ECG

Question 1

What are the chest leads?

Answer 1

V1-V6

Question 2

What are the limb leads? Which ones are bipolar?

Answer 2

I, II, III, aVR, aVL, aVF

I, II and III are bipolar

Question 3

Inferior leads?

Answer 3

II, III, aVF

Question 4

Anterior leads?

Answer 4

V1-V4

Question 5

Lateral leads?

Answer 5

V5, V6, I, aVL

Question 6

Where are the limb leads and chest leads and rhythm strip on the reading?

Answer 6

Limb leads on the left, chest leads on the right, rhythm strip on the bottom.

Question 7

Which is the rhythm strip if there isn’t actually a rhythm strip?

Answer 7

II and V1

Question 8

What does P wave correspond to?

Answer 8

Atrial depolarisation/contraction

Question 9

What is the PR interval?

Answer 9

Distance between P wave and QRS complex

Question 10

What does QRS complex correspond to?

Answer 10

Ventricular contraction (QRS complex hides atrial relaxation

Question 11

What does T wave correspond to?

Answer 11

Ventricular relaxation

Question 12

What is the QT interval?

Answer 12

Distance between Q wave and T wave

Question 13

First things you do when interpreting ECG?

Answer 13

Patient name, DoB and symptoms.
ECG date and time.
Check calibration: paper speed (25mm/s), 1mV calibration (at start of trace) - 2 large squares in height.

Question 14

How do you work out rate?

Answer 14

Number of small sqaures in one R-R interval - divide this into 300.

Question 15

Rate if RR interval = 3 squares?

Answer 15

100bpm

Question 16

Rate if RR interval = 4 squares?

Answer 16

75bpm

Question 17

Rate if RR interval = 5 squares?

Answer 17

60bpm

Question 18

How to work out rhythm?

Answer 18

Mark 4 R peaks on piece of paper and move along trace to confirm consistency.

Question 19

What are you looking for to confirm sinus rhythm?

Answer 19

Regular normal P waves before each QRS complex

Question 20

No clear P waves and irregular QRS = ?

Answer 20

AF

Question 21

Leads for axis?

Answer 21

I and II

Question 22

QRS complexes in I and II are both predominantly…?

Answer 22

Positive

Question 23

If I and II R waves point away from each other?

Answer 23

LAD (Legs apart)

Question 24

If I and II R waves point towards each other?

Answer 24

RAD

Question 25

Cause of left axis deviation?

Answer 25

Heart conduction defects

Question 26

Cause of right axis deviation?

Answer 26

RVH

Question 27

What are looking for in P waves?

Answer 27

Are P waves present? Do they occur regularly? Does a P wave precede each QRS complex? Do the P waves look normal? (Smooth, rounded and upright?)

Question 28

What should the height of the P wave be?

Question 29

What do bifid P waves indicate?

Answer 29

P Mitrale - left atrial hypertrophy (mitral stenosis)

Question 30

What does peaked P waves indicate?

Answer 30

P Pulmonale (right atrial hypertrophy)

Question 31

How long should the PR interval be?

Answer 31

3-5 small squares (0.12-0.2 seconds)

Question 32

What does a prolonged PR interval indicate?

Answer 32

Heart block

Question 33

What does a reduced PR interval indicate?

Answer 33

Accessory conduction pathway (Wolff-Parkinson-White Syndrome)

Question 34

Where should you look when looking at the QRS complex?

Answer 34

Rhythm strip

Question 35

Width of QRS complex?

Answer 35

3 small sqaures (0.12 seconds)

Question 36

If QRS complex longer than 0.12 seconds...?

Answer 36

Complex originated in the ventricles

Question 37

If QRS complex shorter than 0.12 seconds...?

Answer 37

The complex is supra-ventricular in origin

Question 38

Where do you look for bundle branch block?

Answer 38

V1 and V6

Question 39

QRS in V1 has M pattern and QRS in V6 has W pattern...?

Answer 39

RBBB (MaRRoW)

Question 40

QRS in V1 has W pattern and QRS in V6 has M pattern?

Answer 40

LBBB (WiLLiaM)

Question 41

Where do you look for R wave progression?

Answer 41

Chest leads (V1-V6)

Question 42

What is R wave progression?

Answer 42

QRS complexes should progress from mostly negative in V1 to mostly positive in V6

Question 43

Where should you check the ST segment?

Answer 43

All leads

Question 44

What constitutes significant elevation or depression?

Answer 44

>1 small square

Question 45

Main cause of ST elevation?

Answer 45

MI

Question 46

Main cause of ST depression?

Answer 46

Ischaemia

Question 47

Where should you check the T waves?

Answer 47

All leads

Question 48

Where is T wave inversion normal?

Answer 48

aVR, V1 (right leads)

Question 49

What does T wave inversion indicate?

Answer 49

Ischaemia/Post-MI

Question 50

What do tented T waves indicate?

Answer 50

Hyperkalaemia

Question 51

What do flat T waves indicate?

Answer 51

Hypokalaemia

Question 52

Typical pattern in PE?

Answer 52

an S1Q3T3 pattern - a prominent S wave in lead I, a Q wave and inverted T wave in lead III SINUS TACHY