ECGs Flashcards
Inferior MI
II, III, aVF changes
RCA/LCx
Anterior MI
V1, 2, 3, 4 Changes
LAD
Lateral MI
I, aVL, V5, V6 changes
Lcx/LAD diagonal branch
Wellens Syndrome
Biphasic T wave in V1 and V2
Critical LAD stenosis
Pericarditis
Widespread concave ST elevation with PR depression, later on ST changes normalise with T wave inversions
(Tx = NSAID, colchicine)
Brugada Syndrome
Coved ST segment elevation in more than one of V1, V2, V3
Followed by T wave inversion
Hypertrophic Obstructive Cardiomyopathy
Left ventricular hypertrophy = non specific ST segment and T wave changes:
voltage criteria - modulus sum of deep S wave in V1 and tall R wave in V5-V6>35mm
non voltage - ST depression TWI in left sided leads
Asymmetrical deep septal hypertrophy = deep, narrow Q waves in lateral and inferior leads
Left atrial enlargement - P mitrale: double notched P waves
High take off
Young healthy men - wide spread ST elevation at J point (junction btw end of QRS and start of ST)
First Degree Heart Block
PR interval is prolonged only (>200ms), QRS relationship is maintained
Mobitz I (Wenckebach)
PR interval is prolonged progressively until the QRS is skipped
“Grouped beating”
Mobitz II
PR interval normal
Randomly skipped QRS complexes (can be wide)
Third Degree Heart Block
AV dissociation - no relationship between P waves and QRS complexes
Bifascicular Block
RBBB AND Left anterior or posterior fascicular block ie left or right axes deviation respectively (in absence of any other cause of deviation)
Trifascicular Block
Bifascicular block AND first degree heart block
misnomer - a true trifascicular block is a complete heart block
Monomorphic VT
Identical repetitive morphology of broad QRS
Concordant (all up or down)
Polymorphic VT
Multiple morphology of broad QRS complexes of different amplitude axes and duration
Concordant (all up or down)
Torsades de pointes
Polymorphic VT with long QT with an axis that twists around an isoelectric baseline So discordant (alternating up then down)
Ventricular Fibrillation
Chaotic irregular waveforms of varying amplitude. No P or QRS or T.
Tachy-brady syndrome
Alternating Brady and tachycardia
Tx = pacemaker for bradycardia and rate control (Betablockers) for tachycardia
PEA
ANY ECG rhythm but clinically no pulse
Wolf-Parkinson-White
Slurred upstroke of QRS complex (delta wave)
Short PR interval
Arrythmogenic Right ventricular cardiomyopathy
Small positive deflection at the end of QRS (epsilon wave)
Slightly wide QRS
Hypothermia
Bradycardia with ventricular ectopics
Prolongation of everything: PR, QRS, QT
Positive deflection at J point (Ie end of QRS, start of ST segment) = Osborn (J) Waves
Hypercalcaemia
Short QT mainly
Hypocalcaemia
Long QT can degenerate into torsades de pointes
Hyperkalaemia
Prolonged PR interval, small/absent P waves
Peaked T waves
Widened QRS complexes
Eventually degenerate to sinusoidal rhythm -> VF -> asystole
Hypokalaemia
Deflection after the T wave (U wave)
Flat T waves
ST depression
Right Bundle Branch Block
In V1-3: narrow RS complex with another large positive deflection called R’ (RSR’ wave) hence looks like an “M”. (V1 is Upright)
Left Bundle Branch Block
In V1-3 deep downward deflecting S wave (QS or rS wave) looks like a “W”
Pacemaker rhythms
RV pacemaker will lead to LBBB and vice versa
Pulmonary Embolism
Most common ECG = Sinus tachycardia
Evidence of right heart strain: right axis deviation, ST depression and T wave inversion in V1-3, II, III, aVF
Q1S3T3 (Q wave in 1, S and T wave inversion in III) is RARE
