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ECGs > ECGs > Flashcards

ECGs Flashcards

1
Q

How do you calculate HR on ECG?

A

300/no. of large squares between R-intervals

If pulse irregular: total R waves on ECG X 6

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2
Q

What HR counts as sinus bradycardia?

A

<60bpm

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3
Q

What HR counts as sinus tachycardia?

A

> 100bpm

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4
Q

How do you check the regularity of HR?

A

mark 4 R peaks on a piece of paper, move along trace to confirm

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5
Q

How do you check that an ECG is in sinus rhythm?

A

look for a P before every QRS complex

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6
Q

What are the two common features of AF on an ECG?

A

no clear P waves

Irregular QRS complex

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7
Q

Which arrhythmia presents with a ‘sawtooth’ baseline?

A

atrial flutter

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8
Q

What arrhythmias may present with broad-complex tachycardia with no p waves?

A

VF
VT

sometimes SVT with BBB/WPW

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9
Q

What are key features of SVT?

A

narrow complex tachycardia

abnormal or no P waves

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10
Q

How can you confirm that an ECG does not have any axis deviation?

A

QRS complexes in lead I and II are predominantly positive

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11
Q

How can you identify left-axis deviation?

A

R waves point away from each other in leads I and II

QRS predominantly +ve in lead I and negative in lead II

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12
Q

What are some common causes of L-axis deviation?

A 
LV hypertrophy/strain
L anterior hemiblock
Inferior MI
WPW
VT

(anything where more electricity is going towards left)

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13
Q

How can you identify right-axis deviation?

A

R waves point towards each other in leads I and II

QRS predominantly -ve in lead I and positive in lead II

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14
Q

What are some common causes of R-axis deviation?

A 
tall, thin body type
RV hypertrophy/strain eg. PE
L posterior semi-block
lateral MI
WPW
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15
Q

How tall should a P-wave be?

A

<=2 small squares

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16
Q

What might cause a raised p wave?

A

right atrial hypertrophy (caused by pulmonary hypertension or tricuspid stenosis)

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17
Q

How long should the PR interval be?

A

3-5 small squares

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18
Q

What can cause an increase in PR interval?

A

AV block ‘heart block’

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19
Q

How can you identify 1st degree AV block?

A

PR>5 small squares and regular

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20
Q

What are the different types of 2nd degree AV block?

A

Mobitz type 1 (Wenkebach)

Moritz type 2 - 2nd degree AV block with 2:1/3:1/4:1 block

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21
Q

What are the features of Mobitz type 1 heart block (Wenkebach)?

A

PR progressively elongates until there is failure of conduction of an arterial beat
(then cycle repeats)

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22
Q

What are the features of Mobitz type 2?

A

constant normal PR interval
Occasional dropped ventricular beats
(constant ratios: 2:1/3:1/4:1)

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23
Q

What is third degree heart block commonly known as?

A

complete heart block

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24
Q

What are the features of 3rd degree heart block?

A

complete dissociation between p waves and QRS complexes

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25
Q

What are some causes of 1st and second degree AV block?

A 
increased vagal tone/athletes
coronary artery disease
myocarditis
acute rheumatic carditis
digoxin toxicity
electrolyte disturbances
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26
Q

What are some causes of 3rd degree heart block?

A

fibrosis around bundle of His caused by ischaemia, congenital, idiopathic, aortic stenosis or trauma) or block of both bundle branches

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27
Q

How should R waves progress?

A

QRS complexes should progress from mostly negative in V1, to completely positive in V6

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28
Q

How big should a QRS segment be?

A

<3 small squares

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29
Q

What can cause an increase in QRS complex length?

A

bundle branch block

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30
Q

How can you identify RBBB?

A

QRS in V1: M pattern

QRS in V6: W pattern

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31
Q

How can you identify LBBB?

A

QRS in V1: W pattern

QRS in V2: M pattern

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32
Q

What can cause RBBB?

A

normal variant
atrial septal defect
PE

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33
Q

What can cause LBBB?

A 
ischaemic disease
acute MI
cardiomyopathy
hypertension
aortic stenosis
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34
Q

Where should you look to assess QRS complexes?

A

Chest leads: for R wave progression

Rhythm strip: R wave length

35
Q

Where should you look to assess QRS height?

A

V1 and V5/6

36
Q

How high should a QRS be?

A

<4 squares

37
Q

What can cause a R wave > 5 big squares (in V5/6)?

A

LVH

normal (physically fit pts)

38
Q

What can cause a dominant wave in V1?

A

RVH (if there are other signs too eg. T wave inversion in R chest

39
Q

Where should you check for Q waves?

A

all leads

40
Q

What are Q waves a sign of?

A

Previous MI (but small Q waves can be normal in ! aVL and V6)

Full-thickness MI

41
Q

In which leads should you check the ST segment?

A

All leads

42
Q

What counts as ST elevation?

A

increase by >=1 small square

43
Q

What can ST elevation be a sign of?

A

Infarction

Pericarditis or tamponade if in every lead

44
Q

What counts as ST depression?

A

reduction by >=1 small square

45
Q

What can ST depression be a sign of?

A

ischaemia

posterior infarction ‘reciprocal change’

46
Q

What are the different types of ST changes (apart from elevation and depression)? What do they suggest?

A

Saddled: pericarditis/tamponade

Upward sloping: normal variant

Downward sloping (reverse tick): digoxin toxicity

47
Q

In which leads should you check the T wave?

A

All leads

48
Q

In which leads is T wave inversion normal? Why?

A

III, aVR and V1 (also V2-3 in black people)

Due to the angle from which they look at the heart

49
Q

What can cause T-wave inversion (in leads where this would not be considered normal)?

A

ischaemia/post=MI
R/L VH
Bundle branch block
digoxin treatment

50
Q

What can cause tall-tented T waves?

A

Hyperkalaemia

51
Q

What can cause flat T waves?

A

Hypokalaemia

52
Q

What should the QT interval be?

A

<450ms (ECG should calculate this)

53
Q

What causes increased QT interval? Why is this a problem?

A 
Congenital syndromes
Anti-psychotics
Sotalol/amiodarone
TCAs
Erythromycin
Hypokalaemia
Hypomagnesaemia
Hypocalcaemia

Predisposes to polymorphic VT

54
Q

Where can U waves be seen? What can cause them?

A

Rhythm strip

Normal or hypkalaemia

55
Q

What do ST changes in leads II, III and aVF indicate? Which artery is affected?

A

Inferior MI

Right coronary artery

56
Q

What do ST changes in leads V1 - V4 indicate? Which artery is affected?

A

Anteroseptal MI

LAD artery

57
Q

What do ST changes in leads V4-V5 and aVL indicate? Which artery is affected?

A

Anterolateral MI

LAD or L circumflex

58
Q

What do ST changes in leads I, aVL +/- V5-6 indicate? Which artery is affected?

A

Left circumflex

59
Q

What would a dominant R wave in V1-V2 and ST depression indicate to you?
Which artery would be affected?

A

Posterior MI

Left circumflex or Right coronary

60
Q

What are key features of AF on an EGG?

A

Irregular

Without P waves

61
Q

What are key features of atrial flutter on an ECG?

A

Regular

Saw-tooth base line (2:1, 3:1 and 4:1 block)

62
Q

What are key features of atrial tachycardia on an ECG?

A

Regular

Abnormal P waves

63
Q

What are key features of VF on an ECG?

A

no discernable P waves/QRS complexes (random wavy line)

NO PULSE

64
Q

What are key features of VT on an ECG?

A

Broad complex tachycardia

65
Q

What are key features of an atrial ectopic on an ECG?

A

narrow QRS with/without preceding ectopic p wave

66
Q

What are key features of a ventricular ectopic on an ECG?

A

abnormal broad QRS at abnormal time

p occurs at predicted time

67
Q

What are key features of WPW on an ECG?

A

slurred upstroke into QRS complex
Short PR interval
QRS complexes may be slightly broad
Dominant R wave in V1

68
Q

What are key features of infarction on an ECG?

A

ST elevation (first change)
T wave inversion
Pathological Q waves (signify full-thickness MI)

69
Q

After what time do pathological Q waves appear?

A

8-12 hours after ST elevation (if myocardium is not reperfused)

70
Q

What are the STEMI criteria?

A

St elevation of >2 small squares in 2 adjacent chest leads

ST elevation of >1 small square in 2 adjacent limb leads

OR

new LBBB

71
Q

What are key features of ischaemia on an ECG?

A

ST depression

new T-wave inversion

72
Q

What are key features of previous infarcts on an ECG?

A

T wave inversion (weeks-months)

Pathological Q waves (permanent)

73
Q

What are key features of hyperkalaemia on an ECG?

A

low flat P waves
Wide bizarre QRS
slurring into ST segment
tall-tented T waves

74
Q

What are key features of hypokalaemia on an ECG?

A

small flattened T waves
Prolonged PR
Depressed ST
Prominent U wave

75
Q

What are key features of hypercalcaemia on an ECG?

A

short QT

76
Q

What are key features of hypocalcaemia on an ECG?

A

prolonged QT

77
Q

What changes to an ECG might a PE cause?

A 
tachycardia
RV strain (RBBB, right axis deviation)
RA enlargement (P pulmonale)

S1Q3T3 (prominent S wave in lead I, and Q wave and inverted T wave in lead III) - rare

78
Q

What ECG changes are associated with pericarditis?

A 
ST elevation in all leads
PR depression (specific)
saddle-shaped ST interval
79
Q

Which leads show septal MI?

A

V1-2

80
Q

Which leads show anterior MI?

A

V3-4

81
Q

Which leads show lateral MI?

A

I + aVL

V5-6

82
Q

Which leads show inferior MI?

A

II, III and aVF

83
Q

Which leads show right ventricular MI?

A

V1

V4

ECGs (2 decks)

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