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A- Resp and cardio > ECGs > Flashcards

ECGs Flashcards

1
Q

What is the normal cardiac axis?

A

-30 to 90 degrees,

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2
Q

Why is there positive deflection towards Leads I, II and III?

A

Because in a healthy person the overall direction of electricity is in this direction

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3
Q

Where is Right Axis deviation? (degrees)

A

between 90 and 180 degrees

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4
Q

What happens to the deflection in Lead I in Right ventricular hypertrophy?

A

Becomes more negative

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5
Q

What happens to the deflection in lead aVF and IIIin RVH?

A

More positive

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6
Q

When is Right Axis deviation a normal finding?

A

Very tall individuals (more vertical orientation of the heart)

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7
Q

Where is Left axis deviation in degrees?

A

between -30 and -90 degrees

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8
Q

When is left axis deviation considered significant?

A

Lead II negative as well as lead III (if just lead III insignificant)

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9
Q

Most common cause of LAD?

A

Conduction abnormalitisS

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10
Q

Which coronary artery correlates with V1-V4?

A

Left anterior descending

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11
Q

Which coronary artery correlates with the lateral leads?

A

Left circumflex, LAD diagnonal branch in some people

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12
Q

Which coronary artery correlates with inferior leads?

A

Right coronary artery or Left circumflex

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13
Q

Draw a basic ECG waveform labelling:QRS complex
R wave
P wave
Q wave
ST segment
T wave
S wave
QT interval
Isoelectric line

A

check

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14
Q

Add these features to the basic ECG:

A

Atrial depolarization
Ventricular repolarization
Ventricular depolarization
Atrial repolarization
Atrial systole
Ventricular systole
Atrial diastole
Ventricular diastole

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15
Q

What does the P wave represent?

A

Atrial depolarisation

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16
Q

What does the PR interval represent?

A

Represents time taken for depolarisation go from atria to ventricles

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17
Q

QRS complex represents

A

The depolarisation of the ventricles

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18
Q

What does the ST segment represent?

A

Isoelectric line = time between de and repolarisation of ventricles - ventricular contraction

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19
Q

What does T wave represent?

A

Ventricular repolarisation

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20
Q

Draw out a labelled ECG

A
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21
Q

RR interval is

A

the peak of R waves = time between QRS complexes

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22
Q

QT interval represents

A

Time taken for ventricles to depolarise and repolarise

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23
Q

How many large squares are 1 second?

A

5

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24
Q

What is a small square on an ECG worth?

A

0.04s

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25
Q

Draw the postiions of chest leads

A
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26
Q

What leads are anterior view?

A

V3+ V4

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27
Q

What leads are lateral?

A

Lead I, aVL, V5, V6

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28
Q

Septal leads

A

V1 + V2

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29
Q

Inferior leads

A

Lead II, Lead III, aVF

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30
Q

What happends to the R wave vs the S wave when depolarisation is moving towards the lead?

A

R wave is greater than S

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31
Q

When S is bigger than R wave where is depolarisation?

A

Away from the lead

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32
Q

Route of electrical activity in healthy individual?

A

SA node -> AV node -> Bundle of His -> Purkinje fibres -> ventricular contraction

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33
Q

Draw the cardiac axis?

A
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34
Q

Where does the cardiac axis lie in healthy individuals?

A

-30 to +90 degrees - positive deflection in Leads aVL, I II, aVF

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35
Q

What are the parameters for Right axis deviation?

A

90 and 180 degrees

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36
Q

Most common cause of RAD

A

Right ventricular hypertrophy - more cells = stronger signal

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37
Q

What conditions is right axis deviation ass with + when is it normal

A

Pulm HPTN
normal in v tall individuals

38
Q

Parameters for LAD degrees

A

-30 to -90 degrees

39
Q

What happens to lead III in LAD + when significant

A

Lead III = negative
Significant = Lead II also negative

40
Q

What causes LAD

A

Conduction abnormalities
LVH

41
Q

How to calculate heart rate with a regular rhythm

A

300/number of squares within one RR interval

42
Q

Sawtooth baseline suggests

A

AF

43
Q

Absent P waves and irregulare rhythm suggest?

A

AF

44
Q

Normal PR interval

A

120-200 ms (3-5 small squares)

45
Q

What does a prolonged PR interval signal?

A

> 0.2s = AV block

46
Q

First degree heart block sign on ECG

A

Fixed prolonged PR interval >200ms

47
Q

2nd degree mobitz I heart block features on ECG

A

Progressive prolongation PR interval
QRS complex completely dropped then resumes and repeats pattern

48
Q

2nd degree heart block mobitz II on ECG

A

Consistent PR interval duration intermittnetly dropped QRS complexes - repeating cycle

49
Q

What is third degree heart block

A

No communciation between atria and ventricles

50
Q

Third degree heart block on ECG

A

Presence of P waves and QRS complexes with no association to each other - atria and ventricles functioning independently

51
Q

Where does narrow QRS complex escape rhythms originate

A

Above bifurcation of bundle of His = <0.12s

52
Q

Character of tousseads de points

A

Twisting Ventricular tachycardia

53
Q

What is the diagnosis of ST elevation in Lead III?

A

Inferior STEMI

54
Q

How can you discern where the MI has taken place?

A

Wherever there are ST elevations - which lead compares to which area of the heart

55
Q

If there was ST elevation in V3 - V6, what MI would it be?

A

ANTERIOR lateral STEMI

56
Q

If there is ST elevation in I + AVL + V5 + V6 where is the MI?

A

Lateral - LCx or diagonal LAD branch

57
Q

What MI occurs when LAD obstructed in patietns where supplies the majority of the heart?

A

Intero-inferolateral (confirm by angiogram)

58
Q

What imbalance can cause hyperacute T waves?

A

Hyperkalemia

59
Q

Which leads can ST depression be reciprocal in?

A

VI, V2

60
Q

What three types of ST depression are there?

A

Upsloping, downsloping or horizontal

61
Q

When do horizontal or downsloping ST depression indicate MI?

A

> 0.5mm at J point in more than 2 contigpious leads

62
Q

What does an ST depression above 1 vs 2 mm indicate?

A

Above 1 - needs to be more specific
2 - in 3 or more leads, high probablility NSTEMI

63
Q

What defines a VT on ECG and when is it sustained

A

Broad complex tachycardia
3 or more Ventricular atopoic beats at a rate of >120 bpm
If >30 s = sustained

64
Q

Which VT is ass with MI and is more common?

A

Monomorphic

65
Q

What does polymorphic VT ook like on an ECG

A

QRS 200bpm +, changes amplitude and axis, appear twist around baseline

66
Q

Casues of VT

A

Channelopathies (Na+ and K+)
WPW
QT prolongation
Electrolyte disturbances
Hyporthermia
Structural HD

67
Q

What to look for in V1 and V6 in RBBB

A

V1 = M
V6 = W
MaRroW

68
Q

What to look for in LBBB

A

V1 - W
V6 - M
WiLliaM

69
Q

Features of RBBB om ECG

A

QRS duration > 120ms
Dominant S wave in V1
Broad monophasic R wave in lateral leads (I, aVL, V5-6)
Absence of Q waves in lateral leads
Prolonged R wave peak time > 60ms in leads V5-6

70
Q

VF on ECG

A

Chaotic irregular deflections of varying amplitude
No identifiable P waves, QRS complexes, or T waves
Rate 150 to 500 per minute
Amplitude decreases with duration (coarse VF –> fine VF)

71
Q

What are examples of structural heart disase that cause VT?

A

LV dysfunction
CAD
MI
HOCM

72
Q

Causes of RBBB

A

Ischaemic heart disease
Structural HD eg Right ventricular hypertrophy/ cor pulmonale, Rheumatic heart disease, Congenital heart disease(e.g. atrial septal defect), Myocarditis, Cardiomyopathy
Pulmonary embolus
Lenègre-Lev disease: primary degenerative disease (fibrosis) of the conducting system
Aortic stenosis
Anterior MI
Hyperkalaemia (resolves with treatment)
Digoxin toxicity

73
Q

Bifascicular + first degree AV block on ECG

A

RBBB
LAD
First degree AV block

74
Q

True trifascicular block 2 presentaions on ECG

A

3rd degree AV block + RBBB + either LAFB or LPFB

75
Q

What is true fascicular block

A

Conudction delay in all three fascilcles below the AV node
RBBB, LAFB,.LPFB

76
Q

What cna be seen on ECG of an NSTEMI?

A

Nothing or T wave inversion, ST segment depression

77
Q

What is S1Q3T3 ECG pattern?

A

S wave in lead I (indicating a rightward shift of QRS axis) with Q wave and T inversion in lead III.

78
Q

When is the PR interval lengthened?

A

1st degree HB
Hyperkalemia

79
Q

Mobitz 1 vs 2

A

1 - prolonging PR intervals then drop QRS and return to start
2 - PR intervals are same length, occasionally drop QRS

80
Q

3rd degree HB

A

No ass p wave and QRS

81
Q

What extra waves are present in hypokalemia

A

U waves

82
Q

ECG changes for thrombolysis or PCI

A

anterior leads (V1-V6) OR

ST elevation of greater than 1mm (1 small square) in greater than 2 consecutive inferior leads (II, III, avF, avL) OR

New Left bundle branch block

83
Q

LVH vs RVH on ECG

A

LVH
Tall R waves >25mm, ST depression, T wave flattening in L ventricular leads V5, V6
Deep S waves >30mm in R v leads - V1+V2

RVH
Tall R waves in RV leads V1+2

84
Q

When do braod QRS occur

A

Delayed conduction through ventricles eg R or LBBB

85
Q

What can ST elevation signify

A

=>1mm
STEMI or pericarditis

86
Q

QT interval normal time

A

<440ms in females
<460ms in males

87
Q

Causes of prolonged QT interval

A

Hypokalaemia
Hypocalcemia
Hypomagnesaemia
Meds

88
Q

What arrhythmia is increased risk with QTc syndrome

A

Torsades de pointes VT and sudden death

89
Q

What does doppler scanning assess

A

Valve lsions severeity
Estimate CO
Assess coronary blood flow

90
Q

When is stress ECHO used

A

Increase oxygen demand of mycoardium
detect CA disease
Risk post MI and perioperatively
Can use dobutamine if cant exercise

91
Q

Investigation of choice for CAD

A

CTCA - coronary angiogram

A- Resp and cardio (58 decks)

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