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Anaesthetic FRCA Primary - eLFH Data Interpretation > eLFH - The Electrocardiogram Part 2 > Flashcards

eLFH - The Electrocardiogram Part 2 Flashcards

1
Q

Types of Heart Block

A

1st Degree Heart Block

2nd Degree Heart Block - Mobitz Type 1 (Wenckebach)

2nd Degree Heart Block - Mobitz Type 2

3rd Degree Heart Block

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2
Q

1st degree heart block definition

A

Prolongation of PR interval

Delay at the AV node

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3
Q

2nd degree heart block - Mobitz type 1 definition

A

Progressive prolongation of PR interval until P wave is not conducted to ventricles and process restarts

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4
Q

2nd degree heart block - Mobitz type 2 definition

A

Intermittent failed conduction via AV node from atria to ventricles

Commonly 2:1 or 3:1 block

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5
Q

3rd degree heart block definition

A

Complete dissociation of atrial and ventricular activity

Aka complete heart block

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6
Q

Components of Left Bundle branch

A

Anterior fascicle

Posterior fascicle

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7
Q

Causes of LBBB

A

IHD

LVH - HTN, AS

Cardiomyopathy

Pacing of right ventricle

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8
Q

Causes of RBBB

A

IHD

HTN

Cardiomyopathy

RV strain - PE, COPD, ASD

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9
Q

ECG changes in LBBB

A

Broadened QRS

V1 negative at end of QRS

V6 positive at end of QRS

‘WiLLiaM’

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10
Q

Reason for ECG changes in LBBB

A

Normal left bundle branch conduction is blocked

Septum and left ventricle reliant on depolarisation spreading from right ventricle

Septum still depolarises first but now from right to left - initial V1 small downstroke, V6 small upstroke

Then right ventricle depolarises which may be hidden by ongoing septal depolarisation - V1 small upstroke, V6 small downstroke

Lastly left ventricle depolarises making biggest contribution to QRS as it is largest - V1 large upstroke, V6 large downstroke

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11
Q

ECG changes in RBBB

A

Broadened QRS

V1 positive and end of QRS

V6 negative at end of QRS

‘MaRRoW’

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12
Q

Reason for ECG changes in RBBB

A

No longer conduction down right bundle branch

Septum depolarises left to right - initial V1 small upstroke, V6 small downstroke

Then left ventricle depolarises normally - V1 large downstroke, V6 large upstroke

Right ventricle conduction delayed and spreads from LV - V1 large upstroke, V6 large downstroke

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13
Q

Left anterior hemiblock definition

A

Block of anterior fascicle of left bundle branch

More common than left posterior hemiblock as coronary blood supply more vulnerable to anterior fascicle

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14
Q

ECG changes with left anterior hemiblock

A

Left axis deviation in otherwise normal ECG

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15
Q

Left posterior hemiblock definition

A

Block of posterior fascicle of left bundle branch

Uncommon and less clinically significant

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16
Q

Bifasicular block definition

A

RBBB + Left fascicular hemiblock (usually anterior)

17
Q

Bifasicular block ECG changes

A

RBBB
Left axis deviation

18
Q

Trifasicular block definition

A

Bifasicular block + 1st degree heart block

19
Q

Trifasicular block ECG changes

A

RBBB
Left axis deviation
Prolonged PR interval

20
Q

Trifasicular block importance

A

Risk of developing complete heart block

21
Q

Indications for pacemaker insertion

A

3rd degree heart block

2nd degree HB Mobitz Type 2

2nd degree HB with symptoms

Bifasicular or Trifasicular block with intermittent 3rd degree or 2nd degree Mobitz type II

Sinus node dysfunction with symptomatic bradycardia and significant pauses

22
Q

Pacemaker categories

A

External or Transvenous

Temporary or Permanent

23
Q

Pacing lead placement

A

Usually either RA and/or RV

Biventricular pacemakers inserted for cardiac resynchronisation therapy - LV paced via coronary sinus

24
Q

ECG findings in Atrial pacing vs Ventricular pacing vs Dual chamber pacing

A

Atrial pacing - pacing spike directly precedes P waves

Ventricular pacing - pacing spike directly precedes QRS (QRS similar to RBBB appearance as RV is being paced)

Dual pacing - pacing spike directly precedes both P wave and QRS

25
Q

Coronary blood supply to AV node

A

Right coronary artery

Therefore inferior MI can cause complete heart block

26
Q

Drug to avoid in SVT with WPW

A

Digoxin as it acts to block AV node, therefore faster atrial rate would be transmitted directly to ventricles via accessory pathway

Results in VT

Anaesthetic FRCA Primary - eLFH Data Interpretation (6 decks)

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