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Emergency Medicine > ECG > Flashcards

ECG Flashcards

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1
Q

What does a +ve and -ve deflection mean?

A

Positive = depolarisation wave moving towards electrode

Negative = away from electrode

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2
Q

What does the P wave represent?

A

Atrial depolarisation

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3
Q

What does the PR interval represent?

A

Beginning of atrial contraction to beginning of ventricular contraction

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4
Q

What does the PR segment represent?

A

AV node delay

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5
Q

What does the QRS wave represent?

A

Ventricular depolarisation

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6
Q

What does the T wave represent?

A

Ventricular repolarisation

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7
Q

What does the QT interval represent?

A

Time taken for ventricular depolarisation + repolarisation

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8
Q

What does the U wave represent?

A

Represents purkinje fibre repolarisation

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9
Q

What is the y + x axis?

A

Y = voltage X = time (1mm = 0.4s)

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10
Q

What are the bipolar leads?

A

I, II, III (Have a positive + negative electrode)

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11
Q

What are the unipolar leads?

A

AVR, AVL, AVF + chest leads

(Have a positive electrode + rely on combination of others to make up negative electrode)

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12
Q

What are the lateral leads?

A

I, AVL, V5, V6

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13
Q

What are the inferior leads?

A

II, III, AVF

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14
Q

What are the septal leads?

A

V1 + V2

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15
Q

What are the anterior leads?

A

V3 + V4

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16
Q

Which leads should have an upright P wave?

A

I, II, AVF

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17
Q

What HR is equal to = 1 block, 2 blocks, 3 blocks, 4 blocks, 5 blocks, 6 blocks?

A

1 = 300bpm

2 = 150 bpm

3 = 100 bpm

4 = 74 bpm

5 = 60 bpm

6 = 50 bpm

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18
Q

What is a normal PR interval?

A

0.12-0.2s

3-5 small boxes

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19
Q

What is a normal QRS interval?

A

<0.12s

(less than 3 small boxes)

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20
Q

How to approach an ECG in an OSCE?

A

Name + DOB

Date + time

1) HR (number of QRS on 10s strip x 6)
2) Rhythm (regular, regularly irregular, irregularly irregular)
3) Cardiac axis
4) P waves - present, normal, followed by QRS?
5) PR interval
6) QRS complex
7) ST segment
8) T waves

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21
Q

How to determine cardiac axis?

A

Lead II should have most positive deflection compared to I + III

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22
Q

What does right axis deviation look like?

A

Lead III most positive Lead I negative

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23
Q

What does left axis deviation look like?

A

Lead I most positive Lead II + III negative

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24
Q

What does a prolonged PR interval show?

A

>0.2s AV block

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25
Q

What does a shortened PR interval show?

A

P wave originating from closer to AV node Atrial impulse getting to ventricle quickly via accessory pathway (delta wave = WPW)

26
Q

What is a delta wave?

A

Slurred upstroke of QRS complex

27
Q

Describe the assessment of the QRS complex

A

Width (narrow <0.12 or broad >0.12)

Height:

Small = <5mm in limb leads or <10mm in chest leads

Tall = >5 or >10 Morphology

28
Q

Describe assessment of ST segment

A

Should be isoelectric line

ST elevation = MI

ST depression = ischaemia

29
Q

Describe assessment of T wave

A

Tall = >5mm in limb + >10mm in chest

Inverted = normal in V1 but abnormal in other leads

30
Q

What do tall T waves indicate?

A

Hyperkalaemia

Hyperacute STEMI

31
Q

What do inverted T waves indicate?

A

Ischaemia

Bundle branch block (V4-6 in LBBB + V1-3 in RBBB)

PE

32
Q

What does a biphasic T wave indicate?

A

Hypokalaemia

Ischaemia

33
Q

What does a flattened T wave indicate?

A

Ischaemia

Electrolyte imbalance

34
Q

Difference between AV blocks

A

1st = fixed prolonged PR interval (>0.2s)

2nd type 1 = PR interval steadily increasing until dropped QRS

2nd type 2 = PR interval fixed but with occasional dropped beats

3rd = P waves + QRS totally unrelated

35
Q

What does a broad QRS complex indicate?

A

Abnormal depolarisation sequence eg ventricular ectopic or bundle branch block

36
Q

What does a LBBB look like?

A

Broad QRS >0.12

Secondary R waves in V1-V3

Slurred S waves in lateral leads (I, AVL, V5-6)

37
Q

What does a RBBB look like?

A

Broad QRS >0.12

Dominant S wave in V1

Absence of Q aves + broad R waves in lateral leads

38
Q

What does atrial enlargement look like?

A

Biphasic p waves in lead V1

Amplitude of P waves

39
Q

What does right ventricular hypertrophy look like?

A

V1 = huge S

V5 + 6 = Huge R

40
Q

What does left ventricular hypertrophy look like?

A

V1 = big R

V5 = big S

41
Q

What does subendocardial ischaemia look like on ECG + what is its name, and what leads are affected?

A

Stable angina

ST depression

Often affecting leads I, II, V4, V5 + V6

42
Q

What does subendocardial infarction look like + what is the name of it, and what leads are affected?

A

Unstable angina/ NSTEMI

ST depressions

T wave inversion

Most noticeable in chest leads - must be contiguous (leads next to each other)

43
Q

What does transmural ischaemia look like + whats its name, and what leads are affected?

A

Unstable angina/ NSTEMI

ST depressions

T wave inversion

Most noticeable in chest leads - must be contiguous (leads next to each other)

44
Q

What does transmural infarction look like + whats its name?

A

STEMI

T wave inversions

Hyperacute T waves

ST elevation

Pathological Q waves

45
Q

Whats the difference between an NSTEMI + unstable angina?

A

NSTEMI - heart cells produce troponin + CK-MB

46
Q

What other conditions cause ST elevation?

A

Coronary artery spasm

left ventricular hypertrophy

Pericarditis

47
Q

How to locate where the infarction is?

A

Lead with pathological Q waves

48
Q

What leads show pathological Q waves in septal wall infarcts?

A

V1 + V2

49
Q

What leads show pathological Q waves in anterior wall infarcts?

A

V3 + V4

50
Q

What leads show pathological Q waves in anterolateral wall infarcts?

A

V3, V4, V5, V6 1 AVL

51
Q

Other causes of pathological Q waves

A

Bundle branch block

WPW syndrome

52
Q

How long do ECG changes last for in STEMIs?

A

ST elevation = days

T wave inversion = weeks to months

Pathological Q waves = months to years

53
Q

What is the most common cause of left axis deviation?

A

Defects of conduction system

54
Q

Which coronary artery is most commonly involved in MI?

A

Left anterior descending

55
Q

If leads V1 + V2 show ST segment changes, what area is affected + what artery is likely blocked?

A

Septal

Left anterior descending

56
Q

If leads V3 + V4 show ST segment changes, what area is affected + what artery is likely blocked?

A

Anterior

Left anterior descending

57
Q

If leads I + AVL show ST segment changes, what area is affected + what artery is likely blocked?

A

Lateral

Left circumflex artery

58
Q

If leads II, III + AVF show ST segment changes, what area is affected + what artery is likely blocked?

A

Inferior

Right coronary artery

59
Q

What does LVH look like on ECG?

A

Tall S waves + R waves

60
Q

What ECG changes are typical of massive PE?

A

RBBB

S1Q3T3 (deep S wave lead 1, patholgical Q wave + T wave inversion in lead 3)

R axis deviation - 1 + 3 are reaching to each other

Emergency Medicine (24 decks)

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