ECG

Question 1

Normal magnitude

Answer 1

10mm/mV

Question 2

Normal speed

Answer 2

25mm/s

Question 3

Calculate rate

Answer 3

Count QRS, x 6

Question 4

Determining SR

Answer 4

-Each p wave followed by QRS
- Each QRS preceeded by p
- QRS regular
- PRi consistent

Question 5

Normal PR

Answer 5

120ms-200ms

Question 6

PR <120ms

Answer 6

Wolf Parkinson White - can cause re-entry tachycardias
A/w delta waves

Question 7

PR >200ms (5 small sq)

Answer 7

1st degree heart block

Question 8

QRS follows some, but not all, Pw

Answer 8

2nd degree heart block

Question 9

Types of 2nd degree heart block

Answer 9

Mobitz Type 1 - gradual increase in PRi, finally missed QRS

Mobitz Type 2 - fixed PRi, regular droppings of QRS in a set ratio, e.g. 2:1 block

Question 10

Which type of 2nd deg HB more likely requires pacing?

Answer 10

Mobitz Type 2

Question 11

Pw and QRSc in no way linked

Answer 11

3rd deg HB, urgent pacing required

Question 12

Best leads to determine axis

Answer 12

Lead 1 and aVF

Question 13

Causes of L. axis deviation

Answer 13

LBBB
LVH
Old inf.MI
Pacing
LAFB
WPWs

Question 14

Causes of R. axis deviation

Answer 14

RVH
PE
COPD
Old lat.MI
LPFB
NA channel blocker toxicity (e.g TCA OD)
WPWs

Question 15

Causes of negative L1 & aVF

Answer 15

Hyperkalaemia
VT
Limb lead misplacement

Question 16

Pw represents

Answer 16

atrial contraction

Question 17

New onset AF can indicate

Answer 17

Sepsis
Thyrotoxicosis
Electrolyte abnormalities

Question 18

Q waves are abnormal in

Answer 18

V1-3
Any other lead where Qw is large

Question 19

Qw are normal in

Answer 19

III and aVR
Leads other than V1-3 as long as small

Question 20

QRS duration

Answer 20

<120ms (3ssq)

Question 21

Causes of wide QRS

Answer 21

Bundle branch block
Artificial pacing
Ventricular pacing

Question 22

LBBB findings

Answer 22

RSR shape in V6 (‘M’)
Deep broad S in V1
LAD
STe in anterior leads

Question 23

RBBB findings

Answer 23

RSR in V1
Wide, slurred S in V6
Axis likely normal
TWi V1-3

Question 24

Inferior leads

Answer 24

II, III, aVF

Question 25

Anterior leads

Answer 25

V1-V4

Question 26

Septal leas

Answer 26

V1, V2

Question 27

Lateral leads

Answer 27

I, aVL, V5, V6

Question 28

Differences in STe: STEMI vs pericarditis

Answer 28

STEMI - Curving upward STE PeriC- Curving downward STE

Question 29

Possible presentation of posterior STEMI

Answer 29

Reciprocal change in anterior leads - STE changes only seen if add posterior leads

Question 30

Causes of STDep

Answer 30

Digoxin Hypokalaemia

Question 31

Early signs in STEMI

Answer 31

Tw hyperacute - large and broad ST depression

Question 32

K+ abnormalities

Answer 32

Hypo - flattened Tw Hyper - tall tented Tw, can cause VFib, flat Pw, widening QRS

Question 33

QTc measured from...

Answer 33

ms from first downward deflection of Qw ro very end of Tw

Question 34

QTc changes with HR

Answer 34

Shortens in tachy, lengthens in brady

Question 35

Causes of prolonged QTc

Answer 35

Hypokalaemia Hypocalcaemia Hypomagnesaemia Antipsychotics - lurasidone is best! Cloz, olanz, arip, risp and sulp all ok Antidepressants - citalopram, SNRI and TCA all bad Psychotropics - lithium, methadone Antiarrhythmics - flecainide, amiodarone, sotalol Antibiotics - erythromycin, clari, cipro Antimalarials - chloroquine