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CVS 7 ECG Flashcards

(69 cards)

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1
Q

What colours are the limb electrodes?

A

Ride Your Green Bike

RA - Red
LA - Yellow
LL - Green
RL - Black

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2
Q

Where are the 6 chest electrodes placed?

A

V1- 4th intercostal space to right of sternum
V2- 4th ICS to left of sternum
V3- halfway between V2+V4
V4- 5th ICS at the midclavicular line
V5- level with V4 at the left anterior axillary line
V6 - level with V4+5 at left mid axillary line
(directly under midpoint of armpit)

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3
Q

Location of V1 electrode

A

4th intercostal space to right of sternum

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4
Q

Location of V2 electrode

A

4th intercostal space to left of sternum

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5
Q

Location of V3 electrode

A

Halfway between V2 + V4

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6
Q

Location of V4 electrode

A

5th intercostal space at midclavicular line

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7
Q

Location of V5

A

Level with V4 at left anterior axillary line

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8
Q

Location of V6 electrode

A

Level with V4+5 at left mid axillary line
(Directly under midpoint of armpit)

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9
Q

How do the ECG leads work?

A

Each lead is a representation of a measurement of the change in mV in 2 electrodes
Signal for each of the 12 leads represents change over time
Each lead represents specific part of the heart

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10
Q

What does 1 small square on an ECG represent?

A

0.04 seconds (40ms)

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11
Q

What does 1 large square on an ECG represent?

A

0.20 seconds

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12
Q

What is 1 second on an ECG?

A

5 large squares

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13
Q

How should you approach an ECG?

A

Correct patient?
Rate- 10 second strip - QRS waves x 6 = HR
Rhythm
Axis
Intervals

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14
Q

What gives you lead I?

A

Difference between RA + LA

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15
Q

What gives you lead II?

A

Difference between RA + LL

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16
Q

What gives you lead III?

A

Difference between LA + LL

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17
Q

What are the augmented leads?

A

avR
avF
avL

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18
Q

What type of wave is generated if signal is going directly - to + ?

A

Strong upwards deflection

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19
Q

What type of wave is generated if signal is going partially - to + ?

A

Small upwards deflection

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20
Q

What type of wave is generated if signal is going perpendicular - to + ?

A

Biphasing
Positive and negative

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21
Q

What type of wave is generated if signal is going away at an angle - to + ?

A

Small downward deflection

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22
Q

What type of wave is generated if signal is going directly away - to + ?

A

Strong downwards deflection

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23
Q

Anterior/septal leads
What artery is affected?

A

Septum V1+V2
Anterior V3+V4
Left anterior descending artery

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24
Q

Lateral leads
What artery is affected?

A

I
avL
V5
V6

L - lateral
1+5+6=12 L is the 12th letter of the alphabet

Left circumflex or left anterior descending

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25
Inferior leads What artery is affected?
Lead II Lead III avF INF N - 2 vertical lines >> lead II IN - 3 vertical lines >> lead II F >> avF Right coronary artery or left circumflex
26
What is the axis of the ECG?
Top right - to bottom left +
27
What is sinus rhythm?
Regular spacing with same QRS and P waves before
28
What is sinus arrhythmia?
Irregular spacing between QRS with a p wave before QRS
29
Describe atrial fibrillation
Irregular irregular Irregular spacing with no p wave Atria quiver rather than properly contracting
30
Length of a normal PR interval
0.12-0.2 seconds
31
What are the colours of the chest electrodes?
**Ride Your Great Big Brown Pony** Red Yellow Green Brown Black Purple
32
Left side of the heart leads
Lead I avL
33
What is sinus bradycardia?
Sinus rhythm with <60bpm
34
What is sinus tachycardia?
Sinus rhythm with >100bpm
35
How to calculate heart rate from ECG with regular rhythm?
300/no. of large boxes between complexes
36
How to calculate rhythm of ECG with irregular rhythm?
No. of QRS complexes in 10 seconds x 6
37
What are wider QRS waves associated with?
Abnormal ventricular depolarisations
38
What are longer PR intervals indicative of? What length is long?
slow conduction from atria to ventricles **1st degree branch block Ischaemic heart disease Hypokalaemia** >0.2 seconds
39
What are shorter PR intervals indicative of? What length is short?
Wolf-Parkinson-White (delta wave seen) <0.12seconds
40
What factors affect the amplitude of deflection?
- Size + speed of muscle changing potential - Direction of wave activity towards electrode
41
What structures compose the specialised conducting system of the heart?
SAN AVN Bundle of His Right + left bundle branches Purkinje fibres
42
What is avL being the greatest positive lead indicative of?
Left axis deviation
43
What is lead III being the greatest positive lead indicative of?
Right axis deviation
44
How do you confirm left axis deviation?
avL - greatest positive lead Leads II,III + avF - negative
45
How do you confirm right axis deviation?
avF - most positive lead Lead I + avL - negative
46
What is seen in Wolf-Parkinson-White syndrome?
Delta wave Short PR interval
47
What are the characteristics of first degree heart block? Causes
Consistently prolonged PR interval > 5 small squares QRS complex follows Causes - ischaemic heart disease hypokalaemia
48
What is characteristics of Mobitz Type 1 (second degree heart block)?
Progressive lengthening of PR interval 1 QRS wave drops Cycle repeats
49
What is characteristic of Mobitz Type 2 (second degree heart block)??
PR interval normal Sudden non conduction of beat Dropped QRS
50
What causes complete heart block?
- normal atrial depolarisation but impulses not conducted to ventricle - ventricular pacemaker takes over
51
What is characteristic of third degree heart block?
Very slow rate 30-40bpm >> BP can’t be maintained Wide QRS complex No relationship between P wave and QRS complex
52
What is seen in right bundle branch block?
Bunny rabbit ears in V1 QRS prolonged >3 small squares
53
How do you find the 4th intercostal space?
Find the sternal angle - slight dip in between manubrium + body of sternum - this give you the 2nd ICS, count down to the 4th
54
Describe the cardiac conduction pathway and deflections
- depolarisation towards the electrode = upwards deflection (when impulse is travelling down the septum, this gives the upwards part of QRS complex - depolarisation away from the electrode = downwards deflection (impulse travelling up ventricles giving downwards part of QRS complex - repolarisation towards electrode = downward deflection - repolarisation away from electrode = upward deflection
55
how can you look at an ECG orderly to determine if it is normal
1. calculate the heart rate 2. is the rhythm regular or irregular (mark them out with peaks of QRS complex and slide across to match it up if unsure 3. are there P waves - this suggests atrial activity 4. are there QRS complexes - this suggests ventricular activity 5. is each P wave followed by a QRS complex and is each QRS complex preceded by a P wave 6. measure the intervals of PR, QRS and QT
56
Change in ECG following a STEMI
1- normal ECG 2- hyper acute T wave 3- ST elevation 4- deeper Q wave inverted T wave 5- improved ST elevation 6- Q wave persists + T wave normalises
57
What is a STEM?
Full thickness myocardial infarction ST elevation myocardial infarction
58
What is an NSTEMI?
Partial thickness myocardial infarction Non ST elevation myocardial infarction
59
What is seen on the ECG of a NSTEMI?
Depressed ST segment Inverted T wave
60
ECG of atrial flutter
Sawtooth pattern in inferior leads
61
ECG in hypokalaemia
First sign - T wave inversion ST depression Prominent U wave
62
ECG in hyperkalaemia
Peaked T waves P waves flattening PR prolongation Wide QRS complex
63
What features are seen on an ECG with ectopic beats?
**Atrial ectopic** - early abnormally shaped P wave **Atrioventricular junctional ectopic ** - inverted P wave **Ventricular ectopics** - broad QRS complex
64
Causes of heart block
Fibrosis Ischaemia
65
ECG of 2:1 block
For every 2 P waves There is only 1 QRS complex
66
How do you determine if an ECG is in sinus rhythm?
If each P wave is followed by a QRS complex
67
Describe Torsades de Pointes
Polymorphic ventricular tachycardia QRS complex all look different Long QT interval
68
Most common cause of left axis deviation
Defects in conduction system
69
Most common cause of right axis deviation
Right ventricular hypertrophy

CVS (25 decks)

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