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Baz: Semester 2 > Cardiovascular: ECGs & Arrhythmia > Flashcards

Cardiovascular: ECGs & Arrhythmia Flashcards

1
Q

What are the 6 leads in the coronal plane?

A

The limb leads
* aVR
* aVL
* aVF
* I
* II
* III

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2
Q

What are the 6 leads in the transverse plane?

A

The chest leads

V1-V6

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3
Q

Describe the colour of the limb electrodes

A

Right shouder - Red
Left shoulder - Yellow
Left leg - Green
Right leg - Black

Hint: start with red for right then work through the traffic lights clockwise

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4
Q

Where do each of the coronal leads lie on the QRS axis?

A
  • I: 0’
  • II: +30’
  • aVF: +90’
  • III: +120’
  • aVR: -150’
  • aVL: -30’
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5
Q

What is the normal QRS axis range, and what defines a left axis deviation and a right axis deviation?

A

Normal: -30’ - +90’
RAD: +90’ - +180’
LAD: -30’ - -90’

This is because the wave of propagation normally goes from SA node through bundle of hiss and down in right-left downward direction.

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6
Q

How would you use a QRS deflection in leads I,II&III to calculation deviation?

A
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7
Q

Is there any axis deviation here?

A

No, I&II are positive deflection and III is negative, this is normal QRS axis

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8
Q

Is there any axis deviation here?

A

Yes, I is positive deflection and II&III are negative, this is therefore a left axis deviation

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9
Q

Is there any axis deviation here?

A

Yes, II&III are positive deflection and I is negative, this is therefore a right axis deviation

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10
Q

What does the P wave correspond to?

With regards to electrical conduction

A

Atrial depolarisation

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11
Q

What does the QRS complex correspond to?

With regards to electrical conduction

A

Ventricular depolarisation

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12
Q

What does the T wave correspond to?

With regards to electrical conduction

A

Ventricular repolarisation

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13
Q

What does the PR segment tell us about with regards to electrical conduction?

What does deviations in a PR segment therefore hint at?

A

If P is depolarisation of the atria and QRS is depolarisation of the ventricles then PR segment is the conduction through the AVN/ bundle of hiss.

A prolonged PR segment can indicate conductive tissue dissorder

A shortened PR can indicate that conduction is bypassing the AVN

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14
Q

What does the QRS complex tell us about with regards to electrical conduction?

What does deviations in QRS complex therefore hint at?

A

Time for ventricular depolarisation

Deviations can indicate conductive tissue dissorders in the ventricles such as right bundle branch block or left bundle branch block

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15
Q
A
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16
Q

What does the ST segment tell us about with regards to electrical conduction?

What does deviations in a ST segment therefore hint at?

A

ST segment – start of
ventricular repolarisation
(should be isoelectric aka flat)

ST elevation acute infarction

ST depression ischaemia

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17
Q

What does the T wave tell us about with regards to electrical conduction?

A

Ventricular repolarisation

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18
Q

What time is one small box equivelent to?

A

0.04s

19
Q

What is Wolff-Parkinson-White (WPW) syndrome?

A

A syndrome that causes the an extra path of conduction in the heart bypassing the AV node and is more rapid that AV/bundle of hiss conduction

20
Q

What is this hinting at?

A

Wolff-Parkinson-White (WPW) syndrome

Shorter PR interval therefore AV node being bypassed

21
Q

Why could Wolff-Parkinson-White (WPW) syndrome make AF worse?

A

If conduction between atria and ventricles bypassed and rapid conduction then AF could also lead to VF

22
Q

What is this hinting at?

A

Left ventricular hypertrophy due to high blood pressure

QRS complex phatty on leads V5&V6 corresponding to depolarisation of a large muscle where the left ventricle is. Corresponding negative reflection on the opposite leads

23
Q

What is this hinting at?

A

RSR in V1 is Right bundle branch block

24
Q

What is this hinting at?

A

Left bundle branch block

25
Q

Anything up here?

A

Nope

P wave is followed by a regular PR interval and QRS complex followed by a regular T wave

The change in rate is due to breathing, speeds up when you breath in, slows down when you breath out

26
Q

What is this?

A

Sinus tachycardia

Increased heart rate however the increased rate is still coming from regular sinus node signalling therefore sinus tachycardia

27
Q

What is up here?

A

Sinus bradycardia

28
Q

What is sino-atrial disease

A

A degenerative condition affecting the atria,
including the sinoatrial (SA) and
atrioventricular (AV) nodes

Can lead to sinus tachycardia, sinus
bradycardia, atrial ‘ectopic’ beats, and atrial
fibrillation

29
Q

What is this?

A

Atrial tachycardia

QRS doesn’t always follow P wave meaning somewhere in the atria is fireing itself

A consequence of sino-atrial disease

30
Q

Sino-atrial disease - treatment?

A

permanent pacemaker to prevent slow rhythms

antiarrhythmic drugs to prevent or moderate
rapid rhythms
– beta blocker
– digoxin
– amiodarone

31
Q

What is this?

A

1st degree AV block

PR interval extended indicating a delayed conduction time between atria and ventricles

32
Q

What is this?

A

2nd degree AV block

Blockage at bundle of hiss

Some QRS complexes not fireing at all

If QRS doesn’t fire to long enough then results in passing out

33
Q

What is this?

A

3rd degree AV block

P waves completely independent of ventricular depolarisation, none are getting through

Ventricles still contract on their own rythm as a backup but it is not ideal

34
Q

Causes of AV nodal block

A
  • sino-atrial disease
  • coronary heart disease
  • aortic valve disease
  • damage during heart surgery
  • drugs
    – beta-blockers
    – digoxin
    – calcium channel blockers
35
Q

What is this?

A

Atrial fibrillation

Atria activating rapidly therefore they can’t contract effectively (contractions can’t keep up with signals)

Can also appear on some leads as no P-wave present at all, just flat between each QRS complex with T wave

36
Q

What is this?

A

Atrial flutter

Saw tooth - atrial flutter

Signal keeps going around atria triggering itself rapidly rather than moving down the atria

37
Q

Different look of atrial fibrillation vs atrial flutter?

A

Atrial fibrillation - messy

Atrial flutter - sawtooth

38
Q

Causes of atrial flutter / fibrillation

A
  • sino-atrial disease
  • coronary heart disease
  • valve disease (esp. mitral valve)
  • hypertension
  • cardiomyopathy
  • hyperthyroidism
  • pneumonia, lung pathology
39
Q

Treatments for atrial fibrillation/ atrial flutter

A
  • drugs to block AV node and therefore limit
    heart rate
    – digoxin
    – beta blocker
    – calcium channel blocker
  • electrical cardioversion
  • catheter ablation
40
Q

What arrythmia could childhood pneumonia lead to?

A

Atrial fibrillation/ flutter

Untreated strep as a child can cause a mumour as a child which then makes the atria weakened and the damage effects kick in later in life

41
Q

What is this?

A

Ventricular tachycardia

Short circuiting of impulses within ventricles - signal going round and round ventricles.

Diseased ventricles

No p wave - qrs firing on its ones

42
Q

What is this?

A

Ventricular fibrillation

Carnage

Heart can’t really function

43
Q

Treatment for ventricular fibrillation

A

ACUTE
* defibrillation
* IV antiarrhythmic drugs
* remove any triggering cause
LONG TERM
* oral antiarrhythmic drugs
* treat underlying heart conditions
* implantable defibrillator for some
patients

Baz: Semester 2 (42 decks)

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