ecg

Question 1

deep t wave inversion or biphasic t waves in V2-3

Answer 1

Wellen’s syndrome - refers to specific ECG changes that are consistent with critical stenosis of the proximal LAD a.

note that pt’s with Wellen’s syndrome might be pain free by the time ECG is taken

Question 2

Q waves in lead II, III, aVF

Answer 2

indicates previous inferior MI (caused by obstruction of the dominant right coronary artery in 80% of cases).

Question 3

Downsloping ST depression

Answer 3

indicates digoxin toxicity

Question 4

Peak T waves with PR prolongation

Answer 4

indicated hyperkalaemia

Question 5

Electrical alternans is suggestive of what?

Answer 5

cardiac tamponade

alternation of QRS complex amplitude between beats

Question 6

main ecg findingings for hypercalcaemia (e.g. secondary to malignancy)

Answer 6

shortening of QT interval. if not corrected ventricular arrhythmia’s may occur

Question 7

present on ECG with tall R waves V1-2

Answer 7

posterior MI. typical of a left coronory artery occlusion

Question 8

dextrocardia

Answer 8

associated with an inverted P wave in lead I, right axis deviation, and loss of R wave progression

Question 9

ecg suggesting cardiac tamponade

Answer 9

electrical alterans

Question 10

hypokalaemia

Answer 10

ST depression, flattened T waves and prominent U waves

(prolonged) QT syndrome - normal corrected QT interval is less than 430 ms in males and 450 ms in females.

Question 11

hyperkalaemia

Answer 11

small p wave
tall tented t wave
widened QRS
sinusoidal wave pattern

Question 12

3rd heart sound

Answer 12

can be normal in <30 y/o. due to compliance of LV - fast diastole filling. can also occur in HF so not usually normal is pt is >30
(e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation

Question 13

S4 heart sound

Answer 13

may be heard in aortic stenosis, HOCM, hypertension
caused by atrial contraction against a stiff ventricle
therefore coincides with the P wave on ECG
in HOCM a double apical impulse may be felt as a result of a palpable S4

Question 14

most commonly seen on ecg with PE

Answer 14

sinus tachycardia!! (tries to be trick Q)

Question 15

atrial flutter

Answer 15

sinus tachy with rate 150

Question 16

drug cause of torsades de pointes

Answer 16

macrolides
Antiarrhythmics (e.g. amiodarone, sotalol)
Antibiotics (e.g. erythromycin, clarithromycin, ciprofloxacin)
Psychotropic drugs (e.g. serotonin reuptake inhibitors, tricyclic antidepressants, neuroleptic agents)

Question 17

hypothermia

Answer 17

bradycardia
'J' wave - small hump at the end of the QRS complex
first degree heart block
long QT interval
atrial and ventricular arrhythmias

Question 18

u wave

Answer 18

indicated hypokalaemia

Question 19

sine wave appearance on ECG would be indicative of

Answer 19

hyperkalaemia