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Cardiology > ECG's > Flashcards

ECG's Flashcards

1
Q

name 8 causes of caridac arrhythmias

A
  1. caffine
  2. MI
  3. phaeochromocytoma
  4. HF
  5. metabolic imbalance
  6. pericarditis
  7. myocarditis
  8. alcohol
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2
Q

define bradycardia

A

heart rate less than 60bmp at rest

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3
Q

treatment for bradycardia

A

atropine IV- antimuscarinic, and if that doesnt work give a temporary pacing wire

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4
Q

if there is an ST elevation what does this usually mean

A

there has been an MI

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5
Q

what is meant by the word isoelectric

A

there is no upward or downward motion

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6
Q

if there is ST depression what is the common reason?

A

there is ischaemia to the heart- seen in an non-STEMI and angina

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7
Q

name 4 general symptoms of arrhythmia

A 
palpitations
chest pain
syncope
pulmonary oedema
hypotension
can also be asymptomatic
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8
Q

what is sinus sick syndrome?

A

this is sinus node dysfunction- results in bradycardia ± arrest, SAN block or an SVT alternating with bradycardia and asystole (tachy-brady syndrome)

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9
Q

what is narrow complex tachycardia?

A

HR >100bpm and QRS complex duration of

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10
Q

define broad complex tachycardia

A

HR>100bmp and QRS complex of >120ms

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11
Q

how do you calculate HR on an ECG?

A

count the number of big squares per R-R interval and divide it by 300 if the UK standard ECG speed of 25mm/s is used

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12
Q

when do you see a J wave?

A

in hypothermia, subarachnoid haemorrhage, hypercalcaemia

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13
Q

what is cardiac tamponade?

A

accumulation of pericardial fluid in the pericardium causing increased pressure on the hear- therefore it cannot fill and pumping stops- may be due to trauma, cancer- lung or breast, MI, pericarditis, SLE

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14
Q

what does hyper and hypokalaemia show on an ECG?

A

Hypokalaemia; small T waves, and prominent U waves

Hyperkalaemia: tall tented T waves widened QRS complex and absent P waves.

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15
Q

what does decremental conduction mean?

A

it means that greater stimulation results in slower depolarisation. IE the AVN has a decremental conduction- the more it is stimulated by the SAN the slower it depolarises.

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16
Q

describe the appearance of Wolf parkinson white syndrome with AF on an ECG

A

irregular rhythm, broad complexes and chaotic looking tachycardia

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17
Q

why do you not give the standard treatment for AF to a patient with wolf parkinson white syndrome?

A

because if you block the AVN the depolarisation will be forced to go down the accessory pathways- these are not slowed like the AVN and respond in a one :one ratio to SAN depolarisation. Hence if the patient is in AF and the SAN is depolarising over 300bpm the accessory pathways will depolarise at the same rate- ventricular fibrillation and death.

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18
Q

what is the treatment for SVT?

A

if no AF: give beta blocker, digoxin
if AF: vagal manouvers to stimulate vagus nerve and slow SAN depolarisation
then give Beta blocker- adenosine to reduce ventricular contraction, or Potassium channel blocker- amiodarone- to slow SAN automicity

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19
Q

what is seen on the ECG in sinus tachycardia?

A

P wave is often hidden by pre-ceeding T wave presenting as a camel hump appearance
normal QRS complex

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20
Q

what is seen on an ECG in atrial fibrillation?

A

abscent P wave, irregular QRS wave (can be narrow or broad) between 75-160bpm

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21
Q

what is seen on an ECG in atrial flutter

A

classic saw tooth appearance- HR around 300bpm

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22
Q

what is seen on an ECG in atrial tachycardia?

A

abnormal P waves- may be more than the QRS complex because AVN cannot contract at a rate >200 bpm

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23
Q

what is seen on an ECG with junctional tachycardia

A

HR 150-250bpm
p wave is burried in the QRS complex/ found very close to the QRS complex
commonly due to re-entry circuits at the AVN

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24
Q

what is seen on the ECG with atrial tachycardia?

A

P waves are superimposed on the T wave of the pre-ceeding beat. QRS is normal

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25
Q

what is the likely problem if there is a broad complex tachycardia with an irregular rhythm?

A

ventricular fibrillarion

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26
Q

what is the likely problem if there is a broad complex tachycardia with a regular rhythm?

A

ventricular tachycardia

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27
Q

what is the likely problem if there is a narrow complex tachycardia with an irregular rhythm

A

atrial fibrillation

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28
Q

what is torsade de pointes?

A

polymorphic ventricular tachycardia; looks like VF but the axis varies above and below the baseline continuously. can be congenital or caused by iatrogenic means- antiarrhythmics

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29
Q

what is the commonest cause of atrial fibrillation?

A

heart failure, pulmonary embolism

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30
Q

how do you treat acute atrial fibrillation?

A

atenolol beta blocker, heparin anticoagulant, and digoxin if necessary

31
Q

how do you treat chronic atrial fibrillation

A

control rate with class 3 antiarrhythmic potassium channel blocker- amiodarone, and give warfarin for anticoagulation

32
Q

what is commonly seen on ECG with ventricular fibrillation?

A

no QRS, P or T wave. The ventricles are spasming and no blood is being moved out of the heart- the patient is likely to be unconcious

33
Q

what is atrial escape?

A

a supraventricular tachycardia occuring when the normal depolarisation of the SAN has not occured and some other part of the atrium has started the depolarisation instead

34
Q

how does an atrial escape present on an ECG?

A

abnormal P wave- not in sinus rhythm
normal QRS- supraventricular tachycardia
normal beat after abnormal one

35
Q

what is junctional escape

A

this is when depolarisation occurs in the atria by an ectopic pacemaker- because the impulse travelling to the SAN is slower than that of the ectopic pacemaker for some reason- avoiding the AVN in depolarisation. No p waves but normal QRS waves are seen on ECG

36
Q

what does ECG stand for?

A

Electrocardiogram

37
Q

what is characteristic of torsades de pointes on ECG?

A

long QT interval, looks like VF with the axis varying above and below the baseline continuously

38
Q

what is bifascicular block?

A

any situation where 2 out of the 3 fasicles in the His purkinje system are blocked- normally RBBB, with L anterior or L posterior fascicle blocked

39
Q

what is sinus exit block

A

this is when the SAN fires but the impulse does not reach and cause contraction of the atria

40
Q

what is focal atrial tachycardia?

A

this is sinus rhythm found elsewhere than the sinus node- presents with an abnormal P wave. Treatment: atropine

41
Q

how would you treat acute atrial fibrillation?

A

control rate with amiodarone (class 3 antiarrhythmic- potassium channel blocker) and anticoagulate with heparin- high risk of thromboemboli

42
Q

how would you treat chronic atrial fibrillation?

A

control rate using a beta blocker- bisoprolol
or calcium channel blocker- Diltiazem
anticoagulation if required (risk factor score more than 2) Warfarin

43
Q

risk factors for thromboembolism in AF

A 
age over 65
DM
hypertension
chronic heart failure
stroke/ previous TIA
vascular disease
female gender
44
Q

what is 1st degree heart block?

A

there is a delay at the AVN causing a prolongued PR interval

45
Q

what is 2nd degree heart block?

A

there is a problem with the conduction between the AVN and the purkinje fibres, subdivided into mobitz type 1 and mobitz type 2

46
Q

mobitz type 1

A

type of 2nd degree heart block, characterised by a progressively prolonging PR interval followed by an absent QRS wave. Then a normal P wave and QRS wave, with the circuit repeating again

47
Q

mobitz type 2

A

type of 2nd degree heart block characterised by intermittent abscence of the QRS segment. The PR interval is regular and consant- every 2-3 PR waves there is an abscent QRS wave

48
Q

what is 3rd degree heart block and how does it present?

A

3rd degree heart block is also known as complete heart block. The sinus node depolarises however conduction does not reach the ventricles. P wave is normal, but has no relationship with the QRS interval.
QRS occurs at random and has a varied shape as depolarisation is randomly spread across the ventricles
PR interval varies- depending on when the ventricles depolarise

49
Q

name 2 causes of 3rd degree heart block

A

MI, chronic fibrosis of the bundle of his

50
Q

name 3 causes of LBBB

A

IHD, aortic stenosis, MI, usually indicative of left sided heart disease

51
Q

name a common causes of RBBB

A

atrial septal defect

52
Q

how does RBBB present on an ECG

A

lead 1 M shaped
Lead 6 W shaped
QRS broad

53
Q

how does LBBB present on ECG

A

lead 1 W shaped
Lead 6 M shaped
QRS broad

54
Q

what is use dependency with regards to antiarrhythmic drugs

A

the extent of blockade varies with each heart beat- the faster the heart rate the longer the total time ion channels spend in an individual channel state

55
Q

name a drug used for ventricular tachycardia and explain its mechanism

A 
lidocaine- it is a class 1b sodium channel blocker. 
it has a greater affinity of binding to inactive sodium channels- these are more commonly found in the ventricles because the duration of the action potential in the ventricles is longer than in the atria (ventricles are larger therefore there is more to reach and depolarise) hence the ventricles spend more time in the inactive state.
Acts by shortening the action potential length (from the SAN across the heart) by reducing conduction in the purkinje fibres and ventricles. Hence it inhibits ventricular contraction- slows ventricular tachycardia.
56
Q

name 5 side effects of beta adrenoceptor antagonists

A 
bradycardia
bronchoconstriction
peripheral vasoconstriction
hypogycaemia
diarrhoea
CNS effects
57
Q

what class antiarrhythmic is amiodarone?

A 
amiodarone is a class 3 potassium channel blocker.
prolongues phase 3 in myocyte depolarisation- prolonging the QRS interval.
good for supra ventricular tachycaridas and Wolff parkinson white syndrome
58
Q

name 3 side effects of amiodarone

A
  1. abnormal liver enzymes- inhibits the CP450 system
  2. torsades de points which may lead to ventricular fibrillation
  3. Corneal micro crystalline deposits
59
Q

what is the action and class of sotalol?

A 
sotalol is a class 2 and 3 antiarrhythmic- it both blocks beta adrenoceptors and potassium channels prolonging phase 3 of depolarisation of myocytes. 
good for atrial fibrillation, flutter, supraventricular tachycardias
60
Q

name 3 side effects of digoxin

A
  1. dizziness
  2. nausea and vomitting
  3. mental disturbance
61
Q

what is digoxin most effective against?

A

atrial fibrillation and increasing the contractility of the heart in heart failure

62
Q

how does adenosine work?

A

adenosine slows the conduction through the AVN and interrupts re-entry pathways which restores normal sinus symptoms- effective in supraventricular tachycardia and ventricular tachycardia

63
Q

name 3 side effects of Adenosine

A
  1. flushing
  2. nausea
  3. chest pain
64
Q

what is a myxoma?

A

a benign cardiac tumour- arising from undifferentiated connective tissue of the endocardium near the fossa ovalis. It appears stalk like

65
Q

what is the most common cardiac tumour

A

rhabdomyoma

66
Q

where are metastases to the heart most likely to have come from?

A

the breast, lung or lymphoma

67
Q

what is the initial investigation for a patient presenting with acute CP and SOB with a wide complex tachycardia on ECG?

A

cardioversion

68
Q

what is a cardioversion?

A

this is a medical procedure where an abnormally fast heart rate (tachycardia) is converted into a normal rhythm using drugs or electricity

69
Q

after a STEMI what substance is likely to be depleted in his cardiac myocytes?

A

ATP

70
Q

name 2 changes you would see on an ECG in angina?

A

ST depression, T wave inversion

71
Q

name 2 classes of drugs to treat angina and their mechanism

A
  1. beta blockers- atenolol- inhibits the sympathetic stimulation of b1 receptors in the heart causing vasodilation of the blood vessels, reducing ischaemia
  2. Nitrates- GTN spray (glyceryl trinitrate) causes vasodilation of the coronary vessels- reducing coronary spasms and therefore ischaemia
72
Q

name a class of drugs used to treat angina if beta blockers are contraindicated (eg in asthma)

A

long acting calcium channel antagonsists: amlodipine

73
Q

name 2 treatments for stenotic coronary vessels

A
  1. percutaneous tansluminal coronary angioplasty and stent implementation
  2. coronary artery bypass graft

Cardiology (3 decks)

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