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Year 3 Cardio > Electrocardiography > Flashcards

Electrocardiography Flashcards

1
Q

What is the clinical relevance of the ECG?

A

Conduction abnormalities
Structural abnormalities
Perfusion abnormalities

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2
Q

What are the advantages of ECGs?

A

Relatively cheap and easy to undertake
Reproducible between people & centres
Quick turnaround on results/report

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3
Q

What is a vector?

A

‘a quantity that has both magnitude and direction’

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4
Q

What happens if the wave of excitation travels toward the negative electrode?

A

Downward deflections are towards the anode (-)

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5
Q

What happens if the wave of excitation travels toward the positive electrode?

A

Upward deflections are towards the cathode (+)

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6
Q

What does the isoelectric line represent?

A

represents no net change in voltage. i.e. vectors are perpendicular to the lead.

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7
Q

What does the steepness of the line relate to?

A

Steepness of line denotes the ‘velocity’ of action potential

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8
Q

What does the width of the line relate to?

A

Width of the deflection denotes the ‘duration’ of the event

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9
Q

What is the P wave?

A

The electrical signal that stimulates contraction of the atria (atrial systole)

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10
Q

What is the QRS complex?

A

The electrical signal that stimulates contraction of the ventricles (ventricular systole)

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11
Q

What is the T wave?

A

The electrical signal that signifies relaxation of the ventricles

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12
Q

What comprises the SAN?

A

Autorhythmic myocytes

Small amount of muscle that points more positive than negative

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13
Q

What does the action of the SAN show on an ECG?

A

Deflection is wide (slow)
Not very high (thin muscle)
Positive

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14
Q

What does the action of the AVN show on an ECG?

A

AVN depolarisation
Isoelectric ECG
Slow signal transduction
Protective

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15
Q

What does the action of the bundle branches show on an ECG?

A

Sharp but small downward spike

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16
Q

What does the action of the purkinje fibres show on an ECG?

A

QRS peak

and upward peak

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17
Q

Where do you place the leads?

A 
Lead I (one L) 
Right Arm to Left Arm 
Lead II (two L’s)
Right Arm to Left Leg
Lead III (three L’s)
Left Arm to Left Leg
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18
Q

What is the rule of reading for the leads?

A

English is read left to right and top to bottom.

Polarity does that too.
Drawn as a triangle and reading left to right and top to bottom the first electrode of each pair you reach is the anode (-ve

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19
Q

Where is the V1 electrode placed?

A

Right sternal border

In the 4th intercostal space

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20
Q

Where is the V2 electrode placed?

A

Left sternal border

In the 4th intercostal space

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21
Q

Where is the V3 electrode placed?

A

Halfway between V2 and V4

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22
Q

Where is the V4 electrode placed?

A

Mid-clavicular line

In the 5th intercostal space

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23
Q

Where is the V5 electrode placed?

A

Anterior axillary line

at the level of V4

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24
Q

Where is the V6 electrode placed?

A

Mid-axillary line

at the level of V4

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25
Q

What does each big square represent?

A
  1. 2s

0. 5mV

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26
Q

What does each little square represent?

A
  1. 04s

0. 1mV

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27
Q

What are the three main coronary arteris?

A

Left circumflex
Left anterior descending
Right coronary artery

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28
Q

What are normal values for R-R interval?

A

0.6-1.2 seconds

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29
Q

What is normal for the duration of the P wave?

A

80ms

3 small squares

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30
Q

What is normal for the P-R interval?

A

120-200ms

5 small squares

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31
Q

What is normal for duration of the QRS complex?

A

<120 ms

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32
Q

What is normal for duration of the T-wave?

A

420 ms

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33
Q

What is considered a normal heart rate?

A

60-100 bpm

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34
Q

What is the ECG reporting procedure?

A

Is it the correct recording?

Review the signal quality and leads?

Verify the voltage and paper speed?

Review the

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35
Q

What is the ECG reporting procedure?

A

Is it the correct recording?

Review the signal quality and leads?

Verify the voltage and paper speed?

Review the patient background if available

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36
Q

Can you defibrillate someone in asystole?

A

Not a shockable rhythm

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37
Q

What is sinus rhythm?

A

Each P-wave is followed by a QRS wave (1:1)

Rate is regular (even R-R intervals

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38
Q

What is sinus bradycardia?

A

Each P-wave is followed by a QRS wave (1:1)
Rate is regular (even R-R intervals) and slow (56 bpm)
Can be healthy, caused by medication or vagal stimulation

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39
Q

What is sinus tachycardia?

A

Each P-wave is followed by a QRS wave (1:1)
Rate is regular (even R-R intervals) and fast (107 bpm)
Often a physiological response (i.e. secondary)

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40
Q

What is sinus arrhythmia?

A

Each P-wave is followed by a QRS wave
Rate is irregular (variable R-R intervals) and normal-ish (65-100 bpm)
R-R interval varies with breathing cycle

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41
Q

What is atrial fibrilation?

A

Oscillating baseline – atria contracting asynchronously
Rhythm can be irregular and rate may be slow
Turbulent flow pattern increases clot risk
Atria not essential for cardiac cycle

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42
Q

What is atrial flutter?

A

Regular saw-tooth pattern in baseline (II, III, aVF)
Atrial to ventricular beats at a 2:1 ratio, 3:1 ratio or higher
Saw-tooth not always visible in all leads

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43
Q

What are the features of first degree heart block?

A

Prolonged ST segment/interval caused by slower AV conduction
Regular rhythm: 1:1 ratio of P-waves to QRS complexes
Most benign heart block, but a progressive disease of ageing

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44
Q

What are the two types of second degree heart block?

A

Mobitz I

Mobitz II

45
Q

What are the features of Mobitz I?

A

Gradual prolongation of the PR interval until beat skipped
Most P-waves followed by QRS; but some P-waves are not
Regularly irregular: caused by a diseased AV node
Also called Wenckebach

46
Q

What are the features of Mobtiz II?

A

P-waves are regular, but only some are followed by QRS
No P-R prolongation
Regularly irregular: successes to failures (e.g. 2:1) or random
Can rapidly deteriorate into third degree heart block

47
Q

What are the features of third degree heart block?

A

P-waves are regular, QRS are regular, but no relationship
P waves can be hidden within bigger vectors
A truly non-sinus rhythm – back-up pacemaker in action

48
Q

What are the features of ventricular tachycardia?

A

P-waves hidden – dissociated atrial rhythm
Rate is regular and fast (100-200 bpm)
At high risk of deteriorating into fibrillation (cardiac arrest)
Shockable rhythm – defibrillators widely available

49
Q

What are the features of ventricular fibrillation?

A

Heart rate irregular and 250 bpm and above
Heart unable to generate an output
Shockable rhythm – defibrillators widely available

50
Q

What are the features of ST elevation?

A

P waves visible and always followed by QRS
Rhythm is regular and rate is normal (85 bpm)
ST-segment is elevated >2mm above the isoelectric line
Caused by infarction (tissue death caused by hypoperfusion)

51
Q

What are the features of ST depression?

A

P waves visible and always followed by QRS
Rhythm is regular and rate is normal (95 bpm)
ST-segment is depressed >2mm below the isoelectric line
Caused by myocardial ischaemia (coronary insufficiency)

52
Q

What does aVf stand for?

A

Augmented vector foot

53
Q

What does aVR and aVL stand for?

A

Augmented vector Left/Right

54
Q

How does a persons build influence their normal cardiac axis?

A

Shorter, stockier - normal axis will be more left axis deviate

Taller, leaner - normal axis will be more right axis deviated

55
Q

What do you need to work out cardiac axis

A

Two leads 90 degrees apart

56
Q

What does SOCRATES stand for?

A 
Site
Onset 
Character
Radiation
Associated symptoms
Time course
Exacerbating and Relieving factors
Severity
57
Q

What question might you ask when taking a pain history?

A

Site: Where is the pain?
Onset: When did they pain start? Was is sudden or gradual?
Character: What is the pain like? An ache? Stabbing?
Radiation: Does the move/spread/radiate anywhere?
Associations: Are there any other signs or symptoms that come with the pain?
Time course: Does the pain follow any pattern in when it presents?
Exacerbating/Relieving factors: Does anything make the pain better or worse?
Severity: How bad is the pain?

58
Q

When are ECGs most useful?

A

When you have ECGs over time
e.g. 5 years ago
Current

59
Q

What are the three classifications of chest pain?

A

Typical chest pain
Atypical chest pain
Non-cardiac

60
Q

How do you classify chest pain?

A

Three questions

All three yes = typical
2 yes and 1 no = atypical
1 yes and 2 no = non-cardiac

61
Q

What are the three questions you ask when classifying chest pain?

A

Is it retrosternal?
Is it worsened by exertion?
Is it relieved by rest or glyceryl trinitrate?

62
Q

What is a CABG?

A

Surgically open up the chest. Take a vein from another part of the body and graft it so it reroutes the obstruction or creates a new perfusion pathway.

63
Q

What is balloon angioplasty?

A

Balloon into leg and blow it up- leave it or erect a drug alluting stent to deliver vascodilators

64
Q

What are p-wave problems?

A 
Absent
Inverted
BIfid (left atrial dilation)
Tall (P pulmonale, right atrial dilation)
Sawtooth baseline
65
Q

What can be wrong with a PR interval?

A 
Prolonged 
Shortened 
Delta wave (shorted sloped PR interval) - WPW
66
Q

What are some normal features of QRS complexes?

A 
Should be narrow < 0.12s
Not too tall 
Negative in V1+V2
V3+V4 transition point
Tall QRS in V5+V6
67
Q

What can be wrong with the QRS complex?

A 
Widened 
Short
Alternating size (electrical alternans) 
Absent (cardiac arrest)
Negative even V5+V6
To big (hypertrophy)
68
Q

What is the J point?

A

When the QRS becomes the ST segment

Should be isoelectric

69
Q

What does an osborn wave mean?

A

Hypothermia

70
Q

What is the ST segment complex?

A

Bit between QRS complex and T-wave

Should be isoelectric

71
Q

What is a normal t-wave?

A

Should be positive in all leads except aVR and V1

72
Q

What are t-wave problems?

A

Inverted t-waves

Biphasic t-waves

73
Q

What is a U-wave?

A

Pathological
Waveform after the t-wave
Young, fit, athletic pts usually

Causes e.g. hyperthyroidism, hyper/hypokalaemia

74
Q

What can go wrong with QT interval?

A

Shortened

Prolonged

75
Q

What are the main features of AF?

A

Irregularly irregular rhythm
Absent p-waves
QRS complexes are narrow
Baseline is not narrow

76
Q

What are the main features of atrial flutter?

A 
Sawtooth baseline
Regularly irregular rhythm 
Absent p waves
HR of around 300
Narrow QRS complexes
2:1, 3:1 etc.
77
Q

What is a supraventricular tachycardia?

A

Any tachy that starts above bundle of His

Look out for retrograde p waves after QRS

78
Q

What are the features of 1st degree heart block?

A

Prolonged PR interval
Not necessarily a sign of pathology
Classically fit, young woman

79
Q

What are the features of 2nd degree heart block? Aka Mobitz type I or Wenckenach phenomenon

A

Irregularly irregular rhythm
Progressively prolonger PR intervals
Occasional dropped QRS
Usually benign

80
Q

What are the features of Mobitz type II?

A

PR interval is constant when QRS is present

But some p-waves are not followed by QRS

Bradycardia

Pathological: Damage to conduction system below AV node

81
Q

What are the features of 3rd degree heart block?

A

Complete cessation of AV conduction
P waves and QRS complexes independent
QRS can be broad or narrow

82
Q

What are the main features of wolff parkinson white?

A

Accessory pathway from atria to ventricles

Short PR intervals

Broad QRS complex with slurring of start (delta wave)

83
Q

What are the ECG changes for pericarditis?

A

Widespread changes

84
Q

What is really dangerous in WPW?

A 
AF and flutter
Nothing to slow down the aberrant pathway 
Can go into VF
Need cardiovert 
Don't give AV node blocking drugs
85
Q

What is ventricular fibrillation?

A 
Incompatible with life 
Shockable ACLS 
Rapid, broad complexes 
Complexes start big and gets smaller
Chaotic
Pulseless
86
Q

What is ventricular tachycardia?

A

Monomorphic is most common
Fast HR
Very broad, consisten ventricular complexes
Loss of other features
Sometime ocassional normal cycles - capture beat

Seen in structural heart disease e.g. prev MI

87
Q

What are the main features of LBBB?

A

WiLLiaM or ViLheM
V1 and V6

Damage to left bundle branch

Broad QRS

Deep S wave in V1

Notched R wave in V6

Cannot interpret further - other abnormalities won’t be seen

Concerned about new onset MI

88
Q

What are the main features of RBBB?

A 
MaRRoW/ MaRiNe
Broad QRS
RSR' in V1
Wide downstroke slurred S wave in V6 
V1-3 ST depression
89
Q

What are the features of torsades de pointes?

A

Type of polymorphic VT
Different morphologies throughout the trace

Broad QRS complexed

Calcium abnormalities likely cause of prolonged QT

Changing amplitudes beat to beat

Twisting ‘bigger’ then ‘smaller’ appearance

90
Q

What is the management for torsades?

A

IV Magnesium

91
Q

What is the natural history of a STEMI in terms of ECG changes?

A

Hyperacute t-waves (mins)
ST elevation (0-12 hours)
Q-wave develops (1-12 hours)
ST elevation with T-eave inversion (2-5 days)

92
Q

When should you be careful about giving nitrates?

A

RCA infarcts

93
Q

What is suggestive of a posterior MI?

A

Reciprocal horizontal ST depression in V1-3

No posterior leads so we cannot see the ST elevation there

94
Q

What are the ECG features of a NSTEMI?

A

Sub total occlusion
Widespread ST changes
and t-wave inversion

95
Q

What ECG changes are seen in pericarditis?

A

Inflammation of pericardium
Saddle shaped ST elevation
PR depressions
Maybe tachy

96
Q

What ECG changes are seen in hyperkalaemia?

A

Tented t-waves

Tachycardia

97
Q

What diagnosis is associated with U waves?

A

Hypokalaemia

T-wave inversion

98
Q

What is the difference between PR interval and segment?

A

Interval includes the p-wave

99
Q

What should you tell the patient before doing an ECG?

A

Might need to shave
Chaperone
Stickers might be cold

100
Q

How would you report an ECG?

A

This is a 12 lead ECG for X, DOB, date and time

Presenting complaint

The trace is calibrated at speed 25mm/sec and deflection of 1cm/1mV

Rate, rhythm, axis

Go through cardiac cycle

Abnormalities

101
Q

How do you work out rate on an ECG?

A

Total number of complexes in 10s x 6

102
Q

What are causes of left axis deviation?

A

Disease of conduction

e.g. WPW, Inferior MI, Hyperkalaemia

103
Q

What are causes of right axis deviation?

A

Extra muscle bulk

e.g pulmonary HTN, PE

Normal in tall, thin adults

104
Q

When do you get broad QRS complexes?

A

Problem in ventricles and conductions e.g. VT or VF

105
Q

When do you get narrow QRS complexes?

A

Supra-ventricular

e.g. AF, A Flutter pr SVT

106
Q

What are features of SVT?

A

No p-waves
Regular QRS
Fast

107
Q

What is monomorphic VT?

A

All beats look the same

108
Q

What would you see in RBBB?

A

rSR’ in V1

qRs in V6

109
Q

What would you see in LBBB?

A

rS in V1

R in V^

Year 3 Cardio (12 decks)

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