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ECG Flashcards

1
Q

Regular Rhythm definition

A

R-R interval same across tracing

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2
Q

Irregular rhythm definition

A

R-R interval varies across tracing

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3
Q

NSR definition

A

p wave before each QRS, QRS follows each P-wave, P-wave axis is normal (+ in 2/3 Leads I, II, AVF), rate is between 60 - 100

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4
Q

Normal Axis

A

-30 - 90 degrees (positive QRS in Lead I, II)

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5
Q

Left Axis Deviation

A

< -30

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6
Q

Right Axis Deviation

A

> 90 degrees

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7
Q

LBBB Complete definition

A

QRS > 120 msec, deep broad S wave in V1, v2, broad notched R wave in V4, V5 and usually I and aVL, secondary ST/T changes (+ST in V1-2, -ST in V4-5, I, AVL)

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8
Q

RBBB Definition

A

QRS > 120 msec, positive QRS in leads V1 (rSR, rsr), broad S wave in I, V5-6, T-wave inversion in V1-2,

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9
Q

Left Anterior Fascicular block

A

left axis deviation, small q and prominent R in leads I, AvL, small r and prominent S in leads II, III, aVF

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10
Q

Left Posterior fascicular block

A

Right axis deviation (110 - 180), small r and prominent S in leads I, aVL, small q and prominent R in leads II, III, aVF

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11
Q

Bifascicular block

A

RBBB + RAD/LAD

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12
Q

LVH DDx

A

left anterior hemiblock, inferior MI, WPW, RV pacing, elevated diaphragm, normal variant, endocardial cushion defect

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13
Q

RVH DDx

A

RVH, L posterior hemiblock, PE, COPD, lateral MI, WPW, dextrocardia, septal defects

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14
Q

LVH Definition

A

S in V1 + R in V5 or V6 is > 35 mm above age 40 (>50 mm for ages 31-40, > 45 mm for ages 21-30), R in aVL > 11 mm, R in I + S in III > 25 mm, LV strain pattern (asymetric ST depression and T wave inversion in leads I, AvL< V4-6

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15
Q

RVH definition

A

RAD, R/S Ratio > 1 or qR in lead V1, RV strain pattern (ST depression and T-wave inversion in leads V1-2)

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16
Q

Progression of ECG Changes in STEMI

A

Acute: (hours - days): ST elevation
Recent: (weeks - months) T wave inversion
Old: (months - years) persistent Q waves

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17
Q

LBBB DDx

A

anterior MI, aortic stenosis, HTN, dilated CM, primary degenerative disease, hyperkalemia, digoxin toxicity

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18
Q

DDx of T-wave inversion

A

normal pediatrics (v1-v3), persistent juvenile T-waves, myocardial ischemia/MI, LBBB, RBBB, LVH and RVH (strain pattern), PE, hypertrophic cardiomyopathy, raised ICP

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19
Q

RBBB DDx

A

RVH/cor pulmonale, PE, ischemic heart disease, rheumatic disease, myocarditis, cardiomyopathy, degenerative disease, congenitla disease (ASD)

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20
Q

Brugada syndrome definition

A

ECG finding + clinical criteria (documented VF or VTach, +FHx of SCD, syncope); MGMT: ICD

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21
Q

Brugada Pathogenesis

A

mutation in cardiac sodium channel gene (sodium channelopathy)

22
Q

RF that can unmask ECG Changes in Brugrada syndrome

A

fever, ischemia, drugs, hypokalemia, hyperkalemia, post DC conversion)

23
Q

Wellens Syndrome definition

A

deeply inverted or biphasic T waves in V2-3, highly specific for a critical stenosis of the LAD; high risk for extensive anterior wall MI within days-weeks

24
Q

Wolf Parkinson White ECG Findings

A

short PR (<120 msec), broad QRS (>100 ms), slurred upstroke to the QRS complex called delta wave

25
J-point and TP Segment
first inflexion point after the QRS where you measure the ST elevation from the TP region: between the end of the T-wave and beginning of next P-wave
26
STEMI Criteria for V8,V9 (posterior leads)
+0.5 mm
27
Vascular supply for the heart (anterior, lateral, posterior)
Anterior: LAD, Lateral: circumflex, Posterior: usually RCA but 10% can be supplied by L circumflex
28
Leads to vessels relationship
I, avL: high lateral leads; I, aVL, V5, V6: Left circumflex, V1-v4: LAD, lI, III, aVF, V4R V8, V9: RCA
29
(3) Types of STEMI equivalents
1. ST elevation in aVR with diffuse ST depressions; 2. Wellen's; 3. DeWinter's T-waves
30
Reasons to get a 15 lead ECG
ST depressions in the anterior leads, ST elevations in inferior leads, hypotension NYD
31
aVR ST Elevation (STEMI equivalent)
Due to left main occlusion, triple vessel disease (LMain, LAD, RCA requiring CABG), or severe diffuse ischemia (shock, hypoxemia, sepsis). Definition: widespread ST depression most prominent in leads I, II, V4-v6 (lateral leads), and ST elevation in aVR of 1+mm and ST elevation in aVR > V1
32
Wellen's Syndrome
T-wave inversions or biphasic T-waves in the anterior leads (V2-v3); sign of transient LAD stenosis; (2) Types - Type A is biphasic, Type B in deeply and symmetrically inverted; usually seen when CP resolves
33
DeWinter's T-Waves
anterior STEMI equivalent, due to LAD occlusion; ST depressions and peaked T waves
34
Inferior STEMI additional MGMT
get 15 lead ECG, determine RV involvement (ST elevation III > II)
35
Inferior-lateral STEMI
due to the L circumflex supplying the inferior wall
36
Posterior MI definition
presents with ST depression and prominent R stroke in V1-V4; always get 15 lead ECG
37
ECG changes with LVH
R waves are large in the lateral leads, S waves in R-sided leads, L heart strain (ST depressions and T-wave inversions in lateral leads)
38
Signs of R Heart Strain
ST depressions and T-wave inversions in right precordial leads (V1-V3) and inferior leads
39
Junctional tachycardia definition
rhythm from the AV node; narrow QRS, rate of 60 - 100, retrograde P -waves, inverted retrograde p-waves in the inferior leads and upright in leads aVR + V1
40
DDx of junctional rhythms
digoxin toxicity, beta-agonists, MI, myocarditis, cardiac surgery
41
ECG changes in hypokalemia
increased amplitude and width of P-wave, prolongation of PR interval, T-wave flattening and inversion, ST depression, apparent long QT due to fusion of T and U waves
42
K+ to see ECG changes in hypokalemia
< 2.7 mmol/L
43
MGMT of hypoklaemia
K > 4.0 and Mg to > 1.0 mmol/L
44
4 Stages of pericarditis on ECG
Stage 1: STE and PR depression with reciprocal changes in aVR (first 2 weeks); Stage 2: normalisation of ST changes, generalized T wave flattening (1 - 3 weeks); Stage 3: T-wave inversions (3 - several weeks), Stage 4: ECG returns to normal
45
Causes of pericarditis
idiopathic, autoimmune, infectious, uremia, dressler's syndrome (post MI), trauma, post cardiac surgery, paraneoplastic syndromes, medications, post-radiation
46
ECG changes in PE
sinus tachy, complete or incomplete RBBB, RV strain, RAD, dominant R wave in V1, R atrial enlargement, S1Q3T3 pattern, nonspecific ST and T changes, AF/flutter,
47
DDX for RV strain
pulmonary HTN, mitral stenosis, PE, COPD, cor pu,onale, congenital heart disease, arrhythmogenic RV cardiomyopathy
48
Signs of RV strain
R precordial leads (V1-3) and inferior leads (II, III AVF): STD and T-wave inversions
49
Sgarbossa criteria purpose
help to identify acute MI with LBBB; concordant STE > 1 mm gets 5 points, discordant STE 5+ mm is 2 points, STD 1mm or more in v1-v3 gets 3 points; no longer in favour as points system, enzyme-diagnosed AMI based criteria, inadequate sensitivity and specificity
50
Smith-modified Sgarbossa Criteria
concordant STE/STD, excessive discordant STE/S > 25% or STD/R > 30% to identify occlusion MI in patients with ischemic symptoms and LBBB

PGY1 (12 decks)

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