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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
Draw the postiions of chest leads
26
What leads are anterior view?
V3+ V4
27
What leads are lateral?
Lead I, aVL, V5, V6
28
Septal leads
V1 + V2
29
Inferior leads
Lead II, Lead III, aVF
30
What happends to the R wave vs the S wave when depolarisation is moving towards the lead?
R wave is greater than S
31
When S is bigger than R wave where is depolarisation?
Away from the lead
32
Route of electrical activity in healthy individual?
SA node -> AV node -> Bundle of His -> Purkinje fibres -> ventricular contraction
33
Draw the cardiac axis?
34
Where does the cardiac axis lie in healthy individuals?
-30 to +90 degrees - positive deflection in Leads aVL, I II, aVF
35
What are the parameters for Right axis deviation?
90 and 180 degrees
36
Most common cause of RAD
Right ventricular hypertrophy - more cells = stronger signal
37
What conditions is right axis deviation ass with + when is it normal
Pulm HPTN normal in v tall individuals
38
Parameters for LAD degrees
-30 to -90 degrees
39
What happens to lead III in LAD + when significant
Lead III = negative Significant = Lead II also negative
40
What causes LAD
Conduction abnormalities LVH
41
How to calculate heart rate with a regular rhythm
300/number of squares within one RR interval
42
Sawtooth baseline suggests
AF
43
Absent P waves and irregulare rhythm suggest?
AF
44
Normal PR interval
120-200 ms (3-5 small squares)
45
What does a prolonged PR interval signal?
>0.2s = AV block
46
First degree heart block sign on ECG
Fixed prolonged PR interval >200ms
47
2nd degree mobitz I heart block features on ECG
Progressive prolongation PR interval QRS complex completely dropped then resumes and repeats pattern
48
2nd degree heart block mobitz II on ECG
Consistent PR interval duration intermittnetly dropped QRS complexes - repeating cycle
49
What is third degree heart block
No communciation between atria and ventricles
50
Third degree heart block on ECG
Presence of P waves and QRS complexes with no association to each other - atria and ventricles functioning independently
51
Where does narrow QRS complex escape rhythms originate
Above bifurcation of bundle of His = <0.12s
52
Character of tousseads de points
Twisting Ventricular tachycardia
53
What is the diagnosis of ST elevation in Lead III?
Inferior STEMI
54
How can you discern where the MI has taken place?
Wherever there are ST elevations - which lead compares to which area of the heart
55
If there was ST elevation in V3 - V6, what MI would it be?
ANTERIOR lateral STEMI
56
If there is ST elevation in I + AVL + V5 + V6 where is the MI?
Lateral - LCx or diagonal LAD branch
57
What MI occurs when LAD obstructed in patietns where supplies the majority of the heart?
Intero-inferolateral (confirm by angiogram)
58
What imbalance can cause hyperacute T waves?
Hyperkalemia
59
Which leads can ST depression be reciprocal in?
VI, V2
60
What three types of ST depression are there?
Upsloping, downsloping or horizontal
61
When do horizontal or downsloping ST depression indicate MI?
>0.5mm at J point in more than 2 contigpious leads
62
What does an ST depression above 1 vs 2 mm indicate?
Above 1 - needs to be more specific 2 - in 3 or more leads, high probablility NSTEMI
63
What defines a VT on ECG and when is it sustained
Broad complex tachycardia 3 or more Ventricular atopoic beats at a rate of >120 bpm If >30 s = sustained
64
Which VT is ass with MI and is more common?
Monomorphic
65
What does polymorphic VT ook like on an ECG
QRS 200bpm +, changes amplitude and axis, appear twist around baseline
66
Casues of VT
Channelopathies (Na+ and K+) WPW QT prolongation Electrolyte disturbances Hyporthermia Structural HD
67
What to look for in V1 and V6 in RBBB
V1 = M V6 = W MaRroW
68
What to look for in LBBB
V1 - W V6 - M WiLliaM
69
Features of RBBB om ECG
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
VF on ECG
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
What are examples of structural heart disase that cause VT?
LV dysfunction CAD MI HOCM
72
Causes of RBBB
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
Bifascicular + first degree AV block on ECG
RBBB LAD First degree AV block
74
True trifascicular block 2 presentaions on ECG
3rd degree AV block + RBBB + either LAFB or LPFB
75
What is true fascicular block
Conudction delay in all three fascilcles below the AV node RBBB, LAFB,.LPFB
76
What cna be seen on ECG of an NSTEMI?
Nothing or T wave inversion, ST segment depression
77
What is S1Q3T3 ECG pattern?
S wave in lead I (indicating a rightward shift of QRS axis) with Q wave and T inversion in lead III.
78
When is the PR interval lengthened?
1st degree HB Hyperkalemia
79
Mobitz 1 vs 2
1 - prolonging PR intervals then drop QRS and return to start 2 - PR intervals are same length, occasionally drop QRS
80
3rd degree HB
No ass p wave and QRS
81
What extra waves are present in hypokalemia
U waves
82
ECG changes for thrombolysis or PCI
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
LVH vs RVH on ECG
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
When do braod QRS occur
Delayed conduction through ventricles eg R or LBBB
85
What can ST elevation signify
=>1mm STEMI or pericarditis
86
QT interval normal time
<440ms in females <460ms in males
87
Causes of prolonged QT interval
Hypokalaemia Hypocalcemia Hypomagnesaemia Meds
88
What arrhythmia is increased risk with QTc syndrome
Torsades de pointes VT and sudden death
89
What does doppler scanning assess
Valve lsions severeity Estimate CO Assess coronary blood flow
90
When is stress ECHO used
Increase oxygen demand of mycoardium detect CA disease Risk post MI and perioperatively Can use dobutamine if cant exercise
91
Investigation of choice for CAD
CTCA - coronary angiogram

A- Resp and cardio (58 decks)

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