also provide blood supply to the AV node).A right coronary infarct supplies the AV node so can cause arrhythmias after infarction

Question 15

WPW syndrome

• slurred upstroke of QRS wave which is called?

Answer 15

• delta wave

Question 16

hyperkalaemia

• what do you see on ECG?

Answer 16

• tall Tented T waves
• absent P waves

hyperkalaemia : high T waves

Question 17

hypokalaemia:

- what do you see on ECG?

Answer 17

• flattened T waves
• prominent U waves
• absent P waves

Question 18

A 39 year old athlete attends his team doctor for an annual physical. Which of the following features on his ECG would be a cause for concern?

Sinus bradycardia
LBBB
type 1 AV block
Wenckebach phenomenon

Answer 18

LBBB

Left bundle branch block is never normal and is usually associated with underlying ischaemic or structural heart disease.

Question 19

A 59-year-old female is admitted to the Emergency Department with a 30 minute history of central chest pain radiating to her left arm. An ECG shows ST elevation in leads II, III, aVF. Which coronary artery is most likely to be affected?

RCA
LAD
LCx

Answer 19

RCA

Question 20

Each one of the following may cause left bundle branch block, except:

cardiomyopathy 
atrial septal defect 
HTN 
idiopathic fibrosis 
IHD

Answer 20

atrial septal defect

Atrial septal defects, both primum and secundum, are associated with right rather than left bundle branch block

Question 21

A 60-year-old man is admitted with severe central chest pain to the resus department. The admission ECG shows ST elevation in leads V1-V4 with reciprocal changes in the inferior leads. Which one of the following is most likely to account for these findings?

75% occlusion of LAD
75% occlusion of LCx
75% occlusion of RCA
100% occlusion of RCA
100% occlusion of LAD

Answer 21

100% occlusion of LAD

Question 22

A 63-year-old man undergoes a subtotal colectomy and iatrogenic injury to both ureters is sustained. He develops renal failure and his serum potassium is found to be elevated at 6.9 mmol/L. An ECG is performed, what is the most likely finding?

Increased PR interval
Prominent U waves
Narrow QRS
Peaked T waves

Answer 22

Peaked T WAVES

Question 23

A 55-year old man has just arrived in A&E complaining of 20 minutes of central crushing chest pain. Which feature is most indicative of myocardial infarction at this moment in time?

Inverted T waves
ST depression
ST elevation
Q waves
Raised troponin

Answer 23

ST elevation

Question 24

A 56-year old man presents to A&E with a 2-hour history of central chest pain radiating to the left arm. He is anxious, nauseated and sweaty. His pulse is 120/minute in sinus rhythm and the ECG reveals ST elevation in leads II, III and aVF. The troponin level is significantly raised. This is certainly acute MI. Which is the most likely coronary vessel to be occluded?

Circumflex artery
Left anterior descending artery
Right coronary artery
Left main coronary artery
Posterior descending artery

Answer 24

Right coronary artery