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Cardiology > ECG Interpretation > Flashcards

ECG Interpretation Flashcards

1
Q

ECG definition of a STEMI

A

Men
1. 2.5 small square rise in ST in V2 - 3 (2 squares if over 40 y/o)

Women
2. 1.5 small squares in V2 - 3

  1. 1 square in any other leads
  2. must be 2 consecutive leads

5.New LBBB

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2
Q

Pericarditis (3)

A
  1. Widespread ST elevation
  2. Saddle-shaped ST
  3. PR depression - most specific
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3
Q

Atrial Flutter (2)

A
  1. Sawtooth Baseline (rapid successive P waves)
  2. Ventricular rate depending on degree of AV Node Block
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4
Q

Brugada Syndrome

A
  1. J point Elevation in V1-3
  2. Convex ST elevation
  3. Inverted T waves
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5
Q

Left Ventricular Hypertrophy (2)

A
  1. Sum of S wave in V1 and R wave in V5 or 6
  2. Exceeds 40mm - 8 big squares
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6
Q

Left Atrial Enlargement (3)

A
  1. Bifid P Wave in lead 2 with duration
  2. > 120 ms - 3 little sqaures
  3. In V1 P wave is Terminal Negative (last portion is negative deflection)
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7
Q

Causes of Left Axis Deviation (7)

A
  1. Left anterior Hemiblock
  2. LBBB
  3. Inferior MI
  4. WPW syndrome - Right sided accessory pathway
  5. Hyperkalaemia
  6. Congenital - Ostium Primum ASD, Tricuspid Atresia
  7. Minor in Obese people

TEST ANSWER IF NOT SPECIFIED - WPW SYNDROME

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8
Q

Causes of Right Axis Deviation (9)

A
  1. RVH
  2. Left Posterior Hemiblock
  3. Lateral MI
  4. Chronic Lung Disease - Cor Pulmonale
  5. PE
  6. Ostium Secundum ASD
  7. WPW Syndromre with Left Accessory Pathway
  8. Normal Infant <1
  9. Minor in Tall People

TEST ANSWER IF NOT SPECIFIED = WPW Syndrome

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9
Q

Define Bifasicular Block (2)

A
  1. Combined RBBB with either Anteriror or Posterior left fascicle also blocked
  2. Causes RBBB with Left Axis Deviation
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10
Q

Define Trifasicular Block (2)

A
  1. Combination of Bifasicular block and an AVN block above it like a 1st or 2nd degree
  2. Results in RBB with LAD AND a prolonged PR interval or 2nd degree signs

Its a Misnomer - it is NOT a complete hearet block like it sounds

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11
Q

Which Leads pertain to the Left Anterior Descending Artery (1)

A
  1. ANTEROSEPTAL LEADS - V1 - V4
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12
Q

Which Leads pertain to the Richt Coronary Artery (3)

A
  1. INFERIOR LEADS - 2, 3, aVF
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13
Q

Which Leads pertain to the Proximal Left Anterior Descending Artery (1)

A
  1. ANTEROLATERAL LEADS - V1-6, aVL
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14
Q

Which Leads pertain to the Left Circumflex Artery (1)

A
  1. LATERAL LEADS - 1, aVL, V5-6
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15
Q

Which Leads pertain to the Left Cirumclex/Right Coronary Artery (1)

A
  1. V1-3 +/- POSTERIOR LEADS placed on back to confirm V7-9
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16
Q

Sign of new ACS on ECG (1)

A
  1. New LBBB
17
Q

Signs of Digoxin on ECG (4)

A
  1. Down-Sloping ST depression “Reverse Tick”
  2. Flatened / Inverted T waves
  3. Short QTc
  4. Arrhythmias - AV Block, Bradycardia
18
Q

Signs of Hypokalaemia on ECG (5)

A
  1. U waves
  2. Small or absent T waves (opposite to hyperK)
  3. Prolonged PR
  4. ST Depression
  5. Long QTc

“U have no Pot and no T, but a long PR and a long QTc”

19
Q

Signs of Hypothermia on ECG (5)

A
  1. Brodycardia
  2. J waves - Osborne Waves = small bump at end of QRS
  3. 1st deg Heart block - long PR
  4. Long QTc
  5. Arrhythmias
20
Q

Signs of LBBB on ECG (4)

A
  1. WiLLiaM
  2. V1- rS - basically a single negative deflection in V1 with a small upstroke first (the little r and big S)
  3. V6 - R - M shaped / notched R wave in V6
  4. Wide QRS
21
Q

Causes of LBBB (5)

A
  1. MI
  2. HTN
  3. AS
  4. Cardiomyopathy
  5. Fibrosis

NEW LBB IS ALWAYS PATHOLOGICAL

22
Q

Sign onECG of previous infarction (1)

A
  1. Pathological Q waves
23
Q

Describe ECG changes seen in MI in a temporal order (what comes first etc) (4)

A
  1. First sign is Hyper Acute T waves meaning - broad, asymmetrically peaked T waves
  2. ST elevation follows
  3. T wave inversion next within 24 hours and resolve between days and months
  4. Pathological Q waves which remain permenantly
24
Q

Normal ECG changes in an Athlete (4)

A
  1. Sinus brady
  2. Junctional rhythms
  3. 1st Deg AVN block
  4. Mobitz 1 - Wenckebach
25
Q

P wave changed and Dxs on ECG (3)

A
  1. Increased P wave Amplitude is called P Pulmonale and is a sign of = Cor Pulmonale - which is pulmonary hypertension stressing the right heart
  2. Broad, notched, bifid P waves = often best seen in Lead II, Left Atrial enlargement = Mitral Stenosis
  3. Absence of P = AFib
26
Q

Causes of prolonged PR interval (9)

A
  1. Idiopathic
  2. IHD
  3. Digoxin toxicity
  4. Hypokalaemia
  5. Aortic root disease secondary to IE
  6. Lyme disease
  7. Sarcoidosis
  8. Myotonic Dystrophy
  9. Athletes
27
Q

Causes of Short PR interval (1)

A
  1. WPW Syndrome
28
Q

Signs of RBBB on ECG (4)

A
  1. MaRRoW
  2. V1 - rSR’ - means a small deflection up (r) then large down (S) then second large up (R’) - creating the M shape in V1 andnis caused by the delayed right vent depolarising (the 2nd large R wave)
  3. V6 - qRs - (really small downard q, then large positive R, then slurred/notched S wave that slowly rejoins iso line) The S wave is the bit considered to look like a W as it slurrs to the electric line.
  4. Broad QRS
29
Q

Causes of RBBB (7)

A
  1. Normal Variant in increasing age
  2. RVH
  3. Chronic increase RV pressure - Cor Pulmonary
  4. PE
  5. MI
  6. ASD - Ostium Secundum
  7. Cardiomyopathy or myocarditis
30
Q

Causes of ST depression (5)

A
  1. Secondary to abnormal QRS (LVH, LBBB, RBBB)
  2. Ischaemia
  3. Digoxin
  4. Hypokalaemia
  5. Syndrome X
31
Q

Causes of ST Elevation (7)

A
  1. MI
  2. Pericarditis / myocarditis
  3. Normal Variant - “high take off”
  4. LV aneurism (following serious transmural ischaemia / death)
  5. Prinzmetal’s Angina (coronary spasm)
  6. Takotsubo Cardiomyopathy (broken heart syndrome from severe meotional distress - think death of partner)
  7. SAH - rare
32
Q

Causes of Peaked T Waves (2)

A
  1. HypERkalaemia
  2. Myocardial Ischaemia - acute phase of MI
33
Q

Causes of Inverted T waves (6)

A
  1. Myocardial Ischamia - later sign in STEMI
  2. Digoxin Toxicity
  3. SAH
  4. ARVH
  5. PE (s1q3 “T3” - means T inversion)
  6. Brugada Syndrome
34
Q

Wellen’s Syndrome on ECG (4)

A
  1. A pattern seen in significant LAD stenosis
  2. Biphasic or Deep T wave inversion in V2 and V3
  3. Minimal ST elevation
  4. No Q Waves
35
Q

Effect of Hypercalcaemia on QTc (1)

A
  1. Shortens QTc
36
Q

HOCM (4)

A
  1. LVH
  2. Non specific ST and T changes
  3. Deep Q waves
  4. AFib occaisionally
37
Q

WPW Syndrome (4)

A
  1. Short PR inteval
  2. Wide QRS with Slurred upstroke (delta waves)
  3. Left Axis Deviation if right sided accessory pathway - most cases and most Questions (TYPE B)
  4. Right Axis Deviation if Left sided accessory pathway (TYPE A)
38
Q

Normal QRS duration? (1)

A
  1. 80 - 100 ms (0.08 -0/1 seconds)

Cardiology (8 decks)

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