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ECG Theory > ECG Interpretation > Flashcards

ECG Interpretation Flashcards

1
Q

What is the Flowchart for interpreting an ECG

A
  1. Right patient?
  2. Rate
  3. Sinus Rhythm?
  4. Cardiac Axis
  5. Assess P waves
  6. P-R Interval
  7. QRS Complex Width
  8. ST-elevation?
  9. T Wave inversion?
  10. Q Waves?
  11. QT Interval
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2
Q

Where is T wave inversion normal

A

In aVR, III, V1 and V2

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3
Q

What does T wave inversion represent

A

Ischemia (24-48 hours), Ventricular Hypertrophy, BBB, Digoxin

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4
Q

What may cause ST elevation

A

MI, Pericarditis

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5
Q

How do you differentiate ST elevation in an MI from Pericarditis

A

localised in MI, in most leads in pericarditis

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6
Q

What causes ST depression

A

Ischemia

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7
Q

What does bundle branch block cause

A

delayed depolarisation of ventricles, causing a wide QRS

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8
Q

Where is RBBB best seen

A

V1

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9
Q

Where is LBBB best seen

A

V6

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10
Q

What does RBBB look like

A

M shape in V1 OR Positive v1 + wide QRS

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11
Q

What does LBBB look like

A

Wide QRS + negative V1 OR M shape in V6/W shape in V1

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12
Q

What does asymptomatic LBBB indicate

A

Aortic Stenosis

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13
Q

What does (new) LBBB + chest pain indicate

A

Acute MI

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14
Q

What is the minimum requirement for ST elevation to be considered significant

A

> 2mm in a chest lead, >1mm in a limb lead, must be at least 2 leads to be significant

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15
Q

What causes Right axis deviation

A

Right ventricular hypertrophy

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16
Q

What most commonly causes left axis deviation

A

Conduction deficits

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17
Q

What does an axis deviation indicate

A

Not much if in isolation, although signs of RVH/LVH/Pulmonary embolus( in RAD)/conduction deficits should be investigated

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18
Q

What indicates right ventricular hypertrophy

A

Tall V1 R wave + Right axis deviation + V5/V6 having equal R + S waves

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19
Q

what indicates left ventricular hypertrophy

A

Tall V6 R wave (+ potentially left axis deviation)

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20
Q

Whats the height rule for R waves in V5/V6 and the s wave in V1

A

Combined height shouldn’t exceed 25mm (otherwise this indicates LVH)

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21
Q

What indicates 1st degree heart block

A

PR interval >220ms

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22
Q

What causes 1st degree heart block

A

Found in athletes commonly, coronary aa disease, acute rheumatic fever, electrolyte disturbance, digoxin toxicity

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23
Q

What are the 3 variations of 2nd degree heart block

A 
Mobitz type 2 
Wenkebache phenomenon (Mobitz type 1) 
2:1/3:1/4:1 conduction
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24
Q

What is Mobitz type 2 heart block

A

constant P-R interval with occasional non conducted p waves

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25
Q

What is Mobitz type 1/Wenkebache heart block

A

Gradually lengthening P-R interval until a non conducted beat and repeat

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26
Q

What is 3rd degree heart block

A

atrial contraction + ventricle contraction independent of eachother

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27
Q

What does 3rd degree heart block indicate

A

MI/Chronic tissue disease, Pacing required

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28
Q

What is sinus bradycardia associated with

A

athletic training, fainting, hypothermia, hypothyroidism, post MI

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29
Q

What is sinus tachycardia associated with

A

exercise, fear, pain, haemorrhage or thyrotoxicosis

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30
Q

Where are the 3 places non-sinus rhythms can originate from

A

Atrial muscle, Ventricular muscle, AVN

31
Q

What does a non sinus atrial rhythm look like

A

abnormal p waves

32
Q

What does a non sinus ventricular rhythm look like

A

wide/abnormal QRS complexes

33
Q

What does a non sinus AVN rhythm look like

A

no p wave

34
Q

How fast does the AVN depolarise

A

50 bpm

35
Q

What is the rough speed of an excape rhythm

A

30bpm

36
Q

How do you manage bradycardia

A

Treat reversible causes
asses for adverse factors (shock, syncope, heart failure, MI, recent asystole, mobitz type 2, type 3 heart block)
if non present monitor
if some present 500mcg IV atropine (up to 3g) + pacing if necessary

37
Q

What needs to be identified to be able to say an ECG is showing a tachycardic rhythm

A

P waves

38
Q

Whats the speed of atrial tachycardia

A

100-200bpm

39
Q

What is the maximum conduction speed of the AV node

A

200bpm

40
Q

When should Atrial fibrillation be treated

A

if the rhythm is irregular

41
Q

What should you do if there is atrial fibrillation at a regular rate

A

attempt vagal manouvers (carotid sinus massage, valsava manover)
If unsuccessful Adenosine 6mg (12mg if ineffective, verapimil in asthma)
Last resort cardioversion

42
Q

What does ventricular tachycardia look like

A

wide QRS in all 12 leads

43
Q

Why is ventricular tachycardia dangerous

A

may progress to ventricular fibrillation

44
Q

When does ventricular tachycardia require cardioversion

A

<90mmHg systolic
Chest pain
Heart failure
Rate >150

45
Q

If no abnormal features are present how do you treat ventricular tachycardia

A

amiodarone 300mg

Cardioversion if this fails

46
Q

What does ventricular fibrillation look like on an ECG

A

No QRS, disorganised

47
Q

What does atrial fibrillation look like on an ECG

A

Irregular baseline with no p waves , 450-600 bpm, normal QRS

48
Q

if AF is suspected but not seen on an ECG what should be the next line of investigation

A

24-hour ambulatory ecg monitoring

49
Q

what is the treatment cascade for fibrillation

A

Symptomatic or haemodynamically unstable = immediate cardioversion
Haemodynamically stable = rate/rhythm control (beta blocker or rate limiting Ca2+ inhibitor) + anticoagulation (aspirin if low risk of stroke via CHADVASC, warfarin if medium-high risk, aspirin + clopidogrel if warfari is CI)

50
Q

What does atrial flutter look like

A

Saw tooth baseline, 300-450bpm , similar to AF but baseline looks regularly irregular as opposed to AF where it looks irregularly irregular

51
Q

What does hyperkalaemia look like on an ECG

A

tall ‘tented’ t waves, wide QRS, prolonged PR interbal

52
Q

What does hypokalaemia look like on an ECG

A

T wave flattening, V wave at the end of T wave

V wave = larger wider t wave

53
Q

What does hypercalcaemia look like on an ECG

A

QT shortening

54
Q

What does hypocalcaemia look like on an ECG

A

QT lengthening

55
Q

What is wolf-parkinson-white syndrome + what does it look like on an ecg

A

There is an additional conducting bundle alongside the bundle of his, unconnected to the AVN, causing spontaneous paroxysmal tachycardia
ECG shows a delta wave (lengthening of the proximal part of the QRS complex due to pre-excitation of the accessory bundle)

56
Q

What region/artery is represented in lead 1

A

Lateral region, supplied by the circumflex artery

57
Q

What region/artery is represented in Lead 2

A

Inferior region, supplied by the right coronary artery

58
Q

What region/artery is represented in Lead 3

A

Inferior region, supplied by the right coronary artery

59
Q

What region/artery is represented in aVL

A

Lateral (no artery)

60
Q

What region/artery is represented in aVF

A

Inferior region, supplied by the right coronary artery

61
Q

What region/artery is represented in V1

A

Septal region, supplied by the left anterior descending artery

62
Q

What region/artery is represented in V2

A

Septal region, supplied by the left anterior descending artery

63
Q

What region/artery is represented in V3

A

Anterior region, supplied by the left anterior descending artery

64
Q

What region/artery is represented in V4

A

Anterior region, supplied by the left anterior descending artery

65
Q

What region/artery is represented in V5

A

Lateral region, supplied by the circumflex artery

66
Q

What region/artery is represented in V6

A

Lateral region, supplied by the circumflex artery

67
Q

What do p waves look like in right atrial hypertrophy

A

peaked

68
Q

What do p waves look like in left atrial hypertrophy

A

notched and broad

69
Q

what do deep Q waves indicate

A

previous infarction

70
Q

where are deep Q waves normal

A

Leads I, aVL, V5 + V6

71
Q

What is a normal QT interval

A

<0.45 seconds

72
Q

What is the minimum for a wide QRS

A

> 120ms

73
Q

How big and how much time does a small square on the ECG paper represent

A

1mm, 0.04 seconds (40ms)

ECG Theory (1 decks)

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