ECG

Question 1

What is sinus bradycardia ?

Answer 1

<60BPM

Question 2

What is sinus tachycardia?

Answer 2

> 100BPM

Question 3

What part of ECG shows atrial depolarisation?

Answer 3

P wave

Question 4

What part of the ECG shows ventricle depolarisation?

Answer 4

QRS compelx

Question 5

What are the four limb ECG and where are they on the body?

Answer 5

Red (AVR) on the right arm
Yellow (AVL) on the left arm
Green (AVF) on the right leg
Black is neutral on right leg

Question 6

What creates lead 1?

Answer 6

AVR to AVL

Question 7

What creates lead 2?

Answer 7

AVR to AVF

Question 8

What creates lead 3?

Answer 8

aVL to AVF

Question 9

What are the chest electrode placement positions?

Answer 9

1 – 4th Intercostal Space, Rt. Sternal Edge.

V2 – 4th Intercostal Space, Lt. Sternal Edge.

V3 – Midway between V2 & V4.

V4 - 5th Intercostal Space, Mid Clavicular.

V5 – Midway between V4 & V6.

V6 – 5th Intercostal space, Mid Axillary.

Question 10

What are leads 2,3 and AVF looking at?

Answer 10

Inferior view of the heart

Question 11

What are V1 and V2 looking at?

Answer 11

Septal view of the heart

Anterior

Question 12

What are V3 and V4 looking at?

Answer 12

anterior wall

Question 13

What are lead 1 and AVL looking at?

Answer 13

Superior lateral view of the heart

Question 14

What are V5 and V6 looking at?

Answer 14

Inferior lateral view of the heart

Question 15

What do you initially comment on when looking at ECG?

Answer 15

Patient name and DOB
Date of ECG and indication
Quality of ECG and if its 12 lead
Scale

Question 16

What is the system that should be used when looking ECG?

Answer 16

Rate ?
Rhythm ?
P wave ?
PR interval ? (AV conduction time).
QRS Complex interval ?
QT interval ? (Ventricular contraction time).

Question 17

What does one small box horizontally represent?

Answer 17

0.04s

Question 18

What does one large box horizontally represent?

Answer 18

0.20s

Question 19

What does one large box vertically represent?

Answer 19

0.5mv

Question 20

When looking at rhythm strip what are you trying to identify?

Answer 20

Clear P wave
QRS regular or irregular
Is the QRS narrow or broad

Question 21

What is the normal length of a P wave?

Answer 21

0.11s just less than 3 small squares

Question 22

What does absent P wave indicate?

Answer 22

AF or nodal rhythm

Question 23

What is the PR interval?

Answer 23

P wave to start of QRS complex

Question 24

What is normal size of PR interval?

Answer 24

0.12-0.2

3-5 small squares

Question 25

What does a short PR interval indicate?

Answer 25

Wolff Parkinson syndrome --> abnormal fast heart rate or it can be normal

Question 26

What does long Pr interval indicate?

Answer 26

AV block -->1st 2nd or 3rd degree

Question 27

What is normal ORS size?

Answer 27

3 small squares | 0.12s

Question 28

What does ST depression indicate?

Answer 28

NStemi | Ischaemia

Question 29

What does ST elevation indicate?

Answer 29

Stemi | Infarction

Question 30

What does a peaked T wave indicate?

Answer 30

Hyperkalaemia or normal for young man

Question 31

What does a inverted/biphasic T wave indicate?

Answer 31

Previous infarct/ ischaemia Hypokalaemia Bundle branch block Wolf Parkinson White syndrome

Question 32

What does a small T wave indicate?

Answer 32

Hypokalaemia

Question 33

What are the characteristics of atrial fibrillation ECG?

Answer 33

Irregular Baseline. Unable to distinguish P waves. Irregular and narrow QRS complexes. Normal T Waves.

Question 34

What are the characteristics of atrial flutter in a ECG?

Answer 34

Difficult to distinguish P and T waves. Narrow QRS. No flat baseline between P waves. Giving a saw toothed appearance

Question 35

What are the characteristics of ventricle fibrillation in a ECG?

Answer 35

No P Waves. A rhythm of ventricular origin with rapid, bizarre and wide QRS ( ventricle when wide QRS) No identifiable T wave

Question 36

Can you see the P wave and QRS complex in ventricular fibrillation?

Answer 36

No

Question 37

What are the characteristics of asytole?

Answer 37

Rhythm - Flat absence of all ventricular activity. Rate - 0 Beats per minute. P Wave – None. No QRS Complexes

Question 38

What is a pulseless electrical activity?

Answer 38

``` Ventricular Activity. Still electrical activity but pump not working IE. QRS complexes. No Major Circulation. PATIENT HAS NO PULSE. Non shockable but correctable Normal Sinus Rhythm – Pulseless. ```

Question 39

What are the 4 H's and 4 T's reversible causes of cardiac arrest?

Answer 39

Hypovolemia Hypoxia Hyper/hypokalemia Hypothermia ``` Tablets/toxins cocaine overdose Cardiac Tamponade Thrombosis Trauma Tension pneumothorax ```

Question 40

What is the treatment for PEA?

Answer 40

Adrenaline and CPR | Not shockable

Question 41

Is asystole shockable?

Answer 41

Yes

Question 42

What is the PR interval a indication of?

Answer 42

It represents the time taken for electrical activity to move between the atria and ventricles. Atrial contraction time

Question 43

What is the QT interval a indication of?

Answer 43

Ventricle contraction time | It represents the time taken for the ventricles to depolarise and then repolarise.

Question 44

In normal cardic axis what is the most positive and negative?

Answer 44

Lead 2 most positive | AvR most negative

Question 45

what causes right axis deviation?

Answer 45

Right ventricle hypertrophy | Great electrical current from the right side of the heart

Question 46

What affect does right axis deviation have on the ECG?

Answer 46

Lead 1 negative and AVL negative | Lead 3 and AvF more positive

Question 47

In who can right axis deviation on a ECG be normal?

Answer 47

Very tall patients

Question 48

What is the cause of left axis deviation?

Answer 48

Conduction defect

Question 49

What is the ECG change of left axis deviation?

Answer 49

Lead 3 negative and AvF negative | Lead 1 and AvL are positive

Question 50

When is Left axis deviation significant?

Answer 50

When lead 2 is also negative

Question 51

What does a increase PR interval indicate?

Answer 51

Heart block

Question 52

What can a reduce PR interaval indicate?

Answer 52

Wolf parkinson white syndrome

Question 53

What would a QRS shorter than 0.12 seconds (3 small squares) indicate?

Answer 53

The complex is supraventricular in origion

Question 54

What would a QRS greater than 0.12 seconds (3 small squares) indicate?

Answer 54

The complex is ventricle in origin

Question 55

What is the structure of the QRS in ventricle tachycardia and what does this indicate?

Answer 55

Regular Bizarre wide QRS which indicate origin in ventricle

Question 56

What is the cause of ventricular tachycardia?

Answer 56

Direct damage to the myocardium secondary to MI or cardiomyopathy

Question 57

What is the treatment for ventricular tachycardia?

Answer 57

Pace maker or defibrillator | Stable patient= give 300 mg Iv of amiodarone in first hour then 900mg IV/24hrs

Question 58

What is the immediate treatment of VF (cardiac arrest)

Answer 58

Defibrillation

Question 59

What is the rate rhythm and character of VF?

Answer 59

``` Rate = >300 Rhythm= irregular Character = No P, QRS complex ```

Question 60

What do you need to do immediately for patient who is asystole?

Answer 60

CPR

Question 61

Are AvL and AVf facing each other or away each other in left axis deviation?

Answer 61

Facing away from other

Question 62

Are AvL and AVf facing each other or away each other in right axis deviation?

Answer 62

Facing towards each other

Question 63

Describe the Pr interval in 1st degree heart block

Answer 63

fixed prolonged PR interval (>200 ms)

Question 64

Describe second degree heart block type 1?

Answer 64

If the PR interval slowly increases then there is a dropped QRS complex

Question 65

Describe second degree heart block type 2?

Answer 65

If the PR interval is fixed but there are dropped beats, t

Question 66

Describe third degree heart block?

Answer 66

If the P waves and QRS complexes are completely unrelated