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Anaesthetic FRCA Primary - eLFH Data Interpretation > eLFH - The Electrocardiogram Part 3 > Flashcards

eLFH - The Electrocardiogram Part 3 Flashcards

1
Q

ECG features of AF

A

Narrow complex tachyarrhythmia

Absence of P waves

Irregularly irregular ventricular response

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2
Q

Common causes of AF

A

Electrolyte disturbance - especially low K+ or low Mg2+

Dehydration

Valvular (especially mitral) disease

IHD

HTN

Hyperthyroidism

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3
Q

Main considerations of AF patients

A

Consider anticoagulation - risk of thromboembolic events

Rate control - tachycardia may provoke heart failure

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4
Q

ECG features of Atrial Flutter

A

Narrow complex tachyarrhythmia

Saw tooth baseline at rate of 300 bpm

Variable conduction to ventricles - 2:1 = 150 bpm, 3:1 = 100 bpm

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5
Q

Drugs to avoid in WPW with SVT

A

Drugs that slow AV conduction - e.g. Digoxin

Otherwise leads to direct transmission of atrial rate to ventricles via accessory pathway and results in VT

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6
Q

Differentials for broad complex tachycardia

A

Monomorphic ventricular tachycardia

Polymorphic ventricular tachycardia (Torsades de Pointes)

Ventricular fibrillation

SVT with aberrant conduction (i.e. bundle branch block)

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7
Q

Features which may differentiate VT from SVT with aberrant conduction

A

VT more likely if presence of:
- P waves
- Capture beats
- Fusion beats

Above features indicate there is independent atrial and ventricular activity occurring

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8
Q

ECG example of P waves in VT

A
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9
Q

Capture beat definition

A

Independent atrial depolarisation occasionally reaches AV node at appropriate time to ‘capture’ cardiac conduction to produce narrow QRS complex within the VT rhythm

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10
Q

Fusion beat definition

A

Similar to capture beat - atrial depolarisation timed such that it arrives simultaneously with ventricular depolarisation

QRS morphology is part way between broad VT complex and narrow complex

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11
Q

Left atrial hypertrophy causes

A

Aka P mitrale

Mitral valve disease

LAH can predispose to AF

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12
Q

Left atrial hypertrophy ECG changes

A

Increased P wave amplitude > 2.5 mm and duration > 0.12 s

Notched P wave (looks like an M shape - M for P Mitrale)

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13
Q

Right atrial hypertrophy causes

A

Aka P pulmonale

Seen in chronic lung disease tricuspid valve disease

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14
Q

Right atrial hypertrophy ECG changes

A

Only increased P wave amplitude > 2.5 mm
Duration of P wave not prolonged

Best seen in II, III, aVF

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15
Q

Left ventricular hypertrophy causes

A

Hypertensive disease

AS

HOCM

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16
Q

Left ventricular ECG changes

A

Various criteria can be used - most common is:
S wave in V1 + R wave in V5 or V6 (whichever is largest) >=35 mm

LVH can also be associated with LV strain (ST depression)

17
Q

Cause of strain pattern in LVH

A

Likely due to more severe hypertrophic disease

Increased muscle mass causes higher LV diastolic pressures when coronary perfusion occurs - results in less coronary perfusion and myocardial ischaemia

18
Q

Right ventricular hypertrophy causes

A

RV overload

E.g. Pulmonary hypertension

19
Q

Right ventricular hypertrophy ECG changes

A

Dominant R wave in V1

Right axis deviation

20
Q

Coronary blood supply

A
21
Q

ECG territories associated with Anterior-septal ischaemia and Coronary artery associated

A

V1-V3

Left anterior descending artery

22
Q

ECG territories associated with Anterior-lateral ischaemia and Coronary artery associated

A

V1-V6

Left main stem

23
Q

ECG territories associated with High lateral ischaemia and Coronary artery associated

A

I and aVL

Circumflex

24
Q

ECG territories associated with inferior ischaemia and Coronary artery associated

A

II, III and aVF

Right coronary artery

Most likely to be associated with atrioventricular heart blocks

25
Q

ECG territories associated with posterior ischaemia and Coronary artery associated

A

V1 and V2 - inverse of usual changes (ST depression, R wave rather than Q wave)

Right coronary artery or circumflex depending on which system is dominant

May be associated with inferior or lateral infarct depending on affected artery

26
Q

ECG territories associated with Subendocardial ischaemia

A

Any leads

27
Q

ECG changes with coronary ischaemia seen within first hours

A

ST elevation

28
Q

ECG changes with coronary ischaemia seen in days

A

Abnormal Q waves appear

T wave inversion may be seen

29
Q

ECG changes with coronary ischaemia seen in weeks

A

ST segments resolve to normal

Q waves remain present

30
Q

ECG changes with high Mg2+

A

Prolonged PR
Wide QRS

31
Q

ECG changes with low Mg2+

A

Prolonged PR
ST depression
Flat T waves or Peaked T waves
Wide QRS
Long QT
U waves

32
Q

ECG changes with high Ca2+

A

Short QT

33
Q

ECG changes with low Ca2+

A

Long QT

34
Q

ECG changes with high K+

A

Tall tented T waves
Wide QRS
Prolonged PR
Flattened P waves

VT / VF / Asystole

35
Q

ECG changes with low K+

A

Prolonged PR
ST depression
Flattened or inverted T waves
U waves

VF / ventricular ectopics

Anaesthetic FRCA Primary - eLFH Data Interpretation (6 decks)

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