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MD2 > ECGs > Flashcards

ECGs Flashcards

1
Q

Which leads show anterior pathology?

A 
V1-V4 = Left Anterior Descending (LAD)
V1&V2 = Septal
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2
Q

Which leads show lateral pathology?

A

V5, V6, I, aVL = Circumflex

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3
Q

Which leads show inferior pathology?

A

II, III, aVF = Right Coronary Artery (RCA)

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4
Q

What is shown with a normal axis?

A

leads I, II, and III positive (II most positive)

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5
Q

What is shown with right axis deviation?

A

QRS is positive (dominant R wave) in leads III and aVF

QRS is negative (dominant S wave) in leads I and aVL

Causes:

Left posterior fascicular block

Lateral MI

Right ventricular hypertrophy

Acute Lung Disease (PE)

Chronic Lung Disease (COPD)

Ventricular Ectopy

WPW Syndrome

Hyperkalaemia

Horizontally positioned heart

Septal Defects

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6
Q

What is shown with left axis deviation?

A

QRS is positive (dominant R wave) in leads I and aVL

QRS is negative (dominant S wave) in leads II and aVF

Causes:

Left anterior fascicular block

LBBB

Left ventricular hypertrophy

Inferior MI

Ventricular ectopy

Pacing

WPW syndrome

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7
Q

What is the regular PR interval?

A

Normal 120-200ms

3-5 small squares

Prolongation suggests heart block, hypokalaemia, acute rheumatic fever

Shortening with upsweeping Q wave indicative of WPW

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8
Q

What is the regular QRS complex width?

A

<120ms

3 small squares

Wide suggests ventricular origin

Narrow suggests supraventricular origin

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9
Q

Reporting an ECG

A

Patient Name

Date of ECG

Rate (# of beats)

Rhythm (regular/irregular)

Axis

P wave (presence, amplitude)

PR interval (normal, shortened, widened)

QRS complex (presence, size)

ST segment

T waves (presence, inversion)

QT interval (elongated)

Other: LBBB, RBBB, pacing, ectopics, Q waves

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10
Q

Sinus Rhythm

A

each QRS complex is preceded by a P wave

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11
Q

Bradycardia vs Tachycardia

A

<60 = brady

>100 = tachy

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12
Q

Escape Rates

A

Atrial: 60-80bpm

Junctional: 40-60bpm

Ventricular: 20-40bpm

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13
Q

First Degree Heart Block

A

PR interval widened (P waves may be burried in T wave)

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14
Q

Right Bundle Branch Block

A

MaRRoW (M in V1, W in V2)

Broad QRS > 120ms

Typical RSR’ pattern in V1-3

Wide slurred S wave in I, aVL, V5-6

NB: Delayed activation of the right ventricle also gives rise to secondary repolarization abnormalities, with ST depression and T wave inversion in the right precordial leads.

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15
Q

Left Bundle Branch Block

A

WiLLiaM (W in V1, M in V2)

QRS duration > 120ms

Dominant S wave in V1

Broad monophasic R wave in I, aVL, V5-6

Absence of Q waves in lateral leads

LBBB can mask ECG signs of MI

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16
Q

Second Degree Heart Block (Mobitz I)

A

Progressive prolongation of PR interval culminating in non-conducted P wave

17
Q

Second Degree Heart Block (Mobitz II)

A

Intermittent non-conducted P waves without progressive prolongation of the PR interval

18
Q

Third Degree Heart Block

A

Atrial rate is approximately 100bpm

Ventricular rate is approximately 40bpm

Perfusing rhythm is maintained by Junctional or Ventricular escape rhythm

19
Q

Atrial Flutter

A

Serrated / saw-toothed P waves

May show alternating pattern of 2:1, 3:1, 4:1 conduction ratios

250-350bpm

20
Q

Atrial Fibrillation

A

Irregularly irregular rhythm

no P waves

no isoelectric basline

>350bpm

21
Q

Wolff-Parkinson White

A

Delta waves - slurring slow rise of initial portion of QRS

22
Q

Ventricular Fibrillation

A

Chaotic irregular deflections of varying amplitude

No P waves, QRS complexes, or T waves identifiable

Fatal if not cardioverted

23
Q

Ventricular Ectopic Beats (Premature Ventricular Complex)

A

Premature broad QRS complex with abnormal morphology

ST segment discordant to QRS

bigeminy = frequent PVCs coupled with sinus rhythm

24
Q

Atrial Ectopic Beats (Premature Atrial Complex)

A

Abnormal P wave followed by normal QRS (P wave may be hidden in T wave)

25
Q

AV nodal (junctional) rhythm

A

Junctional rhythms are narrow complex, regular rhythms arising from the AV node.

P waves are either absent or abnormal (e.g. inverted) with a short PR interval (=retrograde P waves).

26
Q

Hyperkalaemia

A

Peaked/ Tall T waves

Loss of P wave

Widening QRS (approaching sine wave)

27
Q

Ventricular Tachycarida

A

Wide QRS

May degenerate to VF (fatal)

28
Q

Pulmonary Embolism

A

S1Q3T3

  • prominent S wave in lead I
  • abnormal Q wave in lead III
  • T wave inversion in lead III
29
Q

Past MI

A

Q waves seen in leads V1-3

Inferior Q waves (II, III, aVF)

May have T wave inversion

30
Q

Supraventricular Tachycardia

A

Similar to VT but has narrow QRS and possible evidence of P waves (although not sinus rhythm)

31
Q

Causes of Regular Rhythm Bradycardia

A

Physiological (athletes, during sleep: due to increased vagal tone)

Drugs (e.g. beta-blockers, digoxin, amiodarone)

Hypothyroidism (decreased sympathetic activity secondary to thyroid hormone deficiency)

Hypothermia

Raised intracranial pressure (due to an effect on central sympathetic outflow)—a late sign

Third-degree atrioventricular (AV) block, or second-degree (type 2) AV block

Myocardial infarction

Paroxysmal bradycardia: vasovagal syncope

Jaundice (in severe cases only, due to deposition of bilirubin in the conducting system)

32
Q

Causes of Irregular Rhythm Bradycardia

A

Irregularly irregular

Atrial fibrillation (in combination with conduction system disease or AV nodal blocking drugs) due to:

● alcohol, post-thoracotomy, idiopathic

● mitral valve disease or any cause of left atrial enlargement

Frequent ectopic beats

Regularly irregular rhythm

Sinus arrhythmia (normal slowing of the pulse with expiration)

Second-degree AV block (type 1)

Apparent

Pulse deficit* (atrial fibrillation, ventricular or atrial bigeminy)

33
Q

Causes of Regular Rhythm Tachycardia

A

Hyperdynamic circulation, due to:

● exercise or emotion (e.g. anxiety)

● fever (allow 15–20 beats per minute per °C above normal)

● pregnancy

● thyrotoxicosis

● anaemia

● arteriovenous fistula (e.g. Paget’s disease or hepatic failure)

● beri-beri (thiamine deficiency)

Congestive cardiac failure

Constrictive pericarditis

Drugs (e.g. salbutamol and other sympathomimetics, atropine)

Normal variant

Denervated heart, e.g. diabetes (resting rate of 106–120 beats per minute)

Hypovolaemic shock

Supraventricular tachycardia (usually >150)

Atrial flutter with regular 2:1 AV block (usually 150)

Ventricular tachycardia (often >150)

Sinus tachycardia, due to:

● thyrotoxicosis

● pulmonary embolism

● myocarditis

● myocardial ischaemia

● fever, acute hypoxia or hypercapnia (paroxysmal)

Multifocal atrial tachycardia

Atrial flutter with variable block

34
Q

Causes of Irregular Rhythm Tachycardia

A

Atrial fibrillation, due to:

● myocardial ischaemia

● mitral valve disease or any cause of left atrial enlargement

● thyrotoxicosis

● hypertensive heart disease

● sick sinus syndrome

● pulmonary embolism

● myocarditis

● fever, acute hypoxia or hypercapnia (paroxysmal)

● other: alcohol, post-thoracotomy, idiopathic

Multifocal atrial tachycardia

Atrial flutter with variable block

35
Q

What is the normal QT interval?

A

The QT interval should be aproxametly less than half the cardiac cycle

A lengthened QT interval is a marker for the potential of ventricular tachyarrhythmias like torsades de pointes and a risk factor for sudden death.

36
Q

What is a delta wave

A

Early ventricular depolarisation typically due to Bundle of Kent activation pathway

Seen in Wolff Parkinson White Syndrome

37
Q

CHADS2

A

Assessment Scale for Atrial Fibrillation and need for anticoagulants

MD2 (34 decks)

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