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MBChB OSCE > ECG > Flashcards

ECG Flashcards

1
Q

What 2 things do you do when checking the calibration of an ECG?

A
  • Ensure 10mm = 1mV
  • Ensure paper speed is 25 mm/sec
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2
Q

What does a small box representon an ECG?

A

0.04 secs or 40 ms

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3
Q

What do the larger boxes on an ECG represent?

A

5 small boxes = 1 big box

0.2 secs or 200 ms

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4
Q

How do you determine the HR (ventricular rate)?

A

300 / number of big squares between R waves

(calculated in standard lead II)

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5
Q

Describe a normal P wave

A
  • Height < 0.25 mV
  • Width < 110 msec (3 small boxes)
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6
Q

What is a normal PR interval?

A

120 to 200 msec (0.12 to 0.2 secs)

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7
Q

What does a prolonged PR interval suggest?

A

Heart block (primary, secondary or tertiary)

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8
Q

What is a normal QRS complex?

What is a wide QRS complex?

A

Normal < 120 msec

Wide > 120 msec

(120 msec = 3 small boxes)

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9
Q

What is the normal axis of an ECG reading?

A

-30 to +90 degrees

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10
Q

In what leads is T wave usually inverted?

A
  • Standard lead aVR
  • Chest lead V1
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11
Q

In what leads would it be abnormal for a T wave to be inverted?

A

I, II and V4 to V6

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12
Q

What does a tall/peaked T wave suggest?

A

Hyperkalaemia

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13
Q

Where is the QT interval measured between?

A

From start of QRS to end of the T wave

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14
Q

What does QT vary with?

A

Heart rate

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15
Q

How do you calculate the corrected QTc interval?

A

QTc = QT / √RR

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16
Q

What is the normal range for QTc?

A

380 to 420 msec (0.38 to 0.42 secs)

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17
Q

What degrees of the hexaxial diagram does aVR sit at?

A

-150 degrees

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18
Q

What degrees of the hexaxial diagram does aVL sit at?

A

-30 degrees

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19
Q

What degrees of the hexaxial diagram does I sit at?

A

0 degrees

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20
Q

What degrees of the hexaxial diagram does II sit at?

A

+60 degrees

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21
Q

What degrees of the hexaxial diagram does aVF sit at?

A

+90 degrees

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22
Q

What degrees of the hexaxial diagram does III sit at?

A

+120 degrees

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23
Q

What does P in the ECG represent?

A

Atrial depolarisation

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24
Q

What does T represent in the ECG?

A

Ventricular repolarisation

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25
Q

What does Q represent in the ECG?

A

Septum depolarisation

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26
Q

What does R represent in the ECG?

A

Ventricular (main) depolarisation

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27
Q

What does S represent in the ECG?

A

Base of heart depolarisation

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28
Q

What are the inferior leads?

A

III, aVF, II

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29
Q

What are the left lateral leads?

A

aVL, I, V6, V5

30
Q

What are the front leads?

A

V2, V3, V4

31
Q

What are the chest leads?

A

V1 - V6

32
Q

What are the limb leads?

A

aVL, aVR, aVF, II, III

33
Q

Describe the order of conduction?

A

SAN -> AVN -> Bundle of His -> R and L Bundle Branches

Left Bundle Branch -> Anterior and Posterior Fascicles

34
Q

What are Einthoven’s labelling rules for the QRS?

A
  • First positive is an R
  • Any negative preceding an R is a Q
  • Negative following an R is an S
  • Any further positive following an S is called R1 (R prime)
35
Q

What are the characteristics of right bundle branch block?

A
  • M pattern in V1 to V3
    • Rabbit ears
  • W pattern in V6
36
Q

State 2 signs of myocardial ischaemia?

A
  • ST depression
  • T wave inversion
37
Q

Comment on the ECG

A

NORMAL

38
Q

Comment on the ECG

A

ST DEPRESSION

39
Q

Comment on the ECG

A

T WAVE DEPRESSION

40
Q

What do you use to determine if there is left ventricular hypertrophy (LVH)?

A

Sokolow-Lyon criteria

41
Q

What is sokolow-lyon criteria?

A

Sum of the height of the R wave in leads V5 or V6 plus the depth o the S wave in lead V1

> 35 mm = LVH

42
Q

What signs on the ECG would suggest Right Ventricular Hypertrophy?

A
  • R wave in V1 greater than 7mm
  • Right axis deviation
    • S waves in V5-V6
43
Q

What are the different types of Acute Coronary Syndrome?

A
  • Unstable angina
  • Non-ST segment elevation MI
  • ST segment elevation MI
44
Q

What would be the signs on an ECG of NSTEMI?

A
  • No ST elevation
  • Troponin elevated
45
Q

What does Troponin < 14 ng/L signify?

A
  • Troponin negative
  • Unstable angina
46
Q

What does a troponin between 14 and 99 ng/L suggest?

A

Myocardial infarction

47
Q

What does a troponin greater than 99 ng/L suggest?

A

Myocardial infarction

48
Q

What are the inferior leads?

A

II, III, aVF

49
Q

What are the lateral leads?

A

V5-V6, I and aVL

50
Q

What are the anterior leads?

A

V2-V5

51
Q

What are the signs on an ECG that may suggest a PE?

A

S1 Q3 T3 pattern

Inverted Ts V1-V4

52
Q

What are the ECG signs of hyperkalaemia?

A
  • Tall T waves
  • Prolonged PR
  • Widened QRS
  • Arrhythmias
53
Q

What are the signs of hypokalaemia?

A
  • Flattened T wave
  • Depressed ST
  • Tall U waves
  • Prolonged QT
  • Arrythmias
54
Q

What is the normal height/amplitude of a T wave?

A

1/3 to 2/3 of the corresponding R wave

55
Q

How does hypercalcaemia show on an ECG?

A

Short QT interval

56
Q

How does hypocalcaemia show on an ECG?

A
  • Long QT interval
  • Small T waves
57
Q

What does DIGOXIN do to a patients ECG?

A
  • Shortened QT interval
  • Characteristic down-sloping ST depression
    • “Reverse tick”
  • Arrythmias
58
Q

First degree heart block?

A

Delayed PR interval

59
Q

2nd-degree heart block Mobitz type 1 (wenckenbachs)?

A

Signals are delayed more and more until the heart skips a beat then resets

60
Q

2nd degree heart block Mobitz type 2?

A

Some electrical signals don’t reach the ventricles

61
Q

Third-degree heart block?

A

No electrical signals reach the ventricles

62
Q

Where do you find the apex beat?

A
  • Left 5th ICS
  • Mid-clavicular line
63
Q

What is a thrill?

What does it indicate?

A
  • Palpable vibration caused by turbulent blood flow
    • Aortic stenosis
64
Q

What is a heave?

What does it indicate?

A

Vibration felt on the heel of the hand

  • Caused by left atrial hypertrophy
    • mitral stenosis
    • mitral regurgitation
65
Q

What can the tricuspid valve be auscultated?

A
  • Left 4th ICS
  • Sternal edge
66
Q

What can the pulmonary valve be auscultated?

A
  • 2nd left ICS
  • Lateral to sternum
67
Q

What can the aortic valve be auscultated?

A
  • Right 2nd ICS
  • Lateral to sternum
68
Q

What are the shockable rhythms?

A
  • Ventricular fibrillation
  • Pulseless ventricular tachycardia
69
Q

What drugs should you administer intermittently for shockable rhythms?

A
  • Adrenaline 1mg IV
  • Amiodarone 300mg IV
70
Q

What should the minimum power be for a first shock?

A

150J

71
Q

What are the non-shockable rhythms?

A
  • Pulseless electrical activity (PEA)
  • Asystole
72
Q

What drug should you administer intermittently for non-shockable rhythms?

A

Adrenaline 1mg IV

MBChB OSCE (14 decks)

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