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Year 3 > ECGs > Flashcards

ECGs Flashcards

1
Q

What are the 3 types of ECG leads?

A
  1. Limb leads (bipolar)
  2. Augmented limb leads (unipolar)
  3. Chest leads (unipolar)
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2
Q

What type of deflection does re-polarisation away from an ECG lead produce?

A

Positive deflection

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3
Q

What type of deflection does depolarisation away from an ECG lead produce?

A

Negative deflection

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4
Q

What is the normal amplitude of a QRS complex in mV?

A

<2.5mV

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5
Q

What is the normal range for a P-R interval?

A

0.12- 0.2 seconds

3-5 small squares

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6
Q

How wide should a QRS complex be on an ECG?

A

0.06-0.12 secs
<3 small squares

Anything wider than 3 small squares is considered a “broad complex”

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7
Q

What are the causes of tachycardia with broad QRS?

A

VT

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8
Q

What are the causes of tachycardia with narrow QRS?

A

Irregular: AF or atrial flutter

Regular: SVT, atrial tachycardia (rare) or atrial flutter

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9
Q

What could cause a PROLONGED PR interval? (>5 small squares)

A

1st degree heart block

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10
Q

What could cause a SHORTER PR interval? (<3 small squares)

A

Wolf Parkinson White (Accessory pathway)

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11
Q

Where does ventricular depolarisation normally originate?

A

Atria, passes down Bundle of His

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12
Q

When may a QRS complex be broad (>3 small squares) WITHOUT tachycardia?

A
  1. Ventricle-ventricle conduction eg. Ventricular ectopics
  2. Bundle branch block
  3. Hyperkalaemia
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13
Q

Which 2 leads should be added together to see if there is ventricular hypertrophy?

A

V1 + V5

If > 7 squares suggests hypertrophy

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14
Q

What might a pathological Q wave suggest?

A

Old MI

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15
Q

What causes a tall tented T wave?

A

Hyperkalaemia

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16
Q

What causes a flat T wave?

A

Hypokalaemia

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17
Q

What causes an inverted T wave?

A
  1. Normal in lead V1, aVR
  2. Old MI (weeks)
  3. Bundle branch block
  4. Ischemia
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18
Q

What ECG changes are seen in Hyperkalaemia?

A
  1. Tall tented T wave
  2. Broad QRS complex
  3. Flat P wave
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19
Q

What causes ST depression?

A
  1. NSTEMI
  2. Posterior MI
  3. Digoxin toxicity
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20
Q

What does the ECG trace look like in 1st degree heart block?

A

Prolonged PR interval >5 small squares

No missed beats

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21
Q

What does the ECG trace look like in Mobitz type 1 heart block (Wenckebach)?

A

Beat by beat prolongation of PR interval until a missed QRS complex

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22
Q

What does the ECG trace look like in Mobitz type 2 heart block?

A

QRS complexes are regularly missed eg. P, QRS, P

Can have a 2:1 block or 3:1 block

23
Q

What does the ECG trace look like in 3rd degree heart block?

A

Complete dissociation between P and QRS complex

No impulses are passed from atria to ventricles, so can lead to bradycardia

24
Q

Which ECG leads represent the ANTERIOR territory of the heart?

A

V1-V4

25
Q

Which ECG leads represent the LATERAL territory of the heart?

A

V5, V6, I and aVL

26
Q

Which ECG leads represent the INFERIOR territory of the heart?

A

II, III and aVF

27
Q

Which coronary artery supplies the anterior heart?

A

Left anterior descending

28
Q

Which coronary artery supplies the lateral heart?

A

Left circumflex

29
Q

Which coronary artery supplies the inferior heart?

A

Right coronary artery

30
Q

What does the ECG trace look like in Left Bundle Branch Block?

A
  1. QRS > 3 small squares in V4, V5 and V6
  2. V1 has downwards QRS with “W” shape
  3. V5 has “M” shape WRS
  4. T wave inversion in V5, V6, aVL and I
31
Q

What are the causes of LBBB?

A
  1. Ischemic heart disease
  2. Left ventricular hypertrophy
  3. Cardiomyopathy
  4. Hypertension
32
Q

What does the ECG trace look like in Right Bundle Branch Block?

A
  1. Broad QRS in V1, V2 and V3
  2. V1 has “M” shape RSR in the QRS
  3. V6 has “W” shape slurred S
  4. Inverted T waves in V1, V2 and V3
33
Q

What are the causes of RBBB?

A
  1. Isolated RBBB
  2. Right ventricular hypertrophy
  3. Cor pulmonale
  4. PE
  5. Atrial septal defect
  6. Ishemic heart disease
34
Q

How may a NSTEMI appear on ECG?

A
  1. Inverted T waves

2. ST depression

35
Q

What causes a broad QRS complex tachycardia?

A

Ventricular tachycardia (VT)

36
Q

What causes a narrow QRS complex tachycardia that is IRREGULAR?

A

Atrial fibrillation

Atrial flutter

37
Q

What causes a narrow QRS complex tachycardia that is REGULAR?

A
  1. SVT
  2. Atrial flutter
  3. Atrial tachycardia (very rare)
38
Q

What is the cause of an SVT?

A

Area conducting directly from atria to ventricles without passing through the AV node (Pathway)

Has no parsympathetic or sympathetic involvement

39
Q

What is the classical history of a patient with an SVT?

A

Sudden onset tachycardia of around 160bpm

Can go away

40
Q

How can SVT be proven?

A

Give adenosine/ do vagal manouvres which will block the AV node
The tachycardia will remain if it is an SVT

41
Q

What are the common ventricular rates in atrial flutter?

A

Factors of 300:
100
150

42
Q

What are the different types of ventricular tachycardia? (Broad QRS complex)

A
  1. Ventricular fibrillation- chaotic with no pattern
  2. Ventricular tachycardia
  3. Torsades de pointes
43
Q

List 10 causes of Atrial Fibrillation (AF)?

A
  1. Heart failure
  2. Hypertension
  3. Mitral valve disease
  4. Ischemic heart disease
  5. PE
  6. Hyperthyroidism
  7. Pneumonia
  8. Caffeine, alcohol
  9. Post operative
  10. HYPOkalaemia/ HYPOmagnesia
  11. Cardiomyopathy
44
Q

What is Atrial Fibrillation (AF)?

A

Arrhythmia caused by a chaotic irregular atrial rhythm at 300-600bpm

The AVN responds intermittantly

Results in irregularly irregular pulse

45
Q

What are the SIGNS of AF?

A

Irregularly irregular pulse
Signs of LVH
1st heart sound may change in intensity

46
Q

What are the SYMPTOMS of AF?

A

Palpitations
Chest pains
Dyspnoea

47
Q

What 3 tests should be done in a patient where AF is suspected?

A
  1. ECG- absent P wave, irregular QRS
  2. Bloods- UandEs, thyroid function, cardiac enzymes
  3. Echo- look for mitral valve disease, signs of LVH, signs of left atrial enlargement
48
Q

What are the main aims in treating chronic AF?

A
  1. Anticoagulation

2. Rate control

49
Q

What is sinus bradycardia?

A

Sinus rhythm at rate <60 bpm

50
Q

How does SA node disease (bradycardia) appear on ECG?

A
  1. No P wave
  2. Ventricular escape rhythm of 20-30bpm (ventricular myocyte to myocyte conduction is slow so broad QRS)
  3. If no ventricular escape rhythm
51
Q

What can a permanent pacemaker be used for?

A
  1. Complete heart block (3rd degree)
  2. Mobitz Type II
  3. AV node block after MI
  4. Symptomatic bradycardias eg. sick sinus syndrome
52
Q

What is WPW syndrome?

A

Congenital abnormality with accessory pathway between atria and ventricles

Has slurred upstroke QRS and shortened PR interval

53
Q

What is Sick sinus syndrome?

A

Fibrosis of SA node in elderly affects SA node activity

Can cause syncope, light-headedness, palpitations

Year 3 (22 decks)

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