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Cardiology > ECG > Flashcards

ECG Flashcards

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1
Q

Q waves

A

Small septal q waves often seen in 1, aVL, V5-6

Normal variant in III (if not also in contiguous leads)

Pathological:

  • Q wave longer than half a little square or any QS waves in V2-3
  • Q waves one little square wide or deep in two or more contiguous leads
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2
Q

Pathological P waves

A

P mitrale
-P wave wider than 4 little squares

M mitrale
-P wave taller than 2.5 little squares

Inverted P wave
-Ectopic

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3
Q

Sinus rhythym

A

P waves before every QRS

P waves positive in II and aVF

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4
Q

Left ventricular hypertrophy

A

Causes

  • Hypertension
  • AS
  • AR
  • HCM

Criteria:
-S wave depth V1 plus tallest R wave in V5-6 >7 little squares

Strain pattern

  • ST depression and discordant T wave inversion in V5-6
  • ST elevation in V1-3
  • Indicative or underlying CAD or significant LVH
  • Poor prognostic marker (risk of HF and death)

Other features

  • Left axis deviation
  • Widened QRS (unlikely LBBB)
  • Left atrial enlargement
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5
Q

LBBB

A

Causes

  • IHD
  • Anterior MI
  • AS
  • DCM
  • Hyperkalaemia
  • Digoxin toxicity
  • Fibrosis of conducting system

Features

  • Depolarisation occurs last in LV, shifting vector to the left
  • Left axis deviation
  • QTS > 120ms (3 little squares)
  • WilliaM (morrow). Deep S wave or Q/S wave in V1-3. M shaped, notched, tall R waves in V5-6, I and aVL
  • Appropriately discordant T/ST segments. Positive T waves in positive leads can be normal. Negative T waves in negative leads are abnormal.
  • Some ST elevation in negative leads and ST depression in positive leads is normal
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6
Q

RBBB

A

Causes

  • Right ventricular hypertrophy
  • Cor pulmonale
  • PE
  • IHD
  • Rheumatic heart disease
  • Fibrosis of conduction system

Features

  • Depolarisation in RV is late, shifting vetor to the right
  • QRS >120 ms (three little squares)
  • (william) MorroW: RSR’ (R’>r) in V1-3, wide and slurred S wave in 1, aVL, V5-6
  • Appropriate ST discordance in V1-3: ST depression or T wave inversion
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7
Q

QT

  • Normal values
  • Measurement
  • Causes of prolonged and shortned
A

Normal value

  • Men 350-440
  • Women 350-460

Measure QTc

  • Start of Q wave to end of T wave
  • T wave end: where a tangent from steepest past of T wave intersects isoelectric line
  • If QRS >120ms: QT = QT - (QRS - 120)
  • Plug info into Bazett formula

Causes of prolonged QT

  • Medications (look at torsades.org)
  • Congenital long QT syndrome
  • Hypomag/calc/kalaemia
  • Hypothermia
  • Ischaemia
  • Raised ICP

Causes of shortned QT

  • Hypercalcaemia
  • Digoxin toxicity
  • Congenital short QT syndrome
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8
Q

Axis

A

Normal (-30 to 90)
-Positive in I and aVF

Left (90 to -30)

  • Positive in I
  • Negative in aVF
  • Negative in II

Right (90 to 180)

  • Negative in I
  • Positive in aVF

Extreme (180 to -90)

  • Negative in I
  • Negative in aVF
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9
Q

T wave morphology

A

Normal

  • Concordant with QRS
  • Upright in I, II, aVL, aVF, V3-6
  • Down in aVR, V1and sometimes III
  • Amplitude <5 little squares in limb leads and 8-10 little squares in precordial leads

Abnormal

  • Inverted: more than half a little square negative in I, II, aVF, V3-6
  • Flat: less than half a little square in I, II V3-5
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10
Q

Abnormal T waves

A

Peaked

  • Tall, narrow and symmetrical
  • Hyperkalaemia

Hyperacute

  • Broad, asymmetrical
  • Loss of precordial balance is upright V1 T wave large than V6
  • Early MI

Inverted

  • Normal in children, BBB, strain pattern and occasionally in III
  • MI
  • PE
  • HCM/LVH/RVH
  • Raised ICP

Biphasic

  • Hypokalaemia
  • MI (Wellens)

Flattened

  • Ischaemic (if in contiguous leads)
  • Electrolyte derangement
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11
Q

ST elevation causes

A

Pericarditis

Early repolarisation

PE

Hypothermia

HCM/LVH

Brugada

Acute neurological insult

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12
Q

Right ventricular hypertrophy

A

Causes

  • Pulmonary hypertension
  • PE
  • Mitral stenosis
  • CHD
  • Arrythmogenic right ventricular cardiomyopathy

Criteria

  • Right axis deviation
  • Dominant R wave in V1 (bigger than 7 little squares or R:S >1)
  • Dominant S wave in V5 or V6 (bigger than 7 little squares of R:S <1)
  • Changes not due to RBBB

Other features

  • Right atrial enlargment
  • Deep S waves in I, aVL, V5-6
  • Prolonged QRS

Strain pattern
-ST depresssion or T wave inversion in II, III, aVF and V1-4

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13
Q

Sgarbossa criteria

A

Concordant ST elevation of more than one little square in more than one lead

Concordant ST depression of more than one little square in at least two of V1-3

ST elevation more than one little square greater than 25% of preceding S wave

More specific than sensitive for MI

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14
Q

Early repolarisation ST elevation

A 
Often in young men
No reciprocal ST depression 
Widespread ST elevation 
Concave ST segment (smiley face)
Slurred R wave or J point (fish hook)
Large symmetrical T wave, concordant 
ST:T wave height < 0.25 (>0.25 is pericarditis)
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15
Q

ST depression causes

A 
Reciprocal change
LVH
Digoxin 
Low K/Mg
Acute neurological insult
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16
Q

Sinus tachycardia

Study These Flashcards
A

Regularity
-regular

Atrial rate
-100-180

Ventricular rate
-100-180

Origin
-Sinus node

P wave
-precedes every QRS

Adenosine
-gradual slowing

Cardiology (3 decks)

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