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CVS > 7. Interpreting ECGs > Flashcards

7. Interpreting ECGs Flashcards

1
Q

Where could supra ventricular rhythms arise form?

A

SA node (sinus)
Ectopic atrium
AV node

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2
Q

What are the characteristics of supra ventricular rhythms?

A

Conducted into and within ventricles via normal his-purkinje system, so NORMAL ventricular depolarisation will occur with narrow QRS complexes.

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3
Q

What are the characteristics of ventricular rhythms?

A

Depolarisation takes longer as not via his-purkinje system, widened and bizarre QRS complexes.

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4
Q

What are 3 types of abnormal ventricular rhythms?

A
  1. Ventricular premature beats
  2. Ventricular tachycardia
  3. Ventricular fibrillation
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5
Q

What would you see on the ECG if an ectopic atrial beat is present?

A

P wave no perfectly rounded

QRS normal

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6
Q

What would you see on an ECG if there was an AV node beat?

A

P wave inverted as depolarising away from the apex

QRS normal

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7
Q

What would you see if there was a ventricular ectopic beat?

A

Widened QRS
RV - upwards
LV - downwards

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8
Q

How can you determine if there is normal sinus rhythm?

A

If every QRS is preceded by a P wave

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9
Q

What would be visible on an ECG of atrial fibrillation?

A

No P waves, wavy baseline.

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10
Q

What happens to ventricular depolarisation during atrial fibrillation?

A

Impulses arrive at AV node at rapid irregular rate, only some conducted to ventricles at irregular intervals.
Ventricles depolarise and contract normally.

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11
Q

Which rhythm abnormality can be described as ‘irregularly irregular’?

A

Atrial fibrillation

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12
Q

What is a complication of atrial fibrillation?

A

Stagnant blood in atria can form thrombosis and enter systemic circulation - Stroke

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13
Q

How is CO affected during atrial fibrillation?

A

Cardiac output remains ok

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14
Q

What are the 3 types of heart block (AV conduction block)?

A

1st degree
2nd degree- mobitz 1 +2
Third degree - complete heart block

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15
Q

What ECG changes are visible in first degree heart bloc?

A

PR interval prolonged (> 0.20 seconds)

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16
Q

What happens in first degree heart block?

A

Slow conduction in AV node and His bundle.

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17
Q

What is the outcome/mangagement of first degree heart block?

A

Usually benign and no treatment needed, but worse blocks may follow.

18
Q

What is mobitz type 1 HB called?

A

Wenkebach rhythm

19
Q

What ECG changes are visible in mobitz type 1 HB?

A

Progressive lengthening of PR interval until a QRS complex is dropped. Cycle begins.

20
Q

What is the prognosis of wenkebach rhythm?

A

Generally benign, less likely to progress to CHB.

21
Q

How does mobitz type 2 differ to mobitz type 1?

A

PR interval normal

Sudden dropped QRS and skipping of a beat.

22
Q

What is the prognosis of type 2 mobitz?

A

High risk of progression to CHB

23
Q

What is third degree heart block?

A

Atrial depolarisation remains normal but is not conducted to the ventricles. No link between atria and ventricles.
* Ventricular escape rhythm kicks takes over

24
Q

How does ventricular escape rhythm differ to sinus rhythm?

A

Very slow, 30-40 bpm

25
Q

What ECG changes would you see in third degree heart block?

A

Normal, regular P waves but no relationship to wide QRS complexes

26
Q

What is the outcome of third degree HB?

A

Often too slow to maintain BP and organ perfusion

Urgent pacemaker insertion required.

27
Q

How can wenkebach rhythm be described?

A

Regularly irregular - regular rate with a dropped beat

28
Q

How is VT defined?

A

> =3 consecutive ventricular ectopics

29
Q

What is the risk of VT?

A

Dangerous rhythm which has a high risk of leading to VF (cardiac arrest)

30
Q

What is happening to the ventricles in VF?

A

Quivering , no coordinated contraction.
NO CARDIAC OUTPUT - CARDIAC ARREST
NO PULSE

31
Q

What leads to myocardial ischaemia?

A

Reduced perfusion due to coronary atherosclerosis.

32
Q

Which area of the heart is most vulnerable to ischaemia?

A

Endocardium- vessels are on epicardial surface

33
Q

Explain what would you expect to see on ECG leads facing an area of myocardial ischaemia?

A

ST segment depression and/or T wave inversion due to abnormal current during repolarisation.

34
Q

What causes ST elevation MI?

A

Complete occlusion of a coronary artery.

35
Q

What would you expect to see in an acute ECG of a STEMI?

A

ST elevation in leads facing infarcted region

36
Q

What evolving changes would you see following a STEMI?

A 
Acute - ST elevation
Hours -Smaller R wave
Day 1/2 - Q wave deepens, T wave inversion
Days later - T wave inverted
Weeks - Deep Q wave persists
37
Q

How can you define pathological Q waves?

A

> 1 small square wide
2 small squares deep
(Depth >1/4 of height of R wave)

38
Q

What ECG changes would you see in a patient with hyperkalaemia?

A

Tall, tented T waves

Big Pot, High tea

39
Q

What ECG changes would you see in a patient with hypokalaemia?

A

Low T waves

40
Q

What is the most common ventricular arrythmia?

A

Ventricular premature beats

CVS (16 decks)

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