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ECG Interpretation > How to Interpret the ECG > Flashcards

How to Interpret the ECG Flashcards

1
Q

What do you check first when checking an ECG?

A

Demographics and Calibration

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2
Q

What do you look for in Demographics?

A

Patient Name, DoB, Any Symptoms

ECG date and Time

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3
Q

What is the correct calibration of an ECG trace?

A

Paper speed 25mm/s

1 mV calibration deflection (Start of Trace) = 2 large squares in height

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4
Q

How many seconds in one small square?

A

0.04s

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5
Q

How many in one big square?

A

0.2s (5 x Small Squares)

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6
Q

What do you analyse next?

A

Rate and Rhythm - Use the Rhythm Strip

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7
Q

How do you calculate rate?

A

300/ no. of big squares between R peaks

OR

If irregular - total R waves on ECG x 6 (ECG STRIP USUALLY 10 SECONDS LONG)

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8
Q

How do you work out the rhythm regularity?

A

Mark 4 R waves on a piece of paper and move along trace to confirm

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9
Q

How do you figure out if it is a sinus rhythm?

A

look for a normal P wave before each QRS

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10
Q

What is the normal rate?

A

60-100 bpm

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11
Q

What are causes of sinus bradycardia?

A

<60 bpm

Physical fitness, hypothermia, hypothyroidism, SA node disease, beta-blockers

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12
Q

What are the causes of sinus tachycardia?

A

> 100 bpm

exercise, pain, anxiety, thyrotoxicosis, pregnancy, anaemia, PE, hypovolaemia, fever

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13
Q

What can cause irregularity (missing P waves)

A

AF, ectopics, 2nd degree AV block

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14
Q

What can cause loss of sinus rhythm?

A

No P waves, irregular QRS - AF
Sawtooth Baseline - Atrial Flutter
Broad complex tachy with no P waves - VF or VT
Narrow complex tachycardia with abnormal/no P waves - SVT

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15
Q

What leads to you look at for cardiac axis?

A

Leads I and II

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16
Q

What should the QRS complexes be in normal axis?

A

Predominantly positive

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17
Q

What happens in Left Axis Deviation

A

R waves point away from each other - QRS positive in lead I and negative in lead II

https://lifeinthefastlane.com/wp-content/uploads/2011/02/Left-Axis-Deviation-LAD-ECG-Labelled.jpeg

(Legs apart)

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18
Q

What happens in Right Axis deviation?

A

R waves point towards each other. QRS negative in Lead I and positive in lead II and Lead III.

https://lifeinthefastlane.com/wp-content/uploads/2011/02/Right-Axis-Deviation-RAD-ECG-Labelled.jpeg

(Legs together)

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19
Q

What causes left axis deviation?

A

LV hypertrophy strain, left anterior hemiblock, inferior MI, WPW, VT

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20
Q

What causes right axis deviation?

A

Tall & thin, RV hypertrophy/strain e.g. in PE, left posterior hemiblock, lateral MI, WPW

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21
Q

What do you look at next?

A

P wave in rhythm strip

22
Q

What’s the height of P wave?

A

2 or less small squares

23
Q

What causes a bifid P wave?

A

LA hypertrophy caused by mitral stenosis

P mitrale wave

24
Q

What causes a peaked P wave?

A

RA hypertrophy

P pulmonale wave

25
Q

What should we look at next friends?

A

PR Interval in da rhythm strip

26
Q

What is the correct length of the PR interval?

A

3-5 small squares

27
Q

What is the PR interval?

A

Start of P (atrial depolarization) to the start of the QRS complex (ventricular depolarization)

28
Q

What causes a decreased PR interval?

A

Accessory conduction pathway

29
Q

What causes an increased PR interval?

A

1st degree AV block, 2nd degree AV block, 3rd degree (complete) heart block

1st degree - PR >5 small squares and regular

30
Q

What do you look at next?

A

QRS complex

31
Q

What do you look at first with QRS?

A

R waves progression in chest leads (V1-V6)

Dominant S in V1 to dominant R in V6, transition point V3/V4

32
Q

What are some abnormalities in R wave progression?

A

Dominant R wave in V1 and V2 - RV hypertrophy, posterior MI

clockwise rotation i.e. transition point after V4 - RV enlargement (chronic lung disease)

33
Q

What’s the correct length of the QRS complex?

A

<3 small squares

34
Q

Where do you look for the QRS complex length?

A

Rhythm strip

35
Q

What do you look for in RBBB?

A

RSR1 pattern (M pattern) in V1 and W pattern in V6 (Remember: MaRRoW)

36
Q

What do you look for LBBB?

A

W pattern in QRS in V1 and M (RSR1) pattern in V6

Remember: WiLLiaM

37
Q

Where do you look for the height of the QRS?

A

Leads V1 and V5/V6

38
Q

What is the correct height of the QRS complex?

A

<4 big squares

39
Q

What is a dominant R wave in V1 signify?

A

RV hypertophy

40
Q

Which leads have small Q waves?

A

I, aVL and V6 (LV leads)

41
Q

What is a pathological Q wave?

A

> 40ms in width, >2mm in depth, seen in leads V1 to V3. They indicate prior or current full thickness MI.

42
Q

Where do you look at the ST segments?

A

Check in all leads

43
Q

What is ST elevation?

A

The ST segment is isoelectric. ST elevation is an elevation greater than 1 small square that occurs in infarct.

44
Q

What is ST depression?

A

A depression in the ST segment deeper than 1 square or more. Sign of ischaemia.

45
Q

What are different morphological abnormalities of the ST segment and what do they signify?

A 
Saddled - Pericarditis
Upperward sloping - normal variant
Downward sloping (reverse tick) - digoxin toxicity
46
Q

What leads show an inferior MI and which vessel is occluded?

A

Lead II, III, aVF

Right coronary artery

47
Q

What leads show an anteroseptal MI and which vessel is occluded?

A

V1-V4

LAD

48
Q

What leads show an anterolateral MI and which vessel is occluded?

A

V4-V5, I, aVL

LAD or left circumflex

49
Q

What leads show a lateral MI and which vessel is occluded?

A

V5-V6, I, aVL

Left circumflex

50
Q

What leads show a posterior MI and which vessel is occluded?

A

Dominant R wave in V1-V2, ST depression

Left circumflex or right coronary

51
Q

Where do you check the T wave?

A

All leads

52
Q

Where is the T wave NORMALLY inverted?

A

III, aVR, V1 (right leads)

ECG Interpretation (2 decks)

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