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Emergency Medicine > ECG > Flashcards

ECG Flashcards

(60 cards)

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1
Q

What does a +ve and -ve deflection mean?

A

Positive = depolarisation wave moving towards electrode

Negative = away from electrode

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2
Q

What does the P wave represent?

A

Atrial depolarisation

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3
Q

What does the PR interval represent?

A

Beginning of atrial contraction to beginning of ventricular contraction

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4
Q

What does the PR segment represent?

A

AV node delay

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5
Q

What does the QRS wave represent?

A

Ventricular depolarisation

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6
Q

What does the T wave represent?

A

Ventricular repolarisation

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7
Q

What does the QT interval represent?

A

Time taken for ventricular depolarisation + repolarisation

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8
Q

What does the U wave represent?

A

Represents purkinje fibre repolarisation

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9
Q

What is the y + x axis?

A

Y = voltage X = time (1mm = 0.4s)

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10
Q

What are the bipolar leads?

A

I, II, III (Have a positive + negative electrode)

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11
Q

What are the unipolar leads?

A

AVR, AVL, AVF + chest leads

(Have a positive electrode + rely on combination of others to make up negative electrode)

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12
Q

What are the lateral leads?

A

I, AVL, V5, V6

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13
Q

What are the inferior leads?

A

II, III, AVF

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14
Q

What are the septal leads?

A

V1 + V2

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15
Q

What are the anterior leads?

A

V3 + V4

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16
Q

Which leads should have an upright P wave?

A

I, II, AVF

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17
Q

What HR is equal to = 1 block, 2 blocks, 3 blocks, 4 blocks, 5 blocks, 6 blocks?

A

1 = 300bpm

2 = 150 bpm

3 = 100 bpm

4 = 74 bpm

5 = 60 bpm

6 = 50 bpm

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18
Q

What is a normal PR interval?

A

0.12-0.2s

3-5 small boxes

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19
Q

What is a normal QRS interval?

A

<0.12s

(less than 3 small boxes)

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20
Q

How to approach an ECG in an OSCE?

A

Name + DOB

Date + time

1) HR (number of QRS on 10s strip x 6)
2) Rhythm (regular, regularly irregular, irregularly irregular)
3) Cardiac axis
4) P waves - present, normal, followed by QRS?
5) PR interval
6) QRS complex
7) ST segment
8) T waves

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21
Q

How to determine cardiac axis?

A

Lead II should have most positive deflection compared to I + III

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22
Q

What does right axis deviation look like?

A

Lead III most positive Lead I negative

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23
Q

What does left axis deviation look like?

A

Lead I most positive Lead II + III negative

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24
Q

What does a prolonged PR interval show?

A

>0.2s AV block

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25
What does a shortened PR interval show?
P wave originating from closer to AV node Atrial impulse getting to ventricle quickly via accessory pathway (delta wave = WPW)
26
What is a delta wave?
Slurred upstroke of QRS complex
27
Describe the assessment of the QRS complex
Width (narrow \<0.12 or broad \>0.12) Height: Small = \<5mm in limb leads or \<10mm in chest leads Tall = \>5 or \>10 Morphology
28
Describe assessment of ST segment
Should be isoelectric line ST elevation = MI ST depression = ischaemia
29
Describe assessment of T wave
Tall = \>5mm in limb + \>10mm in chest Inverted = normal in V1 but abnormal in other leads
30
What do tall T waves indicate?
Hyperkalaemia Hyperacute STEMI
31
What do inverted T waves indicate?
Ischaemia Bundle branch block (V4-6 in LBBB + V1-3 in RBBB) PE
32
What does a biphasic T wave indicate?
Hypokalaemia Ischaemia
33
What does a flattened T wave indicate?
Ischaemia Electrolyte imbalance
34
Difference between AV blocks
1st = fixed prolonged PR interval (\>0.2s) 2nd type 1 = PR interval steadily increasing until dropped QRS 2nd type 2 = PR interval fixed but with occasional dropped beats 3rd = P waves + QRS totally unrelated
35
What does a broad QRS complex indicate?
Abnormal depolarisation sequence eg ventricular ectopic or bundle branch block
36
What does a LBBB look like?
Broad QRS \>0.12 Secondary R waves in V1-V3 Slurred S waves in lateral leads (I, AVL, V5-6)
37
What does a RBBB look like?
Broad QRS \>0.12 Dominant S wave in V1 Absence of Q aves + broad R waves in lateral leads
38
What does atrial enlargement look like?
Biphasic p waves in lead V1 Amplitude of P waves
39
What does right ventricular hypertrophy look like?
V1 = huge S V5 + 6 = Huge R
40
What does left ventricular hypertrophy look like?
V1 = big R V5 = big S
41
What does subendocardial ischaemia look like on ECG + what is its name, and what leads are affected?
Stable angina ST depression Often affecting leads I, II, V4, V5 + V6
42
What does subendocardial infarction look like + what is the name of it, and what leads are affected?
Unstable angina/ NSTEMI ST depressions T wave inversion Most noticeable in chest leads - must be contiguous (leads next to each other)
43
What does transmural ischaemia look like + whats its name, and what leads are affected?
Unstable angina/ NSTEMI ST depressions T wave inversion Most noticeable in chest leads - must be contiguous (leads next to each other)
44
What does transmural infarction look like + whats its name?
STEMI T wave inversions Hyperacute T waves ST elevation Pathological Q waves
45
Whats the difference between an NSTEMI + unstable angina?
NSTEMI - heart cells produce troponin + CK-MB
46
What other conditions cause ST elevation?
Coronary artery spasm left ventricular hypertrophy Pericarditis
47
How to locate where the infarction is?
Lead with pathological Q waves
48
What leads show pathological Q waves in septal wall infarcts?
V1 + V2
49
What leads show pathological Q waves in anterior wall infarcts?
V3 + V4
50
What leads show pathological Q waves in anterolateral wall infarcts?
V3, V4, V5, V6 1 AVL
51
Other causes of pathological Q waves
Bundle branch block WPW syndrome
52
How long do ECG changes last for in STEMIs?
ST elevation = days T wave inversion = weeks to months Pathological Q waves = months to years
53
What is the most common cause of left axis deviation?
Defects of conduction system
54
Which coronary artery is most commonly involved in MI?
Left anterior descending
55
If leads V1 + V2 show ST segment changes, what area is affected + what artery is likely blocked?
Septal Left anterior descending
56
If leads V3 + V4 show ST segment changes, what area is affected + what artery is likely blocked?
Anterior Left anterior descending
57
If leads I + AVL show ST segment changes, what area is affected + what artery is likely blocked?
Lateral Left circumflex artery
58
If leads II, III + AVF show ST segment changes, what area is affected + what artery is likely blocked?
Inferior Right coronary artery
59
What does LVH look like on ECG?
Tall S waves + R waves
60
What ECG changes are typical of massive PE?
RBBB S1Q3T3 (deep S wave lead 1, patholgical Q wave + T wave inversion in lead 3) R axis deviation - 1 + 3 are reaching to each other

Emergency Medicine (24 decks)

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