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6. Cardiovascular System > ECG Basics > Flashcards

ECG Basics Flashcards

1
Q

ECG: what is the J point?

A

Where the QRS complex becomes the ST segment.

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2
Q

ECG: what is the normal axis of the QRS complex?

A

-30° -> +90°

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3
Q

ECG: what does the P wave represent?

A

Atrial depolarisation.

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4
Q

ECG: how long should the PR interval be?

A

120 - 200ms.

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5
Q

ECG: what might a long PR interval indicate?

A

Heart block.

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6
Q

ECG: how long should the QT interval be?

A

0.35 - 0.45s.

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7
Q

ECG: what does the QRS complex represent?

A

Ventricular depolarisation.

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8
Q

ECG: what does the T wave represent?

A

Ventricular repolarisation.

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9
Q

ECG: where would you place lead 1?

A

From the right arm to the left arm with the positive electrode being at the left arm. At 0°.

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10
Q

ECG: where would you place lead 2?

A

From the right arm to the left leg with the positive electrode being at the left leg. At 60°.

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11
Q

ECG: where would you place lead 3?

A

From the left arm to the left leg with the positive electrode being at the left leg. At 120°.

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12
Q

ECG: where would you place lead avF?

A

From halfway between the left arm and right arm to the left leg with the positive electrode being at the left leg. At 90°.

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13
Q

ECG: where would you place lead avL?

A

From halfway between the right arm and left leg to the left arm with the positive electrode being at the left arm. At -30°.

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14
Q

ECG: where would you place lead avR?

A

From halfway between the left arm and left leg to the right arm with the positive electrode being at the right arm. At -150°.

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15
Q

Leads I, II and aVF are from what part of the heart?
Therefore, what artery is affected?

A

Inferior
Right coronary

(can remember this as aVf has an F like inFerior)

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16
Q

Leads V3 and V4 are from which part of the heart?
Therefore, which artery is affected?

A

Anterior.
LAD.

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17
Q

Leads V1 and V2 are from which part of the heart?

A

Septum

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18
Q

Leads I, V5, V6 and aVL are from which part of the heart?
Which artery is therefore implicated?

A

Lateral.
Left circumflex.

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19
Q

What is the dominant pacemaker of the heart?

A

The SA node. 60-100 beats/min.

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20
Q

How many seconds do the following represent on ECG paper?

a) small squares.
b) large squares.

A

a) 0.04s.

b) 0.2s.

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21
Q

How long should the QRS complex be?

A

Less than 110 ms.

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22
Q

In which leads would you expect the QRS complex to be upright in?

A

Leads 1 and 2.

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23
Q

In which lead are all waves negative?

A

aVR.

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24
Q

In which leads must the R wave grow?

A

From chest leads V1 to V4.

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25
Q

In which leads must the S wave grow?

A

From chest leads V1 to V3. It must also disappear in V6.

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26
Q

In which leads should T waves and P waves be upright?

A

Leads 1, 2, V2 -> V6.

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27
Q

What might tall pointed P waves on an ECG suggest?

A

Right atrial enlargement.

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28
Q

What might notched, ‘m shaped’ P waves on an ECG suggest?

A

Left atrial enlargement.

29
Q

Give 3 signs of abnormal T waves.

A
  1. Symmetrical.
  2. Tall and peaked.
  3. Biphasic or inverted.
30
Q

What happens to the QT interval when HR increases?

A

The QT interval decreases.

31
Q

What part of the ECG does the plateau phase of the cardiac action potential coincide with?

A

QT interval.

32
Q

What HR is considered sinus tachycardia?

A

>100bpm

33
Q

Name some causes of sinus tachycardia

A

Anxiety, dehydration, recent exercise, sepsis, pneumonia etc etc

34
Q

What lead(s) would you look in to assess sinus bradycardia/tachycardia?

A

any - rhythm strip is best

35
Q

What HR is considered sinus bradycardia?

A

<60bpm

36
Q

List some causes of left axis deviation

A

left anterior hemiblock

WPW syndrome

inferior MI

ventricular tachycardia

LVH

37
Q

What is the most likely cause of right axis deviation? List any alternative causes

A

RVH is most likely

normal variant - tall thin people

lateral MI

WPW syndrome

dextrocardia or R/L arm lead switch

left posterior fascicular block

38
Q

How would you detect left axis deviation?

A

Look for lead I and II “Leaving” each other - small lead I, negative lead II and III

39
Q

What is a more likely cause of left axis deviation, conduction issues or LVH?

A

conduction issues

40
Q

Describe what is seen:

A

Complete heart block.

atrial rate is 60bpm

ventricular rate is 27bpm

slow ventricular escape rhythm

41
Q

Describe what is seen:

A

2:1 heart block

42
Q

Describe what is seen:

A

3:1 heart block

43
Q

Describe what is seen:

A

Mobitz II second degree heart block

Intermittent P waves without progressive lengthening of PR interval

44
Q

Describe what is seen:

A

Mobitz I second degree heart block

aka Weckebach phenomenon

progressive lengthening of PR interval until a QRS fails to conduct (dropped beat)

45
Q

Describe what is seen:

A

First degree heart block

PR >0.2s (5 small squares)

46
Q

Describe what is seen:

A

Right axis deviation

leads I and II reaching towards each other

47
Q

Describe what is seen:

A

Left axis deviation

Leads I and II are leaving each other

48
Q

Describe what is seen:

A

atrial fibrillation

irregularly irregular, absent P waves

49
Q

Describe what is seen:

A

Atrial fibrillation

irregularly irregular

absent P waves

50
Q

Describe what is seen:

A

Atrial flutter

“saw tooth P waves” at c300bpm

51
Q

Describe what is seen:

A

atrial tachycardia

narrow complex tachycardia at 120bpm

each QRS is preceded by an abnormal p wave

52
Q

Describe what is seen:

A

junctional tachycardia

narrow QRS

retrograde P waves before, during or after QRS

53
Q

Describe what is seen:

A

RBBB

broad QRS

M complex in V1-3

W complex in V6 (slurred S waves)

54
Q

Describe what is seen

A

LBBB

broad QRS

dominant S in V1 - W

broad R in lateral leads - M

55
Q

Describe what is seen:

A

ST elevation in I and aVL (high lateral leads)

reciprocal ST depression in III and aVF (inferior leads)

acute MI localised to superior part of lateral wall -

high lateral STEMI

occluded first branch of LAD

56
Q

Describe what is seen

A

ST elevation in inferior (II, III, aVF) leads and lateral (I, V5-V6) leads

ST depression in V1-V3 suggests associated posterior infarction

acute anterolateral STEMI with posterior extension

occlusion of proximal circumflex

57
Q

Describe what is seen:

A

ST elevation in leads II, III and aVF

Q-wave formation in III and aVF

reciprocal ST depression and T wave inversion in aVL

inferior STEMI

circumflex occlusion - ST elevation in lead II = lead III

58
Q

Describe what is seen:

A

marked ST elevation in leads II, III and aVF

reciprocal changes in aVL

inferior STEMI

RCA occlusion as ST elevation in lead III> lead II

59
Q

What does this V2 lead trace suggest?

A

posterior MI

horizontal ST depression

upright T wave

dominant R wave (R/S ratio >1)

60
Q

Describe what is seen:

A

ST elevation is maximal in anteroseptal leads (v1-V4)

Q waves present in septal leads (V1-2)

hyperacute (peaked) T waves in (V2-4)

hyperactute anteroseptal STEMI

61
Q

Describe what is seen:

A

ST elevation in V1-6 + I and aVL

minimal reciprocal depression in III and aVF

anterior STEMI

62
Q

Describe what is seen:

A

ventricular fibrillation

63
Q

Describe what is seen:

A

sinus rhythm

broad QRS with slurred upstroke - delta wave

dominant R wave in V1

Wolff-Parkinson-White

64
Q

Describe what is seen

A

Digoxin effect

“sagging” ST segements

hockey stick T waves

65
Q

Describe what is seen:

A

pericarditis

widespread concave ST elevation and PR depression throughout V2-V6 and I, II, aVL, aVF

reciprocal ST depression and PR elevation in aVR

66
Q

What might ST elevation in leads 2, 3 and aVF suggest?

A

RCA blockage.
These leads show the activity of the inferior aspect of the heart and the RCA supplies the inferior aspect of the heart with blood.

67
Q

Name a disease that might cause tall P waves.

A

Right atrial enlargement.

68
Q

Name a disease that might cause broad notched P waves.

A

Left atrial enlargement.

6. Cardiovascular System (24 decks)

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