ECG Flashcards
U have no Pot no T just a long PR & QT
mnemonic for?
Hypokalemia (no pot)
U waves
absent T waves
Prolonged PR & QT
Jesus Quist it’s Bloody Freezing
mnemonic for?
Hypothermia J waves prolonged QT Bradycardia First degree heart block
ECG: digoxin
long QT interval
false
short
ECG: digoxin
raised T waves
false
flattened or inverted
ECG: digoxin ST wave features?
down-sloping ST depression (‘reverse tick’, ‘scooped out’)
ECG: digoxin arrhythmias?
AV block, bradycardia
ECG: hyperkalaemia Peaked or ‘tall-tented’ T waves occurs first
true
ECG: hyperkalaemia which waves absent?
P waves
ECG: hyperkalaemia narrow/broad QRS
broad
ECG: hyperkalaemia can lead to VF
true
ECG: hyperkalaemia characteristic wave pattern
sinusoidal
WiLLiaM MaRRoW looks at changes in which leads
V1 & V6
in LBBB there is a ‘?’ in V1 and a ‘?’ in V6
in LBBB there is a ‘W’ in V1 and a ‘M’ in V6
in RBBB there is a ‘?’ in V1 and a ‘?’ in V6
in RBBB there is a ‘M’ in V1 and a ‘W’ in V6
Bifascicular block features RBBB/LBBB
RBBB
Bifascicular block features RBBB alongside right/left hemiblock
left anterior or posterior hemiblock
e.g. RBBB with left axis deviation
Trifascicular block includes
features of bifascicular and
1st-degree heart block
Posterior STEMI features which ECG changes
Tall R waves V1-2
STEMI areas and coronary artery affected
Anteroseptal V1-V4 Left anterior descending
Inferior II, III, aVF Right coronary
Anterolateral V4-6, I, aVL Left anterior descending or left circumflex
Lateral I, aVL +/- V5-6 Left circumflex
Posterior Tall R waves V1-2 Usually left circumflex, also right coronary
LBBB/RBBB may point towards a diagnosis of acute coronary syndrome.
LBBB
Acute myocardial infarction (MI) T wave changes in first few minutes are T waves typically become inverted
false
hyperacute T waves are often the first sign of MI but often only persists for a few minutes
Acute myocardial infarction (MI) T wave changes in first 24 hours
T waves typically become inverted within the first 24 hours
Acute myocardial infarction (MI) inversion of the T waves can last for 48 hours
false
days to months
Acute myocardial infarction (MI) pathological Q waves develop after several hours to days
true
Acute myocardial infarction (MI) pathological Q waves persists infinitely
true
clinical symptoms consistent with ACS (generally of ≥ 20 minutes duration) with persistent (> 20 minutes) ECG features in ≥ 2 contiguous leads
true
A posterior MI causes ST depression not elevation on a 12-lead ECG.
true
ECG features STEMI
in men under 40 years
2.5 mm (i.e ≥ 2.5 small squares) ST elevation in leads V2-3
ECG features STEMI
in men over 40 years
≥ 2.0 mm (i.e ≥ 2 small squares) ST elevation in leads V2-3
ECG features STEMI in women
1.5 mm ST elevation
new LBBB/RBBB is ECG feature of STEMI
new LBBB
ECG features STEMI 1 mm ST elevation in other leads (not V2/V3)
true
Causes of RBBB
right ventricular hypertrophy chronically increased right ventricular pressure - e.g. cor pulmonale pulmonary embolism myocardial infarction atrial septal defect (ostium secundum) cardiomyopathy or myocarditis
RBBB is a normal variant - more common with increasing age
True
Causes peaked T waves includes hyperkalaemia & myocardial ischaemia
True
Inverted T waves causes
myocardial ischaemia
digoxin toxicity
subarachnoid haemorrhage
arrhythmogenic right ventricular cardiomyopathy
pulmonary embolism ('S1Q3T3')
Brugada syndromeIncreased P wave amplitude is a feature of
cor pulmonale
Broad, notched (bifid) P waves a sign of left atrial enlargement, classically due to
mitral stenosis
often most pronounced in lead II
In atrial fibrillation, there is an absence of P waves.
true
Causes of ST depression
secondary to abnormal QRS (LVH, LBBB, RBBB) ischaemia digoxin hypokalaemia syndrome X
A prolonged PR interval may also be seen in athletes
true
Causes of a prolonged PR interval
idiopathic ischaemic heart disease digoxin toxicity hypokalaemia* rheumatic fever aortic root pathology e.g. abscess secondary to endocarditis Lyme disease sarcoidosis myotonic dystrophy
A prolonged PR interval may also be seen in WPW
false
short PR
Causes of left axis deviation (LAD)
left anterior hemiblock
left bundle branch block
inferior myocardial infarction
Wolff-Parkinson-White syndrome* - right-sided accessory pathway
hyperkalaemia
congenital: ostium primum ASD, tricuspid atresia
minor LAD in obese people
Causes of right axis deviation (RAD)
right ventricular hypertrophy left posterior hemiblock lateral myocardial infarction chronic lung disease → cor pulmonale pulmonary embolism ostium secundum ASD Wolff-Parkinson-White syndrome* - left-sided accessory pathway normal in infant < 1 years old minor RAD in tall people
The following ECG changes are considered normal variants in an athlete
sinus bradycardia
junctional rhythm
first degree heart block
Wenckebach phenomenon
Causes of ST elevation include
myocardial infarction pericarditis/myocarditis normal variant - 'high take-off' left ventricular aneurysm Prinzmetal's angina (coronary artery spasm) Takotsubo cardiomyopathy
ECG changes WPW
short PR interval
wide QRS complexes with a slurred upstroke - ‘delta wave’
left axis deviation if right-sided accessory pathway*
right axis deviation if left-sided accessory pathway*
