ECG + GERD

Question 1

How many total electrodes does the ECG have, where?

Answer 1

9 electrodes
- 2 on hands
- 1 foot
- 6 chest (horizontal views)

Question 2

How many leads are are there on ECG

Answer 2

12 leads

Question 3

In ECG paper what does each represent in seconds
Small square
Large square
5 large squares

Answer 3

Small box: 0.04 sec
Large square: 0.20 sec
5 large squares: 1 sec

Question 4

What does the following show:
Pwave
QRS complex
S-T wave

Answer 4

P-wave: atrial depolarization (contraction)
QRS complex: ventricular depolarization (contraction)
S-T wave: ventricular repolarization (relaxation)

Question 5

ECG paper
- what is measured horizontally
- What is measured vertically

Answer 5

Horizontal
- time

Vertical
- voltage

Question 6

How fast does ECG paper travel?

Answer 6

25mm/sec

Question 7

What is the 6 second method

Answer 7

Count the QRS complexes and multiply by 10 people

Question 8

What is atrial flutter characterized by?
Where

Answer 8

2-4 p waves before the QRS complex
- looks like sawtooth pattern in lead II

Question 9

What is Afib characterized by?

Answer 9

No P-waves
Irregular QRS intervals

Attempt to pace the atria with no single pacemaker in control

Question 10

What is the following intervals mean:
Which points on the ECG?

PR interval
QRS width
QT interval
P-P interval
R-R interval

Answer 10

PR interval
- from P to start of QRS
- time for pulse to go from SA node, AV node, to the ventricles

QRS width
- Spread of impulse through the ventricles

QT interval
- time for ventricles to depolarize and then repolarize

P-P interval
- rate of atrial cycle

R-R interval
- rate of ventricular cycle

Question 11

What are normal interval seconds for the following
PR interval
QRS width
QT interval
QTc

Answer 11

PR: 0.12 -0.2 sec
QRS: <0.12 sec
QT: 0.4-0.44
QTc: male: <0.450
female: <0.460

Question 12

What is bazzet’s equation for QTc

overestimates/underestimates at:
HR > 100
HR <60

Answer 12

QT / Square root RR

HR > 100 = overestimates
HR <60 = underestimates

Question 13

What indicates a normal QT in comparison to RR?

Answer 13

The QT should be less than half the R-R interval

Question 14

What is First degree AV block characterized by?
symptomatic/asymptomatic

Answer 14

Long PR interval (greater than 0.2 sec)
- Start of P to start of Q
- asymptomatic

Question 15

What is 2nd degree type 1 AV block characterized by?

Answer 15

PR interval lengthens with a shorter RR interval

Question 16

What is 2nd degree type 2 AV block characterized by?

Answer 16

PR interval the same but QRS dropped every few beats

Question 17

What is 3rd degree heart block characterized by?

Answer 17

P and QRS have no correlation with each other
- symptomatic
- NEED a pacemaker

Question 18

Drug effects on the QT interval (3)

Answer 18

QT prolongation
Risk of Torsade de pointes
Primary or secondary
- metabolic (hypokalemia)
- metabolic condition (myocarditis)

Question 19

What are some non-modifiable risk factors

Answer 19

Age 68+
Female
Structural heart disease (HF, LV dysfunction, MI)
Bradycardia
Congenital long QT

Question 20

Modifiable risk factors

Answer 20

• 2+ QT prolonging medications
• Electrolytes (hypokalemia, hypomagnesemia)
• Drugs that can cause lyte imbalance
• Bradycardia

Question 21

What drugs are group 1 QT medications
Effect on QT and TdP?

Answer 21

Group 1:
- ibutilide
- procainamide
- sotalol

• haloperidol
• clarithryomycin
• erythromycin
• methadone

Known to prolong the QT
KNOWN risk of TdP when used as directed

Question 22

What drugs are group 2 QT medications
Effect on QT and TdP?

Answer 22

Group 2:
- levofolaxacin, moxi
- mirtazipine, olanzapine
- risperiodne, quetiapine

Increase QT
- may NOT cause TdP on their own when used as labelled
- possible risk if 2+

Question 23

What drugs are group 3 QT medications
Effect on QT and TdP?

Answer 23

Group 3:
- amitriptyline
- fluconazole
- cipro
- fluoxetine, trazodone

Known to prolong the QT
Risk of TdP ONLY in EXCESSIVE dosing

Question 24

In the TISDALE risk score, what is the most points given to (4)
What is considered low, moderate, high total score

Answer 24

Highest risk scores (=3)
- 2+ QTc prolonging drugs
- sepsis
- HF
- 1 QTc prolonging drug

Low: 0-6
Mod: 7-10
High: 11-21