ECG Flashcards

1
Q

What is an ECG

A

Monitors electrical activity of the heart by recording potential changes on the body surface via electrodes that is simple and non-invasive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do the potentials at the body surface arise

A

From currents that flow when the membrane potential of only large masses of myocardial tissue changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What information does an ECG provide and what diseases does it detect (5)

A
Cardiac rate
Cardiac rhythm
Chamber size
The electrical axis of the heart
Main test to assess myocardial ischaemia and infarction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Electrical activity within and between myocytes causes (2)

A

Current flow within the heart and surrounding tissues

Potential differences between distant sites on the body surface that is recorded by the electrocardiograph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Physics of the ECG (3)

A

The AP propagating in sequence through the conducting system and heart muscle causes separation of charge
Charges that are separated constitute an electrical dipole which is a vector
The net dipole during contraction moves from negative to positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why is the electrical vector vital clinically

A

It has a magnitude and direction that allows the electrical axis of the heart to be estimated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Magnitude is determined by

A

The mass of cardiac muscle that generates the signal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Direction is determined by

A

The overall activity of the heart at any instant in time during the cardiac cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

An ECG lead is the (2)

A

Imaginary line - The lead axis between 2 or more electrodes

It is NOT the wire that connects the electrode to the electrocardiograph

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Measured potential is the greatest when

A

The lead axis is parallel to the direction of the dipole and zero when they are perpendicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In a lead one electrode acts as a _________ while the other is the _________

A

Reference electrode

Recording (positive) electrode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When depolarization moves towards the recording electrode what deflection is produced

A

An upward deflection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When depolarization moves away the recording electrode what deflection is produced

A

A downward deflection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The 12 lead ECG comprises

A

3 standard limb leads (I,II and III) - These are bipolar and vertical (or coronal)
3 augmented voltage leads (aVR - right), (aVL - left) and (aVF - foot) - These are unipolar and vertical (or coronal)
6 chest leads (V1 - V6) - These are percordial and transverse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Standard Limb Lead placements and terminals (3)

A

Lead I : Right Arm negative to Left Arm positive
Lead II : Right Arm negative to Left Leg positive
Lead III : Left Arm negative to Left Leg positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

P wave (3)

A

Duration shows atrial depolarization to be complete
Depolarization moves towards recording electrode in lead II producing an upward direction
Duration is 80 to 100 ms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

QRS complex (4)

A

Represents ventricular depolarization
Has a duration of 100 ms or less
A downward (negative) deflection preceding an R wave is called a Q wave
A deflection upwards (positive) irrespective of the Q wave is called an R wave
A downward (negative) deflection following an R wave is called an S wave

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

QRS complex vectors (3)

A

Q wave is down-right
R is down-left
S is up-right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

T wave (2)

A

Represents ventricular repolarization

Its an upwards (positive) deflection due to wave of repolarization spreading away from recording electrode

20
Q

PR interval (3)

A

Reflects the time for the SAN impulse to reach the ventricles
Duration is 120 - 200 ms
It is influenced by the delay of conduction through the AVN

21
Q

ST segment (2)

A

Point of ventricular systole

Normally isoelectric

22
Q

QT interval (3)

A

Reflects the time for ventricular depolarization and repolarization
Duration is 440 ms in males and 460 ms in females
Prolongation predisposes to disturbances of cardiac rhythm

23
Q

Augmented Limb Lead Placements and terminals (3)

A

aVR is Right Arm (+) to Left Arm and Left Foot (-)
aVL is Left Arm (+) to Right Arm and Left Foot (-)
aVF is Left Foot (+) to Right Arm and Left Arm (-)

24
Q

Limb Lead Records (2)

A

Leads I and aVL are lateral leads – each has the recording electrode on the left arm and views the heart from the left
Leads II, III and aVF are inferior leads – each has the recording electrode on the left foot and views the heart from an inferior direction

25
Chest (Precordial) Leads placements (6)
V1 – 4th intercostal Right hand side V2 – 4th intercostal left hand side V3 - halfway between lead 3 and 4 on the rib and between them V4 – 5th intercostal space mid clavicular line V5 – 5 intercostal space anterior axillary line V6 –5th intercostal mid axillary line.
26
Chest Lead Records (6)
V1 and V2 coming from the right are looking at the interventricular septum V3 and V4 are looking at the anterior of the heart V5 and V6 are looking at the lateral aspect (left ventricle) of the heart The first positive deflection in the QRS complex in V1 is an R wave The negative deflection following immediately is the S wave The R wave progressively increases while the S wave decreases from V1 to V6
27
TP segment
Point of ventricular diastole
28
Calibration of ECG trace (3)
Paper speed is 25mm/sec Reference pulse is 10mm/1mV One large box represents 200ms of time and 5mm
29
Heart rate calculations via ECG trace (2)
= 300/number of large squares between beats (for regular rhythm) = 300/number of large squares between R-R interval
30
What is the ECG Rhythm Strip (2)
Prolonged recording of one lead - Normally lead 2 | Allows to determine heart rate and identify cardiac rhythm
31
The importance of 12 leads (3)
The 12 leads look at the heart at different directions to: Determine the heart axis Look for ST segment or T wave changes - Crucial in diagnosing Ischaemic Heart Disease Look for any voltage criteria changes - Crucial in diagnosing chamber hypertrophy
32
Practical approach to ECG analyzing (6)
Verify patient details: name and date of birth Check date and time ECG was taken Check the calibration of the ECG paper Determine the axis Workout the rate and rhythm via the rhythm strip Look at individual leads for voltage criteria changes OR any ST or T-wave changes
33
7 questions to ask when working out the rate and rhythm
``` Is electrical activity present? Is the rhythm regular or irregular? What is the heart rate? P-waves present? What is the PR interval? Is each P-Wave followed by a QRS complex? Is the QRS duration normal? ```
34
What significant heart diseases does a normal resting ECG not exclude (3)
Myocardial Infarction Intermittent Rhythm Disturbance Stable Angina
35
How to find the HR if it is irregular
Count the number of QRS complexes in 30 large squares and multiply by 10
36
High QRS complex with chest pain indicates
Left ventricular hypertrophy
37
What leads determine axis deviation
1 and aVF
38
AF identification
P waves are not present in between QRS complexes
39
If AVF is down
Axis is deviated to the left
40
M shape in QRS complex in V1 and W in V6 indicates
Right Branch Bundle Block
41
Ventricular tachycardia shows
Broad QRS complex
42
W shape in V1 and M in V6 of QRS complex indicates
Left Branch Bundle Block
43
Someone with LBBB and symptoms of MI indicates
Non STEMI
44
Hyperkalaemia patterns (4)
Tall tented T waves Small P waves Wide QRS Long PR interval
45
Hypokalaemia patterns (5)
``` Prolonged PR interval U waves Small/absent T waves ST depression Long QT ```
46
U waves characteristics (3)
Small (0.5 mm) deflection immediately following T wave Usually in same direction as T wave Seen in leads V2 and V3