Cardiology Seminars

Question 1

SEMINAR ONE - VALVULAR HEART DISEASE

Answer 1

DR BINNS (to do)

Question 2

SEMINAR TWO - ECGs

Answer 2

DR BINNS (started)

Question 3

How can the axis of an ECG be calculated?

Answer 3

Using vectors - look at the difference between upstrokes and downstrokes of the QRS complex in leads I and aVF. This will show which quadrant the axis is in and if there is deviation. Positive on the axis is left and down, negative is up and right.

Question 4

What are the boundaries for the different axes of ECGs?

Answer 4

Normal: -30 to +90
Left axis deviation: -30 to -90
Right axis deviation: +90 to +180
Bizarre: +180 to -90

Question 5

What are the causes of left axis deviation?

Answer 5

Left anterior fascicular block, left ventricular hypertrophy, or RBBB.

Question 6

What are the causes of right axis deviation?

Answer 6

Right ventricular hypertrophy or strain, left posterior fascicular block, or RBBB.

Question 7

What are the three types of P wave seen on ECG?

Answer 7

Normal, P-mitrale, P-pulmonale.

Question 8

What is the appearance and cause of P-mitrale?

Answer 8

Mitre’s hat (two mini peaks), due to increased left atrium.

Question 9

What is the appearance and cause of P-pulmonale?

Answer 9

Tall tented P wave, due to increased right atrium.

Question 10

What is the normal PR interval?

Answer 10

3-5 small squares = 0.12-0.2 seconds.

Question 11

Where is the PR interval measured from and to?

Answer 11

Start of the P wave to the start of the QRS complex.

Question 12

What causes lengthened PR intervals?

Answer 12

Heart block.

Question 13

When is a long PR interval worrying?

Answer 13

When it’s very long - 0.28 seconds, there are other conducting tissue disease signs (trivesicular block = long AVN + RBBB + left anterior fascicular block), aortic valve has infective endocarditis SURGICAL EMERGENCY.

Question 14

What causes shortened PR intervals?

Answer 14

Accessory pathways where depolarisation starts earlier from pre-excitation.

Question 15

What are the voltage criteria for left ventricular hypertrophy?

Answer 15

S wave in V1/2 + R wave in V5/6 > 35. Any S or R wave in chest lead > 30mm. R wave in lead I and aVL >14mm.

Question 16

What are the criteria for a pathological Q wave?

Answer 16

The very first deflection, at least 1/4 of the height of the subsequent R wave, not in lead III unless also in II and/or aVF.

Question 17

What are Q waves a sign of?

Answer 17

Full thickness MI that happened at some point.

Question 18

What can ST elevation be due to?

Answer 18

Acute myocardial injury or pericarditis.

Question 19

How does the shape of ST elevation in AMI and pericarditis differ?

Answer 19

AMI - tombstones. Pericarditis - saddle shaped.

Question 20

Where is there ST elevation in AMI vs pericarditis?

Answer 20

AMI - regional, others have ST depression. Pericarditis - all leads.

Question 21

What is the PR in AMI vs pericarditis?

Answer 21

No PR depression in AMI, PR depression in pericarditis.

Question 22

What is the history of AMI and pericarditis with ST elevation?

Answer 22

AMI - bad pain on history. Pericarditis - worse pain on lying down.

Question 23

What are the possible causes of ST depression on exercise ECGs?

Answer 23

Fine and of no consequence, coronary disease.

Question 24

What are the possible morphologies of T waves?

Answer 24

Peaked, flat, inverted, biphasic, deep inversion, asymmetric.

Question 25

What is the risk of prolonged QT interval?

Answer 25

Leads to Torsade de pointes.