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CP3 Medicine > ECGs and arrythmias > Flashcards

ECGs and arrythmias Flashcards

1
Q

How do you calculate rate of ECGs?

A

300/large squares

or number of complexes in rhythm strip x 6

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2
Q

Describe normal sinus rhythm

A

P followed by QRS

Constant PR interval

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3
Q

What is normal cardiac axis?

A

I + II both positive

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4
Q

Describe right axis deviation

A

RAD - reaching
I = negative and II = positive

right ventricular hypertrophy
left posterior hemiblock
lateral myocardial infarction
chronic lung disease → cor pulmonale
pulmonary embolism
ostium secundum ASD
Wolff-Parkinson-White syndrome* - left-sided accessory pathway
normal in infant < 1 years old
minor RAD in tall people
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5
Q

Describe left axis deviation

Causes?

A

LAD - leaving
Lead 1 = positive and lead 2 = negative

left anterior hemiblock
left bundle branch block
inferior myocardial infarction
Wolff-Parkinson-White syndrome* - right-sided accessory pathway
hyperkalaemia
congenital: ostium primum ASD, tricuspid atresia
minor LAD in obese people

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6
Q

what do P waves signify?

A

atrial depolarisation

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7
Q

What sort of P waves are there in right atrial hypertrophy?

A

Tall

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8
Q

What sort of P waves are there in left atrial hypertrophy?

A

notched/broad

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9
Q

What is the normal length of the PR interval?

A

3-5 small squares

120-200ms

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10
Q

What’s the normal width of the QRS complex?

A

3 small squares

120ms

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11
Q

What does a wider QRS complex signify?

A

ventricular origin / Bundle Branch Block

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12
Q

What does a tall R in V1 signify?

A

RVH

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13
Q

What does a tall R in V6 signify?

A

LVH

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14
Q

What do ST segment changes signify?

A 
MI (region)
and pericarditis (all over) - saddle deformity
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15
Q

In what leads is T wave inverted?

A

Always upright in leads I, II, V3-V6
Always inverted in aVR

Can be inverted in III and v1/2 but be normal

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16
Q

What does a Q wave show?

A

old infarction

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17
Q

What is the normal length of the QT?

A

<0.45s

Drugs that prolong QT: 
amiodarone, sotalol, class 1a antiarrhythmic drugs
TCA / SSRI (CITALOPRAM) 
methadone
chloroquine
erythromycin
haloperidol
ondanestron
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18
Q

Where do V1 and V2 go?

A

4th ICS

Right and left sternal edge

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19
Q

Where does V4 go?

A

5th ICS MCL

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20
Q

Where does V3 go?

A

In between V2 and V4

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21
Q

Where does V6 go?

A

ICS MAL

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22
Q

Where does V5 go?

A

in between v4 and v6

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23
Q

When are t waves normally inverted?

A

Avr, III and V1/2

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24
Q

What does t wave inversion signify?

A

Ischaemia
STEMI
NSTEMI
Happens after 24-48 hours and is permanent

Ventricular hypertrophy
Bundle branch block
Digoxin

PE

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25
Q

What does ST elevation signify?

A

ACS

Pericarditis (most leads)

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26
Q

What leads could you see a LATERAL MI?

A

lead 1

V5, V6

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27
Q

What lead would you see an inferior MI?

A

Leads II, III and Avf

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28
Q

What leads would you see an anterior MI?

WHAT LEADS WOULD YOU SEE POSTERIOR MI?

A

V1-V4

Tall R waves V1-2

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29
Q

What is a bundle branch block?

A

depolarisation of wave reaches the septum normally
therefore PR interval is normal
This is due to abnormal conduction through RL bundles of HIS

There is delayed depolarisation and therefore QRS is >120

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30
Q

What are the signs of RBBB?

A

MaRRoW

Look at V1/V6

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31
Q

What are the causes of RBBB?

A

normal variant - more common with increasing age
right ventricular hypertrophy
chronically increased right ventricular pressure - e.g. cor pulmonale
pulmonary embolism
myocardial infarction
atrial septal defect (ostium secundum)
cardiomyopathy or myocarditis

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32
Q

What are the signs of LBBB?

A

WiLLiaM

If present then no further interpretation of ECG possible

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33
Q

What are causes of LBBB?

A

Always pathological - may be a sign of myocardial infarction

ischaemic heart disease
hypertension
aortic stenosis
cardiomyopathy
rare: idiopathic fibrosis, digoxin toxicity, hyperkalaemia
34
Q

What rate is tachycardia?

A

> 100bpm

35
Q

What rate is bradycardia?

A

<60

36
Q

What is a normal PR interval?

A

3-5 small squares
120-200
Over 220ms = heart block

37
Q

What prolongs the QT interval?

A

drugs and electrolyte abnormalities

can lead to ventricular tachycardia

38
Q

What is the sign of first degree heart block?

A

PR interval >220ms

39
Q

What is the cause of first degree heart block?

A 
Delay from SAN to ventricles
Can indicate: CA disease
rheumatic fever
electrolyte disturbance
digoxin toxicity
40
Q

What are the three different types of 2nd degree heart block?

A

Mobitz 1
Mobitz 2
2:1/3:1

41
Q

What is Mobitz type 1?

A

WENCKEBACH:

PR interval progressively longer until you get a lost beat

42
Q

What is Mobitz type 2?

A

Constant PR interval, sometimes atrial contraction without ventricular contraction

43
Q

What is the third type of 2nd degree heart block?

A

2:1 or 3:1
2/3 x p waves as QRS
may need pacing

44
Q

What is 3rd degree heart block?

A

Atrial contraction normal button ventricular contraction
P wavers therefore not associated with QRS

Wide QRS
pacing required

45
Q

How does sinus arrhythmia occur in young people?

A

heart rate changes with respiration

R-R interval changes on a beat-beat basis

46
Q

Why might sinus bradycardia occur?

A

Athletic training
fainting attacks
hypothermia
hypothyroid

47
Q

Why might sinus tachycardia occur?

A 
exercise 
fear
pain
haemorrhage 
increased thyroid
48
Q

What are the three places non-sinus rhythms come from?

A

atrial muscle
ventricular muscle
AVN

49
Q

What is the location of supraventricular arrythmia?

A

Sinus - normal P wave
atria - abnormal P wave
junctional - no P wave

50
Q

What is rhythm controlled by?

A

the part of heart that beats the fastest

SAN: 70bpm
atrial focus: 50bpm
AVN: 50pbm
ventricular focus 30/min

51
Q

What is the management of arrhythmia?

A

A-E
assess for:
adverse features (shock, syncope, heart failure, MI

Asystole risk: recent systole, mobitz I or II or complete block

Bradycardia - atropine 500mcg IV
may need pacing

52
Q

What is extrasystole?

A

If any part of the heart depolarises too quickly
atrial: abnormal P wave and normal qrs

ventricular: widened QRS

53
Q

What is supra ventricular tachycardia?

A

> 150bpm
P wave merge with previous T wave

Tx: Vagal manœuvrés
Adenosine IV

54
Q

What is the management of SVT?

A

A-E resus
adverse features: DC cardio version

if irreg - treat as AF

If regular:
carotid sinus massage, valsalva manoeuvre

IV adenosine - 6mg then 12 the 12

Electrical cardio version
Secondary prevention with B blocker

55
Q

What is Ventricular tachycardia>

A

Wide QRS

can transform into VF therefore needs immediate tratment

56
Q

What is the management of VT?

A

immediate electrical cardio version if:
BP <90
chest pain
<159bpm

If none of the above, amiodarone (30mg) + cardio version if fails

57
Q

What is ventricular fibrillation?

A

independent muscle fibres can’t contract independently

NO QRS complexes
LOC
Mx as cardiac arrest

58
Q

What is atrial flutter?

A

Atrial rate >250
NO flat baseline between p waves
saw toohed
Mx as per AF

59
Q

What is the sign of hyperkalaemia on ECG?

A

Tall, tented T waves
Wide QRS
Prolonged PR

60
Q

What is the management of hyperkalaemia?

A

Stabilise the heart:
Calcium gluconate

To shift K+
combined insulin/dextrose infusion
nebulised salbutamol

Additional:
calcium resonium (orally or enema)
enemas are more effective than oral as potassium is
loop diuretics
dialysis
haemofiltration/haemodialysis should be considered for patients with AKI with persistent hyperkalaemia

61
Q

What is the sign of hypokalaemia on ECG?

A

T wave flattened

U wave after T wave

62
Q

What is the sign of hypocalcaemia on ECG?

A

QT prolongation

63
Q

What is the sign of hypercalcaemia on ECG?

A

QT shortened

64
Q

What is WPW syndrome?

A

Some people born with 2nd conducting system in heart

Usually located in LHS
No AVN delay: short pr interval and delta wave

Normal QRS

65
Q

What are the ECG signs of WPW?

A

RAD
Sinus
Short PR
Delta wave

66
Q

What is atrial fibrillation?

A

abnormal rapid rate - irregularly irregular rhythm: no Ps

67
Q

What are the underlying causes of AF?

A

Cardiac: HTN, valve disease, heart failure, IHD

Resp: chest infection, PE, lung cancer

Systemic: increased alcohol, increased thyroid, decreased electrolytes, infection, DM

68
Q

What are the classifications of AF?

A

Acute (48 hours)
Paroxysmal - spontaneous termination in 7 days
Recurrent (more than 2 episodes)
Persistent (not self-termination), lasts longer than 7 days or until cardio version

Permanent: over 1 year - rate control and anticoagulant

69
Q

What are the features of AF?

A 
Asymptomatic
SOB
Palpitations
Syncope
Chest pain 
Stroke/TIA
70
Q

What are the ECG findings of AF?

A

Irregular baseline with no P waves

71
Q

What other investigations are there for AF?

A

FBC, U+E, TFT, BM, echo, CXR

72
Q

What is the emergency management of AF?

A

If harm-dynamic instability and symptoms: electrical cardio version.
<48 hours - immediately

> 48 hours - 3 weeks anticoagulation prior

73
Q

What is the routine management of AF?

A

Step 1: Rate control
Step 2: anticoagulation

Anticoagulation based on CHADS-VASC score
1+ = anticoagulation

74
Q

What is the rate control of AF?

A

1st line = BISOPROLOL
contraindicated in asthma

Calcium channel blocker: verapamil/diltiazem

75
Q

What is the anticoagulation part of AF?

A

Heparin at initial presentation
Assess for long term stroke risk using CHA2DS2-Vasc score

anticoagulant if score is more than 2 for females and more than 1 for males (HEPARIN)

Can also use HASBLED to assess risk of major bleed

76
Q

What does rhythm control for AF entail?

A

Electrical cardio version

Medical:
flecainide or amiodarone in those without structural heart disease
amiodarone if structural heart disease

77
Q

What is the management of bradycardia?

A

Atropine 500mg IV up to 6 doses

78
Q

What is the ECG sign of hypokalaemia?

A

U waves

U have no Pot and no T but a long PR and a Long QT

79
Q

What is the ECG sign of hypothermia?

A

J waves

80
Q

What is the appearance of Torsades de Point?

A

Arctic Monkeys Cover album

81
Q

What Is the treatment of Torsades de Point?

A

IV magnesium sulphate

CP3 Medicine (19 decks)

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