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PHTY3250 > ILP 6: CAL 3 ECG > Flashcards

ILP 6: CAL 3 ECG Flashcards

1
Q

What are the components of ECG?

A

An ECG complex consists of a P wave, QRS complex and a T wave. The ECG represents the electrical events occurring in a cardiac cycle.

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2
Q

What is the Normal Conduction Pathway?

A
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3
Q

What are 6 steps of the Normal Conduction Pathway?

A
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4
Q

What does the P wave represent in ECG?

A

The P wave represents depolarisation of the ATRIA

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5
Q

What does the QRS complex represent in ECG?

A

The QRS complex represents depolarisation of VENTRICLES

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6
Q

What does the T wave represent in ECG?

A

The T wave represents repolarisation of the VENTRICLES

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7
Q

What are the 4 basics of electrocardiography (ECG)?

A
  1. All ECGs require leads to sense and record electricity in patient
  2. 12 lead ECG – all views of heart
  3. Ensure leads are attached and reading is accurate prior to treatment
  4. Ensure manual techniques (eg, chest percussion, vibrations) do not interrupt trace; check this is a movement artefact (cease for a moment to see effect on trace)

The part of the heart observed depends on the position and number of ECG leads used, eg, 12 (top image), 6 (middle), 3 (bottom).

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8
Q

What are different views of the heart for the ECG?

A
  1. Positive QRS in Lead 1
  2. Negative QRS in lead aVR

The position of the lead will also influence the signal observed. Here the same QRS complex is positive in lead I, but negative in lead aVR.

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9
Q

What does the ECG paper look like?

A
  1. 1 millimeter squares – height and depth of wave recorded in millimeters
  2. Horizontal axis = time
  3. 0.04s for 1mm
  4. 0.2s for 1 large box (5 small boxes = 5 x 0.04s)

ECG is usually recorded in ECG paper (electronic or hardcopy).This is used to measure the size of the ECG complex and calculate the rhythm.

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10
Q

What are the 6 steps in analysing an ECG?

A
  1. Ventricular rate
  2. Ventricular rhythm
  3. P wave
  4. PR interval
  5. QRS duration
  6. T wave
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11
Q

What is step 1 of ECG interpretation?

A

Ventricular rate: Count the number of large boxes between two R waves. Divide 300 by this number. Eg. 300 / [6 boxes] = 50 beats/min

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12
Q

What is step 2 of ECG interpretation?

A

Ventricular rhythm: Are the R-R intervals equal along the trace?

  • If yes, then the rhythm is regular.
  • If no, then the rhythm is irregular
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13
Q

What is step 3 of ECG interpretation?

A

P wave: Is there a P wave present before every QRS complex?

  • Yes => Regular
  • No => Irregular
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14
Q

What is step 4 of ECG interpretation?

A

P-R interval: Is the P-R interval normal? (between 0.12 – 0.2 seconds or 3 – 5 small squares)

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15
Q

What is step 5 of ECG interpretation?

A

QRS duration: Is the QRS duration normal? (between 0.08 – 0.10 seconds or 2 – 2.5 small squares)

NB: Vertical size will depend on the lead and you may not always see all 3 deflections (Q, R, S).

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16
Q

What is step 6 of ECG interpretation?

A

T wave: Is the T wave upright?

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17
Q

What are 3 terms that can be discussed in all ECGs?

A
  1. Rate
  2. Rhythm
  3. Ischaemia
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18
Q

What is normal sinus rhythm?

A
  • Ventricular rate: 60-100 beats per minute
  • Ventricular rhythm: Regular
  • P waves: Normal, present before each QRS
  • P-R interval: 0.12 to 0.20 seconds (3-5 small sq)
  • QRS duration: 0.08-0.10 seconds (2 – 2.5 sq)
  • T wave: Present
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19
Q

What are 3 disturbances of rate?

A
  1. Bradycardia
  2. Tachycardia
  3. Heart Block
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20
Q

What are 6 steps of interpretating ECG of bradycardia?

A
  1. Ventricular rate: < 60 beats per minute
  2. Ventricular rhythm: Regular
  3. P waves: Normal, present before each QRS
  4. P-R interval: 0.12 to 0.20 seconds (3-5 small sq)
  5. QRS duration: 0.08-0.10 seconds (2 – 2.5 sq)
  6. T wave: Present
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21
Q

What are 7 causes of bradycardia?

A
  1. Normal in fit athlete
  2. Vagal stimulation
  3. Block in conduction system
  4. Severe hypoxaemia
  5. Beta blockers or Digoxin
  6. Ischaemia of sinus node
  7. Increased intracranial pressure
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22
Q

What are 2 implications of physiotherapy treatment of bradycardia?

A
  1. Decide cause
  2. Ascertain whether patient displays symptoms of hypoperfusion eg dizziness, chest pain – if so don’t treat, consult medical team.
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23
Q

What are 6 steps of interpretating ECG of tachycardia?

A
  1. Ventricular rate: >100 beats per minute
  2. Ventricular rhythm: Regular
  3. P waves: Normal, present before each QRS
  4. P-R interval: 0.12 to 0.20 seconds (3-5 small sq)
  5. QRS duration: 0.08-0.10 seconds (2 – 2.5 sq)
  6. T wave: Present
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24
Q

What are 7 causes of tachycardia?

A
  1. Exercise, Anxiety
  2. Pain, Fever
  3. Respiratory Distress
  4. Haemorrhage, shock
  5. Brain stem failure
  6. Ectopic focus in ventricles
  7. Medications eg Aminophylline
25
Q

What are 5 implications of treatment of tachycardia?

A
  1. Check cause of tachycardia
  2. Increases work of heart – may result in cardiac ischaemia
  3. Provide pain relief if necessary
  4. Ensure cardiac output is sufficient
  5. Avoid treatment which will further increase heart rate
26
Q

What are the 3 various degrees of heart block?

A
  1. 1st degree = mild
  2. 2nd degree = moderate
  3. 3rd degree = severe
27
Q

What is a heart block?

A
  1. Usually some defect in conduction system
  2. Associated with coronary artery disease, digitalis toxicity, electrolyte disturbances
28
Q

What are 2 implications of treatment of heart block?

A
  1. 3rd degree – leads to decreased cardiac output, ischaemia and failure – don’t exercise
  2. 2nd degree and 3rd degree need pacemakers

You are NOT expected to identify these on an ECG.

29
Q

What are 2 atrial distrubances of rhythm for ECG?

A
  1. Fibrillation
  2. Flutter
30
Q

What are 3 ventricular distrubances of rhythm for ECG?

A
  1. Ectopic beats
  2. Tachycardia
  3. Fibrillation
31
Q

What are 5 characteristics of Fibrillation & Flutter of Atrial Arrhythmias?

A
  1. Usually rapid rhythms, however may be normal rate but irregular
  2. Originate in atria
  3. Often associated with coronary artery disease, increased age
  4. Atrial flutter – regular
  5. Atrial fibrillation - irregular
    1. Total disorganization of atrial electrical activity
    2. Not every beat initiates ventricular contraction
    3. Irregular, normal shaped QRS
    4. May be chronic
    5. May cause thrombus
32
Q

What are 3 implications for treatment of Fibrillation & Flutter of Atrial Arrhythmias?

A
  1. If chronic, can treat patient, ensure cardiac output is sufficient
  2. If acute and increased rate – delay treatment
    1. Electrolytes need to be checked especially Magnesium and Potassium
    2. Often prescribed Amiodarone to stabilize rate
    3. Check if rhythm is decreasing blood pressure, if so do not treat
    4. Often given DC current to initiate normal rhythm
33
Q

What are 6 steps of interpretating ECG of atrial fibrillation?

A
  1. Ventricular rate: 60-100 beats per minute
  2. Ventricular rhythm: Irregular
  3. P waves: Fibrillatory waves, not able to define.
  4. P-R interval: Cannot be determined (no P wave)
  5. QRS duration: 0.08-0.10 seconds (2 – 2.5 sq)
  6. T wave: Present or lost Atrial
34
Q

What are 6 steps of interpretating ECG of atrial flutter?

A
  1. Ventricular rate: 70 - 150 beats per minute
  2. Ventricular rhythm: Regular
  3. P waves: Flutter waves (sawtooth appearance)
  4. P-R interval: Cannot be determined (no P wave)
  5. QRS duration: 0.08-0.10 seconds (2 – 2.5 sq)
  6. T wave: Present or lost (due to flutter waves)
35
Q

What are 2 characteristics of ventricular rhythms?

A
  1. Ventricular rhythms are potentially more dangerous than atrial rhythms.
  2. Width of QRS (>0.12) is important in diagnosing ventricular rhythms.
36
Q

What are 6 steps of interpretating ECG of ventricular ectopic beats (VEB)?

A
  1. Ventricular rate: Normal (60 – 100)
  2. Ventricular rhythm: Regular except for ectopics
  3. P waves: Normal
  4. P-R interval: Normal, except for ectopics
  5. QRS duration: Wide ectopic
  6. T wave: Normal
37
Q

What are ventricular ectopic beats?

A

Characterised by normal beats with ectopic beats. Varies between 1 in 2 up to >1 in 5 normal beats.

  • If 1 in 2 => Bigeminy
  • If 1 in 3 => Trigeminy
38
Q

What are the 6 causes of ventricular ectopic beats?

A
  1. Occur normally in healthy people
  2. Excessive coffee
  3. Irritable foci in ventricles
  4. Electrolyte disturbance eg Magnesium,Potassium
  5. Hypoxaemia, acidosis
  6. Ischaemia
39
Q

What are the 2 implications of ventricular ectopic beats?

A
  1. May go into Ventricular Tachycardia and Ventricular Fibrillation especially if >1 in 5 and multi-focal
  2. Can usually complete treatment but if worsening, investigate electrolytes and wait for normalization of values
40
Q

What are 6 steps of interpretating ECG of Ventricular Tachycardia?

A
  1. Ventricular rate: 100 - 170
  2. Ventricular rhythm: Regular
  3. P waves: Normal (if visible)
  4. P-R interval: Varies, may not be able to see P wave
  5. QRS duration: Wide
  6. T wave: Difficult to see
41
Q

What are Ventricular Tachycardia?

A

Characterised by broad QRS complex. May be self limiting. Can also be defined as >5 VEB in a row at HR >150 bpm

42
Q

What are the 5 causes of Ventricular Tachycardia?

A
  1. Chronic severe heart disease
  2. Cardiomyopathy
  3. Myocardial ischaemia
  4. Digitalis toxicity
  5. Electrolyte disturbances
43
Q

What are the 3 implications for treatment of Ventricular Tachycardia?

A
  1. VT may be either output maintained or output not maintained
  2. Check BP and CO:
    1. If BP decreases, pale, unresponsive and pulseless –> CPR
    2. If BP normal and patient awake –> obtain help and monitor – output maintained
  3. Will increase myocardial ischaemia in patient with heart disease
44
Q

What are 6 steps of interpretating ECG of Ventricular Fibrillation?

A
  1. Ventricular rate: Cannot identify QRS complex
  2. Ventricular rhythm: Irregular
  3. P waves: Cannot identify P wave
  4. P-R interval: Cannot determine (No P wave)
  5. QRS duration: Wide
  6. T wave: Cannot identify T wave
45
Q

What are 3 characteristics of Ventricular Fibrillation?

A
  1. Chaotic electrical activity in ventricles
  2. Ventricles unable to contract effectively – no CO
  3. Patients usually pulseless, unresponsive
46
Q

What are 2 implications for treatment of Ventricular Fibrillation?

A
  1. Requires immediate CPR
  2. Requires defibrillation
47
Q

What is the ischaemia in ECG interpretation?

A

Ischaemia relates to the ST segment: Lies between the QRS complex and T wave.

Usually isoelectic – not positive or negative.

48
Q

What are 3 characteristics of ST segment elevation?

A
  1. If ST segment elevated >1mm then indicates myocardial injury ie STEMI
  2. Caused by hypokalemia, hypomagnesemia
  3. If ST segment alters during Rx – STOP and ask for 12 lead ECG.
49
Q

What are 3 characteristics of ST segment depression?

A
  1. If ST segment depressed >0.5 mm then indicates myocardial ischaemia or digitalis toxicity.
  2. Caused by hyperkalemia
  3. If ST segment alters during Rx – STOP and ask for 12 lead ECG.
50
Q

To identify the above trace, lets start with the following step:

  1. What is the ventricular rate?

Count the number of large boxes between two R waves.

Divide 300 by this number.

The ventricular rate in the above example is:

  • a) 80 beats/min
  • b) 100 beats/min
  • c) 150 beats/min
A
  1. Ventricular rate: 150

Correct – the rate is 150 beats per minute.

There are 2 boxes between the 2 R waves above

= 300/2

= 150 beats/min

51
Q
  1. Determine the rhythm:

Are the R-R intervals equal along the trace?

If yes, then the rhythm is regular.

If no, then the rhythm is irregular.

For the above trace:

  • a) Rhythm is regular
  • b) Rhythm is irregular
A
  1. Determine the rhythm: Regular

Correct – the rhythm is regular

There R-R intervals are evenly spaced throughout the trace

52
Q
  1. P wave:

Is there a P wave present before every QRS complex?

Are they normally shaped?

Look at the trace above:

  • a) Present before each QRS
  • b) Irregular, not present before each QRS
  • c) Not present at all
A

P wave: Normal, present before each QRS

Correct – the P wave is normally shaped and present before

each QRS complex.

53
Q
  1. P-R interval:

Is the P-R interval normal? (between 0.12 – 0.2 seconds or 3 –

5 small squares)

Look at the trace above, the P-R interval is:

  • a) Less than 3 small squares
  • b) Between 3-5 small squares
  • c) Greater than 5 small squares
A

P-R interval: 0.12 to 0.20 seconds (3-5 small sq)

Correct – the P-R interval is within normal values

54
Q
  1. QRS duration:

Is the QRS duration normal? (between 0.08 – 0.10 seconds or 2 – 2.5 small squares)

Look at the trace above, the QRS duration is:

  • a) Less than 2 small squares
  • b) Between 2-2.5 small squares
  • c) Greater than 2.5 small squares
A
  1. QRS duration:

Correct – the QRS duration is within normal values (2 – 2.5 squares)

55
Q
  1. T wave:

Is there a T wave? Is it upright?

  • a)Yes, T wave present and upright
  • b)No, T wave not present
  • c)No, T wave present, but inverted
A
  1. T wave:

Correct – the T waves are present after each QRS complex and are upright.

56
Q

Consider the steps you have completed - the above ECG

trace is:

  • a) Sinus rhythm
  • b) Sinus tachycardia
  • c) Sinus bradycardia
  • d) Atrial fibrillation
A

Correct! The above trace is sinus tachycardia.

  1. Ventricular rate: 150 (>100 beats per minute)
  2. Ventricular rhythm: Regular
  3. P waves: Normal, present before each QRS
  4. P-R interval: 0.12 to 0.20 seconds (3-5 small sq)
  5. QRS duration: 0.08-0.10 seconds (2 – 2.5 sq)
  6. T wave: Present
57
Q

Follow the 6 steps to interpret the above ECG trace.

  1. Ventricular rate:
  2. Ventricular rhythm:
  3. P waves:
  4. P-R interval:
  5. QRS duration:
  6. T wave:

The above ECG trace is:

  • a) Atrial fibrillation
  • b) Atrial flutter
  • c) Ventricular fibrillation
  • d) Ventricular ectopic beats
A

The above trace is atrial flutter.

  1. Ventricular rate: 75 beats per minute
  2. Ventricular rhythm: Regular
  3. P waves: Flutter waves (Sawtooth appearance)
  4. P-R interval: Cannot be determined (no P wave)
  5. QRS duration: 0.08-0.10 seconds (2 – 2.5 sq)
  6. T wave: Lost (due to flutter waves)
58
Q

Follow the 6 steps to interpret the above ECG trace.

  1. Ventricular rate:
  2. Ventricular rhythm:
  3. P waves:
  4. P-R interval:
  5. QRS duration:
  6. T wave:

The above ECG trace is:

  • a) Ventricular tachycardia
  • b) ST segment depression
  • c) Ventricular fibrillation
  • d) Ventricular ectopic beats
A

The above trace is ventricular ectopic beats.

  1. Ventricular rate: 60
  2. Ventricular rhythm: Regular except for ectopics
  3. P waves: Normal
  4. P-R interval: Normal, except for ectopic
  5. QRS duration: Wide ectopic (9 squares)
  6. T wave: Normal

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