ECG midterm Flashcards
ID point
Where the QRS turns downwards the last time
Normal ID values (left+right)
V1 & V2 (right): ID < 40 ms
V5 & V6 (left): ID < 60 ms
*Fra start av QRS til ID point (siste peak)
Incomplete bundle branch block
QRS characteristics of a BBB, but not pathologically wide (>0,12s)
Extreme left deviation
More than -30*
Often LAH
Extreme right deviation
More than 110*
Often LPH
Lenegre syndrome
Type of bifascicular block
RBBB + LAH
Bifascicular block
RBBB + LAH/LPH
Trifascicular block
Bifascicular block + 1* AV block
RBBB
- QRS > 0,12s
- “MoRRoW”: V1, Right, V6
- Wide S in lead I as well
LBBB
- QRS > 0,12s
- “WiLLiaM”: V1, Left, V6
- rS or QS in V1-V4
When consider BBB
When:
- QRS is wide
- Impulse of supraventricular origin
- and WPW excluded
WPW
Wolff-Parkinson-White preexcitation syndrome
- Kent bundle
- δ wave (-> short PR, wide QRS)
LGL
Lown-Ganong-Levine preexcitation syndrome
- James bundle (atrio-hisian)
- Short PR
AVNRT
Atrioventricular nodal reentrant tachycardia
- Regular tachycardia ~140-280 bpm.
- QRS narrow (< 0,12s)
- QRS alternans – phasic variation in QRS amplitude
- P waves if visible exhibit retrograde conduction with P-wave inversion in leads II, III, aVF.
AVRT antidromic
- HR: 200-300 bpm
- Wide QRS
AVRT orthodromic
- HR: 200-300 bpm
- Narrow QRS (after wide QRS’s in WPW)
- QRS alternans - variation in amplitude
- T inversion common
- ST depression
Hyperacute STEMI
- ST elevation
- Peaked T wave (=T en dome)
*Ischemia and lesion
Acute STEMI
- ST elevation
- Inverse T
- Pathological Q
- Ischemia, lesion and necrosis
Subacute STEMI
- Inverse T (coronary)
- Pathological Q (and/or reduction R)
*Ischemia and necrosis
Definitive/ Old STEMI
- Pathological Q
* Necrosis
Subendocardial lesion
- TP and PR elevation
- ST depression
- Pathological Q og R reduction
Subepicardial/transmural lesion
- TP and PR depression
- ST elevation
- Pathological Q or QS
Transitional zone shift
Normal: V3-V4 Right shift (V1-V2): Right ventricular hypertrophy Left shift (V5-V6): Left ventricular hypertrophy
Missing R-progression
“R-regression”
- Often necrosis (MI)
P wave morphology not symmetrical in same lead
Multifocal
Pre-excitation definition
PQ shorter than 0,12 s
AV block definition
PQ longer than 0,2 s
PQ interval time
0,12-0,2 s (3-5mm)
LAH
Left anterior hemiblock
Extreme left deviation (more than -30)
LPH
Left posterior hemiblock
Extreme right deviation (more than 110)
Always isoelectric
TP segment
Ascending ST segment
Can be normal
Max normal deviation J-point
Up: 0,1 mV
Down: 0,05 mV
Escape beats vs premature contractions
Escape beats: comes after pause
Premature beats: comes too early, then pause
Paroxysmal supraventricular tachycardia (PSVT)
- Sudden onset and termination
- Rhythmic
- HR: 150-250 bpm
- No P wave
- Can be terminated by carotid massage
Atrial flutter
- F-waves (constant and rhythmic)
- Regular ventricular rhythm
- Functional AV block (2:1, 3:1, 4:1…)
Atrial fibrillation
- Numerous impulse generation sites
- Absolute arrhythmia
- No P waves (small f-waves may be seen)
MAT
Multifocal atrial tachycardia
- P waves present!
- Diff. sites of impulse generation, but do not fire simultaneously
- Absolute arrhythmia
- Compare to atrial fibrillation!
Angina pectoris types
Classic: ST depression
Prinzmetal: ST elevation
Stable
Unstable
Atrial enlargement
Leads II and V1
Right ventricular hypertrophy
- V1: R > S (R>7mm)
- V6: S > R
- Right deviation
Anterior infarction
- V1-V4
- Proximal LAD occlusion
Lateral infarction
- I, aVL, V5 and V6
- High lateral: I and aVL
- Circumflex occlusion
Inferior infarction
- II, III and aVF
- Distal posterior descending
Posterior infarction
- Mirror V1-V4
- Branches posterior descending
Septal infarction
- (V1), V2, V3, (V4)
- Septal branches (LAD or post desc)
Anterolateral infarct
- I, aVL, V1-V5
Extensive anterior infarct
I, aVL, V1-V6
Posteroinferior infarct
- II, III, aVF
- Mirror V1-V4
Sokolow criteria left ventricular hypertrophy
R in V5/V6 + S in V1/V2 > 35 mm
Scoop-like ST
Digitalis toxicity
Hypercalcemia
Shorter QT
Hypocalcemia
Longer QT
Hyperkalemia
Tented T
Hypokalemia
- Flat T
- U wave
- ST depression
Arythmogenic factors
HIS DEBS
- Hypoxia
- Ischemia + Irritability
- Sympathetic stimulation
- Drugs
- Electrolyte disturbances
- Bradycardia
- Stretch
AV dissociation
No correlation between P and QRS
