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4th year > ECG > Flashcards

ECG Flashcards

(107 cards)

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1
Q

In which position should a patient be before taking an ECG

A

semi-recumbant position at a 30-40 degree angle

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2
Q

Where should limb leads be placed

A

On the bony prominences of the wrist and ankle

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3
Q

Where should the chest leads be placed

A 
V1 - 4th ICS RHS
V2 - 4th ICS LHS
V3 - between V2 + 4
V4 - 5th ICS left mid clavicular line
V5 - 5th ICS left anterior axillary line
V6 - 5th ICS left mid axillary line
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4
Q

What could mistakenly be identified if the patient is sitting upright whilst having an ECG

A

ST elevation

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5
Q

How do you calculate the HR if the tracing is regular

A

300 divided by the number of large squares between 2 R waves

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6
Q

How do you calculate the HR if the tracing is irregular

A

count the number of QRS complexes in 30 large squares and times that by 10

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7
Q

What does the P wave represent

A

Atrial depolarisation

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8
Q

What does the PR interval represent

A

AV node conduction

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9
Q

What is the normal PR interval

A

0.12-0.20 seconds

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10
Q

What does the QRS complex represent

A

Ventricular depolarisation

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11
Q

What is the normal QRS complex duration

A

<0.12 seconds

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12
Q

How do you calculate the QTc

A

square root of R-R interval (sec) / QT interval (ms)

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13
Q

what is the R wave

A

the first positive deflection of QRS complex

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14
Q

what does the cardiac axis tell you

A

the overall direction of travel of electrical activity

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15
Q

How do you assess the horizontal cardiac axis

A

look at R wave progression across the CHEST leads

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16
Q

Which leads do you look at to determine vertical cardiac axis

A

leads I and aVF

Look at the most pointy part of the QRS complex

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17
Q

lead I: positive
aVF: positive
What is the cardiac axis?

A

normal

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18
Q

lead I: positive
aVF: negative
What is the cardiac axis?

A

left axis deviation

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19
Q

lead I: negative
aVF: positive
What is the cardiac axis?

A

right axis deviation

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20
Q

Causes of left axis deviation

A 
Left anterior hemiblock 
Expiration 
LBBB
WPW
emphysema
hyperkalaemia
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21
Q

Causes of right axis deviation

A 
Normal 
Inspiration 
Right ventricular hypertrophy 
RBBB 
left posterior hemiblock 
dextrocardia 
Ventricular ectopic 
WPW
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22
Q

What is heart block

A

specific set of conditions related to conduction between the atria and ventricles through the AV node
ie AVN dysfunction

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23
Q

What are the types of heart block

A

First degree
Second degree Mobitz I
Second degree Mobitz II
Third degree

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24
Q

What is first degree heart block

A

Prolonged PR interval (>0.20s)

Fixed and stable rhythm

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25
What is second degree Mobitz type I heart block
PR interval gets progressively longer until it drops a beat | Progressive PR prolongation leads to eventual missed beat
26
What is second degree Mobitz type II heart block
Constant prolonged PR interval but then you drop a beat | Every so often there is no QRS following a P wave
27
Which is more worrying, Mobitz I or II
Mobitz II is always abnormal and needs intervention | may progress into asystole
28
What is third degree heart block
No relationship between atria and ventricles (ie P waves and QRS complexes) QRS complexes are fixed but P waves are random Always abnormal and needs intervention
29
How do you define tachycardia
HR >100bpm
30
You can use regular/irregular to define rhythm, true or false
FALSE | You should say, sinus rhythm, VT, VF, SVT, AF...
31
What is sinus tachycardia
tachycardia in sinus rhythm HR varies with inspiration, expiration and pain Will not be fixed
32
Describe atrial fibrillation
Chaotic atrial activity Irregularly irregular Absent P waves Ragged baseline
33
Irregularly irregular = AF until proven otherwise, true or false
True
34
If there is a noisy baseline in lead II, where can you look for P waves
V1
35
Causes of atrial fibrillation
``` Coronary artery disease mitral stenosis or regurgitation hypertrophic cardiomyopathy pericarditis pneumonia lung cancer PE sarcoidosis Holiday heart syndrome - alcohol Hyperthyroidism CO poisoning Genetics ```
36
Describe atrial flutter
Re-entry circuit involving the whole atrium Regular rhythm usually 300bpm or divisible Sawtooth baseline - F waves
37
If the HR is too fast, what can you give to identify underlying flutter waves in atrial flutter
adenosine to block the AVN
38
Which drug interacts with adenosine to inhibit its breakdown and should therefore be avoided
dipyridamole
39
Describe junctional rhythm
Electrical impulse starts in the AVN instead of the SAN causing the electrical impulse to simultaneously move to the atria and ventricles You see an inverted P wave after the QRS complex
40
Define a narrow complex tachycardia
Originates above the AVN ie within the AVN itself or the atria His-Purkinje system still activates the ventricles giving a narrow QRS complex
41
What are the types of narrow complex rhythms/SVTs
AVNRT AVRT including WPW Atrial tachycardia Supraventricular ectopics
42
What is AVNRT
AV node re-entry tachycardia Occurs within the AVN itself commonest cause of SVT ectopic beat causing a re-entry circuit around the AVN
43
What is AVRT
AV re-entry tachycardia | Conduction happens normally but when they reach the ventricles it finds an accessory pathway and creates another circuit
44
How do you manage SVTs?
vagal manoeuvres: valsalva, carotid massage, head in cold water adenosine
45
What is the function of adenosine
very short acting drug that blocks the AV node temporarily to break the re-entry circuit
46
What is the management of a clinically unstable SVT
defibrillation (stops all cardiac cells)
47
What is WPW syndrome
presence of an accessory pathway causes the ventricles to immediately depolarise instead of having the delaying mechanism of the AVN
48
What is a delta wave caused by and in which condition is it seen
delta wave - pre-excitation of the ventricles | WPW
49
What is a supraventricular ectopic
sinus rhythm but the morphology of the P waves differs
50
define broad complex tachycardias
originates within the ventricular myocytes or SVT with aberrancy
51
Broad complex arrythmias are always abnormal, true or false
true
52
What is a PVC
Premature Ventricular Complex = premature beat arising from an ectopic focus within the ventricles
53
what is bigemy
1 sinus beat with a VPC
54
what is trigemy
1 sinus beat couples with 2 VPCs
55
What are the types of ventricular tachycardia
monomorphic | polymorphic
56
describe monomorphic VT
regular broad complex tachycardia | QRS >0.12s
57
describe polymorphic VT
broad complex tachycardia that looks like its twisted "forth rail bridge" torsades de pointes
58
what is torsades de pointes usually associated with
Long QT interval | hypomagnesaemia
59
describe ventricular fibrillation
irregular random baseline broad complex tachycardia it is BAD
60
what is a capture beat
when a sinus beat conducted through the AVN beats the next VT beat resulting in an early narrow complex beat
61
what is a fusion beat
fusion between a sinus beat and the next VT beat
62
What are the differentials of a broad complex tachycardia
VT | SVT with aberrancy
63
What is the pathology behind a VT
rhythm originates in the ventricles and does not use the His-Purkinje system causing broad complexes Re-entry circuit within the ventricle often involving scarred myocardium
64
How is VT defined
>=3 beats of ventricular origin at >120bpm | sustained VT needs >30s of tachycardia
65
What is idioventricular rhythm
VT less than <100bpm
66
what is accelerated idioventricular rhythm
VT between 100-120bpm
67
What can SVT with pre-existing L/RBBB look like on ECG
broad complex tachycardia
68
Who is more likely to get SVT with aberrancy
younger patients
69
how can you differentiate between SVT with aberrancy or VT
vagal manoeuvres or adenosine
70
what is aberrancy
conduction not over the usual conducting system
71
What are almost always diagnostic of VT
capture and fusion beats
72
What are the shockable rhythms
VF | Pulseless VT
73
What are the non-shockable rhythms
asystole | PEA
74
How do you manage complete AV block
IV atropine and isoprenaline
75
what is PEA
Pulseless electrical activity = cardiac arrest occurring with any rhythm that would usually be associated with a pulse
76
Which parts of an ECG trace are important to look at in the context of ischaemia/infarction
ST segment T waves Q waves
77
which leads are associated with an inferior MI
Leads II, III, aVF
78
which leads are associated with a lateral MI
Leads I, aVL, V5, V6
79
which leads are associated with an anterior MI
Leads V1-4
80
what are ECG markers of ischaemia
tall T waves --> biphasic --> inverted --> flattened | ST depression
81
What are the strict criteria for thrombolysis
ST elevation: - >1mm in 2 contiguous limb leads - >2mm in 2 contiguous chest leads
82
What are Q waves and why are they pathological
Q waves indicate septal depolarisation but are usually masked so when present, something is abnormal suggests myocardial necrosis
83
Criteria for pathological Q waves
any Q waves in leads V1-3 | >= 0.03s in remaining leads
84
D.Dx of ST elevation
``` MI pericarditis LBBB left ventricular hypertrophy coronary vasospasm Brugada syndrome SAH ventricular aneurysm ```
85
What should be considered in patient with NEW LBBB
MI
86
what is a hallmark of BBB
Prolonged QRS
87
in which direction is the septum normally activated
left to right
88
what happens to septal depolarisation in LBBB
it reverses and goes from right to left
89
Causes of LBBB
``` MI aortic stenosis IHD HTN dilated cardiomyopathy hyperkalaemia digoxin toxicity ```
90
What are signs of a posterior MI on ECG
ST depression in leads V1-3
91
What is pericarditis
inflammation of the pericardium secondary to MI or viral infection
92
Symptoms of pericarditis
pleuritic chest pain fever pericardial rub eases upon sitting forward
93
ECG signs of pericarditis
saddle ST elevation changes do NOT evolve widespread changes involving >1 vascular territory PR depression
94
what can the left bundle branch be divided into
left anterior and posterior hemi-bundle
95
what is non-specific interventricular conduction delay
broad QRS that does not display L/RBBB
96
what is BBB
delay in conduction in either one of the bundle branches
97
what happens to the QRS complex in BBB
QRS duration >0.12s (>3 small squares)
98
What does RBBB look like on ECG
QRS >0.12s M shaped complex in V1 (RSR wave) MaRRoW
99
What does LBBB look like on ECG
QRS >0.12s W shaped complex in V1 and M shaped complex in V6 WiLLiam
100
What happens in RBBB
the right ventricle is stimulated by an impulse from the left ventricle
101
What happens in LBBB
the left ventricle is stimulated by the right bundle | damage has occurred to both the left anterior + posterior hemi-bundles
102
what is hemi-block
defect in conduction along one of the 2 hemi-fascicles of the left bundle branch
103
what are the types of hemi block
LAHB | LPHB
104
LAHB causes left/right axis deviation?
left axis deviation
105
LPHB causes left/right axis deviation?
right axis deviation
106
define sinus rhythm
there is a P wave for every QRS complex and a QRS complex for every P wave with a normal PR interval
107
what is sinus arrhythmia
meets all the criteria for sinus rhythm except for the rhythm itself which is irregular caused by physiological changes in respiration

4th year (2 decks)

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