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++ECG++ > ECGs > Flashcards

ECGs Flashcards

1
Q

What position must patient be in to perform an ECG?

A

Lying on bed at 30-40 degrees with one or two pillows supporting neck

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2
Q

Electrodes should be applied over bone or muscle to limit interference?

A

Bone

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3
Q

Explain placement of the limb electrodes?

A 
RA = red
LA = yellow 
LL = green
RL = black (earthed)

Ride, your, green, bike (clockwise starting at right hand)

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4
Q

Explain placement of chest electrodes?

A

V1 - 4th ICS on right
V2 - 4th ICS on left
V3 - midway between V2 and V4
V4- 5th ICS midclavicular line
V5- same level as V4 anterior axillary line
V6 - same level as V4 and 5, mid axillary line

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5
Q

ECG lead placement on the body?

A
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6
Q

1 large box on an ECG is worth?

A

0.2 seconds (200 ms)

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7
Q

5 large boxes on an ECG are worth?

A

1 second

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8
Q

1 small box on an ECG is worth?

A

0.04 seconds (40 ms)

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9
Q

Boxes on ECG?

A
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10
Q

How do you calculate rate on an ECG?

A

Regular - large number of squares between 2R waves and divide into 300
Irregular - count the number of QRS complexes in 6 seconds (30 large square)

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11
Q

Calculate Heart Rate on regular ECG. Example image

A
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12
Q

Calculate HR on irregular ECG. Example image

A
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13
Q

Lead 1 is positive and AVF is positive?

A

Normal axis

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14
Q

Lead 1 is positive and AVF is negative?

A

left axis

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15
Q

Lead 1 is negative, AVF is positive?

A

Right axis

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16
Q

Lead 1 is negative and AVF is negative?

A

Indeterminate axis

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17
Q

Define the PR interval and give normal length?

A

onset of P to onset of QRS, represents AV node delay, normal if 120-200 ms (3-5 small squares)

you should look at it and ask does the PR measure 1 big square or less

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18
Q

What is normal length of QRS?

A

120 ms or less (3 small boxes or less)

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19
Q

Define the QT interval and give normal length?

A

Start of QRS until end of T wave - 8-12 small boxes (varies a lot though and there can be formulas to work out what should be normal

20
Q

ECG intervals. Example image

A
21
Q

Define a supra ventricular rhythm and list some examples

A

Supraventricular rhythms - originate above the AV node whether conducted through it or not

E.g. Sinus rhythm, sinus arrhythmia, AF, atrial flutter, AVNRT (WPW), wandering atrial pacemaker, SVT/ AVNRT

22
Q

ECG meets all the criteria of sinus rhythm but the rhythm itself is irregular, the irregularity is caused by physiological changes in the cardiac timing caused by respiration, it is considered a normal variant

A

Sinus arrhythmia

23
Q

Disorganised electrical activity in the atria, irregularly irregular QRS complexes and absent P waves

A

Atrial Fibrillation

24
Q

Regular usually narrow complex tachycardia, saw tooth baseline, F waves, regular QRS complexes, rate divisible into 300

A

Atrial flutter

25
Q

Rhythm originates at the AV junction, retrograde p waves can be seen, normal QRS morphology

A

Junctional rhythm

26
Q

Sinus rhythm with differing morphologies of P waves on beats

A

Supraventricular ectopics

27
Q

Define ventricular rhythms? are they ever normal? give some examples?

A

rhythms that originate in the ventricle - always pathological, always broad complexes QRS > 120 ms

E.g. ventricular premature complexes, ventricular tachycardia (monomorphic), polymorphic ventricular tachycardia (torsades de pointes), ventricular escape rhythm, ventricular fibrillation

28
Q

Regular broad complex tachycardia with QRS > 120 ms

A

Ventricular tachycardia

29
Q

What is torsades de pointes and what is it often associated with?

A

Polymorphic VT often associated with long QT interval and R on T phenomenon

30
Q

Irregular random baseline with no discernible waveforms

A

VF

31
Q

Define heart block?

A

Term given to a block in conduction between the atria and ventricle
Not to be confused with bundle branch block
Due to AV nodal dysfunction (drugs, ischaemia, age)

32
Q

Define first degree heart block?

A

PR interval > 200 ms, no progressive lengthening, stable rhythm

33
Q

Define Mobitz 1 second degree heart block?

A

mobitz 1 - progressive PR prolongation until a missed beat - not treated unless severe or HD compromise

34
Q

Define mobitz 2 second degree heart block?

A

constant PR interval but every nth beat is dropped - always abnormal

35
Q

Define 3rd degree heart block?

A

no relationship between P wave and QRS

36
Q

Lateral leads?

A

1, AVL, V5, V6

37
Q

Inferior leads?

A

2,3 and AVF

38
Q

Anterior leads?

A

V1 V2 V3 V4

39
Q

ST elevation?

A

More than 1mm in 2 contiguous limb leads
More than 2mm in two contiguous limb leads

contiguous = leads next to each other

40
Q

Evolution of ST changes in MI?

A

Normal > Peaked t wave > ST segment elevation that gradually increases > Q wave formation and loss of R wave > T wave inversion

41
Q

What is pericardial inflammation usually secondary to?

A

MI or Viral infection

42
Q

Symptoms of pericarditis?

A
  • Pleuritic chest pain (worst on inspiration)
    • Fever
  • Pericardial friction rub
43
Q

ECG changes in pericarditis?

A
  • Upward concave ST elevation
    • Changes do not evolve (unlike MI)
    • Widespread changes involving > 1 vascular territory e.g. inferior and anterior ST elevation
    • Can be difficult to differentiate from ST elevation MI
  • PR Depression is a useful diagnostic tool
44
Q

How is ventricular hypertrophy shown on ECG?

A

increased height of QRS complexes

45
Q

Left bundle branch block will be shown in ?

A

V5 and V6

QRS will be more than 0.12 secs

46
Q

Right bundle branch block will be shown in ?

A

V1 and V2

QRS will be more than 0.12 secs

++ECG++ (2 decks)

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