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Medicine block (Y3) > Week 4: Cardiology (6) (ECG) > Flashcards

Week 4: Cardiology (6) (ECG) Flashcards

1
Q

reading protocol

A
  1. check patient name and date of ECG
  2. rate
  3. rhythm
  4. AXIS
  5. intervals
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2
Q

rate

A

QRS x6 = HR

brady <50

tachy >120

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3
Q

rhythm

A

regular, sinus, irregular

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4
Q

AXIS

A
  • Look at limb leads only
  • Normal = lead II most positive
  • Left axis deviation = AVL most positive
  • Right axis= lead III most positive
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5
Q

sinus arrhythmia

A

p waves preceding QRS

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6
Q

example normal ECG

A
  • Rate = 11x 6= 66
  • Rhythm= Regular (sinus)
  • No axis deviation (lead 2 most positive)
  • Normal PR
  • Normal QRS
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7
Q

talk through this ECG

A
  • 20x 6= 120
  • Sinus tachycardia
  • Left axis deviation (aVL most positive)
  • PR normal
  • QRS normal
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8
Q

talk through this ECG

A
  • 11x6 = 66
  • irregular
  • normal axis
  • normal PR, normal QRS,

diagnosis - atrial ectopic beat (atrial bigemini)

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9
Q

talk through this ECG

A
  • 6x 11= 66
  • Rate change
    • Negative P QRST
      • Short run of APB – atrial premature beats (x5)
    • Atrial ectopic rhythm- node down is normal

Short run of APB – atrial premature beats (x5)

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10
Q

talk through this ECG

A
  • 240 bpm tachycardia
  • Regular
    • P waves (discrete)
  • Right axis deviation
  • QRS narrow
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11
Q

talk through this ECG

A
  • Rhythm regular
  • Fluttery p waves
  • QRS narrow
  • Activation from node down normal
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12
Q

talk through this ECG

A
  • 12x6= 72
  • 4 flutter waves for every QRS- saw tooth

atrial flutter

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13
Q

talk through this ECG

A
  • 138 bpm- tachycardia
  • Irregularly irregular
  • no clear p waves
  • QRS height variable

attrial fibrillation

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14
Q

talk through this ECG

A
  • 78bpm
  • Irregular r waves

atrial fibrillation that is being slowed down

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15
Q

talk though this ECG

A
  • 132bpm
  • irregular intervals and heights
  • QRS is broad
  • Left bundle branch blocker
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16
Q

Brady cardias

A
  • <50
  • Causes
    • Sinus node
    • AV node
      • Need to know which degree of block
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17
Q

approach to bradycardias step 1

A

QRS narrow or broad

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18
Q

narrow QRS - brady cardia

A
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19
Q

QRS broad- bradycardia

A
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20
Q

first degree heart block

A

prolonged PR

PR >200ms

regular

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21
Q

2nd degree: mobitz type 1

A

prolonged PR then dropped p

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22
Q

2 degree: Mobitz II (wenkenbach)

A

drop without RP prolongation

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23
Q

3rd degree heart block

A

no association between p and QRS

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24
Q

talk through this QRS

A

tachy brady syndrome

  • some parts tachy some parts bradys
  • QRS narrow and regular
  • 1:1 QRS: P
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25
Q

talk through this ECG

A
  • 8 X6= 48
  • QRS narrow
  • Regular
  • P wave hidden in T wave

bradycardia

26
Q

talk through this ECG

A

Intermittent fixed AV block

  • Narrow QRS
  • 13x 6= 78
    • Intermittedent bradycardia
  • Intermittent fixed AV block - P waves (2P waves: 1 QRS)Intermittent fixed AV block
27
Q

talk throguh this ECG

A
  • 48bpm
  • QRS narrow
  • Regular
  • 2:1 AV block Mobitz type 2
    • Droppage of some QRS
    • PR interval stays the same
28
Q

talk through this ECG

A
  • 66 bpm- intermittent brady cardia
  • regular QRS
  • PR lengthening, QRS droppage
  • Mobitz Type 1 (Wenckebach)
29
Q

talk through this ECG

A

Left branch block

  • QRS broad
  • Left axis deviation (AVL most positive)
  • Poor R wave regression
30
Q

talk through this ECG

A
  • Broad QRS
31
Q

talk through this ECG

A
  • 30bpm
  • Regular
  • Narrow QRS
  • No relationship between P wave and QRS
    • QRS= escape signal
  • Needs a pacemaker
32
Q

Example Pacemakers

A
  • 1 Pacemaker spike (1 wire)
  • P wave with no connection to the ventricle
33
Q

Example Pacemakers- dual chamber

A
  • broad QRS
  • Pacing spike in atria (1 wire) and ventricle (1 wire)
34
Q

tachycardia protocol

A

>120 bpm

step 1: QRS narrow or broad

35
Q

QRS narrow- tachy

A
36
Q

QRS broad

A
37
Q

Example tachycardia ECG- atrial fib

A
  • Tachycardia >120bpm
  • Rhythm is irregular
  • QRS is narrow
  • QRS height variable
  • V1 best to see atrial fib
38
Q

Example tachycardia ECG -atrial flutter

A
  • Tachycardia
  • Mostly regular
  • Narrow QRS
  • Same height
  • Continuous P wave- flutter (sort of sawthooth)
    • Look in inferior leads
39
Q

Example tachycardia ECG- narrow complex tachycardia (NCT)

A
  • Tachycardia
  • Regular
  • Narrow QRS
  • No p waves
40
Q

Example tachycardia ECG- Narrow complex tachycardia

A
  • Tachycardia
  • Regular
  • Narrow QRS
  • No p wave (all t waves)
41
Q

Example tachycardia ECG- ectopic atrial tachy

A
  • Tachycardia
  • Regular
  • Narrow
  • P waves (discrete)
42
Q

regular broad compelx tachycardia

A
  • Is there BBB? Look at V1
  • Is there a delta wave? WPW?
  • Is the RBC coming from the ventricle
43
Q

look for BBB in

A

V1

44
Q

left bundle branch block

A
45
Q

right bundle branch block

A
46
Q

talk through this ECG

A
  • Tachycardia
  • Regular
  • QRS is broad
    • V1- left bundle branch block
    • Left axis deviation- aVL most positive
47
Q

talk through this ECG

A

Tachycardia

  • Regular
  • Broad
  • BBB
    • V1- left bundle branch block still going fast
48
Q

talk through this

A
  • Tachycardia
  • Regular
  • Broad QRS
    • Look at V1- broad QRS
      • Positive with a small R, S, bigger R- right BBB

SVT with R.BBB

49
Q

talk through this ECG

A
  • Tachycardia
  • Regular
  • To start
    • Broad QRS
    • V1- middle R and big R- right bundle branch block
  • Later on
    • Narrow QRS
    • Right bundle woken up QRS becomes narrow
    • Still tachy
50
Q

what does a delta wave look like

A

slurred upstroke

The Delta wave is a slurred upstroke in the QRS complex often associated with a short PR interval. It is most commonly associated with pre-excitation syndrome such as WPW. The characteristic ECG findings in the Wolff-Parkinson-White syndrome are: Short PR interval (< 120ms)

51
Q

example delta wave

A
  • Regular
  • Broad complex
  • Delta wave tall and broad QRS extra piece of tissue that conducts electricity from the atria to the ventrical- WPW accessory pathway
52
Q

another example delta wave

A
  • Very tachycardic (300 bpm)
  • irregular
  • Broad QRS
    • Tall
    • BBB? NO
    • Is there a delta wave? YES
53
Q

ventricular tachycardia caused y

A

Fibrosis in the heart (e.g. caused by ischaemia) which causes the abnormal rhythm to come from the ventricles

54
Q

ventricular tachycardia with fusion and capture beats

A

very rare to see

  • Capture? Yes at the suddenly narrow QRS (normal height)
  • Fusion? Taller and narrow- Yes
55
Q

Example ventricular tachycardia

A
  • Tachycardia
  • Regular
  • Broad QRS
    • BBB? NO
    • Delta wave? NO
    • Therefore must be VT
      • No association between p wave sand broad QRS sinus node is firing at a different rate to the ventricular tachycardia
    • Fusion or capture beats?
      • Capture? Yes at the suddenly narrow QRS (normal height)
      • Fusion? Taller and narrow- Yes
56
Q

polymorphic VT (inferior stemi)

A
  • Tachycaddia
  • irregular
  • WRS are broad and tall at times polymorphic
    • BBB? NO
    • Delta wave? NO
    • Variable shap? Yes
      • Polymorphic VT
57
Q

Torsades de pointe

A

Twisting rhythm

58
Q

talk through this ECG

A
  • Tachycardia
  • Irregular
  • QRS broad
    • Flat QRSventricular fibrillation needs defibrillation STAT
59
Q

Protocol to the ST/T wave ECG

A
  • know your territories of ischaemia
  • infarct or ischaemia
  • reciprocal changes

posterior STEMI- need to to do leads V7/ 8/9

60
Q

ECG changes in ACS

A
61
Q

Coronary anatomy and ECG

A

LII

LI

SSAALL

Medicine block (Y3) (38 decks)

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