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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
SVT treatment
Vagal maneuvers - eg carotid sinus massage Adenosine - impending doom feeling
26
V fib treatment
* Shockable * CPR * Adrenaline every 3-5 mins * Amiodarone after 3 shocks
27
Non shockable vs shockable rhythms
Shockable: * Ventricular tachycardia * Ventricular fibrillation Non-Shockable: * Pulseless electrical activity * Asystole
28
Which leads are anterior?
V2 V3 V4
29
Which leads are lateral?
Lead 1 avL V5 V6
30
Which leada are septal?
V1 V2
31
Which leads are inferior?
Lead II Lead III avF
32
Coronary artery and which leads will see changes in
LAD - V1, V2, V3, V4 (anteroseptal) RCA - Lead II, III avF (inferior) Left circumflex - Lead I, avL V5, V6 (lateral)
33
Early management of STEMI
* 300mg aspirin * Coronary angiography - PCI
34
If having PCI what else for STEMI management
Prasugrel - if not already on oral anticoag Clopidogrel - if they are UFH is also sometimes given (+aspirin ofc)
35
If STEMI with no PCI what is offered?
Ticagrelor + aspirin Fibrinolysis
36
When can PCI be given?
Presentation within 12 hours of symptom onset AND PCI can be delivered within 120 minutes of time when fibrinolysis can be done
37
When is fibrinolysis offered instead of PCI?
If PCI cannot be delivered within 120 minutes that fibrinolysis would be delivered If not suitable for procedure
38
NSTEMI management
300mg aspirin - loading dose Fondaparinux - if no high bleeding risk and no coronary angiography
39
Pericarditis ECG
Widespread concave (saddle shaped) ST elevation in all leads Reciprocal ST depression and PR elevation in avR
40
Symptoms of pericarditis
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
Signs of pericarditis
Pericardial rib on auscultation - high pitched scratching, best heard over left sternal border during expiration
42
Management pericarditis
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
What is added to treatment of pericarditis?
Colchicine - for 3 months 500 mcg BD if >70kg 500mcg OD if <70kg BUT narrow therapeutic index for this drug
44
WPW ECG sign
Delta wave on R wave as it comes up, not straight, bent instead, bit wavy
45
LBBB and RBBB signs on ECG
Wi**LL**iam Mo**rr**ow W shape in V1 and M shape in V6 for **L**BB M shape in V1 and W shape in V6 for **R**BBB
46
Hypokalaemia ECG signs
T wave inversion U wave ST depression
47
Hyperkalaemia ECG signs
Flattened P wave Tall tented T waves PR prolonged Wide QRS
48
Hyperkalaemia management
* 10ml calcium gluconate 10% or calcium chloride * Insulin and glucose (short acting) * Salbultamol nebuliser * +/- calcium resonium * Dialysis (renal replacement therapy) if needed
49

Introduction YR3 + teaching (7 decks)

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