Ecg Flashcards
Absent P waves
Normally 2&1/2 small sq
Junctional rhythm
Dyselectrolytemia- Hyper K
Arrhythmia - Afib and PSVT
Tall P waves
P Pulmonale
RAH
TS, TR, RVH, cor pulmonale (PAH)
Wide P waves
P mitrale
LAH
MS, MR, LVF, systemic HTN
Prolonged PR interval
Normally 2&1/2 small sq
AVN block Drugs - digoxin, verapamil and diltiazem, BB Hyper or Hypo K+ AVN inflammatory edema - ARF AVN infiltration- amyloidosis AVN calcification
Short PR interval
Accessory pathways
- James pathway
- Bundle of Kent
Lawn ganong Levine syndrome
James pathway activates BOH so both ventricles contract simultaneously
ECG - short PR interval and normal QRS
WPW
Bundle of Kent directly excites LV and causes it to contract before RV
ECG - PR shortening + Wide QRS 💀 + Delta wave
QRS pathologies
2&1/2 small sq
Wide
Morphology
Axis
Wide QRS
Both ventricles aren’t contracting simultaneously AVN# 1. Idioventricular rhythm 2. LBBB RBBB 3. WPW 4. Inf wall MI 5. HKMALT High K Hyper Mg Adrenal insufficiency Low thyroid
Morphology of QRS
- RVH
- LVH
- RBBB
- LBBB
QRS in RVH
H/o PS, PAH
V1
R wave > 1 large box
QRS in LVH
H/o systemic HTN, AS
V5/6
R wave > 25mm
Or
V5/6 R wave ➕ V1 S wave > 35mm
RBBB QRS
H/o RV strain - PE
Rabbit ear pattern
rSr’ pattern
LBBB QRS
LV wall MI
rR’ pattern (M pattern)
QRS axis probs
LAD (I and III away each other)
RAD (I and III towards each other)
Extreme axis (dextrocardia)
Arrhythmias
Brady
Sinus
AV block
Tachy
Supra vent (above BOH)
Ventricular (below)
Sinus Brady
HR<60
Each P followed by QRS
Sinus arrest
No P wave
Junctional rhythm
Normal QRS
HR 40-60
Symptomatic = Sick sinus syndrome
Rx artificial pacemaker
AV blocks types
Primary
Secondary
Tertiary
Primary AV block
PR prolonged + each O followed by QRS
(Slow cond from atria to vent but ALL impulses conducted)
Rx underlying cause
Secondary AV block
2 types
Mobitz 1
Mobitz 2
Intermittent failure of atria to conduct to ventricle
Each P NOT followed by QRS
Mobitz 1
Progressive PR prolonging till one P not followed by QRS
⬇️
Wenkebach phenomenon
Rx digoxin (NO PACEMAKER NEEDED)
Mobitz 2
Fixed PR interval (normal or prolonged) with alternate Absent QRS
P:QRS = 2:1
Atrial rate = 80
Vent rate = 40
Rx AVN ischemia give PACEMAKER +
Tertiary AV block
Complete failure of atrioventricular cond
Idioventicular rhythm starts
Wide QRS + QRS independent of P
HR = 40
Rx pacemaker
Tachyarrythmias
SAN 1
Atria 3
AVN 1
SAN origin
Sinus tachycardia
Increase SAN automaticity
HR>100
Each P followed by QRS
Rx thyrotoxicosis, fever
Atrial origin tachy
Atrial tachycardia
Atrial flutter
Atrial fibrillation
Atrial tachycardia
> 3 ectopics Away from SAN at HR = 100-250
Atrial rate = vent rate Each P (abnormal and negative) followed by QRS If P has different morphology - multifical atrial tachycardia
Rx COPD hypoxia
Atrial flutter
Sync depolarisation at 250-350 due to RE ENTRY in RA
Ratio 2:1 fixed
Vent rate < atrial rate
SAW TOOTH P waves and each P not followed by QRS
Rx Atrial flutter stable
Control vent rate BB
Definitive Rx - RFA
Rx Atrial flutter unstable
DC shock
Stop all pathways and re start only SAN
Atrial fibrillation
Async atrial rate > 350
Due to stretching of atria in LAE
small amp p fibrillations and absent P with AV block
Irregularly irregular
Atrial fibrillation Rx stable
Control rate BB
Convert AF into sinus “Cardioversion”
Doc - ibutilide
DC shock
Maintenance doc - Amiodarone
Do TEE to rule out thrombus before DC
Unstable atrial fibrillation
DC shock
PSVT
AV re entry
Absent P wave and HR >100 regular
Rx stable
Carotid massage
Doc IV adenosine
Unstable DC shock
VTachy
> 3 vent ectopics at 100-250 and Endo to epi rule broken
Absent P wave + Wide QRS + T opp to QRS
Variant of VT with different QRS morphology
Polymorphic VT
Torsades de pontes
V flutter
Sync vent depolarisation at >250
Wide QRS and p waves
Rx DC shock
Doc - iv amiodarone > ligno
V fibrillation
Asynchronous vent depolarisation
No definitive QRS
Rx DC shock
Doc - iv amiodarone > ligno
Sustained VT
> 30 sec always unstable
Rx DC shock
Doc - iv amiodarone > ligno
Non sustained VT
<30 sec
Oral amiodarone prophylaxis
