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Cardiovascular > ECGs > Flashcards

ECGs Flashcards

1
Q

What is the methodical approach to reading an ECG?

A 
Name, age, DOB, ECG date
Rate
Rhythm
Axis
P wave
PR interval
QRS complex
QT interval
ST segment
T wave
J wave
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2
Q

How do you calculate the rate?

A

Either count the number of QRS complexes on a 10second strip, or do 300/number of big squares btwn QRS complexes

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3
Q

What should the ECG be set at?

A

25mm/s
10mm/mV
small square is 0.04
big square is 0.2

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4
Q

What are the different types of rhythm?

A

Regular
Regularly irregular
Irregularly irregular .
(AF/VF)

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5
Q

How do you determine the axis?

A

Look at leads 1 and 2/aVF

Normal axis = both leads 1 and 2/aVF are positive

Left deviation = lead 1 is positive and 2/aVF is negative

Right deviation = lead 1 is negative and 2/aVF is positive

Extreme deviation = both are negative

Leaving = Left
(the QRS in 1 and 2 are pointing away from each other)

Returning = Right
(the QRS in 1 and 2 are pointing towards each other)

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6
Q

What are some causes of left axis deviation?

A 
Left anterior hemiblock
Inferior MI
VT from LV
WPW
LVH
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7
Q

What are some causes of right axis deviation?

A 
Left posterior hemiblock
Anterolateral MI
PE
WPW
RVH
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8
Q

What are normal p waves?

A

Preceding each QRS complex
Positive in 2,3 and aVF
Negative in aVR

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9
Q

What are the abnormalities of p waves?

A

Absent: AF/AVRT

Sawtooth: Atrial Flutter

P mitrale (looks like an m): LAH

P pulmonale (peaked): RAH

Pseudo p-pulmonale: hyperkalaemia

Earlier than expected/abnormally shaped: ectopic p waves

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10
Q

How do you differentiate between AF and AVRT?

A

AF is irregularly irregular with a wavy baseline

ART is regular with narrow QRS

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11
Q

What can the PR interval tell us?

A

The normal range is 0.12-0.2 from start of P to start of QRS

A prolonged PR interval implies heart block.

1st degree = the PR interval is regular

2nd degree T1 = PR interval gets longer and longer then is reset “wenkebach”

2nd degree T2 = PR interval is normal but sometimes a p wave occurs without a QRS

3rd degree = completely random p waves and QRS complexes.

A short PR interval implies unusually fast AV conduction, e.g. WPW

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12
Q

What are the options if the HR is below 60 or +100?

A

<60 = sinus brady, sick sinus syndrome, 2/3 heart block, atrial/ventricular escape rhythm

> 100 = ST, SVT, AF, AVRT

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13
Q

Which directions are the QRS complexes supposed to go?

A 
V1/2/3 = negative (3 a bit biphasic)
V4/5/6 = positive
aVR = negative
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14
Q

What is sinus arrhythmia?

A

When the HR = 75 during exp then 90 during insp

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15
Q

What is sick sinus syndrome?

A

When a p wave fails to appear but there is a random QRS complex

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16
Q

What is normal for a QRS complex?

A

<0.12s

3 small squares

17
Q

What are the abnormalities with QRS complexes?

A

Ventricular ectopics = one random wide, shitty QRS every now and then

VT = zigzag QRS, can self terminate

Wide ‘M’ in V1 and ‘W’ in V4 QRS = RBBB

Wide ‘W’ in V1 and ‘M’ in V4 QRS = LBBB

BBB can be intermittent and can have ST elevation w/o MI

VF = random uncoordinated waves

VH = high amplitude waves

18
Q

What is the normal QT interval, and what can a long QT mean?

A

Start of QRS to end of T. Usually 0.38-0.42

Prolonged QT can lead to VT and death

Short QT could be caused by hypercalcaemia and digoxin

19
Q

What are atrial escape rhythm and ventricular escape rhythm?

A

Lack of p waves but normal QRS

If QRS is narrow = atrial escape rhythm

If QRS is broad then ventricular escape

20
Q

What does the ST segment directly tell you about anatomically?

A

The coronary arteries

21
Q

What can go wrong with ST segment?

A

ST depression: narrowed artery and ischaemia

ST elevation: occluded artery

22
Q

How do you know where the MI was?

A

II, III, and aVF = inferior RCA

V1,2,3,4 = anterior LAD

I, V5,6 and aVL = posterior circumflex

23
Q

How does an ECG change in accordance to the stages of an MI?

A

1st stage MI = smaller QRS with a huge T wave

2nd stage = wide Q wave

3rd stage = inverted T wave

24
Q

What is a normal T wave?

A

Inverted in aVR, V1 and V2. Normal if inverted in isolation in lead III

25
Q

What is abnormal T wave?

A

Peaked in hyperkalaemia

Flattened in hypokalaemia

26
Q

What is the Q wave representative of?

A

The impulse spreading through the bundle of his

If big then had an MI

27
Q

What is the J wave?

A

A notch between S and T.

Seen in hypothermia, SubArachH and hypercalcaemia

28
Q

How does one record an ECG?

A

Turn it on
Check settings = 10mm/mV and 25mm/s

RELAX PATIENT and say you’d like to take a recording of their heartbeat. Ask them to remove their shirt and bra.

Use alcohol wipes to clean areas for electrodes because moisturiser can disrupt reading

Apply 4 limb electrodes:
F goes to L foot
N to R foot
R to distal R arm
L to distal L arm
Apply 6 chest electrodes:
V1 = 4RICS
V2 = 4LICS
V4 = 5ICS MID CLAV NOT ON BREAST TISSUE
V6 = In horizontal line @ MID AX
V3 = between V2 &amp; 4
V5 = btwn V4&amp;6 ANT CLAV

Press go

29
Q

Before thinking about cardiac abnormalities, what should you think first?

A

Electrode misplacement if axis is upside down

Electrical interference - check leads

Check settings if waves are huge/tiny

If brady, check 25mm/s

If tense/talking can lead to an unreadable ECG

30
Q

What are some causes of sinus bradycardia?

A 
Physical fitness
Vasovagal attacks
SSS
Drugs (BB, digoxin, amiodarone)
ICP
Cholestasis
31
Q

What are common causes of AF?

A 
IHD
Thyrotoxicosis
HTN
Obesity
HF
Alcohol
32
Q

What are causes of 1st and 2nd degree HB?

A 
Athletes
SSS
IHD (espec inferior)
Acute myocarditis
Drugs - digoxin, BB
33
Q

What are causes of 3rd degree HB?

A 
IHD (inferior MI)
Fibrosis
Congenital
Aortic valve calcification
Cardiac trauma/surg
Digoxin
Infiltration
34
Q

What are causes of STE?

A

Acute MI
Prinzmetal’s angina (variant angina)
Acute pericarditis (saddle shaped)
LVaneurysm

35
Q

What are the causes of STD?

A 
Digoxin toxicity (downward sloping)
Ischaemic (horizontal): angina, NSTEMI, posterior MI if in V1-V3
36
Q

What are the causes of T inversion

A

V1-3: normal, RBBB RV strain 2* to PE

V2-5: anterior ischaemia, HCM, SAH, lithium

V4-6 and aVL: lateral ischaemia, LVH, LBBB

II, III and aVF: inferior ischaemia

Cardiovascular (7 decks)

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