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STP 1st year exams > ECG > Flashcards

ECG Flashcards

(65 cards)

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1
Q

Causes of non-ischaemic sudden cardiac death:

A

Hypertrophic cardiomyopathy

Arrythmogenic RV cardiomyopathy

Brugarda syndrome

Long QT syndrome

Short QT syndrome

Early repolarisation syndrome

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2
Q

What is hypertrophic cardiomyopathy?

A

Condition where heart muscle becomes thickened

Caused by mutations in genes encoding sarcomeric proteins = myocardial disarray

Increased risk of VT/VF

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3
Q

Hypertrophic cardiomyopathy ECG features:

A

LVH + strain pattern

Deep, narrow (“dagger-like”) Q waves in lateral and inferior leads

Apical HCM = Gaint T wave inversion (asymmetrical)

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4
Q

What is arrhythmogenic right ventricular cardiomyopathy?

A

Mutations that cause desmosomal abnormality = causes fibrofatty replacement of RV muscle

(can also include LV muscle)

can trip into VT/VF

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5
Q

Arrhythmogenic right ventricular cardiomyopathy ECG features:

A

RBBB

Inverted T waves V1-3

Slurred S waves or epsilon waves V1-V3

Inferior/lateral T wave inversion = shows LV involvement

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6
Q

What is Brugada syndrome?

A

Sodium ion channel abnormality in RV epicardium

SCD due to fast polymorphic VT during rest/sleep

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7
Q

Brugada syndrome ECG features:

A

Type 1 = Coved ST elevation with T wave inversion V1/2

Type 2 = Saddleback ST elevation with positive T wave V1/2

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8
Q

Brugada sign can be hidden:

A

Diagnosis recommends moving V1/2 electrodes up to 2nd and 3rd intercostal spaces

Can also be revealed by…
* Na channel blockers
* Fever
* Beta blockers
* Tricyclic antidepressants
* Alcohol toxicity
* Cocaine toxicity

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9
Q

Ajmaline challenge:

A

Used to check for Brugada syndrome

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10
Q

What is long QT syndrome?

A

Inherited ion channel abnormality

Prolonged or delayed ventricular repolarisation

Increased risk of lethal ventricular arrhythmias

Females ≥460ms

Males ≥450ms

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11
Q

QTc (ms) =

A

QT (ms) divided by square root of RR (s)

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12
Q

Triggers for cardiac events in Long QT type 1

A

vigorous exercise - swimming/diving

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13
Q

Triggers for cardiac events in Long QT type 2

A

Auditory stimuli – alarm clock, phone, door bell, ambulance siren, door slam – esp on waking Emotional stress, anger

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14
Q

Triggers for cardiac events in Long QT type 3

A

Sleep or rest without arousal

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15
Q

What is short QT syndrome?

A

<340ms QT interval

Inherited

May cause AF, ventricular arrhythmias, SCD

Other causes of short QT: digoxin toxicity, hypercalcaemia

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16
Q

What is early repolarisation syndrome?

A

early repolarisation is usually benign - occasionally a marker for sudden cardiac death

ST elevation + J waves

J wave = slurred or notched

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17
Q

Causes of Left Ventricular Hypertrophy…

A

Hypertension

Aortic stenosis

Coarctation of the aorta

Cardiomyopathies

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18
Q

LVH ECG:

A

S wave in V1 + R wave in V5 or V6 >3.5mV

R wave in aVL ≥ 1.1mV

T wave inversion and ST depression in I, aVL, V5 and V6

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19
Q

Voltage for LVH may be present in the absence of LVH if:

A

Thin build

Young patient

No ST changes will be seen

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20
Q

Causes of Right Ventricular Hypertrophy …

A

Chronic obstructive pulmonary disease

diopathic pulmonary hypertension

Pulmonary stenosis

Complex congenital heart disease

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21
Q

RVH ECG:

A

R wave in V1 + S wave in V5 or V6 ≥1.1mV (11mm)

Dominant R wave in V1

S wave in V6

Right axis deviation

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22
Q

Left atrial abnormality (enlargement) causes…

A

Any disease of the LV which impairs function

LVH

Cardiomyopathy

Mitral valve disease

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23
Q

Left atrial abnormality (enlargement) ECG:

A

P mitrale (broad P)

Lead II = Wide, notched (bifid) P waves (≥3mm)

V1 = Negative component of P wave has a width and depth of 1 mm or more (and is bigger than the initial positive deflection)

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24
Q

Right atrial abnormality (enlargement) ECG:

A

P Pulmonale (tall peaked P)

Lead II = P wave height ≥ 2.5 mm

V1 = Tall upright initial P wave deflection
≥1.5mm

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25
Right atrial abnormality (enlargement) causes...
Pulmonary hypertension RVH Cardiomyopathy Tricuspid stenosis or regurgitation Congenital heart disease (e.g. Ebstein's anomaly)
26
What is dilated cardiomyopathy?
All chambers dilated Poor LV function Can lead to HF Multiple causes: familial, viral, alcoholic
27
Dilated cardiomyopathy
No specific ECG findings although ECG is usually very abnormal LBBB common Combination of LBBB & RAD ST / T wave changes common AF and VPBs common LA abnormality (enlargement) Combination of low voltage QRS in limb leads & high voltage QRS in chest leads
28
What is restrictive cardiomyopathy?
Eg cardiac amyloidosis (Thick heart walls but not LVH) * Rare * Several forms * Infiltrative process * Usually systemic: multi-organ * Initially LV diastolic dysfunction
29
Restrictive Cardiomyopathy: Amyloidosis ECG features
Low voltage of all waveforms, particularly limb leads ≥ 5 mm Marked LAD QS waves in V1-3 (simulating anteroseptal MI) Prolonged AV conduction time T wave inversion
30
Atrial Septal Defect ECG
RBBB pattern rsR’ in V1 + RAD = secundum ASD rsR’ in V1 + LAD = primum ASD Can have Crochetage sign (notch at peak of R wave in inferior leads)
31
Subarachnoid haemorrhage ECG
Widespread deep T wave inversion Can mimic ACS ecg
32
Stroke ECG
widespread T wave inversion long QTc
33
Muscular dystrophy
Deep lateral Q waves Dominant R in V1 Conduction abnormalities/ventricular arrhythmias are common
34
What is Friedreich’s Ataxia?
an autosomal-recessive genetic disease that causes difficulty walking, a loss of coordination in the arms and legs, and impaired speech that worsens over time patients can develop hypertrophic cardiomyopathy
35
Friedreich’s Ataxia ECG
ST depression and T wave inversion common
36
Dextrocardia
Heart is in the right side of the chest and points to the right negative P, QRS and T waves in lead I QRS negative & gets smaller from V1 to V6 Normal R wave progression with right-sided chest leads
37
There are only 2 possible causes of a negative P wave and a negative QRS in lead I...
Dextrocardia Transposal of right and left arm connections QRS progression in chest leads is normal with transposed arm connections
38
Potential massive Pulmonary Embolism ECG characteristics:
S1, Q3, T3 = large S wave in I, large Q wave in III, T wave inversion in III Sinus tachycardia T wave inversion in right chest leads Right axis deviation Transient RBBB ST elevation in V1
39
Acute Pericarditis ECG
Inflammation of the pericardium 1st Stage  Widespread concave upwards ST elevation (due to epicardial injury)  PR segment depression 2nd Stage  ST segment elevation resolves  Widespread T wave inversion develops After several weeks, ECG is usually normal
40
If significant pericardial effusion develops, ECG will show...
Low voltage waveforms Electrical alternans (alternate beats vary dramatically in size or axis as the heart swings in the pericardial fluid)
41
Non-ischaemic chest pain ECGs:
Pulmonary embolism: * S1Q3T3 pattern * T wave inversion V1-V3 * Sinus tachycardia Pericarditis: * Concave upwards ST↑ * ST ↑ < 5mm * ST↑ widespread * No pathological q waves
42
Myocarditis ECG findings:
No ECG abnormality specific for myocarditis Most common finding in acute myocarditis is diffuse T wave changes (particularly inverted T waves) ST elevation, ventricular arrhythmias and heart block may be found
43
Myocarditis:
May mimic acute MI clinically and electrocardiographically MRI shows myocardial inflammation Myocarditis and pericarditis often co-exist
44
unipolar pacing =
big spikes
45
Long QT syndrome types:
1 = run (exercise) 2 = boo (stimulant) 3 = zzz (sleep)
46
bipolar pacing =
small spikes
47
hypokalaemia =
T wave inversion + ST depression U wave
48
hyperkaleamia =
T wave peaked9 P wave flat PR interval prolonged wide QRS complex
49
Pulmonary embolism =
DVT migrates to lungs S1 Q3 T3 tachycardia Right ventricular strain pattern (T wave inversion anterior + inferior leads) RAD RAE (P pulmonale) RBBB
50
LVH =
LAD Deep S waves in V1 Tall R waves in V5/6 R wave in lead V5/6 + S wave in V1 = >35mm R wave in lead all >11mm Any R wave >25mm Strain pattern
51
Causes of LVH
Hypertension aortic stenosis mitral regurgitation coarctation of the aorta HCM
52
RVH =
RAD Dominant R wave in V1 Dominant S wave in V5/6 Right ventricular strain pattern - T wave inversion/ST depression in anterior and inferior leads
53
Causes of RAD
RVH RV strain (pulmonary embolism) COPD Dextrocardia
54
Causes of LAD
LVH LBBB ASD
55
Chest leads swapped
abnormal R wave progression
56
V5/6 too medial
S waves
57
Swapping the black lead with another
flat lines
58
V4-V6 too low
4th should be in 5th intercostal space and 5/6 should be horizontal if too low there will be low R wave amplitude
59
V1/2 too high
V1 looks like aVR V2 looks like aVL RSR negative P waves
60
hypothyroidism =
Brady T wave inversion low voltages
61
hyperthyroidism =
tachy AF common RBBB/LAFB (RBBB +LAD)
62
left anterior fascicle block
LAD with no other cause S wave in V6 no LBBB no Q waves
63
left posterior fascicular block
RAD with no other cause
64
broad QRS tachycardia =
VT unless proven otherwise
65

STP 1st year exams (4 decks)

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