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CARDIO-RESPIRATORY 2 > ECG Analysis > Flashcards

ECG Analysis Flashcards

1
Q

What is a normal heart rate?

A

60-100bpm

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2
Q

How long is a normal p-wave?

A

Less than 80ms

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3
Q

How long is a normal PR interval?

A

Less than 200ms

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4
Q

How long is a normal QRS complex?

A

Less than 120ms

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5
Q

How do you calculate the heart rate from an ECG?

A

Determined from R-R intervals; count the R waves in 30 squares then multiply by 10 (1 sq=0.2s)

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6
Q

What time period does each square on an ECG represent?

A

0.2 seconds

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7
Q

What is a regularly irregular heart rhythm?

A

Where there is a regular abnormality of the ECG

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8
Q

What is an irregularly regular heart rhythm?

A

When the RR intervals vary but the ECG itself is normal

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9
Q

What is an irregularly irregular heart rhythm?

A

Where there is no order to the ECG whatsoever, and this can be indicative of heart failure

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10
Q

What is a normal PR interval?

A

120-200ms

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11
Q

What may a prolonged PR interval represent?

A

Heart block

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12
Q

What may a prolonged QRS complex present?

A

Abnormality of ventricular contraction or conduction

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13
Q

What may an elevated ST segment represent?

A

Myocardial infarction (STEMI)

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14
Q

What may a depressed ST segment represent?

A

Ischaemia - angina

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15
Q

What is another phrase for a normal ECG?

A

Normal sinus rhythm

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16
Q

How would sinus bradycardia appear on ECG?

A

All normal characteristics except a longer R-R interval, with HR less than 60bpm

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17
Q

How would sinus tachycardia appear on ECG?

A

All normal characteristics except a shorter R-R interval, with HR greater than 100bpm

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18
Q

How would ventricular tachycardia appear on ECG?

A

> Increased heart rate (tachycardia)
Prolonged QRS complex (due to abnormal ventricular conduction and contraction)
Unidentifiable p-waves as they are masked by the consistent ventricular depolarisation

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19
Q

What is the cause of ventricular tachycardia?

A

Abnormal tissues in the ventricles, aside from the AVN begin to generate a rapid and irregular heart rhythm

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20
Q

How would ventricular fibrillation appear on ECG?

A

There are no identifiable features on the ECG it becomes a mixture of uncoordinated wiggly lines

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21
Q

What is the cause of ventricular fibrillation?

A

Results from disorganised electrical signals which cause the ventricles to quiver instead of contract in a rhythmic fashion

22
Q

How would first degree heart block appear on ECG?

A

The PR interval will be consistently prolonged (greater than 200ms)

23
Q

What are the types of second degree heart block?

A

Type 1 - wenkenback (progressively longer PR interval until failure of QRS)
Type 2 - Mobitz II (normal PR interval until failure, then restarts)

24
Q

How would second degree type I heart block appear on ECG?

A

Variable PR interval:
PR intervals will become progressively longer until a p-wave fails to produce a QRS complex, then the cycle starts again.

25
Q

What is the cause of second degree, type 1 heart block (Wenkenbach)?

A

This occurs due to each atrial impulse from the SAN finding it more difficult to travel to the AVN and bundles of Hiss

26
Q

How would second degree type 2 (Mobitz II) heart block appear on ECG?

A

The PR interval is constant, but then a p-wave fails to produce a QRS complex, and then several p-waves may follow until one is produced, thereafter the PR intervals again return to normality.

27
Q

What is the cause of second degree, type 2 heart block?

A

This is due to the AVN choosing to spontaneously not respond to atrial impulses from the SAN

28
Q

What types of heart block have a constant PR internal (irrespective of any other failings)?

A

1st degree and 2nd degree (type II)

29
Q

What types of heart block have a variable PR interval?

A

2nd degree (type I) and 3rd degree

30
Q

How would third degree heart block appear on an ECG?

A

The p-waves become independent of the QRS complexes, and bradycardia is often present (less than 60bpm)

31
Q

What is the cause of third degree heart block?

A

When atrial impulses from the SAN can no longer reach the AVN whatsoever due to AVN failure. As a result, a focal point in the ventricles takes over to generate contraction (escape beats) which tends to be slow, leading to bradycardia.

32
Q

How would atrial fibrillation appear on an ECG?

A

There are multiple p-waves present before QRS complexes

33
Q

What is the cause of atrial fibrillation?

A

Many sites within the atria besides the SAN begin generating electrical impulses, which leads to the AVN becoming overwhelmed and therefore irregular conductance to the ventricles, so contraction is not rhythmic.

34
Q

How may a patient suffering from atrial fibrillation present?

A

Palpitations, fainting, chest pain or congestive heart failure

35
Q

How would atrial flutter appear on an ECG?

A

> Tachycardia

> Regularly irregular

36
Q

What is the cause of atrial flutter?

A

There is re-excitation of the electrical impulse in the atria just after it is sent. This leads to a high frequency bombardment of the AVN that leads to a high, but regular heart rhythm.

37
Q

How does atrial flutter differ from atrial fibrillation?

A

In atrial fibrillation there are several sites that are producing electric signals that bombard the AVN leading to an irregularly irregular rhythm. However, in atrial flutter there is only re-excitation of one focal point from the SAN and therefore this just leads to a high frequency of signals to the AVN, but the AVN can facilitate a response to this each time, so each p-wave is followed by a QRS and the beat is regularly irregular.

38
Q

How would junctional rhythm appear on an ECG?

A

Bradycardia and absent p-waves

39
Q

What is the cause of junctional rhythm?

A

This occurs when the AVN takes over as the primary pacemaker of the heart. This occurs if there is damage to the SAN or blockage in the conduction pathway from the atria to the AVN. P-waves are absent due to SAN inactivity and bradycardia ensues due to AVN conduction being slower.

40
Q

What is supra ventricular tachycardia?

A

An elevated heart rate that originates in the atria

41
Q

What are the types of supra ventricular tachycardia?

A

AV nodal re-entry tachycardia, atrial fibrillation, atrial flutter and Wolff-Parkinson White syndrome

42
Q

What is Wolff-Parkinson White syndrome?

A

Where there is an abnormal extra conduction pathway between the atria and ventricles leading to supra ventricular tachycardia

43
Q

What is AV nodal re-entrant tachycardia (AVNRT)

A

This is the most common regular supra ventricular tachycardia and it occurs when a re-entry circuit forms within or just next to the AVN and therefore instead of the atrial impulses dying away after activating the AVN, then go around in a circle and activate the AVN again after a short delay. This involves a fast and a short pathway which are both in the right atrium.

44
Q

How would bundle branch block appear on an ECG?

A

> Widening of QRS complex

> Notch on the R-wave or double R-wave

45
Q

What would a notch in the R wave, or double R-waves represent?

A

Bundle branch block

46
Q

What is the cause of bundle branch block?

A

Bundle branch block involves the abnormal conduction through the bundles of Hiss, which causes a delay in full depolarisation of the ventricles.

47
Q

What may ST depression on an ECG represent?

A

Coronary ischaemia or hypokalaemia

48
Q

How would a STEMI appear on an ECG?

A

If there is a new ST segment elevated above normal in two or more adjacent ECG leads

49
Q

What two leads are used in determining axis deviation?

A

Lead I and aVF

50
Q

What indicates a normal electrical axis of the heart?

A

Lead I should be positive and lead aVF should also be positive

51
Q

What indicates a left axis deviation from ECG leads?

A

Lead I is positive

Lead aVF is negative

52
Q

What indicates a right axis deviation from ECG leads?

A

Lead I is negative;

If aVF is negative, this is extreme RAD, if aVF is positive this is mild RAD.

CARDIO-RESPIRATORY 2 (35 decks)

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