ECG Abnormalities Flashcards by Costanza Coronelli

Sinus Tachycardia

> 100bpm

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Sinus Tachycardia causes

Infection
Pain
Exercise
Anxiety
Dehydration
Bleed
Systemic vasodilation (e.g. sepsis)
Drugs (caffeine, nicotine, salbutamol)
Anaemia
Fever
PE
Hyperthyroidism
Pregnancy
CO2 retention
Autonomic neuropathy
Sympathomimetics

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Sinus Bradycardia

Sinus rhythm <60bpm

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Sinus Bradycardia Causes

Physical fitness
Vasovagal attacks
Sick sinus syndrome
Drugs (beta blockers, digoxin, amiodarone)
Hypothyroidism
Hypothermia
Increased ICP
Cholestasis

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Absent P waves and irregular QRS complexes

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AF causes

IHD
Thyrotoxicosis
Hypertension
Obesity
CCF
Alcohol

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Heart block definition

Disrupted passage of electrical impulse through AV node

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1st degree HB

PR interval is prolonged and unchanging/regular

No missed beats

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2nd degree HB Mobitz I

Wenckebach
PR interval becomes longer and longer until a QRS is missed, then the pattern resets
Regular Irregular

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2nd degree HB Mobitz II

QRSs regularly missed e.g. P-QRS-P-QRS-P

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Causes of 1st and 2nd degree HB

Normal variant
Athletes
Sick sinus syndrome
IHD (especially inferior MI)
Acute myocarditis
Drugs (digoxin, beta-blockers)

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3rd degree HB

Complete HB
No impulses passed from atria to ventricles
P waves and QRS complexes appear independently from each other
Patient becomes very bradycardic, may lead to haemodynamic compromise
Urgent treatment required

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3rd degree HB causes

IHD (esp. inferior MI)
Idiopathic (fibrosis)
Congenital
Aortic valve calcification
Cardiac surgery/trauma
Digoxin toxicity
Infiltration (abscesses, granulomas, tumours, parasites

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ST elevation

Normal variant (high take-off)
STEMI
Prinzmetal's angina- coronary artery spasm; pain without exertion triggered by hyperventilation, cocaine, tobacco
Acute pericarditis (saddle-shaped)
Left ventricular aneurysm

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ST Depression

Normal variant (upward sloping)
Digoxin toxicity (downward sloping)
Ischaemia (horizontal)
Angina 
NSTEMI
Acute posterior MI (in V1-V3)

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T inversion in V1-3

Normal (black patients and children)
RBBB
RV strain 9e.g. secondary to PE)

T inversion in V2-5

Anterior ischaemia
Hypertrophic cardiomyopathy
Subarachnoid haemorrhage
Lithium

T inversion in V4-6 and aVL

Lateral ischaemia
Left ventricular hypertrophy (LVH)
LBBB

T inversion in II, III and aVF

Inferior ischaemia

NSTEMI/unstable angina

ST depression
T wave inversion
non-specific changes, or normal

Ischaemia- changes in I, aVL, V4-6

Lateral heart

Circumflex artery

Ischaemia- changes in V1-3

Anterioseptal

LAD

Ischaemia- II, III, aVF

Inferior heart
RCA in 80%
Circumflex in 20%- left dominant

Posterior MI

Standard 12 lead ECG will not show Q waves, St elevation of hyperacute T waves
Instead you may find these changes but “upside down” in V1-3- Prominent R waves, flat ST depression, T wave inversion
If record V7-9 leads you may fins classic ST elevation –> posterior MI

Pulmonary embolism

Sinus tachycardia (commonest) RBBB Right ventricular strain pattern- RAD, dominant R wave, T wave inversion/ST depression in V1-2 Rarely- deep S waves in I, pathological Q waves in III and T wave inversion in III

Digoxin effect

Down sloping ST depression T wave inversion V5-6 Any arrhythmia may occur

Hyperkalaemia

Tall tented T waves Widened QRS Absent/flattened P waves Sine-wave appearance

Hypokalaemia

Small T waves Prominent U waves Peaked P waves

Hypercalcaemia

Short QT interval

Hypocalcaemia

Long QT interval

Right bundle branch block

QRS>0.12s V1: 'RSR' pattern, dominant R V1-V3 or V4: T wave inversion V6: wide, slurred S wave

Right BBB causes

Normal variant (isolated RBBB) PE Cor pulmonale

Left BBB

QRS >0.12s V5: 'M' pattern V1: dominant S I, aVL, V5-6: T wave inversion

Left BBB causes

IHD Hypertension Cardiomyopathy Idiopathic fibrosis

Bifascicular block

LBBB + RBBB | Manifests itself as an axis deviation

Trifascicular block

Bifascicular block + 1st degree HB

Left ventricular hypertrophy

R wave in V6 >25mm OR sum of S wave in V1 + R wave in V6>35mm

Right ventricular hypertrophy

Dominant R wave in V1 T wave inversion in V1-3 or V4 Deep S wave in V6 RAD

Causes of low voltage QRS complex (QRS <5mm in all limb leads)

``` Hypothyroidism COPD Changes in chest wall impedance PE BBB Carcinoid heart disease Myocarditis + other heart muscle diseases Cardiac amyloid Doxorubicin cardiotoxicity Pericardial effusion Pericarditis ```