ecgs Flashcards
SVT VS ventricular arrytmias
SVT - narrow comlex ?
ventricular - wide QRS
ecg features a fib
irregular r -r
narrow complex-usually
unduluting or evn flat baseline
?
nomral qrs
less than 0.12
a flutter charactristics
generally has regular R-R intervals (not always)
saw tooth
normal pr interval
0.12 - 0.20 (3-5 small squares)
when someone is intoxicated with something what are we looking at mainly in ecg
qtc interval
relationship of qtc with HR
tachy means shortened QTC
brady means leghtned QTC
what are we worried about in a long qtc
ventricular arrhythmias, especially Torsade’s de Pointes
causes of prolonged Qtc
Hypokalemia
Hypomagnesaemia
Hypocalcemia
Hypothermia
Myocardial ischemia
causes of shortene QTc
hypercalcemia
digoxin
normal eletcrical axis
-30 + 90
where is lead 1 , 2 , and AVF in realtion to cardiac axis
lead 1 - 0 degress
lead 2 - like 45 degrees
lead AVF - straight down at 90 degrees
normal axis leads
lead 1 +
lead 2+
lead avf + +
left axis
lead 1 = +
lead AVF=negative
lead 2 = you have to check its negative to confirm for some reason
causes of right axis deviation
RV hypertrophy
what’s the little saying we use for Right axis deviation
right is reaching
what’s the little saying for Left axis devaition
left is leaving
septal leads
v1 -v2
anterior leads
v3 +v4
what lead can we use to calibrate the ecg
AVR should always be pointing RIGHT DOWN if not then you need to repeat the ECG
normal postion of v1
should be negative but the initial has a tiny peak of postive deflection
normal v6
postive
hyperkalemia ecg
tall tented t waves
flattend p waves
prolonged PR
broad qrs
HYPOKALEMIA
t wave inversion
u waves
st depression
in hyperkalemia will you see all fetaures
no depends on severtiy
initially will be the tall tented
where do we find U waves
hypokalemia and bradycardia
When looking at ischemia which parts do ecg do we focus on
- J point
St
T wave
When looking at ischemia which parts do ecg do we focus on
- J point
St
T wave
J point
The transition before ventricular depolarisation and ventricular depolarisation
When having ischemia to the heart which part will be affect ed first and why
The subendocaridal because coronary a bring blood from outside to the inner most heart, so if there is obstruction the first part to suffer is the endocardium as blood supply is less! Then as it prolongs it gradually spreads to the outside
What to look out in a stemi
St elevation
Lbbb
Hyperactive t waves (symmetrical and tall)
Pathological q waves
Stages of a trans mural mi
- Hyperactute t waves
- St elevation
- St elevation and t wave inversion
- Pathological q waves
How do you tell the difference between ischemia or infarction
Q waves deep
How to tell years after if someone had an mi
Q waves (should be more than 1 small box width or more than 1/3 the R wave
What are precocial leads
V1-6
Looking at the heart from front side
What are precocial leads
V1-6
Looking at the heart from front side
Where is a right bundle branch Block most best seen
V1 RSR pattern M
Where is the left bundle branch Block best scene
V6 M Which
Is a Bondo branch Block, always a dangerous thing
Some people have right bundle branch block and are normal so long as the QRS complex is within range around three squares. However, if you have a left bundle branch Block that almost always needs to be investigated because it’s a pathology
Where do you see a deep slurred S wave
Right bond branch, Block
Superventricular rhythms versus ventricular rhythms
Supraventricular rhythms had narrow QS complexes, because it’s the atria, that’s the problem, and the impulse still passes through the ventricles, normally whereas ventricular rhythms, having broad, qrs complex
what is type 2 mobitz 2
pr interval is lenghtened or normal howver you get a non conducted QRS
type 2 mobitz 1 wenkebach
PR interval gets progressivel longer than qrs drops
whats the danger of 2nd degree heart block
progression to third
what are the limb leads
1,2,3,AVR,AVF, AVR
which are the lateral limb leads
1and AVL
criteria for stemi
st elevation in 2 contigious leads
new onset LBBB
PROCESS OF STEMI IN PATIENT
DO A TROP
ECG
PCI WITHIN 120 MINS OF CONTACT
IF NOT POSSIBLE DO FIBRONOLYSIS
TPA CI
recent stroke
have a bleeding disorer
on warfarin
had a surgery recent 3 months
the 300mg aspirin dose what route
preferably chewable for faster absorbiton sub lingual
if ot can get the dissolvavle tablet
should all t waves be upright in an ecg
NO in AVR should always be negative and its abnormal if its upright
what differentiates between NSTEMI AND UNSTABLE
the troponin
indications for an ecg
ACS
arrythmias
syncope!nB - need to figure out why the person fainted
syncope during exercise big red flag
electrolyes
intoxication/drugs
apparenlty there is an inferior MI what should you always look for reciprical depression in
AVL!!! apparnely always and if its not then you even doubt its a inferior one
uusally your high lateral leads are reciprical (1 + aVL) but depending on the area you may not have a chnage in 1 but you 99% have in lead avl
qrs normal lenght
no more than 3 squares
0.12
