ECGs Flashcards
presentation of heart block
syncope
heart failure
regular bradycardia
wide pulse pressure
JVP - cannon waves in neck
variable intensity of S1
1st degree heart block
PR >0.2s
2nd degree heart block, mobitz type 1
progressive prolongation of PR interval until dropped beat occurs
(Wenckebach)
2nd degree heart block, mobitz type 2
PR interval is CONSTANT but P wave is often not followed by QRS
3rd degree heart block
no assoc between Pwaves + QRS
management of torsades de pointes
haemodynamically unstable = DC cardioversion
stable = IV magnesium sulphate 2g over 1-2mins
ST elevation in II, III, aVF
inferior -> right coronary artery
ST elevation in V1-4
anterior -> LAD
ST elevation in I, aVL +/- V5-6
left circumflex
signs of haemodynamically instability
shock - suggests organ hypoperfusion
syncope - brain hypoperfusion
chest pain - myocardial ischaemia
pulmonary oedema - evidence of heart failure
when can sinus bradycardia be normal
adults aged over65
young athletes
how can heart rate in patient with regular rhythm on ECG be calculated?
dividing 300 by the numbers of squares in between the QRS compleses
PE ECG findings
sinus tachycardia = commonest + sometimes only feature
RBBB
right axis deviation
atrial fibrillation ECG features
absent P waves
narrow QRS complex
irregularly irregular rhythm
when should rate control not be given in AF
a reversible cause
new onset (in last 48hrs)
heart failure
symptoms despite being effectively rate controlled
rate control options in AF
beta-blocker
CCB
digoxin - only in sedentary with persistent AF, require monitoring
(give rhythm control)
rhythm control
cardioversion
- pharma -> felcainide, amiodarone
- electrical
long term rhythm control
- betablockers =1st line
- dronedarone
- amiodarone
general treatment of atrial fibrillation
betablocker - rate control
DOAC - for anticoag
ECG features in Wolff-Parkinson white
short PR interval <0.12s
wide QRS >0.12s
delta wave
definitive treatment = ablation of accessory pathway
acute management of supraventricular tachycardias
- vagal manoeuvres - valsalva, carotid sinus massage
- adenosine (rapid bolus)
- verapamil or beta blocker
- synchronised DC cardioversion
when is adenosine avoided
asthma, COPD
heart failure
heart block
severe hypotension
causes of bradycardia
medications - betablockers
heart block
sick sinus syndrome
management of bradycardia
IV atropine
inotropes - adrenaline
temp. cardiac pacing
pacemaker
P wave
atrial depolarization
0.08-0.10 secs
QRS complex
ventricular depolarisation <0.10s
T wave
ventricular repolarisation
PR interval
largely AV node delay 0.12-0.20sec
ST segment
ventricular contraction (systole) occurs in the ST segement
TP interval
ventricular relaxation (diastole) occurs in the TP interval
what does a large box vs a small box represent on an ECG?
large = 0.2 secs
small = 0.04secs
left axis deviation signs on ECG
lead I = positive (left thumbs up)
lead II/aVF = negation
right axis deviation signs on ECG
lead I = negative
lead II/aVF = positive (right thumbs up)
