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CARDIOVASCULAR > ECG and arrhythmias > Flashcards

ECG and arrhythmias Flashcards

1
Q

ECG changes in leads V3-V4 would indicate damage to what area of the heart?

A

Anterior

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2
Q

ECG changes in leads V1-V2 would indicate damage to what area of the heart?

A

Anteroseptal

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3
Q

ECG changes in leads aVL, I, V4-V6 would indicate damage to what area of the heart?

A

Anterolateral

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4
Q

ECG changes in leads aVF, II, III would indicate damage to what area of the heart?

A

Inferior

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5
Q

What do delta waves in an ECG indicate?

A

Wolff- Parkinson - White syndrome

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6
Q

What does T wave inversion in an ECG indicate?

A

Hypokalaemia

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7
Q

What does ST elevation in an ECG indicate?

A

Myocardial Infarction

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8
Q

What does ST depression in an ECG indicate?

A

Ischaemia

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9
Q

What are the ECG signs of hypokalaemia?

A

Small/absent T waves/ T wave inversion
ST segment depression
U waves
long QT

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10
Q

What are the ECG signs of hyperkalaemia?

A

Small or absent P waves
tall tented T waves
broad bizarre QRS complexes

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11
Q

Prolonged PR interval can be found in hypokalaemia, hyperkalaemia or both?

A

Both

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12
Q

Bradycardia
Narrow QRS complexes
A QRS complex is missing after every other P wave.
- What is the diagnosis

A

2:1 heart block

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13
Q

What are 3 typical ECG signs suggestive of the form of ventricular tachycardia called ‘Wolff- Parkinson White Syndrome’ ?

A 
Short PR interval 
Broad QRS complexes 
Delta waves (slurred upstroke on the R wave)
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14
Q

Describe the shape of the deflection when the depolarisation wave spreads towards a lead and when depolarisation wave spreads away from a lead

A

When depolarisation spreads towards a lead, the deflection is predominantly upward/ positive
When depolarisation spreads away from a lead, the deflection is predominantly negative

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15
Q

Which leads are used to estimate the cardiac axis?

A

I, II and III

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16
Q

In a normal heart, which ventricle exerts the most influence on the ECG?

A

The left ventricle

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17
Q

What causes right axis deviation?

A

Right ventricular hypertrophy
- As the RV is enlarged, it exerts greater influence on the QRS complex than the LV, causing the axis to swing towards the right

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18
Q

In right axis deviation, what happens to the deflections in the different leads?

A

The axis swings towards the right and so the deflections in leads II and III remain positive, and the deflection in lead I becomes negative as depolarisation is spreading away from this lead

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19
Q

What causes left axis deviation?

A

Left ventricular hypertrophy
- As the LV s enlarged, it exerts greater influence over the QRS complex than the RV, causing the axis to swing towards the left

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20
Q

In left axis deviation, what happens to the deflections in the different leads?

A

The deflection in lead I is positive
The deflection in leads III +/- II become negative as depolarisation is spreading away from these leads
*The axis deviation is significant when lead II also becomes negative

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21
Q

In a normal heart, why are the deflections in leads VR and II in opposite directions?

A

Leads VR and II look at the heart from opposite directions and therefore their deflections are in opposite directions.
VR = negative deflection
II - positive deflection

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22
Q

From which lead is the cardiac rhythm determined from ?

A

Whichever lead shows the P wave most clearly - usually lead II

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23
Q

What are the 12 ECG leads?

A

6 Limb leads
VR, III,VF, II, I, VL
6 Chest leads
V1- V6

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24
Q

Which areas of the heart do the different ECG leads look at?

A 
VR - the right atrium 
III and VF - inferior surface 
II, I and VL - left lateral surface 
V1 and V2 - right ventricle 
V3 and V4 - septum 
V5 and V6 - left ventricle
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25
Q

Describe what each wave/ segment in an ECG means

A 
P wave - atrial depolarisation 
PR interval - AV node delay 
QRS complex - ventricular depolarisation and atrial depolarisation 
ST segment - ventricular systole 
T wave - ventricular repolarisation 
TP - diastole
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26
Q

What is the normal duration of the PR interval and the QRS complex?

A

PR - 0.12- 0.2

QRS - <0.12

27
Q

How is heart rate worked out if it is regular and how is it worked out if it is irregular?

A

Regular - 300 divided by the number of boxes between R-R

Irregular - the number of QRS complexes in 30 large squares times 10

28
Q

What are some of the causes of AVN conduction disease and heart block?

A 
Ageing 
Previous MI/ Acute MI 
Myocarditis 
Calcified valves 
Beta blockers and CCB
29
Q

What is 1st degree heart block?
What can it be cause by?
How is it managed/ is it managed?

A
  • The PR interval is longer than normal (>0.2)
  • Drugs / Acute MI / Acute rheumatic fever
  • No treatment
30
Q

What is 2nd degree heart block?
What are the two different types of the type of heart block?
What does second degree heart block usually indicate?

A

Intermittent block at the AV node
Mobitz type 1 and Mobitz type 2
Second degree heart block usually indicates heart disease and is often seen in acute MI

31
Q

Describe Mobitz type 1

A

Mobitz type 1 involves progressive lengthening of the PR interval until a dropped beat occurs

32
Q

Describe Mobitz type 2 and how it would be managed

A

Mobitz type 2 involves some action potentials failing to get through the AV node - the PR interval is constant but the P wave is often not followed by a QRS complex
- Treated with ventricular pacing

33
Q

Describe 3rd degree heart block

A

3rd degree heart block is complete heart block in which no action potentials can pass through the AV node.
The atria are not in sync with the ventricles - There is no association between the P waves and the QRS complexes.
Treated with ventricular pacing/ permanent pacemaker

34
Q

Rhythm can still be regular in complete heart block - true or false?

A

True

35
Q

What can cause third degree/ complete heart block?

A
  • MI

- Fibrosis around the Bundle of His

36
Q

What does third degree heart block indicate?

A

Indicates tissue conducting disease, usually due to fibrosis

37
Q

What are some of the causes of RBBB?

A

Atrial Septal Defect
Right Ventricular Hypertrophy
Pulmonary embolism

38
Q

What are some of the causes of LBBB?

A 
Aortic stenosis 
Ischaemic disease 
Hypertension 
Cardiomyopathy
If there is chest pain - think MI
39
Q

List supraventricular arrhythmias

A

Atrial fibrillation
Atrial flutter
Ectopic atrial tachycardia

40
Q

List ventricular arrhythmias

A

VT and Torsade de Pointes
VF
PVC

41
Q

List AV node arrhythmias

A

AVN re-entry

AV block

42
Q

Describe ventricular fibrillation and how it would be managed

A

Chaotic electrical activity
Loss of function
URGENT DEFIRBRILLATION

43
Q

Describe ventricular tachycardia and how it would be managed

A

P waves are not visible
Rapid and distorted QRS complex
Monomorphic VT - regular rhythm
Polymorphic VT - irregular rhythm - chaotic

  • Drug therapy
  • Amiodarone
  • Lidocaine
  • Procainamide
  • NOT VERAPAMIL*
  • Cardioversion
  • EPS
  • ICD ( especially if there is impaired LV function)
44
Q

Describe Torsade De Pointes

A 
A rapid form of VT 
Twisting QRS morphology 
Irregular rhythm 
Long QT interval 
Wide QRS
45
Q

Describe the ECG appearance of atrial fibrillation

A

Irregularly irregular
Rate >300
Absence of P waves

46
Q

Describe the ECG appearance of atrial flutter

A 
Very rapid form of atrial tachycardia 
No P waves 
Normal QRS 
Saw- tooth appearance
High rate 
Inferior leads of the ECG
47
Q

Pharmacological cardioversion refers to rhythm control. Which drugs are used for cardioversion in atrial fibrillation?

A

Amiodarone and Flecainide

48
Q

When is digoxin the most suitable drug for rate control in atrial fibrillation?

A

If there is coexisting heart failure

49
Q

Which arrhythmia can’t be corrected by defibrillation?

A

Asystole

50
Q

What are the characteristics of benign ventricular ectopics

A

An extra beat followed by a slight pause before the rhythm returns to normal.
Thus episodes of palpitations are irregular and often occur after drinking coffee/alcohol.
The pulse will only sometimes be irregular.
The heart is usually structurally normal - Echocardiography is thus normal.

51
Q

Describe the ECG appearance of ventricular tachycardia

A

Palpitations
Broad- complex tachycardia is seen on the ECG
Atrioventricular dissociation

52
Q

What is the treatment of Torsade de Pointes

A

Magnesium sulphate

53
Q

How would Atrial Fibrillation be managed if the patient presented unwell with acute symptoms, as opposed to how they would be managed if they were symptomatic but not too unwell?

A

The ACUTE situation - DC cardioversion followed by thrombophylaxis

Symptomatic but not too unwell - Bisoprolol or verapamil and LMWH

54
Q

3 main points for the control of atrial fibrillation

A

Anti-coagulation
Rate control
Rhythm control

55
Q

What is the most common sustained arrhythmia?

A

Atrial fibrillation

56
Q

Signs/ symptoms of complete heart block

A

Bradycardia
Hypotension
Dizziness
Irregular intermittent visible pulsations on inspection of venous pressure.

57
Q

Describe the management of Atrial Flutter

A

Management is similar to that of atrial fibrillation although medication may be less effective
atrial flutter is more sensitive to cardioversion however so lower energy levels may be used
Radiofrequency ablation of the tricuspid valve is curative for most patients

58
Q

Describe the management of Atrial Fibrillation

A
  • Anti-coagulation
  • Warfarin
  • Rate control
  • CCB - verapamil
  • Beta blockers
  • Digoxin (if coexisting heart failure)
  • Rhythm Control
  • Amiodarone
  • Flecainide (if no structural heart disease)

*DC cardioversion

59
Q

Describe the treatment of ventricular tachycardia

A
  • Cardioversion
  • Adenosine
  • Lidocaine
  • Procainide
  • Electrical cardio version
  • ICD implantation
60
Q

Describe the management of Wolff- Parkinson White syndrome

A
  • Radiofrequency ablation of the accessory pathway
  • Sotalol***
  • Amiodarone
  • Flecainide
61
Q

Narrow complex tachycardias can refer to SVTs, AF, AT etc. Not thinking about the specific diseases, what could be the principle management for this group of arrhythmias?

A
  • Vagal manoeuvres
    (carotid sinus massage, valsava manoeuvre)
  • Adenosine
  • Cardioversion
62
Q

How can brugada syndrome be managed?

A

ICD implantation

63
Q

What part of the ECG corresponds with the first heart sound?

A

The QRS complex - AV valves close and the ventricles contract

64
Q

What part of the ECG corresponds with the second heart sound?

A

The T wave - SL valves close

CARDIOVASCULAR (11 decks)

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