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Introduction YR3 + teaching > ECGs > Flashcards

ECGs Flashcards

1
Q

Steps to Interpreting an ECG

A
  • Rate - if 6s strip x R waves by 10 or do 300/ large boxes between R waves
  • Rhythm - irregular? regular? regularly irregular or irregularly irregular?
  • P wave?
  • PR interval (0.12-0.2s or 3-5 small boxes)
  • QRS duration (0.04-0.12 or 1-3 small boxes)
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2
Q

What does each wave in ECG mean?

A
  • P wave - atria depolarise
  • PR interval - SA to AV node (P to Q wave)
  • QRS complex - ventricles depolarise
  • QT interval - ventricular depolarisation to repolarisation
  • T wave - ventricular repolarise
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3
Q

3 pacemakers in heart

A
  • SA node - dominant 60-100bpm
  • AV node - 40-60bpm
  • Ventricular cells - 20-45bpm
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4
Q

How to determine rhythm?

A

See if distance between R waves is equal
If yes - regular
If not, is there a pattern to this?
If yes - regularly irregular
If no - irregularly irregular

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5
Q

Management if sinus bradycardia

A
  • A-E assessment
  • See if any adverse features
  • Atropine - 500mcg IV up to 3mg
  • Transcutaneous pacing
  • IV adrenalone/isoprenaline
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6
Q

Adverse features of bradycardia

A
  • Shock
  • Heart failure
  • Ischaemia - myocardial
  • Transient LOC

SHIT

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7
Q

What arrhythmia is sawtooth?

A

Atrial flutter

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8
Q

What are PACs?

A

Premature atrial contractions - ectopic beats originating in the atria but not the SA node, cause abnormal looking P waves but normal QRS

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9
Q

Atrial flutter appearance on ECG

A
  • Sawtooth pattern baseline
  • No P waves
  • Only some impulses conduct through AV node
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10
Q

Cause of atrial flutter

A

Re-entrant pathway in the rigth atrium but this is stopped conducting to ventricles by AV node refractory period

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11
Q

Cause of atrial fibrillation

A

Firing of multiple ectopic foci that fire continuously due to multiple re-entrant circuits

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12
Q

Appearance of AF on ECG

A
  • Absent P waves
  • Irregularly irregular rhythm - some impulses get through AV node
  • Wavy baseline
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13
Q

Management of AF if adverse SHIT features

A

Synchronised DC shock followed by amiodarone

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14
Q

Management of AF if stable

A
  • Rate control - beta blocker or diltiazem
  • If HF - digoxin
  • IV magnesium sulfate 2g
  • Anticoagulation
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15
Q

Three types of arrhytmias arising from atria

A
  • PACs
  • Atrial flutter
  • Atrial fibrillation
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16
Q

`

2 types of arhytmias arising from AV junction

A
  • Paroxysmal supraventricular tachycardia (SVT)
  • AV nodal blocks - 1st, 2nd and 3rd degree
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17
Q

Cause of SVT

A

Heart rate suddenly speeds up triggered by a PAC and P waves are lost

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18
Q

Appearance of SVT

A
  • Lost P waves
  • QRS complexes still narrow - arrhytmia is not originating from ventricles
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19
Q

Four types of AV nodal block explained

A
  • First degree - prolonged PR interval (>0.2s)
  • Second degree Mobitz Type 1 - progressively prolonged PR then dropped QRS
  • Second degree Mobitz Type 2 - normal PR but dropped QRS, in ratios often
  • Third degree - no co-ordination between P wave and QRS complex, wide QRS
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20
Q

3 types of arrhytmia arising from ventricles

A
  • PVC - premature ventricular contractions
  • Ventricular fibrillation
  • Ventricular tachycardia
21
Q

PVC explained and appearance

A

Firing occasionally from 1 or more foci
One random wide QRS in normal strip

22
Q

VFib cause and appearance

A

Firing continiusly from multiple foci
Wavy - like arctic monkeys album cover

23
Q

V tach cause and appearance

A

Multiple foci firing continioulsy
‘Tachy tombstones’ - look like gravestones

24
Q

Underlying causes of Vfib

A
  • MI
  • Ischaemia
  • Untreated VT
  • CAD
  • Acid-base imbalance
  • Electrolyte imbalance
  • Hypothermia
25
Q

SVT treatment

A

Vagal maneuvers - eg carotid sinus massage
Adenosine - impending doom feeling

26
Q

V fib treatment

A
  • Shockable
  • CPR
  • Adrenaline every 3-5 mins
  • Amiodarone after 3 shocks
27
Q

Non shockable vs shockable rhythms

A

Shockable:
* Ventricular tachycardia
* Ventricular fibrillation

Non-Shockable:
* Pulseless electrical activity
* Asystole

28
Q

Which leads are anterior?

A

V2
V3
V4

29
Q

Which leads are lateral?

A

Lead 1
avL
V5
V6

30
Q

Which leada are septal?

A

V1
V2

31
Q

Which leads are inferior?

A

Lead II
Lead III
avF

32
Q

Coronary artery and which leads will see changes in

A

LAD - V1, V2, V3, V4 (anteroseptal)
RCA - Lead II, III avF (inferior)
Left circumflex - Lead I, avL V5, V6 (lateral)

33
Q

Early management of STEMI

A
  • 300mg aspirin
  • Coronary angiography - PCI
34
Q

If having PCI what else for STEMI management

A

Prasugrel - if not already on oral anticoag
Clopidogrel - if they are
UFH is also sometimes given
(+aspirin ofc)

35
Q

If STEMI with no PCI what is offered?

A

Ticagrelor + aspirin
Fibrinolysis

36
Q

When can PCI be given?

A

Presentation within 12 hours of symptom onset AND
PCI can be delivered within 120 minutes of time when fibrinolysis can be done

37
Q

When is fibrinolysis offered instead of PCI?

A

If PCI cannot be delivered within 120 minutes that fibrinolysis would be delivered
If not suitable for procedure

38
Q

NSTEMI management

A

300mg aspirin - loading dose
Fondaparinux - if no high bleeding risk and no coronary angiography

39
Q

Pericarditis ECG

A

Widespread concave (saddle shaped) ST elevation in all leads
Reciprocal ST depression and PR elevation in avR

40
Q

Symptoms of pericarditis

A

Sharp, constantt sternal pain
Relieved by sitting forwards
Radiate to left shoulder/left arm/ abdomen
Worse when lying on left side and on inspiration, swallowing and coughing
Can also have fever, cough, joint pain

41
Q

Signs of pericarditis

A

Pericardial rib on auscultation - high pitched scratching, best heard over left sternal border during expiration

42
Q

Management pericarditis

A

NSAID eg ibruprofen 600mg TDS for 1-2 weeks + PPI
Taper off once inflammatory markers decrease
If risk factors for CAD aspirin may be preferred at 900mg TDS 1-2 weeks

43
Q

What is added to treatment of pericarditis?

A

Colchicine - for 3 months 500 mcg BD if >70kg
500mcg OD if <70kg
BUT narrow therapeutic index for this drug

44
Q

WPW ECG sign

A

Delta wave on R wave as it comes up, not straight, bent instead, bit wavy

45
Q

LBBB and RBBB signs on ECG

A

WiLLiam
Morrow

W shape in V1 and M shape in V6 for LBB
M shape in V1 and W shape in V6 for RBBB

46
Q

Hypokalaemia ECG signs

A

T wave inversion
U wave
ST depression

47
Q

Hyperkalaemia ECG signs

A

Flattened P wave
Tall tented T waves
PR prolonged
Wide QRS

48
Q

Hyperkalaemia management

A
  • 10ml calcium gluconate 10% or calcium chloride
  • Insulin and glucose (short acting)
  • Salbultamol nebuliser
  • +/- calcium resonium
  • Dialysis (renal replacement therapy) if needed
49
Q
A

Introduction YR3 + teaching (7 decks)

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