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Internal Medicine > ECG > Flashcards

ECG Flashcards

(42 cards)

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1
Q

Normal ECG paper output speed?

A

25 mm per second = 5 large squares = 25 small squares

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2
Q

ECG: 1 small square?

A

1 mm = 0.04 seconds

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3
Q

ECG: 1 large square?

A

5 small squares = 5 mm = 0.2 seconds

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4
Q

ECG: 1mV amplitude?

A

10 mm = 10 small blocks

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5
Q

How calculate rate on ECG

A

Number of R waves on rhythm strip (bottom) x 6

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6
Q

7 step approach to ECG rhythm analysis?

A

Rate Rhythm I Am pqrst

  1. Rate
  2. rhythm: relationship between P waves and QRS - P before every QRS, AV association/ disassociation., Pr interval
  3. Ischaemia /infarction? St, t wave changes.
  4. Axis
  5. P waves present / absent!!
  6. Pattern of QRS complexes: regular/irregular , QRS morphology: narrow/ wide, qt interval
  7. Individual qrst: q waves present? Poor r wave progression v1-v6?
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7
Q

Interpretation of Narrow complex QRS on ECG? (3)

A

Origin is:

  • sinus
  • atrial
  • junctional
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8
Q

Interpretation of wide complex QRS on ECG? (2)

A

Origin is :

  • ventricular or
  • supraventricular with aberrant conduction
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9
Q

Differential diagnosis narrow complex tachycardia? (11)

A

= supraventricular origin

Atrial + regular rhythm

  • sinus tachycardia
  • atrial tachycardia
  • atrial flutter
  • inappropriate sinus tachycardia
  • sinus node re-entrant tachycardia

Atrial + irregular

  • Afib
  • atrial flutter with variable block
  • multi focal atrial tachycardia

Atrioventricular

  • AV re-entry tachycardia (AVRT)
  • AV nodal re-entry tachycardia (AVNRT)
  • automatic junctional tachycardia
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10
Q

Differential diagnosis broad complex tachycardia (BCT)? (8)

A

Regular rhythm BCT

  • Vtach (all VT until proven otherwise)!
  • antidromic AV re-entry tachycardia (AVRT)
  • any regular supraventricular tachycardia with aberrant conduction eg due to BBB, rate related aberrancy

Irregular

  • Vfib
  • polymorphic VT
  • torsades de pointes
  • AF with Wolff Parkinson White syndrome
  • any irregular supraventricular tachy with aberrant conduction
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11
Q

Differential bradycardia with P wave present and every P followed by a QRS (3)

A

= sinus node dysfunction

  • sinus bradycardia
  • sinus node exit block
  • sinus pause/arrest
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12
Q

Differential bradycardia with P wave present and every P not followed by a QRS (2)

A

= AV node dysfunction

  • AV block second degree
  • AV block third degree (complete heart block)
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13
Q

Differential bradycardia with P wave absent (2)

A

Narrow complex = junctional escape rhythm

Broad complex = ventricular escape rhythm

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14
Q

Normal cardiac axis on ECG

A

QRS axis between -30 and +90 (down and slightly left)

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15
Q

Define left axis deviation

A

QRS axis less than -30
(Less than -90 to 180 = extreme axis deviation)

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16
Q

Define right axis deviation

A

QRS axis more than +90
(More than 180 to -90 = extreme axis deviation)

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17
Q

How estimate cardiac axis on ECG (4)

Study These Flashcards
A

Normal axis = 0 - 90 = lead 1 positive (R>S) and lead aVF positive

Left axis deviation = 0 - -90 = lead 1 positive and lead aVF negative (S>R)

Right axis deviation = 90 - 180 = lead 1 negative and aVF positive

Extreme axis deviation = -90 - 180 = lead 1 negative and aVF negative

18
Q

ECG rule of 4s?

Study These Flashcards
A
  • 4 initial features: history , rate, rhythm, axis
  • 4 waves: P wave, QRS complex, T waves, U waves
  • 4 intervals: PR interval, QRS width, ST segment , QT interval
19
Q

Which leads should be mirror images on ECG?

Study These Flashcards
A

aVL and aVR (limb leads)

20
Q

Normal PR interval?

Study These Flashcards
A

3-5 small blocks = 0.12 - 0.2 seconds

21
Q

Cause prolonged/lengthening PR interval?

22
Q

Cause shortened PR interval? (2)

Study These Flashcards
A
  • WPW syndrome
  • junctional rhythm
23
Q

Normal QRS width?

Study These Flashcards
A

Less than 3 small squares = 0.12 sec

24
Q

Widened QRS meaning?

Study These Flashcards
A

Conduction defect

25
Name 6 types different STEMI patterns on ECG
- septal (V1 V2) - anterior (V3-4) - lateral (I + aVL, V5-V6) - inferior (II,III, aVF) - right ventricular (V1, V4R) - posterior (V7-9) SALI RP
26
Normal P wave duration
Less than 3 blocks (0.12s) = atrial depolarization
27
Define sinus P wave (4)
Morphology = monophasic in lead 2, biphasic in V1 Axis = upright in leads 1 and 2, inverted in aVR Duration = less than 3 blocks (0.12 sec) Amplitude = less than 2.5 mm (0.25mV) in limb leads; less than 1.5 (0.15) in precordial leads
28
How does right atrial enlargement appear on ECG?
Lead 2: Tall P wave > 2.5 mm Width unchanged (<120 ms) Lead V1: Increase height > 1.5 mm in the initial positive portion of the biphasic P wave P pulmonale ( peaked P)
29
How does left atrial enlargement appear on ECG?
Lead 2: Long duration > 120 ms (3 blocks) Height unchanged May have P mitrale (notch) Lead V1: Wide > 40ms and deep > 1mm in the terminal negative portion of the biphasic P wave
30
Cause P wave inversion?
Ectopic atrial and junctional rhythms
31
Name 6 ECG changes in hyperkalaemia
- peaked T waves (early sign - 5.5-6.5) - p wave widening/flattening, PR prolongation (K 6.5-7) - bradyarrythmias: sinus bradycardia, high grade AV block with slow junctional and ventricular escape rhythms, slow AF (7-9) - conduction blocks: BBB, fascicular blocks (late) - QRS widening with bizarre QRS morphology - severe >9: sine wave appearance (pre-terminal rhythm), Vfib, PEA (pulse less electrical activity) with bizarre wide complex rhythm, asystole
32
Name 6 ECG features of hypokalaemia
- increased P wave amplitude - prolonged PR interval - widespread ST depression and T wave flattening/inversion - prominent U waves (best seen V2 V3) - apparent long QT intervals due to fusion T and U waves (actually long QU interval) Severe <2.4: frequent supraventricular and ventricular ectopics , supraventricular tachyarrythmias, potential V arrhythmias
33
Define a pathological Q wave
- >40 ms (1mm) wide - > 2 mm deep - > 25% depth of the QRS complex - seen in leads V1-3 (should be absent in these)
34
What does pathological Q wave indicate
Current or prior MI
35
ECG features left ventricular hypertrophy?
Tall and thin complexes! - R wave in V6 > 25 mm (5 big blocks) or - S wave in v1 + r wave in V6 > 35 mm
36
ECG features left BBB?
Wide QRs! > 0,12s (3 small blocks) Also: - m pattern of QRs in v5 - no septal q waves - inverted T waves lead 1, avL, V5 - V6
37
Name 4 causes lbbb
- IHD - Ht - cardiomyopathy - idiopathic fibrosis
38
ECG finding pulmonary embolism? (4)
- Sinus tachycardia - Rbbb - R ventricular strain: inverted T in v1 to V4 - classical S1 Q3 T3 pattern = rare (deep S wave in lead 1, Q in lead 2, t ware inversion lead 3)
39
ECG findings first degree heart block?
Prolonged Pr interval
40
ECG findings second degree heart block?
Dropped beats - P wave not followed by QRs Mobitz 1: Pr interval lengthens with each beat until dropped beat Mobitz 2: Pr intervals lengthened consistently until beat drop
41
ECG findings third degree heart block?
No correlation P and QRs
42
ECG features unstable angina? (3)
- May or may not have St segment depression - transient St elevation - new t wave inversion

Internal Medicine (20 decks)

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