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NW Studies > ECG Basics > Flashcards

ECG Basics Flashcards

1
Q

Name 4 common cardiac presentations, for which ECGs are useful

A

Chest Pain (Acute Coronary Syndrome)Dyspnea / Heart FailurePalpitationsSyncope

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2
Q

Name 4 systemic pathologies, for which ECGs may be abnormal

A

SepsisPEIntracranial PathologyElectrolyte Disturbance

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3
Q

The 12 lead ECG consists of [two groups of leads]. [How many] leads are in each group? On which plane are they?

A

Praecordial/Chest leads x 6 - Horizontal (V1-6)Limb Leads x 6 - vertical (I, II, III, aVR, aVL, aVF)

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4
Q

Additional Lead Placements[2; think about for what]

A

Right Ventricular Leads: V4R-V6R (RV Infarct)Posterior Leads: V7-9 (Posterior Ischemia)

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5
Q

Location of SA Node

A

RA, near SVC entrance

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6
Q

Location of AV Node

A

RA, near Atrial Septum (and septal cusp of Tricuspid Valve)

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7
Q

Where do you find a U wave?

A

After the T wave

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8
Q

How to calculate rate[2 methods]

A

A) # QRS Complexes on 10sec Strip, multiply by 6B) 300/(#Large squares between QRS complexes)

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9
Q

Define quickly:Sinus TachycardiaSinus Arrhythmia

A

S.Tachy: p waves 1:1 with QRS, but high rateS. Arrhyth: p waves 1:1 with QRS, but irregular rate

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10
Q

Atrial EctopicsDefine [one liner]ECG [3 features]

A

Premature Atrial ComplexEarly + narrow + followed by compensatory pause(Note: followed by flat line / no QRS; then another p wave comes along causing QRS)

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11
Q

Ventricular EctopicsDefine [one liner]ECG [2 features]

A

Premature Ventricular ComplexEarly + Broad QRS

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12
Q

AFDefining feature [1]RhythmNeed to… [in terms of reporting, 2 subpoints]

A

Absence of P wavesRhythm: irregularly irregularComment on Ventricular Response Rate:>100 = Rapid Vent Response RateK 100 = Normal Vent Response Rate

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13
Q

Atrial FlutterDefining Feature [1]Underlying cause [simple explanation]Rhythm

A

“Saw Tooth” AppearanceDue to large re-entrant pathway in atriumregular 300bpm (note: atrial beats / p waves - unlike AF, p waves exist and hence their rhythm matters; p waves are the saw tooths; QRS could be normal?)

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14
Q

2 Types of Tachycardias

A

Narrow Complex Tachy (QRS K120ms / 3 small squares)Broad Complex Tachy (QRS >120ms / 3 small squares)

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15
Q

Paced Rhythm ECG[2 ECG Signs]

A

Atrial Pacing SpikeVentricular Pacing Spike

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16
Q

AxisTell apart via ECGA) Normal AxisB) Left Axis DeviationC) Right Axis Deviation[Leads and pattern]

A

A)^ Lead 1^ Lead 2 /aVFB) “Ladies Adore Diamonds”^ Lead 1v Lead 2/aVFC) “Rovers Adore Digging”v Lead 1^ Lead 2/aVF

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17
Q

Left Axis Deviation - Causes[5; plus one NOT]

A

Left Anterior HemiblockIHDCardiomyopathyHypertensionWPW - R) sided accessory pathway(Note: LV Hypertrophy is NOT a cause)

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18
Q

Right Axis Deviation - Causes[4]

A

Normal: Child or Tall-ThinRV P/V Overload (PE, RV Hypertrophy, Lung Pathology)DextrocardiaWPW - L) sided accessory pathway

19
Q

Extreme Right Axis Deviation - Causes[5]

A

Lead TranspositionVTEmphysemaHyperkalemiaPaced Rhythm

20
Q

P Wave Abnormalities [2 types; name, abnormality this is due, and explain ECG pattern]

A

A) P Pulmonale: RA Dilation - increased/higher P waveB) P Mitrale: LA Dilation - late LA depolarization, causing 2 peaks in p wave (“bifid p wave”)

21
Q

Left Ventricular Hypertrophy- Voltage Criteria[Complicated way of detecting it on ECG]

A

Sum of S in V1 or V2ANDR in V5 or V6should be bigger than 7 Large Squares (35mm)(*whichever one is larger)

22
Q

Q Waves[Normal1; Pathological 3 defining/identifying features]

A

Normal: Q Wave in Lead III (note other?)Pathological- marker of electrical silence which implies: established full thickness death of myocardium i.e. scar- >25% height of the corresponding R wave (or >40msec width, >2mm in depth)- present in MORE than 1 contiguous/adjacent lead

23
Q

Bundle Branch Block- Defining Feature- Mnemonic distinguishing Left vs. Right

A

QRS Complex Duration >120ms (3 small sqaures)WiLLiaM MaRRoW(note: from Q to S!; plus zacken on top do help)

24
Q

LBBB[2 from mnemonic; 2 other features]

A

V1: W (often not obvious)V6: MV5-6, I, aVL: Inverted T wavesNo septal Q waves(Note: if fat + negative in V1 = LBBB)

25
Q

RBBB[2 from mnemonic; 2 other features]

A

V1: M (rSR’ pattern)V6: W + Slurred S waveV2-3: Inverted T Waves(Note: if fat + positive in V1 = RBBB)

26
Q

ST Segment Change indicates …[4 Possibilities - for 2, give further description]

A
  • Myocardial Infarct/Ischemia- Pericarditis (widespread ST segment elevation)- LV Hypertrophy with “strain” pattern (ST segment depression)- Drugs (e.g. Digoxin)
27
Q

Note Heart 3 Main Arteries (Note)

A

Right Coronary ArteryLeft Anterior DescendingCircumflex Artery (Posterior)(from Left Coronary Artery: LAD + Left Circumflex)

28
Q

12 Lead ECG Localizationa) High Lateralb) Inferiorc) Anteroseptald) Lateral

A

a) I + aVLb) II + III + aVFc) V1-4d) V5-6

29
Q

Key Sign of Acute MI

A

ST Elevation

30
Q

Signs of Previous MI [2 ECG]

A
  • Q waves from full thickness infarction- T wave inversion often persists long term
31
Q

ST Elevation vs. Depression [location]

A

STEMI can be localized to a territory (anteroseptal vs. inferior) - unlike ST depression

32
Q

What could Anteroseptal Q Waves suggest?

A

a) May be late presentation of full thickness infarct (anteroseptal STEMI)b) May be old infarction with scar formation

33
Q

Pericarditis[ECG changes, 2]

A
  • Widespread ST Elevation- Saddle-shaped
34
Q

Digoxin Effect[3 ECG features; for one indicate which leads]

A

Atrial Fibrillation - irregular, no p waves”Reverse Tick” ST DepressionT Wave inversion in lateral leads

35
Q

ST Segment DepressionWhat else might you see in the depressed ST Segment, and what would that mean?

A

a) Upsloping ST Depression (note: sort of like a tick; not as bad?)b) Worse if: horizontal or downsloping ST Depression

36
Q

LV Hypertrophy with “strain” pattern [2; indicate which 4 leads]

A

Increased QRS Voltages[V5-6 + I, aVL] Strain Pattern: ST depression with T wave inversion in lateral leads

37
Q

T Wave - normally inverted in…

A

V1, III, aVR(sometime V2

38
Q

T wave abnormality - causes

A
  • Myocardial Ischemia- LV hypertrophy/strain, digoxin- Systemic Issues - electrolytes e.g. (K, Mg, Ca)
39
Q

T Wave - how might it appear in myocardial Ischemia

A

BiphasicorInverted

40
Q

Hypokalemia in ECG [2]

A

Flattening of T WavesPresence of U Waves(Note: difficult to distinguish those two)

41
Q

Hyperkalemia in ECG [2]

A

Tall + Peaked T wavesWidening of QRS(note P waves look like tall tents)

42
Q

WPW Syndrome [Cause, Effect, Consequence]

A

Cause: Accessory pathway that bypasses AV NodeEffect: leads to earlier excitation (pre-excitation)Consequence: may lead to rapid regular tachycardias

43
Q

WPW Syndrome - ECG

A
  • Short PR Interval- Delta Wave: reflects pre-excitation (early excitation) of the Ventricle(Note Delta: a bump that attaches in front of the QRS complex, making the QRS complex more of a ‘2-stairs’ shape)

NW Studies (3 decks)

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