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ECG > ECG abnormalities > Flashcards

ECG abnormalities Flashcards

1
Q

What are the ECG features of RVH?

A 
Diagnostic features:
- RAD of >109
- dominant R wave in V1 (>7mm or R/S ratio >1)
-dominant S wave in V5 or V6
-QRS < 120ms
Supporting criteria
-RAE - p pulmonale
-RV strain ST dep/TWI V1-4, II, III, aVF
- S1Q3T3 patter
- Deep S waves in lateral leads (I, aVL, V5-6)
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2
Q

What are the causes of RVH?

A 
Pulmonary hypertension
Mitral stenosis
PE
Cor pulmonale
Congenital heart disease e.g. TOF, pulm stenosis, Arrythmogenic RV cardiomyopathy
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3
Q

What are the ECG features of LVH?

A

Most common diagnostic criteria is the Sokolov-Lyon criteria
- S wave depth V1 and tallerst R wave height V5 or v^ > 35mm
Voltage criteria must be accompanied by non-voltage criteria to be considered LVH
- Increased R wave peak time in V5 or V6
- ST segment depression and TWI in left sided leads
- May also be LAE, LAD

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4
Q

What is LVH?

A

Hypertrophy of LV in response to pressure overlaod secondary to conditions such as AS and HTN
The thickened LV walls lead to prolonged depolarisation and prolonged repolarisation in the lateral leads

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5
Q

What are the causes of LVH?

A 
HTN
AS
AR
MR
Coarctation of the aorta
Hypertrophic cardiomyopathy
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6
Q

What is RBBB and its ECG features?

A

Activation of the RV is delayed as depolarisation has to spread across the septum from the LV
ECG - Broad QRS
RSR’ pattern in V1-3
Wide slurred S wave in the lateral leads (I, aVL, V5-6)
ST depression and TWI V1-3
Normal axis

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7
Q

What are the causes of RBBB?

A 
RVH
PE
IHD
Myocarditis
Primary degenerative disease of the conducting system
Congenital heart disease (e.g. ASD)
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8
Q

What is LBBB and its ECG features?

A

In LBBB the noral septal depolarisation is reversed (becomes right -to -left) as the impulse spreads 1st to the RV and then the LV
ECG:
- QRS > 120ms
- dominant S wave in V1
- broad monophasic R wave in lateral leads (I, aVL, V5-6)
- prolonged peak R wave in V5-6
-ST segs and T waves are discordant with the QRS vector
- poor R wave progression in chest leads
-LAD

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9
Q

Describe QRS morphology in LBBB

A

maybe rS or QS in V1

R wave may be M shaped or notched

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10
Q

What are the causes of LBBB?

A 
Aortic stenosis
IHD
HTN
Dilated cardiomyopathy
Anterior MI
Primary degenerative disease of the conducting system
Hyperkalaemia
Digoxin toxicity
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11
Q

What is trifascicular block?

A

Conducting disease in RBB, LAF and LPF

Can be incomplete or complete

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12
Q

What are the ECG features of incomplete trifascicular block?

A

Fixed block of 2 fascicles (i.e bifascicular block) with delayed conduction in the remaining (1st or 2nd AV block)

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13
Q

What are the ECG features of trifascicular block?

A

3rd degree AV block with features of bifascicular block

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14
Q

What are the causes of trifascicular block?

A 
IHD
HTN
AS
Anterior MI
Primary degenerative disease of the conducting system
Congenital heart disease
Hyperkalaemia
Digoxin toxicity
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15
Q

What is left posterior fascicle block and what are the ECG features?

A

Impulses are conducted to the LV via the left anterior fascicle which inserts into the upper, lateral wall of the LV along its endocardial surface
ECG - small R waves and deep S waves (rS) in I and aVL
Small Q waves and tall R waves in II, III and aVF
QRS normal duration or slightly prolonged
Prolonged R wave peak in aVF
Increased QRS voltage in limb leads
No evidence of RVH
Rarely occurs in isolation - more likely to be found in the context of bifascicular block

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16
Q

Describe the cardiac conducting system

A

AVN
Bundle of His
Splits into RBB and LBB
LBB divides into LAF and LPF

17
Q

What is left anterior fascicular block (left ant hemiblock) and what are the ECG criteria?

A

Impulses are conducted to the LV via the left posterior fascicle which inserts into the infero-septal wall of the LV
LAD
Small Q waves with tall R waves (qR) in I and aVL
Small R and deep S waves (rS) in II, III, aVF
QRS normal duration or slightly prolonged
Prolonged R wave peak time in aVL
Increased QRS voltage in the limb leads

18
Q

What is bifascicular block?

A

Combination of RBBB with either LAFB or LPFB
Conduction to the ventricles via the single remaining fascicle
ECG shows RBBB and LAD or RAD
RBBB and LAFB is more common

19
Q

What causes bifascicular block?

A 
IHD
HTN
Aortic stenosis
Anterior MI
Primary degenerative disease of the conducting system
Congenital heart disease
Hyperkalaemia
20
Q

What is Brugada syndrome?

A

An ECG abnormality with a high incidence of sudden death in patients with a structurally normal heart
Diagnosis depends on characteristic ECG plus clinical criteria
Due to a defect in the cardiac sodium channel gene (sodium channelopathy)
ECG changes can be transient and unmasked by fever, ischaemia, drugs e.g. B-blockers, cocaine, ETOH, decreased temp, hypokalaemia
Type 1 - coved ST elevation > 2 mm in > 1 of V1-3 followed by a negative T wave
ECG must be associated with documented VT, fmhx of sudden cardiac death < 45, coved-type ECGs in family members, inducible VT, syncope or nocturnal agonal respiration

21
Q

What are the causes of LAD?

A 
LVH
LBBB
Inferior MI
Ventricaular pacing
WPW
Left ant fascicular block
horizontal heart - short, squat person
22
Q

What are the causes of extreme axis deviation?

A

ventricular rhythms e.g. VT
hyperkalaemia
Severe RVH

23
Q

What are the causes of RAD?

A 
RVH
Acute RV strain e.g. PE
Lateral STEMI
Chronic lung disease e.g. COPD
Hyperkalaemia
Sodium channel blockade e.g. TCA poisoning
WPW
Dextrocardia
Normal paediatric ECG
Left post fascicular block
Vertically orientated heart - tall, thin pt
24
Q

What is atrial tachycardia?

A

It’s a form of SVT, originating in the atria but outside the sinus node
Both a.flutter and multifocal AT are specific types
Usually due to a single ectopic focus
The underlying mechanism can involve re-entry, triggered activity or increased automaticity

25
Q

What are the ECG features of atrial tachycardia?

A 
paroxysmal or sustained
atrial rate > 100
P wave abnormal
At least 3 consec identical ectopic p waves
isoelectric baseline
p waves inverted in II, III, aVF

ECG (2 decks)

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