ECG Basic Flashcards
1
Q
1 mm X axis= __ sec
A
0.04
2
Q
P wave normal length
A
Less than 0.1 sec
2.5 small squares
3
Q
PR interval=
A
0.12-0.2 sec
3-5 small squares
4
Q
QRS compex=
A
Less than 0.12
3 small squares
5
Q
Q=
A
Less than 0.04 sec
1 small square
6
Q
Normal T shape
A
Rounded but asymmetrical
7
Q
Normal axis is from
A
-30 to +90
8
Q
Inferion leads MI means which coronary artery?
A
RCA
9
Q
Inferior leads
A
II
III
aVF
10
Q
Anterolateral leads
A
I
aVL
V1-6
11
Q
Lateral leads
A
I
aVL
V5-6
12
Q
ECG rapid interpretation steps
A
Rhythm Rate P wave QRS PR Axis Q wave STE Other abnormalities
13
Q
What does Q wave > 0.04 sec tells as?
A
Injury
14
Q
Atrial flutter important features
A
Rhythmic
HR 250-300 BPM
No P wave but F wave
QRS is normal
15
Q
Atrial fibrillation important features
A
Arrhytmic
HR 300-350 BPM
NO P WAVE
16
Q
Where can we best see A.Fib?
A
V1
17
Q
Common example for pre-excitation syndrome
A
Wolf Parkinson White syndrome
18
Q
What is the name of the accessory bandle in WPW syndrome?
A
Kent byndle
19
Q
ECG of WPW
A
Delta wave connects the PR and PR is very short
20
Q
Why PR interval is very short in WPW?
A
The AP doesnt go through the junction so it doesnt slow down
21
Q
WPW can commonly procead to
A
A.FIb
22
Q
QRS in WPW
A
Wide due to Delta wave
23
Q
First degree AV block
A
Rhythmic
PR unterval > 0.2
24
Q
Second degree AV block Mobitz type I
A
Arrhythmic
PR gradually increases until QRS “falls”
PR last»_space;> PR first
25
Second degree AV block Mobitz type II
Arrhythmic
PR is normal
PR last = PR first
26
Second degree AV block 2:1
For every 2 P only 1 has QRS
27
Third degree AV block
Rhythmic
| No connection btw. P to QRS
28
What does RBBB means regarding the heart?
RV is activated slower from the LV through the muscle cells
29
Mnemonics for RBBB
MaRoW
V1- M pattern
V6- W pattern
30
ECG features of RBBB
QRS > 0.12 sec
rSR in V1
Slurred S wave in I, aVL, V5, V6
31
V1 in RBBB
rSR pattern
32
Incomplete RBBB ECG features
rSR in V1 BUT! QRS is not longer than 0.12 sec
33
Clinically importance of incomplete RBBB
Acute PE
COronary disease
Myocarditis
34
What does LBBB means regarding the heart?
Activation of LV and the septum is abnormal
| LV is activated from the RV
35
Mnemonics for LBBB
WiLiaM
V1- W
V6- M (Notched R)
36
ECG features of LBBB
QRS > 0.12 sec
| Notched R in V5, V6, I, aVL
37
V1 in LBBB
rS
38
V6 in LBBB
Notched R in V5, V6, I, aVL
| Lack of Q
39
VAT time is=
Time from the beginning of QRS and the point where R goes down (from his pick)
40
VAT time in RBBB and LBBB
Prolonged
41
LAH explenation
The Ant. fascicle doesnt conduct so the left ventricle is activated from the posterior fascicle
42
ECG features of LAH
Exterme LEFT axis deviation
I, aVL: qR
II, III aVF: rS
QRS narrow
43
LAH I, aVL:
qR
44
LAH II, III aVF:
rS
45
LPH explenation
Posterior fascicle doesnt conduct, so the left ventricle is activated from the anterior fascicle
46
ECG features of LPH
Extreme RIGHT axis deviation
I, aVL: rS
II, III, aVF: qR
QRS is narrow
47
LPH I, aVL:
rS
48
LPH II, III, aVF:
qR
49
Angina types
Stable
Unstable
Prinzmetal's
Silent
50
ECG of a patient with Prinzmetal's angina
STE at rest or with physical exercise
51
Which angina shows STE on ECG?
Prinzmetal's
52
Which angina shows STD on ECG?
Stable and unstable angina
53
STE/ No STE on ECG + No cardiac symptoms with chest pain may indicate
Unstable angina
54
Serum cardiac biomarkers (3)
```
Troponin I + Troponin T
Creatine Phosphokinase (CK)
Lactate Dehydrogenase (LDH)
```
55
Troponin levels in regarding to MI
Increases after 3-6 hours
Peaks at about 20 hours
Remains elevated for 7-10 days
56
When do Troponin levels peak?
20 hours after MI
57
Which Troponin are cardiac specific?
I and T
58
Is CK specific in STEMI?
No
59
CK-MB levels after MI
Rises within 3-6 hours
60
Which LDH predominent in the heart?
LDH1
| LDH2
61
LDH levels peak _____ after the injury
3-4 days
62
General treatment of MI (5)
```
Anti coagulant (Aspirin)
Vasodilators (Nitrates)
Statins
Ca2+ channel blockers
B blockers
```
63
Order of process of MI
Ischemia
Injury
Necrosis
64
ECG in subendocardial ischemia
T upright but symmetrical
65
ECG in subpericardial ischemia
Inverted T and symmetrical
66
ECG in subendocardial injury
ST depression
V1-6 < 1mm
67
ECG in subpericardial injury
STE
V1-6 > 2mm
Limbs > 1mm
68
ECG sign of necrosis
Pathological Q wave
69
Definition of pathological Q wave
Q > 0.04 sec
| Q > 1/4 size of R
70
We usually dont see Q wave in ______ leads
V1-4
71
RCA responsible for blood supply where?
Inferior and posterior
72
Stages of MI (4)
Hyperacute
Acute
Subacute
Old
73
Hyperacute MI ECG sign
STE
74
Hyperacute MI ECG sign will be visual when?
1-3 hour post MI
75
Acute MI ECG sign
STE and Pathological Q wave
76
Acute MI ECG sign will be visual when?
< 7 days post MI
77
Subacute MI ECG sign will be visual when?
1-4 weeks post MI
78
Subacute MI ECG sign
Pathological Q wave and inverted T
79
Old MI ECG will be visual when
> 4 weeks post MI
80
Right atrial Hypertrophy is also called
P pulmonale
81
In RAH, P wave is > than 0.1 sec
P wave < 0.1 sec
82
RAH ECG sign
Large P wave with tall initial part
83
Left atrial Hypertrophy is also called
P mitrale
84
LAH ECG sign
Large P wave with wide terminal part
85
Where can we best see atrial hypertrophy?
II
| V1
86
RVH on ECG
RIght axis deviation
In V1, R > S (Remember RRRR)
In V5/V6, S > R
Strain pattern
87
LVH on ECG
Left axis deviation
In V5, R > 25 mm
In aVL, R > 11 mm
Sokolof Lyons index
88
Sokolof Lyons index=
S wave in V1 + R wave in V5/V6 > 35 mm
89
K+ EC normal
3.5-5.1 mM
90
Moderate hypokalemia ECG signs
U waves
Flat T and inversion
Long QT
STD
91
Hyperkalemia on ECG
Peaked T
P flat and wide
Long PR
Wide QRS
92
PE on ECG
S1Q3T3
Large and wide S on I
Large Q on III
Inverted T on III
93
PE is the cause of _____
Acute cor pulmonale
94
Digitalis mechanism of action
Blocks Na+/K+ ATPase
IC Na+ Increased
NCX reversed
IC Ca+2 Increases
95
ECG features of digitalis toxicity
Scooped ST depression
96
ECG features of Pericarditis
STE in multiple independent leads
97
What can cause Left axis deviation
Inferior MI
LVH
LAH
LBBB
98
What can cause Right axis deviation
```
Lateral MI
RVH
LPH
Hyperkalemia
PE
COPD
```
99
Necrotic tissue will shoft the axis _____ the side of the necrotic part
Away
100
RBBB Does/Doesnt cause axis deviation
Doesnt
