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ECG Theory > ECG Interpretation > Flashcards

ECG Interpretation Flashcards

(73 cards)

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1
Q

What is the Flowchart for interpreting an ECG

A
  1. Right patient?
  2. Rate
  3. Sinus Rhythm?
  4. Cardiac Axis
  5. Assess P waves
  6. P-R Interval
  7. QRS Complex Width
  8. ST-elevation?
  9. T Wave inversion?
  10. Q Waves?
  11. QT Interval
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2
Q

Where is T wave inversion normal

A

In aVR, III, V1 and V2

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3
Q

What does T wave inversion represent

A

Ischemia (24-48 hours), Ventricular Hypertrophy, BBB, Digoxin

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4
Q

What may cause ST elevation

A

MI, Pericarditis

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5
Q

How do you differentiate ST elevation in an MI from Pericarditis

A

localised in MI, in most leads in pericarditis

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6
Q

What causes ST depression

A

Ischemia

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7
Q

What does bundle branch block cause

A

delayed depolarisation of ventricles, causing a wide QRS

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8
Q

Where is RBBB best seen

A

V1

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9
Q

Where is LBBB best seen

A

V6

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10
Q

What does RBBB look like

A

M shape in V1 OR Positive v1 + wide QRS

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11
Q

What does LBBB look like

A

Wide QRS + negative V1 OR M shape in V6/W shape in V1

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12
Q

What does asymptomatic LBBB indicate

A

Aortic Stenosis

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13
Q

What does (new) LBBB + chest pain indicate

A

Acute MI

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14
Q

What is the minimum requirement for ST elevation to be considered significant

A

> 2mm in a chest lead, >1mm in a limb lead, must be at least 2 leads to be significant

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15
Q

What causes Right axis deviation

A

Right ventricular hypertrophy

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16
Q

What most commonly causes left axis deviation

A

Conduction deficits

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17
Q

What does an axis deviation indicate

A

Not much if in isolation, although signs of RVH/LVH/Pulmonary embolus( in RAD)/conduction deficits should be investigated

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18
Q

What indicates right ventricular hypertrophy

A

Tall V1 R wave + Right axis deviation + V5/V6 having equal R + S waves

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19
Q

what indicates left ventricular hypertrophy

A

Tall V6 R wave (+ potentially left axis deviation)

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20
Q

Whats the height rule for R waves in V5/V6 and the s wave in V1

A

Combined height shouldn’t exceed 25mm (otherwise this indicates LVH)

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21
Q

What indicates 1st degree heart block

A

PR interval >220ms

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22
Q

What causes 1st degree heart block

A

Found in athletes commonly, coronary aa disease, acute rheumatic fever, electrolyte disturbance, digoxin toxicity

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23
Q

What are the 3 variations of 2nd degree heart block

A 
Mobitz type 2 
Wenkebache phenomenon (Mobitz type 1) 
2:1/3:1/4:1 conduction
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24
Q

What is Mobitz type 2 heart block

A

constant P-R interval with occasional non conducted p waves

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25
What is Mobitz type 1/Wenkebache heart block
Gradually lengthening P-R interval until a non conducted beat and repeat
26
What is 3rd degree heart block
atrial contraction + ventricle contraction independent of eachother
27
What does 3rd degree heart block indicate
MI/Chronic tissue disease, Pacing required
28
What is sinus bradycardia associated with
athletic training, fainting, hypothermia, hypothyroidism, post MI
29
What is sinus tachycardia associated with
exercise, fear, pain, haemorrhage or thyrotoxicosis
30
Where are the 3 places non-sinus rhythms can originate from
Atrial muscle, Ventricular muscle, AVN
31
What does a non sinus atrial rhythm look like
abnormal p waves
32
What does a non sinus ventricular rhythm look like
wide/abnormal QRS complexes
33
What does a non sinus AVN rhythm look like
no p wave
34
How fast does the AVN depolarise
50 bpm
35
What is the rough speed of an excape rhythm
30bpm
36
How do you manage bradycardia
Treat reversible causes asses for adverse factors (shock, syncope, heart failure, MI, recent asystole, mobitz type 2, type 3 heart block) if non present monitor if some present 500mcg IV atropine (up to 3g) + pacing if necessary
37
What needs to be identified to be able to say an ECG is showing a tachycardic rhythm
P waves
38
Whats the speed of atrial tachycardia
100-200bpm
39
What is the maximum conduction speed of the AV node
200bpm
40
When should Atrial fibrillation be treated
if the rhythm is irregular
41
What should you do if there is atrial fibrillation at a regular rate
attempt vagal manouvers (carotid sinus massage, valsava manover) If unsuccessful Adenosine 6mg (12mg if ineffective, verapimil in asthma) Last resort cardioversion
42
What does ventricular tachycardia look like
wide QRS in all 12 leads
43
Why is ventricular tachycardia dangerous
may progress to ventricular fibrillation
44
When does ventricular tachycardia require cardioversion
<90mmHg systolic Chest pain Heart failure Rate >150
45
If no abnormal features are present how do you treat ventricular tachycardia
amiodarone 300mg | Cardioversion if this fails
46
What does ventricular fibrillation look like on an ECG
No QRS, disorganised
47
What does atrial fibrillation look like on an ECG
Irregular baseline with no p waves , 450-600 bpm, normal QRS
48
if AF is suspected but not seen on an ECG what should be the next line of investigation
24-hour ambulatory ecg monitoring
49
what is the treatment cascade for fibrillation
Symptomatic or haemodynamically unstable = immediate cardioversion Haemodynamically stable = rate/rhythm control (beta blocker or rate limiting Ca2+ inhibitor) + anticoagulation (aspirin if low risk of stroke via CHADVASC, warfarin if medium-high risk, aspirin + clopidogrel if warfari is CI)
50
What does atrial flutter look like
Saw tooth baseline, 300-450bpm , similar to AF but baseline looks regularly irregular as opposed to AF where it looks irregularly irregular
51
What does hyperkalaemia look like on an ECG
tall 'tented' t waves, wide QRS, prolonged PR interbal
52
What does hypokalaemia look like on an ECG
T wave flattening, V wave at the end of T wave | V wave = larger wider t wave
53
What does hypercalcaemia look like on an ECG
QT shortening
54
What does hypocalcaemia look like on an ECG
QT lengthening
55
What is wolf-parkinson-white syndrome + what does it look like on an ecg
There is an additional conducting bundle alongside the bundle of his, unconnected to the AVN, causing spontaneous paroxysmal tachycardia ECG shows a delta wave (lengthening of the proximal part of the QRS complex due to pre-excitation of the accessory bundle)
56
What region/artery is represented in lead 1
Lateral region, supplied by the circumflex artery
57
What region/artery is represented in Lead 2
Inferior region, supplied by the right coronary artery
58
What region/artery is represented in Lead 3
Inferior region, supplied by the right coronary artery
59
What region/artery is represented in aVL
Lateral (no artery)
60
What region/artery is represented in aVF
Inferior region, supplied by the right coronary artery
61
What region/artery is represented in V1
Septal region, supplied by the left anterior descending artery
62
What region/artery is represented in V2
Septal region, supplied by the left anterior descending artery
63
What region/artery is represented in V3
Anterior region, supplied by the left anterior descending artery
64
What region/artery is represented in V4
Anterior region, supplied by the left anterior descending artery
65
What region/artery is represented in V5
Lateral region, supplied by the circumflex artery
66
What region/artery is represented in V6
Lateral region, supplied by the circumflex artery
67
What do p waves look like in right atrial hypertrophy
peaked
68
What do p waves look like in left atrial hypertrophy
notched and broad
69
what do deep Q waves indicate
previous infarction
70
where are deep Q waves normal
Leads I, aVL, V5 + V6
71
What is a normal QT interval
<0.45 seconds
72
What is the minimum for a wide QRS
>120ms
73
How big and how much time does a small square on the ECG paper represent
1mm, 0.04 seconds (40ms)

ECG Theory (1 decks)

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