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SBM - Pathology > ECG > Flashcards

ECG Flashcards

1
Q

What’re the stages of assessing an ECG?

A
  1. Name and calibration (1 big box wide, 2 big boxes tall)
  2. Rate (ventricular then atrial)
  3. Rhythm - Space between QRS complexes regular? Sinus rhythm? P waves before QRS complexes? Prolonged PR interval? T waves normal? Any Abnormal U waves?
  4. Axis - R-wave progression
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2
Q

What’s the conducting pathway of the heart?

A

SAN / AVN / L. or R bundle branch / Pukinje fibers

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3
Q

What physiological delay happens at the AV node?

A

30ms to from SA to AV node

90ms delay before enting the penetrating portion of the AV bundle

40ms delay in the penetrating bundle

= 160ms delay in the AV network

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4
Q

What is Heart Block?

A

Electrical signal from the atrium to the ventircle is slowed or blocked

1st degree = signal delayed

2nd degree = signal is intermittently blocked

3rd degree = signal is always blocked

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5
Q

1st degree Heart Block

A

PR interval >5 little boxes

Young people

Rarely treated

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6
Q

2nd Degree Heart Block Type 1

A

Some P waves without QRS complex

Increased PR interval

No treatemnt

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7
Q

2nd Degree Heart Block - Type 2

A

PR interval stable

Bundle of His

High risk of 3rd degree block

Implant a pacemaker

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8
Q

Third Degree Heart Block

A

Atrial signals don’t arrive at the ventricles

Ventricles beat at their own pace

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9
Q

Atrial Fibrillation

A

Irregular QRS Complexes

(irratic or not visable P-waves)

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10
Q

Atrial Flutter

A

Sawtooth Appearance

300 BPM

Single re-entrant circuit in the right atrium

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11
Q

What drug can be used for Supraventricular Tachycardiacs

A

Adenosine

Activates specific ligand-gated K+ channels reducing exitability

Administered IV can cause transient HB at the AV node

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12
Q

What does the ECG have to show for the axis to be in the Northwest Territory?

A

Both I and II are negative

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13
Q

What’re some of the casues of Axis Deviation?

A

**Diaphragm pushing upwards **

Hypertrophy of one of the ventricles

Conduction Anomalies (axis moves towards undepolarised tissue)

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14
Q

Causes of Right Axis Deviation?

A

COPD / PE

Child or Tall Thin Person

Right Ventricular Hypertrophy

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15
Q

Causes of Left Axis Deviation?

A

Conduction pathologies

Obese person / pregnant

Artifical Cardiac Pacemaker

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16
Q

What is R-Wave progression?

A

V1 = Small R Wave (QRS complex negative)

V2, V3 = Zone of transition. The QRS is equally positive and negative

V6 = R Wave is dominant (QRS complex is Positive)

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17
Q

What can cause anomalies of R Wave progression?

A

Anterior Myocardial Infarction

LBBB

Wolff-Parkinson White Syndrome

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18
Q

What is Bundle Branch Block?

A

Conduction Pathology

One Bundle branch fails to conduct

That side of the heart is delayed in depolaristion (that side must be stimulated by the other)

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19
Q

What causes broad notched QRS Complexes?

A

Left Bundle Branch Block

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20
Q

What is Ischaemia? What signs are there on the ECG?

A

Relative lack of blood supply to tissues. Although there is no tissue infarct.

Causes ST depression on the ECG

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21
Q

What’re the signs of Acute Injury on an ECG?

A

ST Elevation

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22
Q

What sings would there be on an ECG of infarction?

A

Q-Waves

Potential Inverted T-waves

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23
Q

What’re the signs of Acute Coronary Syndrome on an ECG?

A

**ST elevation **

Receiprocal St depression

**Pathological Q waves **

T wave inversion

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24
Q

What’re pathological Q-waves?

A

Occur in an MI

Pathological Q waves lack R waves

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25
What are normal Q-waves called?
**Septal Q-waves**
26
What **leads** supply the **Septal Region** of the Heart?
**V1 + V2**
27
What **leads** supply to **Anterior Section** of the Heart?
**V3 + V4**
28
What **leads** supply the **inferior region** of the heart?
**aVF + II + III**
29
What **leads** supply the **lateral region** of the heart?
**I + V5 + V6**
30
What **artery** supplies the **anterior** of the heat?
**left anterior descending**
31
What **artery** supplies the **lateral** region of the heart?
**Left Circumflex Artery**
32
What artery supplies the inferior of the heart?
**Right dominant (90%) = Right Coronary Artery** Left dominant is supplied by the Left Circumflex
33
What **artery** supplies the **posterior** region of the heart?
**Posterior Descending Artery**
34
What **artery** supplies the **SA** & **AV** node?
**Right Coronoary Artery**
35
Which region of an MI has a worse prognosis?
**Anterior MI** has a worse outcome than a **Posterior MI**
36
What's the **prognosis** of an **MI** (first and second time)?
**First time** = 1/3 die before discharge **Second time** = \> 50 die before discharge
37
What's the **differential** diagnosis of an **MI**?
**Bengin Early Repolarisation ** ## Footnote (normal varient in the young)
38
Can T waves be depressed?
**No** ## Footnote They can be **_inverted_** or **_negative_**! NOT inverted
39
What can cause **tenting** of **T-waves**?
Hyperkalemia
40
What can cause **U waves**?
Present in **Hypokalaemia**
41
What is a **Broad Complex Tachycardia**?
Wide QRS complexes
42
What's a **Supraventricular Tacycardia**?
**Arrhythmias** that **originate** **above** the **ventricles**
43
What's **Junctional Tacycardia**?
AV node involvement Can occur in junctional pacemakers
44
Describe the image
**Atrial Flutter** with **Carotid Sinus Pressure**
45
What're the **3 scources** of **Arrhythmias**?
1. **Re-Entry** 2. **Enhanced Automaticity** 3. **Triggered Activity**
46
What're the **symptoms** of **Long QT Syndrome**?
**Syncope** & **Sudden Death**
47
What is the **mechainsm** of **Long QT Syndrome**? (i.e what's the also called?)
**Torsades de pointes** A Polymorphic Ventricular Tachyarrhythmia
48
How is **Long** **QT Syndrome treated**?
Pacemaker Beta-blockers Stop drug administration
49
**Torsades De Points** | (Long QT syndrome)
50
How **long** is a **long QT**?
Men \> 440ms Women \> 460 ms
51
What's the **basis** of **Atrial Flutter**?
Re-entery arrhythmia Typically the right atrium
52
What is the basis of Fibrillation?
Abnormal automaticity of tissue in pulmonary veins Re-entrant sources at posterior of left atrium
53
What does **Sinus Rhythm** mean?
Normal heart rhythm Electrical signals start in the SA node P wave is followed by a QRS complex (fixed PR interval - \<5 squares)
54
What is **sinus tachcardia**?
Rate \> 100 BPM
55
What is **Sinus Bradycardia**?
\< 60 BPM
56
What **two ways** can **atrial flutter** occur?
**Fixed degree block** e.g a 3-to-1 block **Variable block** e.g varies
57
Secondary Degree Heart Block Type 1
Gradually increasing PR interval, the most prolonged one is not followed by a QRS complex.
58
Second Degree Heart Block **Type 2**
PR interval is constant (either prolonged or normal) Periodically there is no conduction between the atrium and the ventricle
59
What do **Tall P** and **bifid waves** indicate?
P **P**ulomnale, **P** waves are **P**eaked (_right atrium enlargement_) P **M**itrale, P waves are _Bifid_ and look like the letter **M** (_mitral stenosis_)
60
Can you comment on the ST segment when LBBB is present?
**NO!**
61
What're the two **emergency** **Shockable Rhythms**?
**Ventricular Fibrillation **(trace all over the place) **Ventricular Tachycardia **(regular contractions)
62
What **Rhythms** are **Non-Shockable**?
Pulseless electrical activity Asystole (no identifyable electrical activity) P-wave asytole
63
How can you **determine** if a person has a **pacemaker** or not from an **ECG**?
Pacing spikes are seen If directly to the ventricle, then wide QRS complexes are seen.

SBM - Pathology (3 decks)

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