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CR2 > ECG Qs (stopped at heart block: still to - STEMI and BBB) > Flashcards

ECG Qs (stopped at heart block: still to - STEMI and BBB) Flashcards

1
Q

What does this ECG indicate?

Hypoglycemia
Hyperkalaemia
Hypercalcemia
Hyperglycemia
Hypocalcemia

A

What does this ECG indicate?

Hypoglycemia
Hyperkalaemia
Hypercalcemia
Hyperglycemia
Hypocalcemia

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2
Q

What causes this ECG?

Atrial fibrillation
Normal ECG
Atrial flutter
Junctional Rhythm
WPW

A

What causes this ECG?

Atrial fibrillation
Normal ECG
Atrial flutter
Junctional Rhythm
WPW

electrical activation of the HB from AVN not SAN. Normal QRS

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3
Q

Which best describes the following:

where the heartbeat originates from the AV node or His bundle, which lies within the tissue at the junction of the atria and the ventricle

Atrial fibrillation
Normal ECG
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

A

Which best describes the following:

where the heartbeat originates from the AV node or His bundle, which lies within the tissue at the junction of the atria and the ventricle

Atrial fibrillation
Normal ECG
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

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4
Q

Which best describes the following ECG

Atrial fibrillation
Normal ECG
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

A

Which best describes the following ECG

Atrial fibrillation
Normal ECG
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

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5
Q

Which best describes the following ECG

Atrial fibrillation
Normal ECG
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

A

Which best describes the following ECG

Atrial fibrillation
Normal ECG
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

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6
Q

Which best describes the following ECG

Atrial fibrillation
Normal ECG
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

A

Which best describes the following ECG

Atrial fibrillation
Normal ECG
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

AF with rapid ventricular response

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7
Q

Which best describes the following ECG

Atrial fibrillation
Normal ECG
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

A

Which best describes the following ECG

Atrial fibrillation
Normal ECG
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

Atrial Fibrillation with Normal Ventricular Rate ECG

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8
Q

Name the pathology depicted in this ECG [1]

A

Atrial Fibrillation (with Rapid Ventricular Rate ECG)

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9
Q

Which of the following is not a type of Supraventricular Tachycardias?

AV nodal reentrant tachycardia
Atrial flutter
Wolff–Parkinson–White syndrome
Ventricular fibrillation

A

Which of the following is not a type of Supraventricular Tachycardias?

AV nodal reentrant tachycardia
Atrial flutter
Wolff–Parkinson–White syndrome
Ventricular fibrillation

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10
Q

Which best describes the following ECG

Atrial fibrillation
Normal ECG
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

A

Which best describes the following ECG

Atrial fibrillation
Normal ECG
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

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11
Q

Which of the following best describes the description below:

Electrical impulses in atria cause a high frequency bombardment of AV node (~300 bpm) leading to a high but regular heart rhythm

Atrial fibrillation
Normal ECG
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

A

Which of the following best describes the description below:

Electrical impulses in atria cause a high frequency bombardment of AV node (~300 bpm) leading to a high but regular heart rhythm

Atrial fibrillation
Normal ECG
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

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12
Q

What is the Atrial: Ventricle rate ratio in atrial flutter? [1]

For example, if atrial BPM is 400/min, what would ventricle rate be?

A

2:1 atria to ventricle
400: 200

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13
Q

What does the following picture cause? [1]

A

Atrial flutter

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14
Q

Which best describes the following ECG

Atrial fibrillation
Ventricular fibrillation
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

A

Which best describes the following ECG

Atrial fibrillation
Ventricular fibrillation
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

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15
Q

Which best describes the following ECG

Atrial fibrillation
Ventricular fibrillation
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

A

Which best describes the following ECG

Atrial fibrillation
Ventricular fibrillation
Atrial flutter
Junctional Rhythm
Wolf-Parkinson-White

4:1 ratio instead though

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16
Q

What would this pathology depicted caused?

Atrial flutter
AVN Re-entrant
Ventricular fibrillation
Wolf-Parkinson-White syndrome

A

What would this pathology depicted caused?

Atrial flutter
AVN Re-entrant
Ventricular fibrillation
Wolf-Parkinson-White syndrome

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17
Q

In Wolf-Parkinson-White syndrome, what causes the ‘delta wave’ ? [1]

A

Pre-excitation refers to early activation of the ventricles due to impulses bypassing the AV node via an AP. Also known as bypass tracts,

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18
Q

What would this pathology depicted caused?

Atrial flutter
AVN Re-entrant
Ventricular fibrillation
Wolf-Parkinson-White syndrome

A

What would this pathology depicted caused?

Atrial flutter
AVN Re-entrant
Ventricular fibrillation
Wolf-Parkinson-White syndrome

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19
Q

What would this pathology depicted caused?

STEMI
AVN Re-entrant
Ventricular fibrillation
Wolf-Parkinson-White syndrome

A

What would this pathology depicted caused?

STEMI
AVN Re-entrant
Ventricular fibrillation
Wolf-Parkinson-White syndrome

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20
Q

What would this pathology depicted caused?

STEMI
AVN Re-entrant
Ventricular fibrillation
Wolf-Parkinson-White syndrome

A

What would this pathology depicted caused?

STEMI
AVN Re-entrant
Ventricular fibrillation
Wolf-Parkinson-White syndrome

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21
Q

What would this pathology depicted caused?

STEMI
AVN Re-entrant
Ventricular fibrillation
Wolf-Parkinson-White syndrome

A

What would this pathology depicted caused?

STEMI
AVN Re-entrant
Ventricular fibrillation
Wolf-Parkinson-White syndrome

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22
Q

What would this pathology depicted caused?

STEMI
AVN Re-entrant
Ventricular fibrillation
Wolf-Parkinson-White syndrome

A

What would this pathology depicted caused?

STEMI
AVN Re-entrant
Ventricular fibrillation
Wolf-Parkinson-White syndrome

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23
Q

What would this pathology depicted caused?

STEMI
AVN Re-entrant
Ventricular fibrillation
Wolf-Parkinson-White syndrome

A

What would this pathology depicted caused?

STEMI
**AVN Re-entrant **
Ventricular fibrillation
Wolf-Parkinson-White syndrome

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24
Q

What pathology is depicted here? [1]

A

VF

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25
Q

Which type of heart block describes the following:

intermittent non-conducted P waves without progressive prolongation of the PR interval

First degree
Second degree (Mobitz 1)
Second degree (Mobitz 2)
Third degree

A

Which type of heart block describes the following:

intermittent non-conducted P waves without progressive prolongation of the PR interval

First degree
Second degree (Mobitz 1)
Second degree (Mobitz 2)
Third degree

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26
Q

Which type of heart block describes the following:

P waves present but unsynchronised with QRS complex (contract independently)

First degree
Second degree (Mobitz 1)
Second degree (Mobitz 2)
Third degree

A

Which type of heart block describes the following:

P waves present but unsynchronised with QRS complex (contract independently)

First degree
Second degree (Mobitz 1)
Second degree (Mobitz 2)
Third degree

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27
Q

Which type of heart block describes the following:

PR interval progressively large until PR is blocked (dropped beat) & then starts again

First degree
Second degree (Mobitz 1)
Second degree (Mobitz 2)
Third degree

A

Which type of heart block describes the following:

PR interval progressively large until PR is blocked (dropped beat) & then starts again

First degree
Second degree (Mobitz 1)
Second degree (Mobitz 2)
Third degree

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28
Q

Which type of heart block describes the following:

PR> 220ms. longer for AVN to trigger AP in Bundle of His

First degree
Second degree (Mobitz 1)
Second degree (Mobitz 2)
Third degree

A

Which type of heart block describes the following:

PR> 220ms. longer for AVN to trigger AP in Bundle of His

First degree
Second degree (Mobitz 1)
Second degree (Mobitz 2)
Third degree

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29
Q

What does this ECG indicate?

First degree heart block
Second degree (Mobitz 1) heart block
Second degree (Mobitz 2) heart block
Third degree heart block

A

What does this ECG indicate?

First degree heart block
Second degree (Mobitz 1) heart block
Second degree (Mobitz 2) heart block
Third degree heart block

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30
Q

What does this ECG indicate?

First degree heart block
Second degree (Mobitz 1) heart block
Second degree (Mobitz 2) heart block
Third degree heart block

A

What does this ECG indicate?

First degree heart block
Second degree (Mobitz 1) heart block
Second degree (Mobitz 2) heart block
Third degree heart block

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31
Q

What does this ECG indicate?

First degree heart block
Second degree (Mobitz 1) heart block
Second degree (Mobitz 2) heart block
Third degree heart block

A

What does this ECG indicate?

First degree heart block
Second degree (Mobitz 1) heart block
Second degree (Mobitz 2) heart block
Third degree heart block

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32
Q

What does this ECG indicate?

First degree heart block
Second degree (Mobitz 1) heart block
Second degree (Mobitz 2) heart block
Third degree heart block

A

What does this ECG indicate?

First degree heart block
Second degree (Mobitz 1) heart block
Second degree (Mobitz 2) heart block
Third degree heart block

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33
Q

What does this ECG indicate?

Atrial fibrillation
Ventricular fibrillation
Atrial flutter
AVN reentrant tachycardia
Junctional Rhythm
A

What does this ECG indicate?

Atrial fibrillation
**Ventricular fibrillation**
Atrial flutter
AVN reentrant tachycardia
Junctional Rhythm
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34
Q

What does this ECG indicate?

Atrial fibrillation
Ventricular fibrillation
Atrial flutter
AVN reentrant tachycardia
Junctional Rhythm
A

What does this ECG indicate?

Atrial fibrillation
Ventricular fibrillation
Atrial flutter
AVN reentrant tachycardia
**Junctional Rhythm: starts at AVN not SAN: no P wave & bradycardia**
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35
Q

What does this ECG indicate?

STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
A

What does this ECG indicate?

**STEMI**
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
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36
Q

What does this ECG indicate?

STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
A

What does this ECG indicate?

STEMI
Non STEMI
Atrial Flutter
**Atrial Fibrillation: lack of P wave**
AVN Reentrant Tachycardia
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37
Q

What does this ECG indicate?

STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
A

What does this ECG indicate?

STEMI
**Non STEMI**
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
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38
Q

What does this ECG indicate?

Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
A

What does this ECG indicate?

Type 1 Heart Block
Type 3 Heart Block
**Wolf-Parkinson-White Syndrome**
AVN Reentrant Tachycardia
Atrial Flutter
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39
Q

What does this ECG indicate?

Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
A

What does this ECG indicate?

Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
**Atrial Flutter: saw toothed !!**
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40
Q

What does this ECG indicate?

Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
A

What does this ECG indicate?

Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
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41
Q

Which does the following describe best?

Each atrial impulse encounters a longer and longer delay until one of them does not make it through to the ventricles.

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

A

Which does the following describe best?

Each atrial impulse encounters a longer and longer delay until one of them does not make it through to the ventricles.

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

This is reflected as the PR interval getting progressively longer and longer until all of a sudden, the heart drops a beat.

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42
Q

Which does the following describe best?

Every single atrial impulse eventually makes it to the ventricles, prolonged PR interval

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

A

Which does the following describe best?

Every single atrial impulse eventually makes it to the ventricles, prolonged PR interval

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

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43
Q

Which of the following does this ECG best represent?

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

A

Which of the following does this ECG best represent?

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

none of the electrical impulses are conducted through the AV node, and that’s why it’s also called complete heart block.

So in 3rd degree AV block, the ventricles recognize that they’re not getting any impulses, and respond by generating their own electrical rhythm called a ventricular escape rhythm, just to hang on to dear life.

Because the atria and the ventricles each have their own pacemakers, they now contract independent of one another, which is called AV dissociation. This desynchronization of the heart chambers can reduce cardiac output dramatically, leading to syncope or even sudden cardiac death.

On the ECG, the P-waves and QRS complexes have nothing to do with each other, each appearing at their own rates.

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44
Q

Which of the following does this ECG best represent?

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

A

Which does the following describe best?

Couple of normal PR intervals followed by a dropped beat.

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

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45
Q

What does this ECG indicate?

A

Right bundle branch block

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46
Q

What does this ECG indicate?

A

Left branch bundle block

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47
Q

Name the causes of A and B [2]

A 
A = Afib
B = Atrial flutter (saw toothed)
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48
Q

What ventricular rate would you expect in atrial flutter?

  • 300 bpm
  • 200 bpm
  • 150 bpm
  • 75 bpm
  • 100 bpm
A

What ventricular rate would you expect in atrial flutter?

  • 300 bpm
  • 200 bpm
  • 150 bpm
  • 75 bpm
  • 100 bpm

Atrial flutter consists of a 2:1 block. This means it takes 2 atrial beats for each ventricular beat.

During atrial flutter there will be a atrial rate of 300 and a ventricular rate of 150 bpm.

49
Q

What does this ECG indicate?

Atrial fibrillation
Ventricular fibrillation
Atrial flutter
AVN reentrant tachycardia
Junctional Rhythm
A

What does this ECG indicate?

Atrial fibrillation
**Ventricular fibrillation**
Atrial flutter
AVN reentrant tachycardia
Junctional Rhythm
50
Q

What does this ECG indicate?

Atrial fibrillation
Ventricular fibrillation
Atrial flutter
AVN reentrant tachycardia
Junctional Rhythm
A

What does this ECG indicate?

Atrial fibrillation
Ventricular fibrillation
Atrial flutter
AVN reentrant tachycardia
**Junctional Rhythm: starts at AVN not SAN: no P wave & bradycardia**
51
Q

What does this ECG indicate?

STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
A

What does this ECG indicate?

**STEMI**
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
52
Q

What does this ECG indicate?

STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
A

What does this ECG indicate?

STEMI
Non STEMI
Atrial Flutter
**Atrial Fibrillation: lack of P wave**
AVN Reentrant Tachycardia
53
Q

What does this ECG indicate?

STEMI
Non STEMI
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
A

What does this ECG indicate?

STEMI
**Non STEMI**
Atrial Flutter
Atrial Fibrillation
AVN Reentrant Tachycardia
54
Q

What does this ECG indicate?

Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
A

What does this ECG indicate?

Type 1 Heart Block
Type 3 Heart Block
**Wolf-Parkinson-White Syndrome**
AVN Reentrant Tachycardia
Atrial Flutter
55
Q

What does this ECG indicate?

Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
A

What does this ECG indicate?

Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
**Atrial Flutter: saw toothed !!**
56
Q

What does this ECG indicate?

Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
A

What does this ECG indicate?

Type 1 Heart Block
Type 3 Heart Block
Wolf-Parkinson-White Syndrome
AVN Reentrant Tachycardia
Atrial Flutter
57
Q

Which does the following describe best?

Each atrial impulse encounters a longer and longer delay until one of them does not make it through to the ventricles.

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

A

Which does the following describe best?

Each atrial impulse encounters a longer and longer delay until one of them does not make it through to the ventricles.

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

This is reflected as the PR interval getting progressively longer and longer until all of a sudden, the heart drops a beat.

58
Q

Which does the following describe best?

Every single atrial impulse eventually makes it to the ventricles, prolonged PR interval

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

A

Which does the following describe best?

Every single atrial impulse eventually makes it to the ventricles, prolonged PR interval

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

59
Q

Which of the following does this ECG best represent?

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

A

Which of the following does this ECG best represent?

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

none of the electrical impulses are conducted through the AV node, and that’s why it’s also called complete heart block.

So in 3rd degree AV block, the ventricles recognize that they’re not getting any impulses, and respond by generating their own electrical rhythm called a ventricular escape rhythm, just to hang on to dear life.

Because the atria and the ventricles each have their own pacemakers, they now contract independent of one another, which is called AV dissociation. This desynchronization of the heart chambers can reduce cardiac output dramatically, leading to syncope or even sudden cardiac death.

On the ECG, the P-waves and QRS complexes have nothing to do with each other, each appearing at their own rates.

60
Q

Which of the following does this ECG best represent?

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

A

Which does the following describe best?

Couple of normal PR intervals followed by a dropped beat.

First degree heart block
Second degree, Mobitz 1 heart block
Second degree, Mobitz 2 heart block
Third degree heart block

61
Q

What does this ECG indicate?

A

Right bundle branch block

62
Q

What does this ECG indicate?

A

Left branch bundle block

63
Q

Name the causes of A and B [2]

A 
A = Afib
B = Atrial flutter (saw toothed)
64
Q

What ventricular rate would you expect in atrial flutter?

  • 300 bpm
  • 200 bpm
  • 150 bpm
  • 75 bpm
  • 100 bpm
A

What ventricular rate would you expect in atrial flutter?

  • 300 bpm
  • 200 bpm
  • 150 bpm
  • 75 bpm
  • 100 bpm

Atrial flutter consists of a 2:1 block. This means it takes 2 atrial beats for each ventricular beat.

During atrial flutter there will be a atrial rate of 300 and a ventricular rate of 150 bpm.

65
Q

Based on the quadrant diagram shown, which region would you expect the mean electrical axis to deviate towards in a patient with left ventricular hypertrophy?

A
B
C
D

A

Based on the quadrant diagram shown, which region would you expect the mean electrical axis to deviate towards in a patient with left ventricular hypertrophy?

A
B
C
D

Left ventricular hypertrophy results in a thickening of the cardiac muscle. The increase in mass increases the magnitude of the depolarisation wave on the left side of the heart. This causes the left axis deviation.

66
Q

Based on the quadrant diagram shown, which region would you expect the mean electrical axis to deviate towards in a patient with normal heart?

A
B
C
D

A

Based on the quadrant diagram shown, which region would you expect the mean electrical axis to deviate towards in a patient with normal heart?

A : normal heart axis = -30 to 90 degrees
B
C
D

67
Q

Based on the quadrant diagram shown, which region would you expect the mean electrical axis to deviate towards in a patient with right ventricular hypertrophy?

A
B
C
D

A

Based on the quadrant diagram shown, which region would you expect the mean electrical axis to deviate towards in a patient with right ventricular hypertrophy?

A
B
C
D = 90 to 180 degrees

68
Q

Based on the quadrant diagram shown, which region would you expect the mean electrical axis to deviate towards in a patient with extreme axis deviation?

A
B
C
D

A

Based on the quadrant diagram shown, which region would you expect the mean electrical axis to deviate towards in a patient with extreme axis deviation?

A
B
C
D

69
Q

An 81-year-old man presents to the emergency department after collapsing. Before losing consciousness, he felt light-headed and had palpitations. He was unconsciousness for less than a minute. There is no chest pain. Cardiac examination shows no abnormalities. You perform an ECG, which shows signs of hyperkalaemia. Which of the following is an ECG sign of hyperkalaemia?

ST segment depression
Tall tented T waves
Prominent U waves
Left bundle branch block
Narrow QRS complexes

A

An 81-year-old man presents to the emergency department after collapsing. Before losing consciousness, he felt light-headed and had palpitations. He was unconsciousness for less than a minute. There is no chest pain. Cardiac examination shows no abnormalities. You perform an ECG, which shows signs of hyperkalaemia. Which of the following is an ECG sign of hyperkalaemia?

ST segment depression
Tall tented T waves
Prominent U waves
Left bundle branch block
Narrow QRS complexes

70
Q

A patient has a normal QRS complex, bradycardia and an inverted P wave on an ECG lead II.

How would you describe this pattern? [1]

A

Junctional rhythm

71
Q

What is this ECG? [1]

A

Junctional rhythm

72
Q

What are the characteristics of junctional rhythm ECG? [3]

73
Q

Fibrosis in cardiac conduction system would likely cause what type of ECG? [1]

A

Sinus bradycardia

74
Q

What is the most common type of supraventricular tachycardia? [1]

A

Atrioventricular nodal reentry tachycardia (AVNRT)

75
Q

Why do ventricular ectopics have a wider QRS than a normal, sinus rhythm? [1]

A

Don’t go via purkinje fibres

76
Q

How do you assess if an ECG is normal? [1]

77
Q

Which of the following supraventricular tachyarrhythmias would show a broad QRS (> 120 ms) on an ECG?

A Atrio-ventricular nodal reentrant tachycardia (AVNRT)
B Atrial fibrillation with fast ventricular response
C Atrial tachycardia with bundle branch block
D Multi-focal atrial tachycardia
E Junctional tachycardia

A

Which of the following supraventricular tachyarrhythmias would show a broad QRS (> 120 ms) on an ECG?

C Atrial tachycardia with bundle branch block

78
Q

Which of the following statements regarding heart block is correct?

A First degree heart block is defined as a PR interval > 120 ms
B Second degree heart block is always pathological
C Third degree heart block is associated with AV dissociation
D In Wenckebach, the PR interval is constant
E Third degree heart never requires a pacemaker

A

Which of the following statements regarding heart block is correct?

C Third degree heart block is associated with AV dissociation

79
Q

Supraventricular tachycardia
Ventricular tachycardia
Atrial flutter
Atrial fibrillation
Atrial tachycardia

A

Supraventricular tachycardia

80
Q

How long does the normal delay in conduction at the atrioventricular node last?

A 120 ms
B 100 ms
C 90-200 ms
D 120-200 ms
E > 200 ms

A

How long does the normal delay in conduction at the atrioventricular node last?

D 120-200 ms

The delay in conduction at the AVN is represented by the PR interval on an ECG. The normal PR interval is 3-5 small squares, which equates to 120-200 ms.

Prolongation of the PR interval > 200 ms may be seen in heart block.

81
Q

The transition point describes the lead at which the R wave is equal to the S wave.

What is the normal location of the transition point?

A V1
B V1/V2
C V3/V4
D V5/V6
E V7

A

C V3/V4

The transition point marks the interventricular septum. Typically located at V3/V4.
A shift in the transition point to V4/V5 or V5/V6 is suggestive of right ventricular hypertrophy and this is a subtle sign of pulmonary disease.

82
Q

The term ‘sinus rhythm’ (SR) refers to depolarisation that is initiated in the sino-atrial node (SAN). Normal sinus rhythm (NSR) is a more complete term, but has several parameters that must be met.

Which of the following is not a defining character of NSR?

A Heart rate 66 bpm
B PR interval 140 ms
C Depolarisation initiated in the SAN
D Each p wave and corresponding QRS complex form a 1:1 ratio
E Bundle branch block

A

E Bundle branch block

83
Q

Which of the following supraventricular tachyarrhythmias (SVTs) is the most common?

A Atrial tachycardia
B Multi-focal atrial tachycardia
C Atrioventricular nodal reentrant tachycardia (AVNRT)
D Atrioventricular reentrant tachycardia (AVRT)
E Sino-atrial exit block

A

Which of the following supraventricular tachyarrhythmias (SVTs) is the most common?

A Atrial tachycardia
B Multi-focal atrial tachycardia
C Atrioventricular nodal reentrant tachycardia (AVNRT)
D Atrioventricular reentrant tachycardia (AVRT)
E Sino-atrial exit block

84
Q

Which of the following best describes this ECG finding?

A First-degree heart block
B Mobitz type I
C Mobitz type II
D Complete heart block
E Multi-focal atrial tachycardia

A

B Mobitz type I

85
Q

A Atrial fibrillation
B Atrial flutter
C Atrioventricular nodal reentrant tachycardia
D Ventricular tachycardia
E Atrial tachycardia

A

C Atrioventricular nodal reentrant tachycardia

86
Q

During an acute ST elevation myocardial infarction (STEMI), what is the earliest ECG change?

A ST elevation
B ST depression
C Q waves
D Hyperacute T waves
E T wave inversion

A

During an acute ST elevation myocardial infarction (STEMI), what is the earliest ECG change?

D Hyperacute T waves

Minutes to hours: hyperacute T-waves
0-12 hours: ST-elevation
1-12 hours: Q-wave development
Days: T-wave inversion
Weeks: T-wave normalisation and persistent Q-waves

87
Q

A sinus pause is seen as a transient absence of P waves on an ECG.

How long does the pause need to last to be defined as a sinus pause or arrest?

A 10 seconds
B 0.4 seconds
C 2 seconds
D 1 minute
E 10 minutes

A

C 2 seconds

88
Q

Which of the following is the most appropriate management for a new-onset left bundle branch block (LBBB)?

A Aspirin 75 mg OD
B Reassure and discharge
C Urgent transfer to primary PCI centre
D Management as Non-ST elevation myocardial infarction
E Observe for 24 hours

A

Which of the following is the most appropriate management for a new-onset left bundle branch block (LBBB)?

C Urgent transfer to primary PCI centre

New LBBB may be a sign of acute myocardial infarction and should be treated like an ST elevation myocardial infarction (STEMI) until proven otherwise.

89
Q

Typical causes of LBBB include? [5]

A

Typical causes of LBBB include:
- ST elevation myocardial infarction
- Aortic stenosis
- Ischaemic heart disease
- Cardiomyopathy
- Hypertension

90
Q

Which of the following is not a typical cause of bradycardia?

A Bisoprolol
B Complete heart block
C Sinus arrest
D Hypothermia
E First-degree heart block

A

E First-degree heart block
First-degree heart block leads to an increased delay through the atrioventricular (AV) node (> 200 ms), but does not directly cause bradycardia.

91
Q

Typical causes of RBBB include? [5]

A
  • Right ventricular hypertrophy
  • Pulmonary embolus
  • Right heart failure (cor pulmonale)
  • Ischaemic heart disease
  • Congenital heart disease (septal defects commonly)
92
Q

A Left axis deviation
B Right axis deviation
C Normal axis
D Unable to tell
E Reverse axis

A

Left axis deviation (your answer)

In this example, lead I has a predominantly positive deflection, whereas leads II and III have a predominantly negative deflection. This is consistent with left axis deviation, most likely from a left anterior fascicular block.

93
Q

Which of the following ECG features is most consistent with right ventricular hypertrophy (RVH)?

A Dominant R wave in V6
B T wave inversion in V1
C ST elevation in V1-V4
D Dominant R wave in V1
E Deep S wave in V1

A

Which of the following ECG features is most consistent with right ventricular hypertrophy (RVH)?

A Dominant R wave in V6
B T wave inversion in V1
C ST elevation in V1-V4
D Dominant R wave in V1
E Deep S wave in V1

94
Q

What is the normal width of the QRS complex?

A 100 ms
B < 120 ms
C 40-60 ms
D >120 ms
E 400 ms

A

What is the normal width of the QRS complex?

B < 120 ms

95
Q

A Atrial fibrillation
B Ventricular tachycardia
C Ventricular fibrillation
D Torsades de pointes
E Atrial tachycardia

A

B Ventricular tachycardia

96
Q

What is the likely territory of the myocardial infarction?

A Anteroseptal
B Anterolateral
C Lateral
D Inferior
E Posterior

A

The ECG shows evidence of acute ST elevation within the anterolateral leads V1-V5, I and aVL, which is consistent with a large anterolateral infarction.

97
Q

A Atrial fibrillation
B Ventricular tachycardia
C Supraventricular tachycardia
D Atrial flutter
E Multi-focal atrial tachycardia

A

The ECG shows evidence of atrial flutter with variable block. The ‘flutter’ waves are best visualised in the inferior (II, III, aVF) and anteroseptal (V1, V2) leads

98
Q

Which of the following best describes ‘normal’ cardiac axis?

A -30º to +90º
B -90º to +90º
C 0º to +180º
D 0º to +359º
E -45º to +45º

A

A -30º to +90º

99
Q

What is the standard speed that an ECG is set to?

A 1 mm/s
B 5 cm/s
C 25 mm/s
D 10 cm/s
E 100 mm/s

A

C 25 mm/s

The standard speed of tracing on ECG paper is set at 25 mm/s. This means every 5 large squares equals 1 second.

100
Q

What is the correct anatomical location of the 4th chest lead on a standard 12-lead ECG?

A Left leg
B Midclavicular line, left 5th intercostal space
C Sternal edge, left 4th intercostal space
D Right leg
E Sternal edge, right 4th intercostal space

A

B Midclavicular line, left 5th intercostal space

101
Q

Where would you put the 10 leads for an 12-lead ECG trace? [10]

A

Red: right arm

Yellow: left arm

Green: left leg

Black: right leg

V1: sternal edge, right 4th intercostal space

V2: sternal edge, left 4th intercostal space

V3: between V2 and V4

V4: midclavicular line, left 5th intercostal space

V5: between V4 and V6, left 5th intercostal space

V6: mid-axillary line, left 5th intercostal space

102
Q

Which of the following leads is T wave inversion a normal variant?

A V1
B V4
C V5
D V6
E Lead I

A

Which of the following leads is T wave inversion a normal variant?

A V1
B V4
C V5
D V6
E Lead I

103
Q

P wave should be not more than about 2 small squares long ([] s or [] ms)

A

P wave should be not more than about 2 small squares long (0.08 s or 80 ms)

104
Q

1) QRS duration should be less than [] ms

A

1) QRS duration should be less than 120 ms i.e. three small squares of 40 ms each.

105
Q

small ‘septal’ Q waves typically seen in which leads? [4]

A

small ‘septal’ Q waves typically seen in leads I, aVL, V5 and V6

106
Q

How long after MI would you see pathological Q waves? [1]

A

Myocardial infarction within the first 30-60 minutes

107
Q

Explain why hypoglycemia can be considered a proarrhythmic event [2]

A

. The sympathetic response induced by hypoglycemia also increases the risk of arrhythmias from Ca2+ overload, which occur with sympathomimetic medications and excessive beta adrenergic stimulation

Reduced serum glucose blocks the repolarizing K+ channel HERG, which leads to action potential and QT prolongation

108
Q

Type 2 Mobitz Heart Block:

Patients typically have a pre-existing[]or[] and the 2nd degree AV block is produced by intermittent failure of the remaining fascicle

A

Patients typically have a pre-existingLBBBorbifascicular block, and the 2nd degree AV block is produced by intermittent failure of the remaining fascicle (“bilateral bundle-branch block”)

109
Q

Which population is it normal for T waves to inverted in? [1]

110
Q

Pathological Q waves:
ECG shows T wave inversions secondary to what pathology? [1]

A

ECG shows T wave inversions secondary to inferior wall ischaemia.

111
Q

State 4 commonly negatively chronotropic drugs [4]

A

Beta blockers
Some calcium antagonists: verapamil; diltiazem
Digoxin
Ivabradine

112
Q

Describe the difference between the causes of QRS complexes from narrow-complex and broad complex tachycardias

A

Narrow complex: supraventricular (atrial flutter; afib’ AVRT)
Wide complex: ventricular arrhythmias (ventricular tachycardia)

113
Q

What is sinus arrhythmia? [1]

A

Variation in heart rate that is seen during inspiration and expriation: inspiration heart rate increases and vice versa

114
Q

Name two reasons for sinus bradycarida [2]

A

Drugs (Digoxin; BBB)
MI; Ischaemic heart disease
Hypothyroidism
Hypothermia

115
Q

What effect wiuld salbutamol have on ECG? [1]

A

Sinus tachycardia

116
Q

Name a cause of third degree heart block [1]

A

Lyme disease

117
Q

Describe what causes L/R heart block [1]
Describe the physiological response of L/R ventricle after heart block occurs [2]

A

Conduction down the leeft / right bundle has failed so the left / right ventricle cannot be depolarised by the PF.

However the opposing ventricle can still depolarise normally, so the normally functioning ventricle depolarises first but then this wave of depolarisation spreads slowly across the the other venticle, going from myocyte to myocyte until that ventricle has depolarised

This delay in ventricular activation causes interventricular dyssynchrony

118
Q

Describe the direction of depolarisation in LBBB [1]

How does LBB present on ECG?

A

Interventricular septum has to depolarise from right to left (a reversal of normal pattern), causes:

small Q wave in V1; small r wave in V6

CR2 (59 decks)

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