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Bachelor of Paramedic Science > ECGs > Flashcards

ECGs Flashcards

1
Q

What does the ECG represent?

A

the movement of the negatively charged electrical impulse toward and away from the positive electrode

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2
Q

Lead

A

the view of the heart’s electrical activity from the perspective of the positive electrode

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3
Q

ECG Basics

A

Speed: 25mm/sec

Small square: 0.04sec & 1mm x 1mm

Large square: 0.2sec & 5mm x 5mm

3 seconds between short vertical lines

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5
Q

6 Second Method

A
  1. find dark line and count 6 across from this (= 6 seconds)
  2. count QRS complexes in this 6 seconds
  3. multiply QRS complexes by 10
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6
Q

P Wave

A

should be present, upright, rounded and precede each QRS complex

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7
Q

R-R Method

A

Count number of large boxes between two R waves:

1 = 300 b/m
2 = 150 b/m (about 155b/m)
3 = 100 b/m
4 = 75 b/m
5 = 60 b/m
6 = 50 b/m
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8
Q

PR Interval

A

0.12-0.2 sec (3-5 small squares)

HR <60, maybe >0.2 sec (>5 small squares)

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9
Q

QRS Complex

A

upright and narrow in Lead I & II (for a normal axis)

< 0.12 sec (<3 small squares)

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10
Q

T Wave

A

should be upright and rounded

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11
Q

Q-T Interval

A

should be <0.44 sec (normally between 0.4 and 0.44)

(1 - 11 small boxes)

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12
Q

ST Segment/J Point

A

should return to isoelectric line and NOT be elevated or depressed

J point is where S wave changes shape or direction

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14
Q

Lead Placement

A

RA = right arm (white)

LA = left arm (black)

RL = right leg (red)

LL = left leg (green)

V1 = RHS, 4th intercostal space, 1cm outside sternal border

V2 = LHS, 4th intercostal space, 1cm outside sternal border

V4 = 5th intercostal space, mid clavicular line

V3 = between V2 and V4

V6 = follow 5th intercostal space, mid axillar line

V5 = between V4 and V6

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21
Q

Pathological Q Wave

A

>1mm wide (1 small square); or

>2mm deep (2 small squares); or

>25% depth of preceeding QRS complex

indicates have had a previous STEAC or advancing STEAC or ACS

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22
Q

What are the 12 lead ECG orientation/groupings?

A

HISAL

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23
Q

Heart Vessels Lead I, aVL, V5 & V6

A

left circumflex coronary artery

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24
Q

Heart Vessels Lead aVR

A

aorta

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25
Q

Heart Vessels Lead V1, V2 V3 & V4

A

left anterior descending coronary artery

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26
Q

Heart Vessels Lead II, Lead III & aVF

A

right coronary artery

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27
Q

AV Heart Block Poem

A

1st Degree = far away P (long PR interval)

2nd Degree 1 = longer longer drop (PR gets longer then a QRS drop)

2nd Degree 2 = drop randomly (QRS drops)

3rd Degree = beat independently (no correlation between P and QRS)

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28
Q

starts at the end of the T wave and stops at the start of the next P Wave

A

TP Segment

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29
Q

starts at the beginning of the QRS complex and stops at the end of the T wave

A

QT Interval

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30
Q

What wave is atrial depolarisation

A

P Wave

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31
Q

What represents ventricular depolarisation

A

QRS Waves (QRS Complex)

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32
Q

What represents ventricular repolarisation

A

T Wave

(hides atrial repolarisation)

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33
Q

starts at the end of the P wave and ends at the start of the QRS complex

A

PR Segment

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34
Q

starts at the end of the QRS complex and ends at the start of the T wave

A

ST Segment

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35
Q

where the QRS complex ends and the start of the ST segment

A

J Point

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36
Q

starts at the beginning of the P wave and ends at the beginning of the QRS complex

A

PR Interval

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37
Q

interval between the tips of two consecutive QRS complexes

A

R-R

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38
Q

Which lead is used when monitoring the heart solely for rhythms?

A

Lead II (bipolar limb lead)

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39
Q

Limb Leads

A

I

II

III

vertical plane

AvR is the exact polar opposite of Lead II if normal conduction pathway

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40
Q

Augmented Leads

A

AvF

AvL

AvR

vertical plane

AvR is the exact polar opposite of Lead II if normal conduction pathway

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41
Q

Precordial Leads

A

V1-V6

horizontal plane

look inwards

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42
Q

Rhythm

A

is the distance between the R-R waves the same?

regular

irregular

regulary irregular

irregularly irregular

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43
Q

ST Segment MI Criteria

A

ST Segment Elevation

  • Limb leads >1mm elevation in 2 contiguous leads
  • Chest/Precordial leads >2mm elevation in 2 x contiguous leads

ST Segment Depression (reciprocal change)

  • Limb leads >1mm elevation in 2 contiguous leads
  • Chest/Precordial leads >2mm elevation in 2 x contiguous leads
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44
Q

Diagnosis Proforma

A

genesis of rhythm + heart rate + infarct pattern and reciprocal changes

eg: sinus rhythm at a rate of 90 with an inferior infarct

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45
Q

Septal Reciprocal Leads

A

Facing
V1, V2

Reciprocal
None

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46
Q

Anterior Reciprocal Leads

A

Facing
V3, V4

Reciprocal
None

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47
Q

Anteroseptal Reciprocal Leads

A

Facing
V1, V2, V3, V4

Reciprocal
None

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48
Q

Lateral Reciprocal Leads

A

Facing
I, aVL, V5, V6

Reciprocal
II, III, aVF

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49
Q

Anterolateral Reciprocal Leads

A

Facing
I, aVL, V3, 4, V5, V6

Reciprocal
II, III, aVF

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50
Q

Inferior Reciprocal Leads

A

Facing
II III, aVF
Reciprocal
I, aVL

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51
Q

Posterior Reciprocal Leads

A

Facing
None

Reciprocal
V1, V2, V3, V4

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52
Q

HISAL

A

H - High lateral - I, aVL

I - Inferior - II, III, aVF

S - Septal V1, V2

A - Anterior - V3, V4

L - Lateral - V5, V6

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53
Q

% of Right Ventricular Involvement STEMI/STEAC and its implications

A

33% - 50%

Right ventricular involvement is precaution for GTN due to right ventricle being preload dependant

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54
Q

When do you use V4R?

A

when inferior STEMI presents to ascertain right ventricular involvement

55
Q

What indicates right ventricular involvement in STEMI/STEAC?

A

ST elevation greater in lead III than lead II

inferior STEMI/STEAC

56
Q

How does V4R indicate right ventricular involvement?

A

ST elevation greater than 1mm (1 small box)

57
Q

What does lack of P wave indicate?

A

impulse originates in atria, junction or ventricles

58
Q

What indicates a posterior STEMI?

A

Deep and long T waves in V1 and V2

59
Q

Components of haemodynamic stability

A

HR

BP

GCS

60
Q

Difference between junctional rhythms and SVT

A

junctional rhythms typically regular, no P and narrow QRS

61
Q

Difference between P or T if unsure

A

it is generally a T if it follows QRS

62
Q

Three reasons for aVR to be positive

A

ventricular rhythm

incorrect lead placement

dextracardia (pt’s heart in chest wrong way)

63
Q

What are the ECG features for LBBB?

A
  • QRS duration > 120ms (0.12 sec)
  • big, deep QRS in V1 and V2 (Dominant S wave in V1)
  • Bunny ears in V5 and V6
  • Absence of Q waves in lateral leads
64
Q

What are the ECG features for RBBB?

A
  • QRS duration > 120ms (0.12 sec)
  • RSR in V1, V2, V3
  • Wide, slurred S wave in lateral leads (I, aVL, V5-6)
65
Q
A

Rate: 80
Rhythm:irregular
P Wave: upright, present, rounded and precedes each QRS
PR Interval: 0.12 sec (3 small boxes)
QRS: upright, narrow, 0.8 sec (2 small boxes)
ST: isoelectric
T: inversion in lead VR
Groupings: nil
Interpretation:
Sinus arrhythmia at rate of 80bpm

66
Q
A

Rate: 58
Rhythm: regular
P Wave: none
PR Interval: unknown
QRS: wide >0.12, prolonged QT
ST: isolectric
T Wave: ok
Groupings: RSR V1, wide slurred S V6, terminal R wave aVR
Interpretation: sinus bradycardia @ 58 with RBBB and prolonged QT interval

Flecainide (cardiovascular drug) OD

67
Q
A

Rate: 62
Rhythm: regular
P Wave: present, upright rounded, precedes each QRS
PR Interval: prolonged >0.2 sec
QRS: wide >0.12 sec
ST: isoelectric
T: ok
Groupings: LAFB I, aVL, II, III, aVF, RBBB V1 V2
Interpretation: sinus rhythm @ 62 with borderline 1st degree AV block and bifascicular block (RBBB & LAFB)

Beta blocker toxicity

68
Q

What is the ECG criteria for Left Anterior Fascicular Block (LAFB)?

A
  • Left axis deviation (usually -45 to -90 degrees)
  • qR complexes in leads I, aVL
  • rS complexes in leads II, III, aVF
  • Prolonged R wave peak time in aVL > 45ms
69
Q
A

Rate: 73
Rhythm: regular
P Wave: present, upright, rounded, precedes each QRS
PR Interval: prolonged >0.2 sec
QRS: wide >0.12 sec
ST: isoelectric
T: ok
Groupings: nil
Interpretation: sinus rhythm @ 73 with 1st degree block, RAD & terminal R wave in aVR

Propanolol toxicity

70
Q
A

Rate: 47
Rhythm: regular
P Wave: present, upright rounded, precedes each QRS
PR Interval: 0.2 sec
QRS: narrow <0.12 sec, prolonged QT >0.44 sec
ST: isoelectric
T: ok
Groupings: nil
Interpretation: sinus bradycardia @ 47 with prolonged QT interval

Sotalol toxicity (K+ & Beta blockers)

71
Q
A

Rate: 80
Rhythm: irregular
P wave: present, dissociated
PR interval: unknown
QRS: accelerated junctional complex
ST: isoelectric
T: ok
Groupings: nil
Interpretation: sinus rhythm @ rate 80 with av dissociation and accelerated junctional complex

Verapamil toicity (Ca++)

72
Q

What does the QRS interpretation include?

A
  • QRS after each P-wave
  • QRS duration 0.08 – 0.10s (2 to 2.5 small squares)
  • Q-waves
  • QT interval
  • Normal R-wave progression in V1 to V6
  • Cardiac axis (Normal or deviated)
73
Q

What leads do you use to interpret cardiac axis?

A

I
II
III or aVF

74
Q

What is the normal axis?

A

QRS axis between -30° and +90°

75
Q

What is left axis deviation (LAD)?

A

QRS axis less than -30°

76
Q

What is right axis deviation (RAD)?

A

QRS axis greater than +90°

77
Q

What is Extreme Axis Deviation?

A

QRS axis between -90° and 180° (AKA “Northwest Axis”)

78
Q

Is this positive, equiphasic or negative?

A

positive

79
Q

Is this positive, equiphasic or negative?

A

equiphasic

80
Q

Is this positive, equiphasic or negative?

A

negative

81
Q

What is the axis?
Lead I - positive
Lead II - positive
Lead III - positive

A

normal axis
(0 to +90°)

82
Q

What is the axis?
Lead I - positive
Lead II - equiphasic
Lead III - positive

A

LAD
physiological
(0 to -30°)

83
Q

What is the axis?
Lead I - positive
Lead II - negative
Lead III - negative

A

LAD
pathological
(-30° to -90°)

84
Q

What is the axis?
Lead I - negative
Lead II - positive
Lead III - positive

A

RAD
(90° to 180°)

85
Q

What is the axis?
Lead I - negative
Lead II - negative
Lead III - negative

A

Extreme Axis
(-90° to -180°)

86
Q

What is the axis?
Lead I - equiphasic
Lead II - equiphasic
Lead III - equiphasic

A

Indeterminate
(?)

87
Q

What are the ECG features of hyperkalaemia?

A
  • P wave widening/flattening
  • PR prolongation
  • QRS widening with bizarre QRS morphology
  • Peaked T waves
  • Bradyarrhythmias: sinus bradycardia, high-grade AV block with slow junctional and ventricular escape rhythms, slow AF
  • Conduction blocks (bundle branch block, fascicular blocks)
88
Q

What ECG changes do you see in Hyperkalemia?

A

Wide, flat P Wave
Prolonged PR Interval
Widened QRS interval
Tall, peaked T wave

89
Q

What ECG changes do you see in Hypokalemia?

A

Inverted T wave
Prolonged U wave

90
Q

What does left axis deviation mean?

A

the electrical activity in the heart is traveling towards the left side of the heart, rather than the normal direction towards the right

91
Q

What conditions can cause left axis deviations?

A

left ventricular hypertrophy
RBBB

92
Q

What does right axis deviation mean?

A

the electrical activity in the heart is traveling towards the right side of the heart, rather than the normal direction towards the left

93
Q

What conditions can cause right axis deviation?

A

right ventricular hypertrophy
LBBB

94
Q

What can cause left axis deviation (LAD)?

A

Left Ventricular Hypertrophy
LBBB
Inferior AMI
Short and or obese people
Ventricular Pacing
Wolfe Parkinson White syndrome

95
Q

What can cause right axis deviation (RAD)?

A

Right Ventricular Hypertrophy
Lateral AMI
Tall thin people
COPD
Pulmonary embolism
Paeds

96
Q

What can cause extreme axis deviation (RAD)?

A

Severe Right hypertrophy
Accelerated Idioventricular Rhythm (AIVR)
Idoventricular Rhythm (IVR)
Hyperkalemia
VT

97
Q

What are the ECG features of a sinus rhythm?

A

regular rhythm HR between 60-100
Narrow QRS complex

98
Q

What are the ECG features of atrial fibrillatin?

A

irregularly irregular rhythm

99
Q

What are the ECG features of supraventricular tachycardia (SVT)?

A

regular rhythm
HR >100 (usually >150)
nil P waves or retrograde P waves

100
Q

What are the ECG features of VT?

A

essentially regular rhythm
HR >100 (commonly >120)
bizarre wide QRS complex >0.12sec (3 small squares)

101
Q

What are the ECG features of a 1st degree AV block?

A

prolonged PR interval >0.2 sec (>5 small squares)

102
Q

What are the ECG features of a 2nd degree AV block Type 1?

A

gradually increasing PR interval then dropped beat

103
Q

What are the ECG features of a 2nd degree AV block Type 2?

A

Constant PR interval then dropped beats (various ratios)

104
Q

What are the ECG features of a 3rd degree AV block?

A

complete dissociation

105
Q

What ECG changes do you see in unstable angina?

A

possibly:
hyperacute T-waves
flattening of the T-waves
inverted T-waves
ST depression

106
Q

What ECG changes do you see in a NSTEMI?

A

transient ST elevation
ST depression
new T wave inversions

107
Q

Provide your interpretation of this ECG

A

Rate: 85bpm
Rhythm: regular
P Wave: present, upright, rounded, precedes each QRS
PR Interval: 0.16 sec
QRS: upright, narrow
ST: >1mm I & aVR, >2mm V1-V4

Sinus rhythm @ rate of 85 with anteroseptal ST elevation with reciprocal changes

108
Q

Provide your interpretation of this ECG

A

Ventricular Tachycardia

109
Q

Provide your interpretation of this ECG

A

Evolving anterolateral STEMI or extensive anterior STEMI (there are tombstone in all V leads)

110
Q

Provide your interpretation of this ECG

A

Pulseless Electrical Activity (PEA)

111
Q

Provide your interpretation of this ECG

A

Fine VF

112
Q

Provide your interpretation of this ECG

A
113
Q

Interpret this ECG

A

Rate: 70bpm
Rhythm: irregular
P wave: not present
QRS: wide @ 0.16 sec
ST: OK
Other: QRS notching in 1, aVL, V5 and V6

Atrial fibrillation @ rate of 70 with LBBB

114
Q

Diagnose this ECG in a Pt with no pulse

A

PEA
(pulseless electrical activity)

115
Q

Diagnose this ECG

A

Rate: 130bpm
Rhythm: regular
P wave: present, upright, rounded precedes each QRS
PR interval: 1.04 second, wide/abnormal
QRS complex: 0.12 second, normal
ST: normal

Sinus tachycardia @ rate of 130 bpm

116
Q

Interpret this ECG

A

Rate: 150
Rhythm: 150
P Wave: present, upright, rounded, precedes each QRS
PR Interval: 0.12sec
QRS: upright, narrow, 0.08sec
ST: NAD

Sinus rhythm @ rate 150

117
Q

Interpret this ECG

A

Rate: 170
Rhythm: regular
P Wave: present, upright, precedes each QRS
PR Interval: <0.2 second
QRS: upright narrow 0.08 second
ST: OK?? Slight depression?

Sinus tachycardia @ rate of 170

118
Q

Interpret this ECG

A

Rate: 70
Rhythm: regular
P Wave: present, upright, rounded, precedes each QRS
PR Interval: normal 0.15 second
QRS: 0.12 second
ST: NAD
Other: LBBB

Sinus rhythm @ rate 70

119
Q

Diagnose this ECG

A

Rate: 60bpm
Rhythm: regular
P Wave: present, upright, rounded
PR Interval: wide 0.26 sec
QRS: Wide 0.2sec
ST: NAD
Other: R wave aVR, Notched QRS in V3 – V6

Sinus rhythm @ rate of 60 with 1st degree block

120
Q

Diagnose this ECG

A

Rate: 190bpm
Rhythm: regular
P Wave: present, upright, rounded, precedes each QRS
PR Interval: 0.12 seconds
QRS: upright, narrow, 0.08 seconds
ST: depression in I II III AVf V3 V4 5 V6

Narrow complex tachycardia @ 190 bpm with global ST depression likely rate related

121
Q

Interpret this ECG

A

Rate: 90bpm
Rhythm: regular
P waves: present upright rounded, precedes each QRS
PR interval: long 0.204seconds
QRS: upright narrow
ST: 1mm elevation in V3 and V4
Other: 1st degree block

Sinus rhythm @ rate of 90 with first degree block

Bachelor of Paramedic Science (19 decks)

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