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cardiology > ECG > Flashcards

ECG Flashcards

electrocardiogram

1
Q

how many electrodes do you need to attach to obtain a 12-lead ECG?

A

10 (6 precordial and 4 limb)

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2
Q

where is V1 placed?

A

4th intercostal space, right sternal margin

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3
Q

where is V2 placed?

A

4th intercostal space, left sternal margin

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4
Q

where is V3 placed?

A

midway between V2 and V4

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5
Q

where is V4 placed?

A

5th intercostal space, mid-clavicular line

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6
Q

where is V5 placed?

A

5th intercostal sapce, anterior axillary line (at the same level as V4)

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7
Q

where is V6 placed?

A

5th intercostal space, mid-axillary line (at the same level as V4)

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8
Q

what colour limb lead goes on the right arm (RA)?

A

red

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9
Q

what colour limb lead goes of the left arm (LA)?

A

yellow

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10
Q

what colour limb lead goes on the left leg (LL)?

A

green

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11
Q

what colour limb lead goes on the right leg (RL)?

A

black

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12
Q

what is ventricular fibrillation (VF)?

A

irregular broad complex tachycardia. always a pulseless rhythm

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13
Q

what are the ECG features of VF?

A

QRS complexes are polymorphic and irregular

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14
Q

what is the management of VF?

A

emergency DC cardioversion (200 J biphasic unsynchronised shock)

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15
Q

what are the ECG features of ventricular tachycardia (VT)?

A
  • tachycardia +
  • absent P waves +
  • monomorphic regular broad QRS complexes (>120ms)
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16
Q

what is the management of pulseless ventricular tachycardia (VT)?

A

emergency DC cardioversion (200 J biphasic unsynchronised shock)

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17
Q

what is the management of ventricular tachycardia with a pulse + adverse features?

adverse features = shock, syncope, MI, heart failure

A

synchronsed DC shock

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18
Q

what is the management of ventricular tachycardia with a pulse + no adverse features?

A

amiodarone
* 300mg IV over 20-60 mins
* then 900mg IV over 24 hours

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19
Q

what is torsades de pointes?

A

form of polymorphic ventricular tachycardia (PVT) caused by QT prolongation

need to have QT prolongation + PVT to be diagnosed

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20
Q

what are the ECG features of torsades de pointes (TdP)?

A

QRS complexes ‘twisting’ around the isoelectric line

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21
Q

what are the causes of torsades de pointes?

A
  • congenital long QT syndromes
  • medications
  • MI
  • renal/liver failure
  • hypothyroidism
  • AV block
  • toxins
22
Q

what is the management of torsades de pointes in haemodynamically unstable patients?

A
  • emergency synchronised direct current shock
  • IV amiodarone
23
Q

what is the management of torsades de pointes in haemodynamically stable patients?

A
  • IV magnesium sulphate (2g over 10mins)
24
Q

list the differentials for a broad complex tachycardia

A
  • ventricular fibrillation
  • ventricular tachycardia
  • polymorphic ventricular tachycardia
  • torsades de pointes
25
Q

what are the ECG findings in PE?

A
  • normal or sinus tachycardia
  • right-heart strain = right axis deviation and ST/T wave changes
  • S1Q3T3 = deep S wave in lead I, Q waves in lead III nad inverted T waves in lead III
26
Q

what is the pathophysiology of first degree heart block?

A

prolonged conduction of electrical activity through the AV node

27
Q

what ECG finding is typical for first degree heart block?

A

PR interval >200ms

28
Q

what are some of the causes of first degree heart block?

A
  • high vagal tone (e.g. atheletes)
  • acute inferior MI
  • electrolyte abnormalities (e.g. hyperkalaemia)
  • drugs - NHP-CCBs, beta-blockers, digoxin, cholinesterase inhibitors
29
Q

what is the management of first degree heart block?

A

benign and does not need treating

30
Q

what are the different types of second degree heart block?

A
  • mobitz type I
  • mobitz type II
31
Q

what is mobitz type 1?

A

type of second degree heart block that is usually due to reversible conduction block at the AV node

32
Q

what are the ECG characteristics of mobitz type I?

A
  • irregular rhythem
  • progressive PR-interval prolongation until a dropped QRS complex occurs
33
Q

what are the causes of mobitz type I?

A
  • MI (mainly inferior)
  • drugs - beta/calcium channel blockers, digoxin
  • professional athletes due to high vagal tone
  • myocarditis
  • cardiac surgery
34
Q

what the management of mobitz type I?

A

generally asymptomatic and does not require any specific management

35
Q

what is mobtiz type II?

A

type of second degree heart block where there are intermittent non-conducted P waves

36
Q

what are the ECG characteristics of mobitz type II?

A
  • PR interval is constant
  • broad QRS complex indicating a distal block in the His-Purkinje system
  • pre-exisiting left bundle branch block/bifascicular block
37
Q

what are the causes of mobitz type II?

A
  • infarction - particularly anterior MI
  • surgery - mitral valve repair or septal ablation
  • inflammatory/autoimmune - rheumatic heart disease, SLE, systemic sclerosis, myocarditis
  • fibrosis - lenegre’s disease
  • infiltration - sarcoidosis, haemochromatosis, amyloidosis
  • mediacation - beta-blockers, calcium channel blockers, digoxin, amiodarone
38
Q

what is the management of mobitz type II?

A

permanent pacemaker

39
Q

what is complete/3rd degree heart block?

A

atrial impulses fail to be conducted to the ventricles

40
Q

what are the clinical features of third degree heart block?

A
  • syncope
  • cardiac arrest
41
Q

what are the ECG characteristics in third degree heart block?

A
  • severe bradycardia
  • dissociation between the P waves and the QRS complexes
42
Q

what are the causes of third degree heart block?

A
  • myocardial infarction (especially inferior)
  • drugs acting at the AV node - beta-blockers, calcium channel blockers
  • idiopathic fibrosis
43
Q

what is the management of third degree heart block?

A

permanent pacemaker due to the risk of sudden death

44
Q

what is bradycardia?

A

heart rate <60 bpm

45
Q

what are the causes of acute bradycardia?

A
  • sinus/AV nodal disease
  • drug induced - beta-blockers, calcium channel blockers
  • electrolyte abnormalities
  • hypothyroidism
46
Q

what are the clinical features of bradycardia?

A
  • dizziness
  • syncope
  • tiredness
47
Q

what is the medical management of acute bradycardia?

A
  1. treat any reversible causes
  2. atropine 500mcg IV - repeat boluses can be given up to 3mg
  3. no affect = alternative drugs (e.g. isoprenaline, adrenaline, aminophylline, dopamine)
48
Q

how does atropine affect the heart?

A

blocks the vagus nerve activity on the heart, which increases the firing rate of the SA node

49
Q

what are the factors which increase the risk of asystole in bradycardia?

A
  • mobitz type II block
  • complete heart block + broad QRS
  • recent asystole
  • ventricular pause >3 seconds
50
Q

what is the management of acute bradycardia if medical management has failed?

A

transcutaneous pacing can be used whilst awaiting for transvenous pacing/permanent pacemaker insertion

cardiology (17 decks)

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