ECG analysis Flashcards

1
Q

How to calculate rate

A

If regular:
300/no. of large squares

If irregular:
no. of QRS complexes within 30 large squares x 10

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2
Q

Rythmn

A

Sinus - every P wave followed by QRS

AF - no P waves and irregularly irregular QRS

Atrial flutter: saw-toothed baseline

Nodal rhythm: regular QRS but no P waves

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3
Q

Axis

A

II most +ve = normal axis

AVL most +ve = Left axis deviation

AVF most +ve = right axis deviation

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4
Q

Systematic analysis of ECG

A
  1. Rate
  2. Rhythm
  3. Axis
  4. P waves and PR interval
  5. QRS
  6. ST segment
  7. T waves
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5
Q

P waves

A

Atrial depolarisation

  • Absent: AF, SAN block, nodal rhythm
  • Dissociated: complete heart block

• Bifid P waves = LA hypertrophy
- HTN, Aortic stenosis, Mitral regurgitation or stenosis

• Peaked P waves= RA hypertrophy
- pulmonary HTN, COPD

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6
Q

QRS

A

Ventricular initiation depolarisation

• Wide QRS >120ms - more than 3 small squares

  • Conduction defect
  • WPW
  • Broad complex tachycardia

• Pathological Q wave
- Full Thickness MI

  • RVH: Dominant R wave in V1 + deep S wave in V6
  • LVH
  • R wave in tall V6
  • R wave in V5/V6 + S wave in V1
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7
Q

PR interval

A
PR interval (3-5 small sq)
Start of P wave to start of QRS

• Long: heart block
•Short
- Accessory conduction: e.g. WPW
- Nodal rhythm

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8
Q

Long QT

A

QTc - Start of QRS to end of T wave

> 420ms

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9
Q

ST Segments

A

Elevated
• STEMI
• Pericarditis: saddle-shaped
• Aneurysm: ventricular

Depressed
• NSTEMI
• Unstable angina

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10
Q

T-waves

A
  • Peaked in ↑K+

* Flattened in ↓K+

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11
Q

U waves

A

Hypokalaemia

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12
Q

1st Degree Heart Block

A

Constantly extended PR interval with no absent QRS complexes

PR > 200ms (more than 1 large sq)

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13
Q

2nd Degree Heart Block

- Wenckebach /Mobitz I

A

Progressive lengthening of
PR interval

Absence of QRS complex

Next conducted beat has
shorter PR interval

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14
Q

2nd Degree Heart Block

- Mobitz II

A

Constant PR
Occasional absent QRS

  • block is usually in bundle
    branches of Purkinje fibres
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15
Q

2nd Degree Heart Block

- 2:1 Block

A

Two P waves per QRS
Normal consistent PR
intervals

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16
Q

3rd Degree Heart Block

A

P waves and QRS are dissociated

17
Q

RBBB

A
Broad complex QRS 
Bunny ear V1 
Slurred S wave 
Causes:
• Infarct – Inferior MI
• Normal variant
• Congenital – ASD, VSD, Fallot’s
• Hypertrophy – RVH (PE, Cor Pulmonale)
18
Q

Left BBB

A

Broad complex QRS
-ve V1
+ve at V6
Left axis deviation

Causes:
• Fibrosis
• LVH – AS, HTN
• Infarct – Inf. MI
•Coronary HD
19
Q

Bifascicular Block

A

RBBB + axis deviation

20
Q

Trifascicular Block

A

RBBB + axis deviation + 1st

degree AV block

21
Q

Bradycardia

A

Less than 50bpm

22
Q

TAchycardia

A

More than 100 bpm

23
Q

Atrial escape

A

Missed P wave as SAN fails to depolarise

Normal QRS

24
Q

Atrial Flutter

A

Saw-toothed baseline as
atria contract at 300bpm

2:1 - 150bpm

25
Ventricular tachycardia
Leads to cardiac arrest - requires defibrillator No P waves Regular, wide QRS No T waves
26
VF
Shapeless, rapid oscillations and no organised complexes - Electrical cardioversion
27
Torsades de Pointes
VT where QRS become taller and smaller Broad complex tachycardia
28
Wolf Parkinson White
Accessory conducting bundle Short PR interval Slurred upstroke of QRS - delta wave
29
Pericarditis
Saddle shaped ST
30
Hyperkalaemia
Tall tented T waves Widened QRS Absent P waves Sine wave appearance
31
Hypokalaemia
Small T waves ST depression Prolonged QT interval Prominent U waves
32
SVT
Sinus tachycardia AF Atrial flutter AV re-entry tachycardia
33
Broad complex tachycardia
VT | Torsades de points