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Paramedic - ECG's > ECG's Rules > Flashcards

ECG's Rules Flashcards

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1
Q

Where is the p wave originated from -

A

Atrial contraction generated by SA ( sino-atrial) node

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2
Q

Where is the PR wave originated from-

A

AV ( atrio ventricular) node delay

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3
Q

Where is the QRS wave originated from -

A

ventricular contraction ( generated by the Purkinje Fibres )

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4
Q

Where is the T wave wave originated from -

A

from the ventricular relaxation / repolarisation.

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5
Q

What is the complex in-between the s and t segment that crucial in diagnostic of a stemi

A

J point

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6
Q

Explain or describe the electrical conductivity of the heart - all electric pathways and follow of blood

A

SA node( positioned in right atrial ) fires - across the atria
Atria contracts * P WAVE **
Signal pass through to AV NODE this delay the signal allowing blood to fill the ventricals *** PR INTERVAL ””””
Signal passes from AV NODE to bundle of his, which splits into the bundle branches ( left and right)
This passes to the Purkinje fibre @ the apex of the heart.
The signal passes up the walls from bottom up via the Purkinje fibre - causes ventricular contraction **** QRS COMPLEX
The centrical then repolarisation occurs ** T WAVE **
THE Atrial repolarization occured during the QRS COMPLEX. - not visible due to the high charge at ventricles

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7
Q

What is the duration of the p wave -

A

0.08s ( 2-2.5 sq)

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8
Q

What is the duration of the PR wave -

A

0.12s to 0.20s (equal to 3-5sq)

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9
Q

What is the duration of the QRS complex -

A

less than 0.12s ( 3sq)

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10
Q

What is the duration of the QT interval -

A

0.36s to 0.44s (equal to 9-11 sq)

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11
Q

What is PPCI criteria for STEMI 🚨🚨

A

Limb lead - 2+ lead with elevation in 1 small box plus

Chest lead - 2+ lead with elevation in 2 small boxes plus

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12
Q

What are the lead views on a 12 lead ECG

A

Lateral - L1 avl v5 V6
Inferior - L2, L3 avf
Septal - v1, V2
Anterior- v3, v4
Non - avr

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13
Q

What should be suspected if st depression is seen in the anterior lead
1) what are the anterior lead cover
2) suspected is
3) test we can conduct

A

1) v3v4 V2 v1
2) posterior MI
3) v7, V8،v9

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14
Q

What test should be conducted if ST elevation is seen in the inferior lead
1) what are inferior leads
2) answer to question
3) why - what does this now mean we can’t ….

A

1) L2, L3 , AVF
2) V4R , take v4 and place on right side same spot.
3) if ST elevation see this mean right sided involvement (RMCA) therefore don’t give GTN due to high risk of bp drop therefore cardiac arrest

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15
Q

What are the two sub branches that come off the LMCA ( left main cononary artery)

A

LCF - left circumflex
LAD - left anterior descending

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16
Q

What does the LMCA ( left main coronary artery ) feed

A

Left ventriculal
Left atrial
And the septum

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17
Q

What does the right main cononary artery feed (RMCA)

A

Bothe ventricles
Right atrium
And the posterior portion of the heart

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18
Q

What is the molecules that great a electrical charge in the heart and how do they get affected once a charge arrives

A

Potassium ( INSIDE) the cell - maintained by pump and gated channel ( acting as a door)
Calcium + sodium outside the cell
Electric current arrives
Sodium in - causes more sodium channels to open which inturn cause positivity and open calcium channels

Calcium come bind = contraction

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19
Q

Cardiac axis - what lead are need to determine cardiac axis

A

Lead 1
Avf

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20
Q

Cardiac axis - what is the cardiac axis if both L1 and Avf are positive

A

Normal cardiac axis

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21
Q

What do the lead look like when it’s a normal cardiac axis

A

Lead 1 & avf are positive

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22
Q

Is the if lead 1 is positive and and avf is negative what is the cardiac axis

A

Left axis deviation as the leads are ** leaving**

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23
Q

What does left axis deviation look like

A

The lead are leaving
L1 is positive
Avf is negative

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24
Q

What does right axis deviation look like

A

L1 is negative
Avf is positive
** Reaching for each other **

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25
Q

If L1 is negative and avf is positive
What is the axis deviation

A

Reaching towards each other
Right axis deviation

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26
Q

What does extreme axis deviation look like

A

Both L1 & avf are negative

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27
Q

If both L1 and Avf are negative what is the axis deviation

A

Extream axis deviation

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28
Q

How can you identify a right bundle branch

A

All 3 thing must be true
1) wide qrs complex - 0.12s +
2) upright QRS complex in v1
3) slurred s waves in V6

Can turn paper on it’s right side
If the r wave faces right if not it’s facing left it’s left

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29
Q

How can you identify a left bundle branch block

A

All 3 things must be true
1) broad qrs complex - 0.12s +
2) mainly downward facing ( negative ) QRS COMPLEX in v1
3) with broad upward facing r waves in V6
4) no Q waves in v6

Turn it on it’s side ( right side ) - it’s be facing left

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30
Q

How can you identify a sinus tachycardia

A

1) heart rate above 100 but below 140
2) normal p qrs and t waves

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31
Q

How can you identify re- entrant tachycardia also know as narrow complex tachycardia or SVT

A

HR above 140
Normal qrs length
Constant rate
no p waves - as we are flying 🕊️

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32
Q

What is the pathophysiology of re- entrant tachycardia / svt / narrow complex tachycardia

A

There is a backflow of electrical activity in the atria

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33
Q

What is the treatment for re -enterant tachycardia / svt / narrow complex tachycardia

A

Vasovagal manovour - blow into something and tilt
??? Can we do as paramedic

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34
Q

What is the pathophysiology of wolff Parkinson white syndrome

A

The heart creates a new pathway from atria to centrical call the bundle of Kent which bypasses the bundle of his and av node
This causes an early depolarisation from the centrical seen as the Dela wave

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35
Q

What is an indicator of wolf Parkinson white syndrome on an ECG

A

A delta wave
This is due to early repolarisation of ventricles
This is a slight upward curve at the start of the qrs then it fly’s up

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36
Q

How do you identify a broad complex tachycardia or VT or ventricular tachycardia

A

Ventrical originating rhythm
Qrs size is 0.12s + ++++
Regular
Above 100bpm

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37
Q

What is known as an ectopic beat or escaped beat

A

This is a beat which is not generated by the SA node but from secondary cardiac pacemakers

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38
Q

How do you identify a 1st degree AV block

A

1) the PR interval has to be 0.20+ (5sq)
2) this distance must be constant, regular rhythm

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39
Q

What is an incomplete bundle branch block

A

A bundle branch block which has the morphology of a block however has a duration of less than 0.12s

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40
Q

What is first degree AV Block

A
  • pr interval 0.20+
  • this is constant
  • followed by a qrs complex

Can be a normal variant

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41
Q

What is 2nd degree type 1. AV block

A
  • pr interval 0.20+
    Pr interval gradual increases distance before QRS goes missing

Type 1 runs along

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42
Q

What is 2nd Degree type 2 AV block

A

Pr interval longer than 0.20+
- pr interval constant before a random QRS complex drop off

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43
Q

How do you identify a broad complex tachycardia

A

Rate of above 100bpm
Qrs length larger than 0.12s
Regular

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44
Q

What is torsade debpoint and what is the key in idefinificstion

A

Has Long qt syndrome
R on t ( repolarisation and deoperisation happen as same time
R waves have different amplitude

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45
Q

What is long Qt syndrome ( cause of sudden cardiac arrest

A

Duration between q wave and t wave is 0.44+ or 11 sq +
Ondansatron can further elongate this

46
Q

What is atrial fibrillation

A

Eptopic side of heart takes over as SA node loses control ( random depolarisation at different voltages ) some go through some don’t

  • no p waves
  • irregularity irregular
  • no flat base line ( fibrillation)
47
Q

What is fast AF or AF with rapid ventricular contraction

A

It’s is AF which is tachycardiac above 110bpm

48
Q

What is atrial flutter

A

Right atrial is damage

No isoelectric line
Jagged p waves ( f waves) ( teeth shark)

49
Q

What is wap ( wandering atria pacemaker

A

3 + atrial pacemaker conduct ectopic beats
- different p waves morphology
Different pr intervals
Rate less than 100bpm ( above =multi atria tachycardia

50
Q

What is the job of an eptopic pacemaker cells

A
  • act as a back up for the SA node if it fails
  • not affected by sympathetic or parasympathetic nerve system
51
Q

What is a junctional rhythm
What is the rate set

A
  • escaped beat oreiginting from the AV site
    40-60 BPM
    normal qrs
    Absent inverted or diassosuwed “ P WAVES”
52
Q

What are the causes of escaped rhyms

A

3rd degree AV block
Sinus arrest
Bradycardia
Drugs - beta blockers, CCB, DIGOXIN

53
Q

What are the factors that are identifiable of a ventricular escaped rhythm

A

Beats originating from below BOH
rate - 15 to 40BPM
**QRS bizarre and wide ( may look like BBB)
P WAVES - dissaosited or absent

54
Q

What is an agonal Rhythm

A
  • seen before aystole
  • below 20 BPM
  • wide bizarre qrs complexes
55
Q

What is a PVC

A

Wide abnormal QRS complex
Larger amplitude than other qrs
Followed by a pause= reset then normal
Occurs because of 2 pathways in heart after BOH - FAST = NORMAL
SLOW = PVC

56
Q

What is a bigemany

A

Every second beat = pvc

57
Q

What is couplets
What is this dangerous

A

2 PVC right after each other
3 + pvc = VT
PAD ON - get ready patient may arrest

58
Q

What is the 3 classification of angina

A

Stable - exception
Unstable - random
And prinzaomental - vasoconstriction spasms

59
Q

What is the pathophysiology of stable and unstable angina

A

Atheocrosis layer on the contrary arterioles - reduces diameter = less to flow when need = pain

60
Q

What is the pathophysiology of prinzmental angina

A

Vasoconstriction spasm of the cononary ateryes
Can show ST elevation - which quickly resolves with GTN

61
Q

What is a STEMI Vs non stemi

A

A full major occasion - causing ischemia and necrosis
Non stemi - minor full occlusion - no st segment changes on ECG

62
Q

What is de winters signs

A

Sloped (upwards) st depression with hyper acute (upwards) t waves in the precordial leads
Treat as MI
SIGN OF PROXIMAL LAD occlusion

63
Q

What is biphasic t waves and what does it suggest

A
  • upward a d downwards t waves
    Ischemia or hypokalemia
64
Q

Inverted t waves can be a normal variant in which leads

A

3
Avl
V1 & v2

65
Q

What is wellens syndrome and it’s significants

A

Biphasic t waves - starts possibe ends negative
No st changes
Seen in precordial lead and 1 and avl
This is a sign of stenosis of the LAD - increasing the risk of MI

66
Q

If a patient has a new onset of a LBBB with how should this be treated

A

IF THERE IS ACS symptoms treat
as a STEMI

Otherwise normal road - call PPCI

67
Q

What are the different variations of at depression

A

Horizontal
Upward sloping
And downward sloping

68
Q

What are the 3 different ECG changes which indicates ischemia to the heart

A

St depression - 2+ leads
T waves - , hyperactue, biphasic or flipped
Stemi - but shuttle (not PPCI criteria)
Pathological q waves (old ischemia )

69
Q

When discussing T waves ischemia what should I look for

A

T waves inverion - 2 lead same view of the heart

Biphasic t waves - goes positive to negative or the other way

70
Q

When discussing T waves ischemia what should I look for

A

T waves inverion - 2 lead same view of the heart

Biphasic t waves - goes positive to negative or the other way
Hyperacute t waves

71
Q

What does biphasic t waves mean

A

Ischemia
Hypokalemia (signs )
Wellen syndrome (+2-)

72
Q

What is the nmenonic for finding for understanding where to look for respical changes in a STEMI

A

pails

Got stemi - look at the next letter for the resipical changes

Posterior
Anterior
Inferior
Lateral
Septal

73
Q

What is the progression of a stemi in terms of ECG visual visually looking

A

In the first stage you see by phasic or inverted t waves
-hyper acute t waves which are equal to or longer than the qrs in terms of amplitude next you will see the semi appearance
Pathological key waves with lots of r shape
The morphology stays the same but with added inverted t waves
Pathological key waves remain but rest of the ECG turns back to normal

74
Q

What is the visual st changes caused by

A

Electrical activity passing through ischemic or dead myocardiocytes - they have a shorter contraction phase alongside potential for deoplerisation

75
Q

Ischemia is the the shape of st changes
Why Is some with st elevatoin whilst others depression

A

Elevation - MI facing the lead
Depression - MI FACING away

76
Q

What are the ECG changes seen in PT with pericarditis

A

Global st elevation
Pr segment depression
St depression in AVR

77
Q

What are the ECG changes seen in PT with pericarditis

A

Global st elevation
Pr segment depression
St depression in AVR

78
Q

How can you distinguish LEFT main artery occulsion

A

ST elation in AVR
WITH
st depression in inferior or lateral leads

79
Q

What is a sign of Lad occlusion

A

ST elevation in AVR
WITH RBBB OR v1 st elevation

80
Q

What is early polerisatrisation / high take off - see it on a ECG

A

1) quick repolarisation
2) look like st elevation ( 1-3mm) = if chest pain treat it as stemi - or do it anyways - treat worst case

81
Q

What is early polerisatrisation / high take off - see it on a ECG

A

1) quick repolarisation
2) look like st elevation ( 1-3mm) = if chest pain treat it as stemi - or do it anyways - treat worst case

82
Q

What is brugada syndrome
2) how do you identify it
3) alongside ECG changes what else must be present

A

2) ST elation in (v1 to V3), with coved ST elevation at least 2mm which leads to inverted T wave
3) Syncopy witnessed VT /VF or history of sudden adult death

83
Q

What are the signs you should look for in an ECG which is representative of ACS

A

ST ELEVATION OR DEPRESSION
T WAVE INVERTION
PATHOLOGICAL Q WAVES

84
Q

What are the signs you should look for in an ECG which is representative of ACS

A

ST ELEVATION OR DEPRESSION
T WAVE INVERTION
PATHOLOGICAL Q WAVES

85
Q

What is the most important lead to identify right-sided involvement in an inferior stemi

A

V4r

86
Q

When assessing an inferior stemi what signs on an ECG could be indicative of right ventricular involvement

A

Lead 3 bigger than lead 2
One mil of st elevation in v1 or AVR
St elevation of 0.5 millimeter in a in v4r

87
Q

When assessing an inferior stemi what signs on an ECG could be indicative of right ventricular involvement

A

Lead 3 bigger than lead 2
One mil of st elevation in v1 or AVR
St elevation of 0.5 millimeter in a in v4r

88
Q

What is the inferior stemi right ventricular involvement triad

A

Hypertension
Jugular vein distention
Clear lungs

89
Q

What is the inferior stemi right ventricular involvement triad

A

Hypertension
Jugular vein distention
Clear lungs

90
Q

Why can right entricular involvements in various stemi cause RVI triad

A

As there’s an effect on preload due to death of cardiac muscle
Thus reduced blood flow to the lungs
Hence reduced blood flow to the left ventricle that’s reduced cardiac output

91
Q

What is the management for an inferior stemi with right ventricular involvement

A

Clinical decision on whether to give morphine or gtn as they can affect preload
Maintaining systolic blood pressure of 100 mmgh

92
Q

What is the management for an inferior stemi with right ventricular involvement

A

Clinical decision on whether to give morphine or gtn as they can affect preload
Maintaining systolic blood pressure of 100 mmgh

93
Q

What is the general management of STEMIS

A

ACS bundle- aspirin gtn opioid
Defibrillator pads
Pre alert to ppci

94
Q

What are the indicators for posterior stemi

A

St depression in the septal leads
This is confirmed by st elevation of 0.5 mm in v7 v8 and v9

95
Q

What is the importance of pathological Q waves
How do you identify this on a ECG

A

2mm in depth or 1mmin length - in lead v1 to V3
Sign of previous cardiac muscle death or current mi
-

96
Q

What are the ECG changes for left ventricular hypertrophy

A

Amplitude to the t and s waves
Increase R waves in L1 avl V4 v5 V6
Increased s wave in v1 V2

97
Q

What are the clinical signs shown for right ventricular hypertrophy

A

QRS R wave increases V1 AVR
QRS S WAVE WAVE INCREASE IN LATERAL LEADS 1 AVR V5 V6

98
Q

Why do bunder branch occur

A

Blockages occur in the affective branch
Electrical activity has to flow through opposite ventricle or through septum = takes more time

99
Q

What are the clinical ECG signs of left bundle branch block

A

QRS larger than 0.12 seconds
V1 DOMINANT S WAVES
V6 UPRIGHT R WAVES WITH NO Q WAVES

100
Q

What is an incomplete bunch of branch block

A

Bundle branch block meets the criteria
Butch the qrs complex is shorter than 0.12 seconds

101
Q

What are the clinical signs of a right from the branch block

A

V1 qrs complex positive in rsr pattern
V6 slurred s-waves

102
Q

What is the predominant pattern (qrs) in a right bundle branch block v one and why

A

Rsr
Second r is the right ventricle contraction after delay

103
Q

What is the predominant pattern (qrs) in a right bundle branch block v one and why

A

Rsr
Second r is the right ventricle contraction after delay

104
Q

What is the ECG change for right ventricular strain

A

S1 Q3 T3

105
Q

How do you know if a patient has a atrial pacemaker on ECG

A

Pacing spike before p wave

106
Q

What may a paced rhythm look like and why
What must also be present

A

BBB - as paced ventrical depolerises before other one
- look for pacing spike

107
Q

What are the early stages of hyperkalemia on an ECG

A

Peaked t waves

108
Q

What is the second change of hyperkalemia after peaked tvwavea

A

Increased pr interval
Widening and eventually loss of p waves

Turning to af widening qrs and heart blocks

109
Q

What is the ECG changes seen in mild to moderate hypokalemia

A

Increased pr interval
Increased hight and length of p waves
St depression
Inverted and flattened t waves

110
Q

What are the changes seen in hypercalcaemia

A

Decreased qt and st segment duration
Osborn waves

111
Q

What are the change seen on an ECG for hypothermia

A

Bradycardia
atrial fibrillation
Osborne waves
increased prqrs
and qt interval

Paramedic - ECG's (3 decks)

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