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EC History taking and physical examination > ECG quick > Flashcards

ECG quick Flashcards

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1
Q

sinus rhythm

A
  1. P wave before every QRS
  2. P wave with sinus morphology
  3. Positive in I, II, aVF, negative in aVR
  4. HR 60-100 bpm
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2
Q

Heart axis

A
  1. I + aVF +
    - > 0-90 degrees (normal axis)
2. I+ aVF -
II +
-> 0-(-30) degrees (normal axis)
II -
-> -30-(-90) degrees (LAD -> left-axis deviation)
  1. I - aVF +
    - > 90-180 degrees (RAD -> right-axis deviation)
  2. I- aVF -
    - > -90-(-180) degrees (EAD -> extreme-axis deviation)
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3
Q

P wave duration + amplitude

A

≤ 0.12 s

amplitude -> normally no more than:
1. 0.25mV in frontal plane leads
2. 0.3 mV in precordial leads
3. V1: positive ≤0.15 mV
negative ≤0.1 mV
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4
Q

PR duration

A

adult: 0.12 to 0.20 s

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5
Q

QRS duration

A

0.07-0.11 s

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6
Q

Direction of QRS

A
  1. Always should be positive in:
    1) I, II
    2) aVL
    3) V4, V5, V6
  2. Should be negative in
    1) aVR
    2) V1
    3) V2
  3. In other (III, aVF, V3) can be either
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7
Q

Significant elevation of ST -> norms

A

1) in V2 and V3
1. Women ≥0.15 mV
2. Men <40 years: ≥0.25 mV
3. Men ≥40: ≥0.2 mV
2) in other leads: ≥0.1 mV

3) Measured in point J

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8
Q

Significant decrease of ST -> norms

A
  1. V1, V2, V3 ≥0.05 mV
  2. Other leads ≥0.1 mV
  3. Measured in point J
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9
Q

T wave amplitude

A

1) shouldn’t exceed 0.6 mV in limb leads

2) shouldn’t exceed 1.0 mV in precordial leads

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10
Q

QTc duration

A

≤ 0.46 s

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11
Q

right atrial enlargement

A
  1. peaked proximal part of P wave (A-like appearance)
    - > it’s called P PULMONALE
  2. Amplitudes of P wave: >0.25 mV in II or > 0.15 mV in positive phase of V1
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12
Q

left atrial enlargement

A

Duration of P wave > 0.12s in II or

Increase in duration (>0.04s) and amplitude (0.1 ms) of negative phase of P wave in V1

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13
Q

Left ventricular enlargement suggestion

A

V1 -> increase in S (QS) wave amplitude
V6 -> increase in R amplitude
I and aVL-> increase in R wave amplitude

Cornell criteria: R wave in aVL + S wave in V3:
⩾ 2.8 mV in males
⩾ 2.0 mV in females

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14
Q

Right ventricular enlargement suggestion

A

V1 -> increase in R amplitude
V6 -> increase in S amplitude
R>S in V1
S>R in V5 or V6

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15
Q

RBBB

A
  • > all
    1. QRS ≥ 0.12 s (incomplete ≥ 0.11 s)
    2. V1 or V2: M-shaped QRS (RSR’) and
    3. I and V6: S wave wider than R wave or ≥ 0.04 s)
    4. Possible changes of ST (oblique decrease) and T (negative) -> V1, V2, V3
  • > (if not -> consider myocardial infarction)
    5. Late intrinsicoid in V1 R’ peak or late R peak, >0.05 s
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16
Q

LAFB

A
  1. Left axis deviation (-45 to -90 degrees)
  2. Small Q (qR) in aVL and I
  3. Small R (rS) in III and aVF
  4. QRS <0.12 s
  5. Late intrinsicoid deflection in aVL >0.045 s (qR)
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17
Q

LPFB

A
  1. Right axis deviation (90 to 180 degrees)
  2. Small Q (qR) in III and aVF and
  3. Small R (rS) in I and aVL
  4. QRS <0.12 s
  5. Late intrinsicoid deflection in aVF (>0.045 s)
  6. No evidence of RVH
18
Q

LBBB

A
  1. QRS ≥ 0.12s (incomplete ≥ 0.11 s)
  2. Mid QRS notching/ slurring in two of the left-leaning leads (I, aVL, V5, V6)
  3. QS or rS in V1-V3
  4. V5,V6 -> late (>0.06 s) intrinsicoid
  5. Possible changes in ST and T opposite to QRS amplitude (if not -> consider myocardial infarction)
  6. Always look for STEMI criteria with LBBB
19
Q

Equivalents of STEMI new LBBB criteria

A

LBBB criteria + 1 of:

  1. ST elevation ≥ 0.1 mV in a lead with upward QRS complex
  2. ST depression ≥ 0.1 mV in V1, V2, or V3
  3. ST elevation ≥ 0.5 mV in a lead with downward (discordant) QRS complex

QS in V1-V4 or Q in V5 or V6 can suggest new or past MI

20
Q

Ventricular preexcitation ecg criteria

A
  1. PR interval duration < 0.12 s
  2. Delta wave at the beginning of the QRS complex
  3. QRS > 0.12 s
  4. Changes in ST segment and T wave -> usually opposite side of the QRS complex
21
Q

Brugada syndrome ECG

A

-> in V1-V3
Type I -> ST elevation (usually in J point) ≥0.2 mV with coved ST segment with ST segment decreasing -> to negative T wave
Type II -> High J-point eleviation ≥2mm, saddleback ST first decreasing (but > 1mm above baseline) but T wave positive or biphasic
Type III -> J point eleviation ≥ 2 mm with ST elevation < 1mm (saddleback), positive T wave

22
Q

Eleviation of ST causes

A

Electrolites (Hyperkaliemia)
LBBB
Early repolarization (benign)
Ventricular hypertrophy
A3 -> Arrhyrhmia (VT, Brugada), Aneurysm of LV, Aortic dissection
T -> TBA - Traumatic brain injury or Takotsubo disease
Infarction
Osborn waves (hypothermia)
Non-artherosclerotic vasospasm (Prinzmetal angina)

23
Q

Equivalents of STEMI (signs allowing to diagnose STEMI without additional criteria)

A
  1. new LBBB with addition criteria
  2. Posterior MI
  3. LMCA Occlusion
  4. Wellen’s Syndrome
  5. De Winter’s T Waves
24
Q

Posterior MI

A
  1. RCA (90%), LCX (10%)
  2. V2, V3 -> ST depression ≥ 0.05 mV
  3. Usually broad, prominent and tall R waves in V1-V2 (R≥S, R ≥ 40ms)
  4. V7-V9 ST elevation ≥ 0.05 mV
25
Q

LMCA Occlusion

A
  1. ST elevation in aVR with diffuse (at least 8) ST depressions
26
Q

Wellen’s Syndrome

A
  1. Deeply-inverted or biphasic T waves in V2-3 (V1-V4) with or without ST elevation
  2. Suggests critical LAD occlusion
27
Q

De Winter’s T Waves

A
  1. Precordial ST-segment depression at the J-point
  2. Tall, peaked, symmetric T waves in the precordial leads
  3. Suggest LAD occlusion
28
Q

ECG localization of STEMI

A
  1. Anterior (LAD): V1-V4
    - > Anteroseptal (LAD, diagonal) -> V1-V2
    - > Anteroapical (distal LAD) -> V3-V4
  2. Lateral (LCX) -> I, aVL, V5-V6
  3. Inferior (PDA) -> II, III, aVF -> + in 1/3 RV ischemia
  4. Posterior (PDA) -> ST depressions in V1-V3 with tall R waves, V7-V9 ST elevation
  5. RV (RCA, acute/right marginal artery) -> VR3-VR4, suggested by eleviation of ST in V1
29
Q

Progression of STEMI ECG waves and segements with time

A
  1. Increase in T wave amplitude, tombstoning
  2. ST elevation -> Pardee waves
  3. Q waves (takes several hours to days to develop) and decreasing R wave amplitude
  4. Invertion of T waves (negative), ST return to isoelectric
30
Q

Acute pericarditis ECG

A

STAGE 1 -> because inflammation involves epicardial myocardium

  1. Widespread ST elevations, often horizontal or upward
  2. Upright T waves
  3. PR depression (50%)

STAGE 2

  1. ST return to normal
  2. T waves become inverted
31
Q

Pericardial effusion and chronic constriction ECG

A
  1. Low voltage
  2. Widespread ST-elevation
  3. Total electrical alternans -> alternating high and low voltages of all ECG waveforms between cardiac cycles within a given lead
  4. T-wave inversion
  5. AF in 1/3
32
Q

PE ECG

A
  1. Tachycardia
  2. Nonspecific ST and T changes
  3. Negative T waves in V2-V4
  4. QR in V1
  5. SIQIIITIII -> rarely
  6. Acute Cor Pulmonale, RV overload -> rarely, in massive PE
33
Q

Cor Pulmonale (Pulmonary hypertension, RV overload features) ECG

A
  1. RV dilation/ hypertrophy
  2. RBBB
  3. Rightward axis devation
  4. P pulmonale
34
Q

Hypothermia in ECG

A
  1. Osborn waves -> deflections at the J point at the same direction as QRS complex -> height roughly proportional to the degree of hypothermia
  2. PR and QT prolongation
  3. Widening of QRS
35
Q

Hypokaliemia in ECG

A

LUFTP -> Low K - U waves, Flattened T, Prolongation of QTc

  1. Flattening or invertion of T wave
  2. ↑ prominence of U waves
  3. ↑ of QTc (and sometimes PR interval)
  4. Slight depression of ST segment

-> hyperpolarization
+ often premature beats and sustained tachyarrhythmias, tordases de pointes
ALKALOSIS

36
Q

Hyperkaliemia in ECG

A
  1. Tall, peaked T waves (from 5.5 mM)
  2. Loss or flattening of P waves (from 6.5 mM)
  3. Widened QRS (from 7 mM)
  4. ↓ of QTc
  5. ↑ of PR
  6. Sine wave appearance (K levels 7-8 mM)

-> decrease of potential, AV blocks, VF, Asystolia
ACIDOSIS

37
Q

Hypocalcemia and hypercalcemia in ECG

A

Hypocalcemia -> ↑ QTc

Hypercalcemia -> ↓ QTc

38
Q

Digitalis effect on ECG

A
  1. Coved ST-segement depression -> “Salvador Dali sagging” appearance
  2. Flattened T wave
  3. ↓ QTc interval
39
Q

Tricyclic Antidepressant (TGA) ECG

A
  1. Wide QRS complex

2. ↑ of QTc

40
Q

Class 1 Antiarrhythmics on ECG

A

1A -> ↑ of QTc, ↓ T wave and ↑ U wave amplitude toxicity -> prolongation of QRS
1B -> usually no effect on ECG
1C -> broadening of QRS, without affecting interval between J point and T wave

41
Q

Class 2, 3, 4 Antiarrhythmics on ECG

A 
2 and 4 -> sinus bradycardia, ↑ PR
3 -> ↑QTc (Amiodaron has class 1, 2, 3 effect)

EC History taking and physical examination (12 decks)

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