Interpretation

Question 1

Inverted Narrow P wave

Answer 1

Skinny because both atria depolarise simultaneously instead of right then left
Impulse moves from inner heart outwards
SUPRAVENTRICULAR TACHYCARDIA

Question 2

M shaped P wave

Answer 2

Enlarged left atrium

Question 3

Wide P wave

Answer 3

Atrial enlargement or slow conduction

Question 4

When is it useful to examine elevation or depression of the PR segment

Answer 4

In acute pericarditis

Question 5

Initial wide upstroke of QRS complex

Answer 5

Initial depolarisation takes longer than usual or it’s slower due to:
Accessory pathway or Wolff Parkinson White pattern- slow conduction due to Accessory pathway via delta wave

Left ventricular hypertrophy

Question 6

In a bundle branch block is the QRS normal or delayed

Answer 6

Normal

Question 7

Are Q waves normal in V1 and V2

Answer 7

NO

Question 8

Where is it normal to find a Q wave

Answer 8

aVR

Question 9

Right ventricular hypertrophy

Answer 9

Q waves in V1 and V2

Question 10

Where are small narrow Q waves seen

Answer 10

V6 and Lead I

Question 11

Large QRS

Answer 11

Left ventricular hypertrophy

Question 12

Very wide QRS

Answer 12

Ventricular tachycardia

Question 13

Wide and large QRS plus tachycardia

Answer 13

BBB

Question 14

RV hypertrophy

Answer 14

Voltage more than 7mm

Question 15

Size of pathological Q wave

Answer 15

More than 40ms 1 small block wide

Question 16

Posterior infarction

Answer 16

Usually never occurs in iso and usually with inferior infarction
R waves in V1 and 2 become dominant
ST segment depression and T wave evolves to become upright
Mirror image of pathological Q wave

Question 17

Tall R wave or dominant R wave in V1

Answer 17

Right BBB
Right ventricular hypertrophy

Posterior infarction
WPW
Duchennes Muscular Dystrophy
Left ventricular pacing

Question 18

Small QRS/ low amplitude QRS

Answer 18

Something between heart and skin electrodes such as

Fat
Fluid: pericardial effusion
Air: obstructive airways disease and pneumothorax

Or

Cardiomyopathy (end stage thin globally dilated LV with pericardial effusion)
Do echo

Question 19

ST segment elevation

Answer 19

Myocardial ischaemia
Acute pericarditis (saddle back, also look for PR segment elevation or depression)
Depolarisation abnormalities 
Electrolyte abnormalities 
Bundle branch block

Question 20

Myocardial ischaemia

Answer 20

NEED TO OBSERVE A FEW ECGs
T waves initially become taller and larger but later become inverted and symmetrical
ST segment elevation
Pathological Q waves

Question 21

ST elevation in aVR

Answer 21

Very proximal left anterior descending artery

Question 22

Peaked or deep T waves

Answer 22

Hyperkalaemia
Myocardial ischaemia usually anterior and inferior leads
Post resus
Cardiomyopathy

Question 23

Hyperkalaemia ECG changes

Answer 23

Peaked T waves
Absent P wave or flat
QRS widening
ST segment changes up or down

Question 24

T wave alterans

Answer 24

Tachycardia
Pericardial effusion
Chronic HD
Long QT syndrome

Question 25

QT interval

Answer 25

Congenital or Acquired LQT syndrome
Bradycardia
Short QT is same

Question 26

U waves

Answer 26

Normal as long as U wave is upright if T wave is upright and must be smaller than preceding T wave

Abnormal in myocardial ischaemia and hypokalaemia