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Cardiology 2023 1MB > ECG By Cameron McCloskey > Flashcards

ECG By Cameron McCloskey Flashcards

1
Q

How many large squares pass through per minue on an ECG?

A

300

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2
Q

What is a normal PR length?

A

0.12-0.2 seconds

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3
Q

What is a normal QRS length?

A

0.08-0.12 seconds

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4
Q

What is a normal QT interal length?

A

0.35-0.43 seconds

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5
Q

What may cause a prolonged QT interal?

A

Drugs

Electrolyte abnormalities (hypokalaemia, hypocalcaemia etc.)

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6
Q

What can cause deviation in the QRS complex?

A

Venticular hypertrophy (either left or right)

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7
Q

Deviation in the QRS complex is best seen in which leads?

A

I, II and III

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8
Q

Which distinctive patterns will be present on the ECG for right axis deviation?

A
  • Increases in lead III QRS
  • Negative deflection in lead I QRS

The right ventricle now has more influence on the QRS than the left

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9
Q

Which conditions are likely to cause right axis deviation and why? copd

A

Pulmonary conditions

e.g. PE

These put strain on the right side of the heart so lead to hypertrophy

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10
Q

How does left axis deviation present on an ECG?

A

Negative QRS complex in lead III

Negative QRS complex in lead II

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11
Q

What causes left axis deviation? 2

A

LVH or a conduction defect

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12
Q

Which area of the heart do leads V1 and V2 “look” at and which pattern do they nrmally observe?

A

Right ventricle

  • Small upward deflection (R wave - septum depolarised)
  • Large downward deflection (Q wave - main muscle mass depolarised)
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13
Q

Which area of the heart do leads V5 and V6 “look” at and which pattern do they nrmally observe?

A

Left ventricle

  • Small initial downward deflection (septal Q wave)
  • Large upward deflection (R wave - main muscle mass depolarised)
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14
Q

How is it possible to tell on an ECG where the interventricular septum is present?

A

When R and S waves are roughly equal

That happens around V3/4

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15
Q

How is an ECG reported on? (6)

A
  1. Verify patient details
  2. Check date and time of ECG
  3. Check paper calibration
  4. Determine axis
  5. Look at rhythm strip for: Electrical activity, rhythm, P waves, PR interval, is each P wave followed by a QRS complex, is the QRS of normal duration
  6. Look at individual leads for volatge criteria changes or ST or T wave changes
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16
Q

what is QUADRANT METHOD ? 4

A

E

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17
Q

How to calculate HR on an ECG

A
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18
Q

How to determine the type of acut coronary syndrome

A
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19
Q

How to determine the type of acut coronary syndrome

A
it happen due to plague rapture in the coronary arteries result in blood vessel blockage
20
Q
  1. P wave
  2. PR Segmen
  3. PR Interva
  4. QRS complex
  5. ST Segment -the flat line between S and T
  6. T wave
  7. QT Interval- At the start of the Q wave to the end of T wave
A
  1. Atrial depolarization (From the SA node spreads throughout the atria)
  2. Period where all the electrical activity from SA node converge and come to the AV node, which holds on to it and manifests as an isoelectric line
  3. Time from when SA node fires > AV node depolarization > getting ready to send action potentials down to ventricles
  4. Time from when SA node fires > AV node depolarization > getting ready to send action potentials down to ventricles
  5. Ventricular depolarization But no net electrical activity in any direction, ventricles are just holding on to it
  6. Ventricular repolarization
    1. Time period right before the Q wave starts (ventricular depolarization) up until the end of T wave (ventricular repolarization)
21
Q
  1. RV
  2. Basal septum
  3. Anterior wall of the heart
  4. High lateral wall of the LV
  5. Inferior wall of the hear
A
  1. aVR and V1-V3
  2. aVR and V2-V3
  3. V2-V4
  4. Lead I, avL and V5-V6
  5. Lead II, III, avF
22
Q

What are the steps for reading ECG

A
  1. Rhythm o R-R interval constant? It’s regular. o R-R interval NOT constant? It’s irregular
  2. Rate Too Fast >100 = Tachycardia  Too Slow  <60 = Bradycardia  Normal  60-100 = Normal R-Waves x 6 • Look at the rhythm strip • Count how many R waves x 6 • Ex above: 9 R waves x 6 = 56 bpm
  3. (iv) QRS o <0.12 seconds or 3 small boxes = Narrow o >0.12 seconds or 3 small boxes = Wide
  4. Sinus P-waves present? 0 Is P wave present Upright P-wave in Lead II?  Inverted P-wave in Lead aVR?  Every P followed by QRS?
  5. P-R Interval (block) o Time:  <0.2 seconds = Normal  >0.2 seconds = Prolonged  Constant  Variable  Progressively Longer
23
Q
  1. Narrow + Regular S
  2. Narrow + Irregular
  3. Wide + Regular
  4. Wide + Irregular
A
  1. Sinus Tachycardia Upright P waves in Lead III Inverted P-wave in Lead aVR Every P followed by QRS. 2:1 Atrial Flutter Supraventricular tachycardia.
  2. Atrial fibrillation (most common) Variable A-flutter Multifocal atrial tachycardia
  3. Ventricular tachycardia, until proven otherwise Supraventricular tachycardia with Bundle branch block Sinus tachycardia with Bundle branch block Antidromic WPW
  4. Polymorphic Supraventricular tachycardia Atrial fibrillation with WPW Atrial fibrillation with Bundle branch block
24
Q

When is it called ST elevation

A

• 1 mm in any 2 contiguous leads except V2-V3  true ST segment elevation • 2 mm in V2-V3  true ST segment elevation

25
Q

When is it ST depression and what cause it ?

A

 ≥ 0.5 mm in any 2 contiguous leads  true ST depression o Horizontal ST depression: most concerning for ischemia

Differential Diagnosis:

o NSTEMI

o Posterior MI  ST depression  Upright T waves  Dominant R waves V1-V3

o o Digoxin toxicity  U or sagging type of down sloping ST depression

26
Q

When does T inversion happen and what cause it ?

A

o ≥ 1 mm depression, below the isoelectric line or point

o T wave inversion in _aVL only,_ suspicion of impending inferior MI

Differential Diagnosis:

o LVH Strain

o Increased ICP (cerebral T waves)

o Pulmonary embolism

o Ischemia

27
Q

When Biphasic T-Wave happen

A

CRITERIA

o Upward wave immediately succeeded with downward wave

o Alarming in V2-V3:  Fulfills Wellens A criteria  Proximal LAD occlusion Differential

Diagnosis:

o Hyperkalemia

28
Q

Flat T-Wave

CRITERIA

o Differentiate from ST segment depression which is ≥ 0.5-1 mm in any 2 contiguous leads below the isoelectric line

o Should be between -1 mm of depression up to 1 mm of elevation

Differential Diagnosis:

o Ischemia

o Hypokalemia

A
29
Q

Peaked T-Waves

A

CRITERIA:

o Tall, narrow based, relatively symmetrically peaked o >10 mm height

Differential Diagnosis:

o Hyperkalemia (first thing to think of)

o Hypermagnesemia

o Ischemia

o De Winters T wave

 V1-V3 & Upsloping ST depression → proximal LAD occlusion

30
Q

Wide QRS

A

CRITERIA:

o >0.12 seconds or 3 small boxes

o Indeterminate point: 0.10-0.12 seconds

Differential Diagnosis:

o Bundle branch block

o Hyperkalemia

o Ventricular tachycardia

o Antidromic WPW Syndrome

o Paced rhythm (with pacemaker)

o Drugs: TCA overdose

31
Q

When is it LBBB with wide QRS or RBBB with wide QRS ?

A

Left BBB CRITERIA:

 V1-V2: Deep S wave, may sometimes form a bifid pattern

 V5-V6: positive deflection with a little dip on the QRS, looks like letter “M”

Right BBB CRITERIA:

 V1-V2: characteristics R-S-R’ (r prime) pattern

 V5-V6: slurring of S wave

32
Q

Pathological Q wave

A

wide Q wave

o Never seen in V1-V3

o >0.04 seconds or 1 small box

o >2 mm deep from isoelectric line or point

Differential Diagnosis:

o Old or New Myocardial infarction

o Pulmonary embolism

o LBBB

o LVH

33
Q

Low Voltage QRS

A

Something is blocking the impulse going to the electrodes

Differential Diagnosis: o Pericardial effusion (highest concern)

34
Q

Poor R-Wave Progression

A

Normal: R wave exponentially increases from V1-V6

Pathologic:

o R wave doesn’t progressively increase from V1-V6

o S wave is still a bit big in V5-V6

Differential Diagnosis:

o Anterior MI o RVH with Strain

35
Q

Dominant R-Wave Progressio

A

Normal: Smaller R waves and bigger S waves in V1-V3 (i) Pathologic: o R wave > S waves in V1-V3  which means greater impulse towards the right o ST depression o Upright T waves (ii) Differential Diagnosis: o Posterior MI (first to think about)

36
Q

LVH and RVH

A
37
Q

Prolonged QT Interval

A

CRITERIA:

o Recall: Measured from point before Q wave until after T- wave o Female: Long >460 ms o Male: >450 ms

o Requires QT-C for accurate measuring

 Use Bazett’s formula to see if truly prolonged o QT-interval should be aboult half of preceding R-R interval o Prolonged QT ↑ risk of Torsades de pointes which can present as polymorphic ventricular tachycardia

38
Q

Short QT Interval

A

CRITERIA:

o Short <350 ms

Differential Diagnosis:

o Hyperkalemia

o Hypermagnesemia o Digoxin toxicity

39
Q

Right Atrial Enlargement (RAE)

A

CRITERIA

o Lead II, III and aVF: >2.5 mm P-wave:

o Lead V1: Biphasic P-wave → (+) deflection → (-) deflection

Diagnosis: 2D ECHO

o to see for atrial enlargement (iii) Differential Diagnosis: Tricuspid valve stenosis o Pulmonary Hypertension o Pulmonic Valve Stenosis

40
Q

Right Atrial Enlargement (RAE)

A

CRITERIA

o Lead II, III and aVF: >2.5 mm P-wave:

o Lead V1: Biphasic P-wave → (+) deflection → (-) deflection

Diagnosis: 2D ECHO

o to see for atrial enlargement

(iii) Differential Diagnosis:

Tricuspid valve stenosis o Pulmonary Hypertension o Pulmonic Valve Stenosis

41
Q

Left Atrial Enlargement (LAE)

A

CRITERIA:

o Lead II:  bifid camel’s hump / P-wave > 0.04 second (1 small box) o Lead V1:  Use to enhance diagnostic ability  Biphasic P-wave  (-) deflection > (+) deflection  Explanation: Since impulse is pulled towards the LA, it moves away from the positive electrode at V1 (right inferior)  so (-) deflection > (+) deflection

Differential Diagnosis: o Mitral valve stenosis o Aortic valve stenosis o Systemic HTN  causes things to back up into the pulmonary circulation  ↑ blood volume and pressure in the left atrium (LA

42
Q

Short PR-Interval

A

CRITERIA:

o <0.12 seconds (<3 small boxes)

(ii) Differential Diagnosis:

o WPW Syndrome

o Premature atrial contractions (PAC) in ectopic area somewhere that fires quicker + closer to the AV node = shortening of PR-interval

43
Q

Prolonged PR-Interval

A

) CRITERIA:

o >0.20s (>1 big box or >5 small boxes)

(ii) Differential Diagnosis:

o 1st Degree Heart block: same prolonged PR interval throughout the rhythm strip

o 2nd Degree Mobitz Type 1: prolongation progressively gets longer and longer throughout the rhythm strip

o 3rd Degree Heart block: variable prolongation throughout the rhythm strip

44
Q

Left Axis Deviation (LAD)

A

(i) Lead reading for R wave:

o Lead I → R wave positive deflection → Left thumb UP

o Lead aVF → S wave negative deflection → CHECK Lead II

o Lead II → negative deflection → LAD

 bigger impulse directed to the left side of the heart (ventricle) → ventricular depolarization moves primarily in the left axis →  bigger S wave negative deflection

(ii) Causes:

o Obesity  Due to elevation of the diaphragmatic level

o LBBB: electrical activity has to come from the right side to the left side

o LVH: thicker  more electrical activity pushed to this side

o Inferior Myocardial infarction

o Hyperkalemia

45
Q

Right Axis Deviation (RAD)

A

(i) Lead reading:

o Lead II → S wave negative deflection → Left thumbs DOWN

o Lead aVF → R wave positive deflection → Right thumb UP → RAD

 Since ventricular depolarization is more deviated to the right and approaches the location of the (+) electrode → bigger positive deflection

(ii) Causes:

o Extremely thin people

o RBBB

 Causes the left side of the heart to bring electrical activity to the right side

o RVH

 Thick Right ventricle ↑ electrical activity o Anterior MI

o Ventricular tachycardia

 ↑ electrical activity originating from the left side of the heart which gets pushed to the right side of the heart

46
Q

Extreme Right Axis Deviation (ERAD)

A

(i) Lead reading:

o Lead II → S wave negative deflection  Left thumbs DOWN o aVF → S wave negative deflection  Left thumbs DOWN

(ii) Causes:

o Extreme RVH: RV pulls ↑ electrical activity to it o Ventricular tachycardia:

 Electrical focus developing within the left side → ↑ electrical activity towards the right side

o Extremely thin individuals

47
Q

EKG’S
ECG’s

A

Cardiology 2023 1MB (28 decks)

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