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CR3 > Interpretation fo ECGs > Flashcards

Interpretation fo ECGs Flashcards

1
Q

Electrical conduction of the heart

A

SAN -> AVN -> Bundle of His -> L & R bundle branches -> Purkinje fibres

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2
Q

Where does the left bundle branch conduct to?

A

Left posterior fascicle
Septal fascicle
Left anterior fascicle

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3
Q

What does the P wave represent?

A

atrial depolarisation

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4
Q

What does the QRS complex represent?

A

ventricular depolarisation

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5
Q

What does the T wave represent?

A

ventricular repolarisation

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6
Q

What should you look at first when you look at an ECG?

A

Check it is the right person - name, DOB, hospital number

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7
Q

What should you do second when you look at an ECG?

A

Assess calibration

  • paper speed = 25mm/sec
  • calibration = 1mV=10mm
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8
Q

Position of 6 chest leads

A 
V1 = 4th ICS RHS
V2 = 4th ICS LHF
V3 = 5th rib LHS
V4 = 5th ICS LHS, mid clavicular line, apex beat
V5 = between 4 and 6
V6 = mix axillary line
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9
Q

Which leads should be positive?

A

Lead II
avF
> Lead III

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10
Q

Which leads should be negative?

A

avR

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11
Q

What are your 6 standard leads?

A

avR,L,F

leads 1,2,3

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12
Q

How much does 1 small square represent?

A

40msec

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13
Q

How much does 1 big square represent?

A

200 msec

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14
Q

How long is the PR interval?

A

3-5 small sq

120-200 msec

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15
Q

How long is the QRS duration?

A

<3 small sq

<120 msec

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16
Q

How long is the QT interval?

A

<440 msec

dependent on HR so sometimes corrected

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17
Q

How to read an ECG?

A
  • confirm patient
  • confirm calibration
  • comment of rhythm
  • rate
  • axis
  • P waves
  • PR interval/heart block
  • QRS morphology/ST segments/T waves
  • QT interval
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18
Q

What to do if there is no electrical activity?

A
  • check patient is well
  • are leads connected
  • check for interference (phones/chargers)
  • check calibration is correct
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19
Q

How to assess rhythm/

A
  • are QRS complexes regular?

- is there a P wave before every QRS = sinus rhythm

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20
Q

What is the definition of sinus rhythm?

A

Presence of P wave before every QRS

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21
Q

What is a rhythm strip?

A

Normally in lead II or I as good to look at QRS

10 second strip on 1 lead

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22
Q

Who gets sinus arrhythmia?

A

Young
Good vagal tone
Athletes
Deep slow respirations

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23
Q

What are ectopics?

A

When heart throws off extra beats

  • above AVN = supra-ventricular ectopics
  • below AVN = ventricular ectopics
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24
Q

How can you differentiate between ectopics?

A
  • supraventricular = narrow QRS complex = above AVN

- ventricular = broad QRS complex = below AVN

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25
Q

How to comment on HR?

A
  • normal is 50-100
  • count number of big squares between QRS complexes
  • divide 300 by no. of big squares
  • not to use if irregular rhythm
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26
Q

What is the axis of the heart?

A

The electrical vector of the heart

Direction of depolarisation

27
Q

What is the general normal direction of depolarisation?

A

From aVR -> II

From top of right shoulder diagonally down to left

28
Q

What is the normal axis?

A

-30 to +120

29
Q

What is L axis deviation?

A

Axis more negative than -30

Anticlockwise

30
Q

What is R axis deviation?

A

Axis > +120

Clockwise

31
Q

When is the axis abnormal and when is there deviation?

A

Lead II negative = abnormal
Lead III negative = LAD
Lead I negative = RAD

32
Q

Causes of RAD?

A 
Children 
Tall thin adults
RVH
PE/chronic lung disease
L. posterior hemiblock
ASD/VSD
Wolff Parkinson White Syndrome (L. accessory pathway)
33
Q

Causes of LAD?

A

LVH
LBBB of L. anterior hemiblock
Q waves of inferior MI
Wolff Parkinson White Syndrome (R. sided accessory pathway)

34
Q

How to assess P wave morphology?

A
  • lead II or I
  • P mitrale = looks like an M = due to L atrial hypertrophy
  • P pulmonale = tall and thin = R atrial hypertrophy
35
Q

What is the PR interval?

A

Delay from SAN to AVN conduction

36
Q

Normal PR interval

A

120-200msec

3-5 small sq

37
Q

Types of heart block

A

1st degree
2nd degree (Mobits type 1 and 2)
Complete heart block

38
Q

Bundle branch block

A

PR normal
QRS >120 msec
Delay in ventricular repolarisation
L or R

39
Q

2nd degree heart block Mobitz type 1 (wenkebach)

A

Progressive increase in PR interval

Followed by non-conducted QRS

40
Q

2nd degree heart block Mobitz type 2

A

Non conducted QRS after every 2nd P wave

Broad QRS complex

41
Q

Complete heart block

A

P waves unrelated to QRS

A-V dissociation/loss of conduction

42
Q

Wolf Parkinson White Syndrome

A

Short PR interval
Wide QRS
Delta wave
Pointy QRS

Pre-excitation through accessory pathway

43
Q

Supra-ventricular tachycardia

A

Regular
Narrow complex tachycardia
No P waves or atrial activity
Caused by an eddie

44
Q

LBBB

A 
WiLLiaM morphology
W pattern around V1,2
M pattern around V5,6
QRS >120/3 small sq
LAD
45
Q

RBBB

A 
QRS >120
MaRRoW morphology
M around V1,2
W around V5,6
RAD
46
Q

LVH

A
  • large QRS voltages!

- may have ST depression and T wave inversion

47
Q

What leads look at the lateral wall?

A

V5,6
lead I
aVL

48
Q

What leads look at the anterior wall?

A

V2,3,4

49
Q

What leads look at the inferior wall?

A

Leads 2,3

aVF

50
Q

ECG changes associated with MI

A
  • MINUTES = peaked T waves
  • MINS TO HOURS = ST elevation (if STEMI) or depression (NSTEMI)
  • HOURS = Q waves, inverted T waves
51
Q

Old infarction

A

T wave inversion

Antero-lateral Q waves

52
Q

Wellens Syndrome

A

Very deep T wave inversion
LAD syndrome
Probable antero-lateral NSTEMI
High risk patient

53
Q

AF

A

No P waves

Irregularly irregular ventricular rhythm

54
Q

Atrial Flutter

A 
Re-entrant circuit in RA
Flutter rate = 300bpm
HR = 150bpm
Regularly irregular
Flutter wave = give saw tooth pattern on ECG
55
Q

Atrial tachycardia

A
  • abnormal focus of atrial depol
  • abnormal P wave morphology
  • unexplained tachycardia
56
Q

AVNRT

A

Atrio-ventricular node re-entrant tachycardia
Accessory pathway in AVN
Leads to SVT
Eddie current
Depol and Repol same tissue again and again

57
Q

Broad complex tachycardias

A

VT (emergency)
SVT (with abnormal conduction)
WPW via accessory pathway

ALLWAYS CONSIDERED VT UNTIL PROVEN OTHERWISE

58
Q

Ventricular Fibrillation

A

Abnormal QRS waves
Patient in arrest not conscious
Need defib

59
Q

Regular tachy rhythms

A

Sinus
SVT
Flutter
VT

60
Q

Regular brady rhythms

A

Sinus

CHB

61
Q

Irregular tachy rhythms

A

AF

Sinus with multiple ectopics

62
Q

Irregular brady rhythms

A

AF overuse beta blockers

Exaggerated sinus

63
Q

Narrow QRS complex rhythms

A

Sinus
AF
Flutter
SVT

64
Q

Broad QRS complex rhythms

A

VT
SVT with BBB
CHB

CR3 (30 decks)

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