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Medicine Finals > ECG Interpretation > Flashcards

ECG Interpretation Flashcards

1
Q

What does one small square on an ECG represent?

A

1mm (0.04 seconds)

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2
Q

What does one large square on an ECG represent?

A

5mm (0.2 seconds)

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3
Q

How do you calculate a heart rate from an ECG?

A

If regular - count number of large squares between R-R interval and divide 300 by this number

If irregular - count number of QRS complexes on one strip and times by 6

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4
Q

How do you determine normal cardiac axis from an ECG?

A

Lead I, II and III are all positive
Lead II is the most positive
Lead avR is the most negative

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5
Q

How do you determine right axis deviation from an ECG?

A

Lead I is negative
Lead II and III are positive
Most positive is lead III

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6
Q

What is the most common cause of right axis deviation?

A

Lead I is positive
Lead II and III are negative
Lead I is most positive

Usually due to conduction abnormalities

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7
Q

What most commonly causes an absent P wave?

A

Atrial fibrillation

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8
Q

How long should a PR interval be?

A

3-5 small squares

Should be no more than one large square (0.2s)

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9
Q

What does a prolonged PR interval suggest?

A

Heart block

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10
Q

What is first degree heart block? How is it managed?

A

Prolonged PR interval

No management needed

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11
Q

What is second degree heart block type 1?

How is it managed?

A

Progressive prolongation of the PR interval until a dropped QRS

No management needed

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12
Q

What is second degree heart block Mobitz type 2? How is it managed?

A

Constant prolongation of PR interval with intermittently dropped QRS

Management = Permanent pacemaker

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13
Q

What is third degree heart block?

A

No association between PR interval and QRS complex

QRS complex= usually regular

Management= permanent pacemaker

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14
Q

What is a significant ST elevation?

A

> 1mm in 2 or more limb leads

>2mm In 2 or more chest leads

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15
Q

What does ST elevation in leads V1-V4 signify?

A

Anteroseptal MI

LAD

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16
Q

What does ST elevation in I, avL, V5 and V6 signify?

A

Lateral MI

Left circumflex artery

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17
Q

What does ST elevation in leads II, III, aVF indicate?

A

Inferior MI

Right coronary artery

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18
Q

X

A

X

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19
Q

Which electrolyte disturbances can cause long QT syndrome ?

A 
Hypocalcaemia
Hypokalaemia 
Hypomagmasaemia
Hypothermia
Hypothyroidism
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20
Q

Which drugs can cause long QT syndrome ?

A 
METHCATS
Methadone/Methotrexate
Erythromycin
Terfenadine
Haloperidol
Citalopram
Amiodarone
Tricyclics
Sotalol
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21
Q

How do you determine left axis deviation from an ECG?

A

Lead I is positive
Lead II and III are negative
Lead I is most positive

Usually due to conduction abnormalities

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22
Q

Which electrolyte abnormality is associated with tall T waves?

A

Hyperkalaemia

23
Q

What ECG changes are seen in hyperkalaemia?

A

Tall tented T waves
Widened flattened P wave
Prolonged PR interval
Broad QRS

Severe:
Sinusoidal wave pattern
V fib

24
Q

What is seen on ECG in left bundle branch block?

A

Wide QRS complex
WiLLiaM
V1 = W = rS
V6 = M

25
Q

What is seen on ECG in right bundle branch block?

A

Wide QRS complex
V1 = M = RSR
V6 = W = rS

MaRRoW

26
Q

Which leads is it normal for the T wave to be inverted?

A

Lead V1 and avR

Can also be normal in lead I, avL and V6

Can also be normal in lead III

27
Q

What are the two types of tachycardia?

A

Narrow complex and broad complex

28
Q

What are the two types of ventricular tachycardia?

A

Monomorphic and polymorphic

29
Q

What is the main cause of monomorphic ventricular tachycardia?

A

Myocardial infarction

30
Q

What is an example of polymorphic ventricular tachycardia?

A

Torsades de pointes (caused by long QT)

31
Q

How does atrial fibrillation present on an ECG?

A

Irregularly irregular rhythm
Absence of P wave
Narrow complex

32
Q

How does hypokalaemia present on an ECG?

A

U waves
Small/absent T waves
Prolonged PR interval (same as hyperkalaemia)

33
Q

How is Wolff-Parkinson White Syndrome seen on an ECG?

A

Short PR interval

Broad QRS

Delta wave

Left or right axis deviation

Pseudo-Q waves

34
Q

How can Digoxin use affect an ECG?

A

U waves

Short QT interval

Downward sloping ST depression

T wave flattening

Arrhythmias - AV block

35
Q

What are causes of RBBB?

A

Right ventricular hypertrophy

PE

MI

36
Q

How does hypothermia present on an ECG?

A

Jesus Quist It’s Bloody Freezing

J waves

QT prolongation

irregular

Bradycardia

First degree block

Also: Torsades de pointes

37
Q

How can Wolff-Parkinson White be treated?

A

Radiofrequency ablation of the accessory pathway

38
Q

What is a ventricular ectopic?

A

A premature ventricular beat causes by random electrical discharges

Seen on ECG as an individual random broad QRS complex

39
Q

What ECG change is seen in cardiac tamponade?

A

Electrical alternans (alternating QRS amplitude)

40
Q

How is torsades de pointes treated?

A

IV Magnesium sulfate, Cardioversion

41
Q

How can raised ICP show on an ECG?

A

Long QT

42
Q

What ECG change can be seen in rheumatic fever?

A

P mitrale due to mitral stenosis

Prolonged PR

43
Q

What are indications for cardiac re-synchronisation therapy in heart failure?

A

Widened QRS complex on ECG

Usually last resort

44
Q

What is normal QT length?

A

No more than 11 small squares

45
Q

What is normal QRS length?

A

No more than 0.12s (3 small squares)

Normal = around 2 small squares

46
Q

What is a bi-fascicular block?

A

RBBB + Left axis deviation

47
Q

What is a tri-fascicular block?

A

RBBB + Left axis deviation + 1st degree heart block

48
Q

What is the difference between 2:1 and 3:1 atrial flutter?

A

2: 1 = 2 flutters to each QRS
3: 1 = 3 flutters to each QRS

49
Q

What precipitates Torsades des Pointes?

A

Long QT

50
Q

How is a posterior MI seen on ECG?

A 
Reciprocal changes in V1-V3 :
ST depression
Tall broad R waves
Upright T waves
Dominant R wave in V2
51
Q

In which leads do you get reciprocal changes (ST depression) for each type of STEMI?

A

PAILI (Posterior, anterior, inferior, lateral, inferior)
You get reciprocal changes in area after
E.g. Anterior MI you get inferior reciprocal changes

52
Q

Which ECG leads are the limb leads?

A

I, II, III

avR, avL, avF

53
Q

What can be the first sign of a STEMI on ECG?

A

Hyperacute T waves

Medicine Finals (32 decks)

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