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ECG Flashcards

1
Q

Regular Rhythm definition

A

R-R interval same across tracing

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2
Q

Irregular rhythm definition

A

R-R interval varies across tracing

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3
Q

NSR definition

A

p wave before each QRS, QRS follows each P-wave, P-wave axis is normal (+ in 2/3 Leads I, II, AVF), rate is between 60 - 100

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4
Q

Normal Axis

A

-30 - 90 degrees (positive QRS in Lead I, II)

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5
Q

Left Axis Deviation

A

< -30

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6
Q

Right Axis Deviation

A

> 90 degrees

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7
Q

LBBB Complete definition

A

QRS > 120 msec, deep broad S wave in V1, v2, broad notched R wave in V4, V5 and usually I and aVL, secondary ST/T changes (+ST in V1-2, -ST in V4-5, I, AVL)

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8
Q

RBBB Definition

A

QRS > 120 msec, positive QRS in leads V1 (rSR, rsr), broad S wave in I, V5-6, T-wave inversion in V1-2,

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9
Q

Left Anterior Fascicular block

A

left axis deviation, small q and prominent R in leads I, AvL, small r and prominent S in leads II, III, aVF

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10
Q

Left Posterior fascicular block

A

Right axis deviation (110 - 180), small r and prominent S in leads I, aVL, small q and prominent R in leads II, III, aVF

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11
Q

Bifascicular block

A

RBBB + RAD/LAD

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12
Q

LVH DDx

A

left anterior hemiblock, inferior MI, WPW, RV pacing, elevated diaphragm, normal variant, endocardial cushion defect

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13
Q

RVH DDx

A

RVH, L posterior hemiblock, PE, COPD, lateral MI, WPW, dextrocardia, septal defects

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14
Q

LVH Definition

A

S in V1 + R in V5 or V6 is > 35 mm above age 40 (>50 mm for ages 31-40, > 45 mm for ages 21-30), R in aVL > 11 mm, R in I + S in III > 25 mm, LV strain pattern (asymetric ST depression and T wave inversion in leads I, AvL< V4-6

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15
Q

RVH definition

A

RAD, R/S Ratio > 1 or qR in lead V1, RV strain pattern (ST depression and T-wave inversion in leads V1-2)

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16
Q

Progression of ECG Changes in STEMI

A

Acute: (hours - days): ST elevation
Recent: (weeks - months) T wave inversion
Old: (months - years) persistent Q waves

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17
Q

LBBB DDx

A

anterior MI, aortic stenosis, HTN, dilated CM, primary degenerative disease, hyperkalemia, digoxin toxicity

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18
Q

DDx of T-wave inversion

A

normal pediatrics (v1-v3), persistent juvenile T-waves, myocardial ischemia/MI, LBBB, RBBB, LVH and RVH (strain pattern), PE, hypertrophic cardiomyopathy, raised ICP

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19
Q

RBBB DDx

A

RVH/cor pulmonale, PE, ischemic heart disease, rheumatic disease, myocarditis, cardiomyopathy, degenerative disease, congenitla disease (ASD)

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20
Q

Brugada syndrome definition

A

ECG finding + clinical criteria (documented VF or VTach, +FHx of SCD, syncope); MGMT: ICD

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21
Q

Brugada Pathogenesis

A

mutation in cardiac sodium channel gene (sodium channelopathy)

22
Q

RF that can unmask ECG Changes in Brugrada syndrome

A

fever, ischemia, drugs, hypokalemia, hyperkalemia, post DC conversion)

23
Q

Wellens Syndrome definition

A

deeply inverted or biphasic T waves in V2-3, highly specific for a critical stenosis of the LAD; high risk for extensive anterior wall MI within days-weeks

24
Q

Wolf Parkinson White ECG Findings

A

short PR (<120 msec), broad QRS (>100 ms), slurred upstroke to the QRS complex called delta wave

25
Q

J-point and TP Segment

A

first inflexion point after the QRS where you measure the ST elevation from the TP region: between the end of the T-wave and beginning of next P-wave

26
Q

STEMI Criteria for V8,V9 (posterior leads)

27
Q

Vascular supply for the heart (anterior, lateral, posterior)

A

Anterior: LAD, Lateral: circumflex, Posterior: usually RCA but 10% can be supplied by L circumflex

28
Q

Leads to vessels relationship

A

I, avL: high lateral leads; I, aVL, V5, V6: Left circumflex, V1-v4: LAD, lI, III, aVF, V4R V8, V9: RCA

29
Q

(3) Types of STEMI equivalents

A
  1. ST elevation in aVR with diffuse ST depressions; 2. Wellen’s; 3. DeWinter’s T-waves
30
Q

Reasons to get a 15 lead ECG

A

ST depressions in the anterior leads, ST elevations in inferior leads, hypotension NYD

31
Q

aVR ST Elevation (STEMI equivalent)

A

Due to left main occlusion, triple vessel disease (LMain, LAD, RCA requiring CABG), or severe diffuse ischemia (shock, hypoxemia, sepsis). Definition: widespread ST depression most prominent in leads I, II, V4-v6 (lateral leads), and ST elevation in aVR of 1+mm and ST elevation in aVR > V1

32
Q

Wellen’s Syndrome

A

T-wave inversions or biphasic T-waves in the anterior leads (V2-v3); sign of transient LAD stenosis; (2) Types - Type A is biphasic, Type B in deeply and symmetrically inverted; usually seen when CP resolves

33
Q

DeWinter’s T-Waves

A

anterior STEMI equivalent, due to LAD occlusion; ST depressions and peaked T waves

34
Q

Inferior STEMI additional MGMT

A

get 15 lead ECG, determine RV involvement (ST elevation III > II)

35
Q

Inferior-lateral STEMI

A

due to the L circumflex supplying the inferior wall

36
Q

Posterior MI definition

A

presents with ST depression and prominent R stroke in V1-V4; always get 15 lead ECG

37
Q

ECG changes with LVH

A

R waves are large in the lateral leads, S waves in R-sided leads, L heart strain (ST depressions and T-wave inversions in lateral leads)

38
Q

Signs of R Heart Strain

A

ST depressions and T-wave inversions in right precordial leads (V1-V3) and inferior leads

39
Q

Junctional tachycardia definition

A

rhythm from the AV node; narrow QRS, rate of 60 - 100, retrograde P -waves, inverted retrograde p-waves in the inferior leads and upright in leads aVR + V1

40
Q

DDx of junctional rhythms

A

digoxin toxicity, beta-agonists, MI, myocarditis, cardiac surgery

41
Q

ECG changes in hypokalemia

A

increased amplitude and width of P-wave, prolongation of PR interval, T-wave flattening and inversion, ST depression, apparent long QT due to fusion of T and U waves

42
Q

K+ to see ECG changes in hypokalemia

A

< 2.7 mmol/L

43
Q

MGMT of hypoklaemia

A

K > 4.0 and Mg to > 1.0 mmol/L

44
Q

4 Stages of pericarditis on ECG

A

Stage 1: STE and PR depression with reciprocal changes in aVR (first 2 weeks); Stage 2: normalisation of ST changes, generalized T wave flattening (1 - 3 weeks); Stage 3: T-wave inversions (3 - several weeks), Stage 4: ECG returns to normal

45
Q

Causes of pericarditis

A

idiopathic, autoimmune, infectious, uremia, dressler’s syndrome (post MI), trauma, post cardiac surgery, paraneoplastic syndromes, medications, post-radiation

46
Q

ECG changes in PE

A

sinus tachy, complete or incomplete RBBB, RV strain, RAD, dominant R wave in V1, R atrial enlargement, S1Q3T3 pattern, nonspecific ST and T changes, AF/flutter,

47
Q

DDX for RV strain

A

pulmonary HTN, mitral stenosis, PE, COPD, cor pu,onale, congenital heart disease, arrhythmogenic RV cardiomyopathy

48
Q

Signs of RV strain

A

R precordial leads (V1-3) and inferior leads (II, III AVF): STD and T-wave inversions

49
Q

Sgarbossa criteria purpose

A

help to identify acute MI with LBBB; concordant STE > 1 mm gets 5 points, discordant STE 5+ mm is 2 points, STD 1mm or more in v1-v3 gets 3 points; no longer in favour as points system, enzyme-diagnosed AMI based criteria, inadequate sensitivity and specificity

50
Q

Smith-modified Sgarbossa Criteria

A

concordant STE/STD, excessive discordant STE/S > 25% or STD/R > 30% to identify occlusion MI in patients with ischemic symptoms and LBBB

PGY1 (12 decks)

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