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OSCE > ECG > Flashcards

ECG Flashcards

1
Q

What does L axis deviation mean from the pathological (simple) point of view?

A

L axis deviation = more electricity goes to the L side of the hear

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2
Q

How does L axis deviation look on ECG?

A

L = leaving (positive in lead I and negative in lead II) = point away from each other

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3
Q

Causes for L axis deviation

A

L axis deviation = increased electricity to L side of the heart

Causes:

  • L ventricular hypertrophy
  • Wolf-Parkinson White syndrome
  • VT
  • LBBB
  • inferior MI
  • L anterior hemiblock
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4
Q

How does R axis deviation look like on ECG?

A

R = returning (lead I is negative and lead II is positive) -> the ways point towards each other

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5
Q

What R axis deviation mean and what are possible causes?

A

R axis deviation = more electricity goes towards R side of the heart

Causes: tall and thin body type, RV hypertrophy (e.g. in PE, pulmonary disease), lateral MI, WOlf-Parkinson White Syndrome)

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6
Q

How high P wave should be?

What does it mean if it is higher than that?

A

P wave should be =/< 2 small squares

If it is higher than that -> R atrial enlargement e.g. in pulmonary hypertension

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7
Q

What are possible pathological appearances of P wave? (morphology)

A
  • bifid
  • peaked
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8
Q

How does bifid P wave looks like?

A

Bifid

looks like ‘m’ = P mitrale (left atrial enlargement - caused by mitral stenosis)

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9
Q

How does ‘peaked’ P wave look like? What is its cause?

A

Peaked = P pulmonare

*classically seen in R atrial enlargement in lung disease

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10
Q

What’s the normal length of PR interval?

A

PR interval should be 3-5 small squares

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11
Q

When PR interval is decreased?

A

PR interval decreased in: accessory conduction pathways (e.g. WPW syndrome)

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12
Q

When PR interval is increased?

A

PR interval increased in AV node block (‘heart block’)

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13
Q

Causes of heart block

A
  • athletes /increased vagal tone
  • electrolyte disturbances
  • Drugs that block AV node: B - blockers, digoxin, CCB
  • conduction system fibrosis
  • Inferior MI
  • autoimmune disease (SLE, systemic sclerosis)
  • inflammatory diseases (myocarditis, RF)
  • infiltrative conditions (amyloidosis, haemochromatosis)
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14
Q
A
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15
Q

Size of normal Q wave

A

Normal Q waves = small Q wave:

  • <1 small square wide
  • <2 small squares deep
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16
Q

What leads normal Q waves can be found in?

A

Normal Q wave (small; <1 sq wide, <2 sq deep)

Found in: I, aVL, and V6 -> due to septal depolarization

17
Q

What do pathological Q waves mean?

A

Established/previous full thickness MI

18
Q

What is a normal R wave progression across ECG?

A

Negative in V1 (dominant S wave) -> mostly positive in V6 (dominant R)

19
Q

What’s transition point?

A

Leads where R and S are equal -> usually V3/V4

20
Q

What’s the clockwise rotation and what’s its cause?

A

Clockwise rotation = transition point after V4

Cause: R ventricular hypertrophy e.g. in chronic pulmonary disease

21
Q

What’s ‘M’ pattern in bundle blocks?

A

RSR’

22
Q

Potential causes of RBBB

A

RBBB:

  • R ventricular hypertrophy
  • cor pulmonare
  • PE
  • atrial-septal defect
  • IHD
  • cardiomyopathy
23
Q

Possible causes for LBBB

A
  • aortic stenosis
  • IHD
  • hypertension
  • anterior MI
  • cardiomyopathy
  • conduction system fibrosis
  • hypercalcaemia
24
Q

Pattern seen on LBBB

A

W illia M

W on V1

M on V6

25
Q

Pattern seen on RBBB

A

M arro W

M - V1

W - V6

26
Q

What is the disgnosis if: RSR’ pattern seen with a normal QRS length?

A

Partial (incomplete) bundle branch block - no clinical significance

(normal QRS length is <3 sq)

27
Q

ST segment elevation:

  • convex or straight
  • concave
  • concave/saddle shaped

Causes

A
  • Convex/ straight -> infraction
  • concave -> early repolarisation, LVH
  • saddle shaped -> pericarditis, tamponade
28
Q

What does ST elevation that is downwards slopping/ ‘reverse tick’ mean?

A

Digoxin toxicity

29
Q

In which leads T inversion is normal?

A

It can be normal in leads: III, aVR and V1 (right leads)

This is due to the angle from which they view the heart

Also, in Afro-Caribbean: V2-3

30
Q

T inversion in leads other than normally seen - causes

A
  • ischaemia/post MI
  • PE
  • RL ventricular hypertrophy
  • bundle branch block
  • digoxin use
31
Q

What does tented T wave mean?

A

hyperkalemia

32
Q

What do flat T waves mean?

A

hypokalaemia

33
Q

Biphasic T wave - cause

A

Biphasic

  • ischaemia (up then down)
  • hypokalaemia (down then up)
34
Q

Regions on ECG

A
35
Q

Corrected QT interval

  • value
  • how to calculate
  • significance
A

<450 ms

  • calculated by ECG machine or by use of online calculator
  • if it is increased -> predisposition to polymorphic VT
36
Q

Causes of prolonged QT inerval

A
  • congenital syndromes
  • antipsychotics
  • sotalol/amiodarone (class III)
  • TCAs
  • macrolides
  • hypokalaemia/hypomagnesaemia/ hypocalcaemia
37
Q

Causes of U waves

A
  • can be normal
  • hypothermia
  • hypokalaemia
  • use of anti-arrhythmia
38
Q

The sequence of ECG interpretation

A
  • Personal details: name, DOB
  • Date
  • Symptoms (e.g. chest pain)
  • calibration
  • Rate and rhythm
  • Axis
  • P wave
  • PR interval
  • QRS complex
  • ST segment
  • T wave
  • Other things: corrected QT interval, U waves
39
Q

Pathological changes on ECG in STEMI (in order)

A

OSCE (13 decks)

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