ECG COPY

Question 1

Myocardial ischaemia

Answer 1

• a prolonged PR interval
• a long QT interval
• right bundle branch block
• right axis deviation
• peaked T waves
• inverted T waves
• left bundle branch block
• ST depression
• ST elevation

Question 2

Causes of ST-segment elevation

Answer 2

• STEMI
• LV aneurysm,
• takotsubo (stress) cardiomyopathy
• coronary vasospasm (Prinzmetal angina),
• acute stroke
• Early repolarisation
• Pericarditis (saddle shaped)
• During angioplasty
• Non-standard ECG acquisition settings (eg on monitor)
• normal variant - ‘high take-off’
• Subarachnoid hemorrhage

Link

Question 3

Inverted T waves

Answer 3

• myocardial ischaemia
• digoxin toxicity
• subarachnoid hemorrhage
• arrhythmogenic right ventricular cardiomyopathy
• pulmonary embolism (‘S1Q3T3’)
• Brugada syndrome

Question 4

Peaked T waves

Answer 4

• hyperkalaemia
• myocardial ischaemia

Question 5

Causes of ST depression

Answer 5

• secondary to abnormal QRS (LVH, LBBB, RBBB)
• ischaemia
• digoxin
• hypokalaemia
• syndrome X

Question 6

Causes of LBBB

Answer 6

• ischaemic heart disease
• hypertension
• aortic stenosis
• cardiomyopathy
• rare: idiopathic fibrosis, digoxin toxicity, hyperkalaemia

Question 7

Causes of RBBB

Answer 7

• normal variant - more common with increasing age
• right ventricular hypertrophy
• chronically increased right ventricular pressure - e.g. cor pulmonale
• pulmonary embolism
• myocardial infarction
• atrial septal defect (ostium secundum)
• cardiomyopathy or myocarditis

According to OE both primum & secundum cause RBBB

Question 8

Causes of left axis deviation (LAD)

Answer 8

• left anterior hemiblock
• left bundle branch block
• Wolff-Parkinson-White syndrome (right-sided accessory pathway)
• hyperkalaemia
• congenital: ostium primum ASD, tricuspid atresia
• minor LAD in obese people

Question 9

Causes of right axis deviation (RAD)

Answer 9

• right ventricular hypertrophy
• left posterior hemiblock
• chronic lung disease → cor pulmonale
• pulmonary embolism
• ostium secundum ASD
• Wolff-Parkinson-White syndrome (left-sided accessory pathway)
• normal in infant < 1 years old
• minor RAD in tall people

Question 10

Causes of RBBB + RAD

Answer 10

• right ventricular hypertrophy
• pulmonary embolism
• cor pulmonale
• ostium secundum ASD

Question 11

Causes of RBBB + LAD

Answer 11

• ostium primum ASD

Question 12

Causes of tall R waves in V1

Answer 12

• Right ventricular hypertrophy (myriad causes)
• RBBB
• Posterior infarction
• Dextrocardia
• WPW syndrome with left ventricular pathway insertion (often referred to as type A)
• HCM (septal mass greater than posterior wall).

Question 13

Right ventricular hypertrophy

Answer 13

• right axis deviation
• right bundle branch block

Question 14

Cor pulmonale

Answer 14

• increased P wave amplitude
• right bundle branch block
• right axis deviation