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ECG Flashcards

(122 cards)

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1
Q

Look at ECG notes

A

OK

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2
Q

What changes in anterior-septal MI

A

V1-V4

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3
Q

What coronary artery

A

LAD

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4
Q

What changes in inferior MI

A

II, III, aVF

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5
Q

What coronary artery

A

RCA

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6
Q

What changes in anterior-lateral

A

V4-6
I
aVL

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7
Q

What coronary artery

A

LAD or L circumflex

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8
Q

What changes in lateral MI

A

V5-6
I
aVL

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9
Q

What coronary artery

A

L circumflex

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10
Q

What changes in posterior MI

A

Tall R waves V1-V2

ST depression

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11
Q

What artery

A

L circumflex

Can be RCA

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12
Q

What does LAD supply

A

Anterior left ventricle

2/3 of inter ventricular septum

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13
Q

What changes in STEMI

A

ST elevate V1-V4

T wave inversion

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14
Q

What does left circumflex supply

A

Lateral LV

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15
Q

What changes in STEMI

A

I, II
aVL
V5-V6

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16
Q

What does RCA supply

A

R ventricle
Posterior L ventricle
Posterior 1/3 of interventricular septum
AV node so can cause heart block

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17
Q

What do you get cause of supply to AV node if RCA infarction

A

Can get heart block

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18
Q

What changes in STEMI

A

ST elevation in II, III, aVF

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19
Q

What changes in posterior infarction

A

Tall R waves V1-V3
Recipricol changes so ST depression V1,V2,V3
Often pain more in the back

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20
Q

What do you do if ST depression not settling with GTN or troponin

A

Think posterior MI

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21
Q

What does a defibrillator do

A

Depolarises all cells into refractory period

Able to achieve AP

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22
Q

How does hypokalaemia present on ECG

A 
U wave 
Small or absent T wave
Prolonged PR
ST depression 
Long QT
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23
Q

How does hyperkalaemia present

A 
Talll T wave
PR disappears
Broad QRS
AV block
Sinus Brady or slow AF
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24
Q

Hypothermia on ECG

A 
Bradycardia
1st degree block 
Long QT, QRS, PR 
J wave
VT / VF / asystole
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25
How does hypercalcaemia present
Short QT
26
What is a bifasicular block
RBBB with left anterior or posterior semi block | e.g. RBBB with LAD
27
What is a trifasicular block
Same as above but 1st degree block
28
How do you report an ECG
``` RATE RHYTHM - sinus ? Conduction interval Cardiac axis - normal or deviated Morphology - QRS / ST segment / T wave ```
29
If dizzy turn what do you do
ECG to look for arrhythmia | Holter monitor
30
What criteria for a MI
``` Tall T wave = hyper acute change (lasts only minutes) ST elevation T wave inversion in 1st 24 hours Q wave persist forever New LBBB Posterior - ST Depression Evolving changes ```
31
What does ST elevation need to be
>0.2mv in 2 continuous leads
32
What do you do if T wave inversion
Look at previous ECG to see if evolving or past | If myocardium stays inflamed or oedematous then T wave inversion may persist
33
What does persistent ST elevation post MI suggest
Ventricular aneurysm | Pericarditis
34
What leads look at L lateral side of heart
I, II, aVL
35
What leads look at inferior
III, aVF
36
What lead looks at RA
aVR
37
What causes a +Ve blip
Depolarisation towards +Ve electrode
38
What do horizontal leads look at
Horizontal plane instead of frontal
39
What is progression
V1 = -ve blip as away V6 = +ve as towards Flips over at V3/V4 R wave grows as you go from V1-V6
40
What happens if RVH e.g. COPD
Transition moves towards V6
41
What does V1 and V2 look at
Right ventricle
42
What does V3 and V4 look at
Septum
43
What does V5 and V6 look at
Anterior and lateral wall of the left ventricle
44
Why does progression happen
Electrical from L ventricle outweighs R | Changes in RVH
45
What does P wave show
Atrial depolarisation Usually by SA node R+L at same time so one wave Can get biphasic wave in pathology
46
What is the QRS complex
Ventricle depolarisation
47
How does ventricle depolarise
Down bundle of His which depolarises septum | Purkinke fibres do R+L side of heart in parallel
48
Q wave
1st deflection of heart below baseline | Serum depolarises from L-R away from +VE so -ve blip
49
What is QS
If all waves downward and n R wave
50
What is R
Any upward deflection regardless of whether Q wave before | Big wave of depolarisation
51
What is S
Any deflection below baseline following R wave | Upper part of septum depolarises away
52
What is T wave
Ventricular depolarisation
53
Why is it +Ve
Opposite way to +Ve electrode but depolarisation
54
What is abnormal with R wave
If opposite way to QRS as usually follows its direction | If QRS +Ve and T wave -ve then pathological
55
What is a U wave
If follows normal T wave then assume normal | If T wave flattened could be pathological
56
Why can't you see atrial repolarisation
At same time as ventricular depolarisation
57
How do you interpret interval
Choose lead that shows best after checked all leads
58
What is PR interval
Time for atrial depolarisation to ventricular depolarisation due to transmission through AV node
59
How long should it be
No more than 1 large box Should be 3-5 0.1-0.2s
60
What is QRS
Time for ventricle to depolarise | Shows how well Bundle of His and Purkinje fibres are conducting
61
How long should it be
No more than 3 little boxes (0.08s)
62
What is QT
Time spent in ventricular depolarisation | Varies with HR
63
What is it at 60BPM
0.42s
64
What can prolong
Drugs Electrolyte Can go into VT
65
What is important with ST
Vertical movement
66
What does elevation suggest
Infraction
67
What does depression suggest
Ischaemia
68
Where do you look from
J point
69
What do you get from rhythm strip
``` Speed of ECG - 25mm/s 1 small = 40ms 5 small (1 large) = 0.2s Calibration - 0.5mv Regularity Rate ```
70
Where do you get rhythm from
Lead which shows P wave most clearly - usually II
71
How do you work out if regular or irregular
Mark out R-R then check same distance
72
If there is an AV block what does this mean
Mark atrial and ventricular rate separately as will be different
73
How do you get rate if regular
No of bars between 2 QRS and divide into 300
74
How do you get rate if irregular
Count R waves in 30 large squares (6S) | X10
75
How do you read an ECG
``` Name, date, calibration, speed Rate Rhythm Cardiac Axis P wave PR interval / ST / QT QRS T wave U wave Specific changes ```
76
What should you look for
Regional changes
77
What leads to look at cardiac axis
I,II,III
78
What should cardiac axis be
Lead II = most +Ve if normal
79
What happens in RAD
III most +Ve | I most -ve
80
What happens in LAD
1 most +Ve | 2+3 -ve
81
What is important with P wave
Duration - tachy / fibrillation Amplitude - raised in cor pulmonale Is it follows by QRS
82
What causes prolonged PR interval
``` AV delay IHD Digoxin Hypokalaemia Rheumatic fever Lyme's Sarcoid Myotonic dystrophy ```
83
What causes a shortened PR interval
Atrial impulse getting to ventricle by shorter faster circuit Accessory pathway e.g. in WPW
84
What else can you get with WPW
Delta wave - slurred upstroke to QRS
85
What causes broad QRS
Abnormal depolarisation / conduction Ectopics Bundle branch blocks
86
What height should QRS be
<5mm in limb | <10mm in chest
87
What causes tall QRS
Ventricular hypertrophy
88
What does presence of delta wave suggest
Sign that ventricles were activated earlier and not from AV node Spreads across myocardium causing a slurred uptake
89
How should R wave progress
Small in V1 to large in V6 | Poor progression suggests MI
90
What is a pathological Q wave
>2mm or 0.04ms
91
Where is the J wave
Where S joins ST | Can be elevated toking like STEMI but just high take off
92
How do you differentiate between J wave and MI
Multiple terrotiroy T will also be raised Do not change or evolve
93
What is important to think of with the intervals
Do they change | Is it one off or is there a pattern
94
What classifies as ST elevation
>1mm (1 small square) in limb | >2mm in chest
95
What causes ST elevation
``` MI Pericarditis Cardiomyopathy ANeurysm SAH = rare but can ```
96
What causes ST depression
Ischaemia Digoxin Hypokalaemia
97
What is a tall T wave and what causes
>5mm in limb or >10 in chest Hyperkalaemia STEMI
98
What causes inverted T wave
``` Ischaemia PE HCM / arrhythmogenic SAH Brugada Digoxin Illness ```
99
When is inverted T normal
V1 and III and aVR
100
What causes biphasic
Ischaemic | Hypokalaemia
101
What causes flattened
Ischaemia | Electroylte
102
What causes U wave
Electrolyte | Anti-arrhythmia
103
What is the cardiac axis
Heart depolarises from 11-5 Creates +ve deflection as depolarise towards I,II and III with lead ii most +ve aVR = -ve
104
What causes R axis deviation
``` R ventricular hypertrophy Pulmonary conditions Cor-pulmonale PE Lateral MI WPW if L sided accessory pathway ```
105
What happens in R axis
``` Depolarisation distorted to the R Depolarise now 1-7 Lead 1 = -ve Lead 3 = more +Ve aVF and III more +VE ```
106
What causes L axis deviation
``` Usually conduction defect LBBB Inferior MI WPW if R sided pathway Hyperkalaemia ```
107
What happens in L axis
Lead 1 = most +Ve Lead 3 = -ve Only significant if lead 2 -ve as well
108
What is 1st degree heart block
PR interval increasing
109
What is 2nd degree Mobitz Type 1
Prolonged PR until drop in QRS then returns | Can occur in healthy young people with high vagal tone
110
When do you worry about type 1
If during exercise or cause syncope
111
What is type 2
PR prolonged but content drop in QRS | Ratio of 2:1 or 3:1
112
If syncope + type 2
Admit Pacemaker High mortality
113
What is complete heart block
No relationship between atrial and ventricular activity
114
What is AV dissociation
Atrial and ventricular rate different Must work out rate separately using P and R wave If atria faster = heart block If ventricular faster = VT
115
Where do you look for BBB
V1 and V6
116
What does a new onset LBBB suggest
``` Pathology MI Aortic stenosis IHD Hypertension Cardiomyopathy Digoxin / hyperkalaemia rare ```
117
What are signs of LBBB
Broad QRS William (W in V1 and M in V6) Slurred / broad R wave
118
What are signs of RBBB
Broad QRS Marrow (M in V1 and W in B6) Wide slurred S wave
119
What causes RBBB
``` Normal variant RVH Cor pulmonale PE MI Cardiomyopathy Myocarditis ```
120
Why can't you see P wave in III
Doesn't pick up depolarisation in lead III
121
What occurs in AF
P wave absent as no atrial depolarisation from AV node | QRS with wobbly baseline
122
What does VT look like
Broad mountains

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