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ECG Flashcards

1
Q

What can identify with ECG?

A
  1. Arrythmia
  2. MI/infarction
  3. Pericarditis
  4. Chamber hypertrophy
  5. Electrolyte disturbance
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2
Q

Pacemakers of the heart and rate?

A
  1. SAN = 60-100bpm
  2. AVN = 40-60bpm
  3. Ventricular cells = 20-45bpm
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3
Q

What are the trace parameters for ECG?

A

25mm/sec

10mm/mV

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4
Q

PR interval length

A

120-200ms

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5
Q

QRS complex width

A

<110ms

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6
Q

QRS should be upright in

A

Lead I,II

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7
Q

All waves are negative in

A

aVR

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8
Q

R wave and S wave grows in which leads?

A
  1. R = V1–>V4

2. S = V1–>V3

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9
Q

ST segment should be isoelectric except

A

Leads V1, V2 may be elevated

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10
Q

P and T waves should be upright in?

A

Lead I,II, V2-V6

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11
Q

Two ways to calculate rate in ECG?

A
  1. 60/ (RR interval /25)

2. 300/number of QRS complexes in 10s

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12
Q

What are the causes of bradycardia?

A
  1. Conduction tissue fibrosis
  2. Ischaemia
  3. Inflammation/infiltrative disease
  4. Drugs
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13
Q

Tachycardia classification?

A
  1. Narrow complex tachycardia

2. Broad complex tachycardia

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14
Q

What is narrow complex tachycardia?

A
  1. Ventricular fibrillation
  2. Sinus tachycardia
  3. Supraventricular tachycardia
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15
Q

Broad complex tachycardia?

A

Ventricular tachycardia -

Sinus tachy/SVT/AF with aberrant conduction

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16
Q

What does P wave absent?

A

Ectopic pacemaker rhythm
Atrial flutter
Regular tachycardias

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17
Q

What does regularly irregular rhythm suggesy?

A
  1. Sinus arrhythmia
  2. 2nd degree heart block
  3. Regular ectopics
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18
Q

What could irregularly irregular be?

A
  1. AF

2. Irregular ectopics

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19
Q

What is AF?

A

Irregularly irregular tachycardia at 300-600bpm

Can be paroxysmal or persistent AF

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20
Q

What is parosxysmal AF?

A

Intermittent AF usually terminates within 7 days spontaneously

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21
Q

What is persistent AF?

A

Not self terminating

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22
Q

What is the RF for AF?

A
  1. HTN, HF
  2. CAD, MI
  3. Valvular Heart Disease
  4. Pneumonia, caffeine, alcohol, hyperthyroidism
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23
Q

AF on ECG?

A
  1. Absent P waves

2. Irregularly irregular QRS complex

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24
Q

AF on other tests?

A
  1. Bloods - cardiac enzymes, TFT,

2. Echo - atrial enlargement, mitral valve disease

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25
Effects of AF?
1. Atria respond electrically to randomly depolarising wavelets - no coordinated response, only proportion of impulses reach ventricles 2. Irregularly often rapid ventricular response
26
Clinical presentation of AF?
1. May be asymptomatic | 2. Palpitations, dyspnoea, fatigue, dizziness, angina, and decompensated heart failure
27
What is atrial flutter?
Organised atrial tachycardia ~300bpm
28
Causes of atrial flutter?
1. Idiopathic - 50% 2. CHD 3. HTN 4. Obesity, XS alcohol 5. HF, Pericarditis 6. COPD
29
Presentation of AF?
1. Asymptomatic/ chest pain 2. Palpitations, dizzy, fatigue 4. Syncope, dyspnoea
30
ECG of Atrial flutter
Sawtooth pattern with tracings of P waves on the ECG
31
What is normal QRS axis?
-30 and +90
32
Left axis deviation range
-30 - -90
33
Right axis deviation range
+90 - +180
34
Causes of left axis deviation
1. Left ventricular hypertrophy 2. Left bundle branch block 3. Left anterior fascicular block
35
Causes of right axis deviation?
1. Left posterior fascicular block | 2. Right heart hypertrophy/strain
36
Right atrial hypertrophy on ECG?
P pulmonale - tall pointed P waves, right atrial enlargent
37
Left atrial hypertrophy on ECG?
P mitrale: notched/bifid P wave in limb leads, left atrial enlargement
38
What does PR interval mean?
Atrial depolarisation + delay to AV junction
39
What does constant long PR interval suggest | ?
1st degree heart block
40
What does nonconstant long PR interval?
2nd degree heart block
41
What does short PR interval mean?
- often associated with a delta wave - accessory connection between atria and ventricles - Wolf - Parkinson White Syndrome = short PR + delta wave - accessory pathway - early activation of ventricles
42
What is 1st degree heart block
Slowed AV conduction - asymptomatic - longer PR > 0.22s
43
Causes of 1st degree heart block?
1. Hypokalaemia 2. Myocarditis 3. Inferior MI 4. AVN blocking drugs
44
What can 2nd degree heart block be divided to?
1. Mobitz Type 1 | 2. Mobitz Type II
45
What is Mobitz Type I heart block also known as?
Wenckebach's phenomenon
46
What is Mobitz Type I?
PR interval gets longer and longer until skipped beat - no QRS produced.
47
Causes of Mobitz Type I?
1. AVN blocking drugs | 2. Inferior MI
48
Clinical presentation of Mobitz Type I?
1. Light headedness 2. Dizzy 3. Syncope
49
What is Mobitz Type II aka?
2:1 block
50
What is Mobitz Type II on ECG?
1. Every other P wave fails to conduct
51
Causes of Mobitz Type II?
1. Anterior MI 2. Mitral valve surgery 3. SLE and lyme disease 4. Rheumatic fever
52
What is 3rd degree heart block?
No relationship between P waves and QRS QRS typically abroad: - ventricular spontaneous escape rhythm Usually bradycardic
53
LVH on ECG?
R in V5.6 >30mm | S in V1 > 30mm
54
Causes of 3rd degree heart block?
1. SHD 2. IHD 3. HTN 4. Endocarditis/lyme disease
55
Treatment of recent onset narrow complex AV block/ broad complex escape rhythm?
IV atropine
56
Causes of RBBB?
PE IHD ASD/VSD
57
Causes of LBBB?
IHD, | Aortic valve disease
58
ECG of RBBB?
Tall late R waves in V1 | Deep S wave in V6 and Lead I
59
ECG of LBBB
Deep S wave in V1 | Tall late R waves in V6, Lead I
60
Causes of prolonged QRS
1. Ventricular ectopic 2. Ventricular tachycardia 3. Complete heart block 4. Pre-excitation delta wave
61
Small QRS complexes seen in
1. Obese patients 2. Percardial effusion 3. Infiltrative cardiac disease
62
Tall QRS in
1. LVH | 2. Thin patients
63
What are pathological q waves?
Deeper > 2mm Broader > 1mm May represent full thickness infarction
64
What leads would show an inferior infarct and what artery do they represent
Lead II, III, aVF | Right coronary artery
65
What leads would show an anterior infarct and what artery do they represent
V2,3,4 | Left anterior descending artery
66
What leads would show an lateral infarct and what artery do they represent
V5,6, Lead II | Circumflex artery
67
Congenital abnormal QT?
Long QT syndrome | Short QT syndrome
68
Acquired abnormal QT?
1. Ischaemia 2. Metabolic disturbances 3. Drugs e.g. macrolide abx, anti-epileptics, anti-depressants, 1st generation anti-histamines
69
Equation for QT correction?
QTc = QT duration/ Squarroot(RR interval)
70
What suggests an abnormal T wave?
1. Symmetrical 2. Biphasic 3. Tall/peaked 4. Inverted
71
Causes of abnormal QTs?
1. Ischaemia/infarction 2. Myocardial strain (hypertrophy) 3. Myocardial disease (cardiomyopathy)q
72
Hyperkalaemia ECG?
Tall tented T waves Flattened P waves Broad QRS
73
Hypokalaemia on ECG?
Flat T waves, QT prolongation
74
Hypercalcaemia
QT shortening
75
What is Wolff Parkinson White Syndrome
Congenital remnant muscle strands between atrium and ventricles Early activation of ventricles result in delta wave before QRS on the ECG

Phase 2 Mine (12 decks)

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