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Z Year3 Clinical Skillz > ECG MED ED > Flashcards

ECG MED ED Flashcards

1
Q

Where do the limb electrodes go?

A

Red: right arm (forearm or wrist)
Yellow: left arm (forearm or wrist)
Green: left leg (proximal to ankle)
Black: right leg (proximal to ankle)

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2
Q

Where is V1 placed?

A

4th intercostal space, right sternal edge

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3
Q

Where is V2 placed?

A

4th intercostal space, left sternal edge

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4
Q

Where is V3 placed?

A

midway between V2 and V4

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5
Q

Where is V4 placed?

A

5th intercostal space, mid-clavicular line

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6
Q

Where is V5 placed?

A

Anterior axillary line in straight line with V4

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7
Q

Where is V6 placed?

A

mid-axillary line straight line with V4 and V6

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8
Q

What should you avoid with sticking on electrodes?

A

hair

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9
Q

What do you check with ECG?

A
  1. NAME, DOB, TIME TAKEN
  2. Rate and Rhythm
    3.
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10
Q

What is the first thing to check on ECG?

A

CHECK NAME, DOB and TIME TAKEN

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11
Q

What is the normal paper speed?

A

should be 25mm/sec

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12
Q

How long is one small square?

A

1mm = 0.04 sec

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13
Q

How long is one big square?

A

5mm = 0.20sec

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14
Q

What is the normal calibration?

A

should be 1cm (10mm)/mV

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15
Q

How do you check the calibration signal?

A

should move two big squares (rectangle at the end should be 2 sqaures tall)

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16
Q

What angle does lead III show?

A

120 degrees

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17
Q

What angle does aVF show?

A

90 degrees

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18
Q

What angle does lead II show?

A

60 degrees

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19
Q

What angle does lead I show?

A

0 degrees

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20
Q

What angle does aVL show?

A

-30 degrees

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21
Q

What angle does aVR show?

A

-150 degrees

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22
Q

What do leads I and aVL look at?

A

left side of heart

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23
Q

What do leads III, aVF and II look at?

A

inferior aspect of heart

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24
Q

What do leads V1 and V2 look at?

A

septal

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25
Q

What do leads V3 and V4 look at?

A

anterior of heart

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26
Q

What do leads V5 and V6 look at?

A

lateral left side of heart

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27
Q

How do you determine the rate?

A

count QRS complex in rhythm strip x 6

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28
Q

What is normal rate?

A

Normal range is 60-100bpm

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29
Q

What are the 3 types of rate?

A
  1. normal
  2. tachycardic
  3. bradycardic
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30
Q

What are the 3 types of rythm?

A
  1. sinus
  2. regular irregular
  3. irregular irregular
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31
Q

What is sinus rhythm?

A

P wave starting each QRS

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32
Q

What is a regular irregular rhythm?

A

consistent gap between QRS

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33
Q

What is an irregular irregular rhythm?

A

change gap between QRS

34
Q

Which leads are used to assess cardiac axis?

A

leads I, II, aVF

35
Q

What is the cardiac axis if II is +ve and I is +ve?

A

normal

36
Q

What is the cardiac axis if II is -ve and I is +ve?

A

left axis deviation

37
Q

What is the cardiac axis if II is +ve and I is -ve?

A

right axis deviation

38
Q

What is the cardiac axis if aVF is -ve and I is -ve?

A

extreme axis deviation

39
Q

How can you tell if QRS is +ve or -ve?

A

for something to be -ve or +ve then the great half of QRS will be above or below isoelectric line

40
Q

What is a way to remember left axis deviation?

A

I and II LEAVING eachother

41
Q

What is a way to remember right axis deviation?

A

leads I and II RETURNING to eachother

42
Q

What do P wave’s represent?

A

first deflection: atrial depolarisation

43
Q

What are the features of P waves?

A
  1. Should precede every QRS complex

2. Should be smooth

44
Q

How long should P waves be?

A

<0.12s (<3 small squares)

45
Q

How could p waves vary?

A
  • Long
  • Short
  • Absent
  • Biphasic
  • Inverted
46
Q

What is P pulmonale related to?

A

right atrial dilation (pulmonary stenosis can be a cause)

47
Q

What is P mitrale related to?

A

left atrial dilation – second hump (mitral stenosis can be a cause)

48
Q

What is the defintion of the PR interval?

A

start of P wave to start of QRS complex

49
Q

How long should the p wave be?

A

0.12-0.20secs (3-5 small squares - max one big box)

50
Q

What does the PR interval represent?

A

time between SAN node depolarisation to AV node depolarizations

51
Q

What should the PR interval be?

A

isoelectric

52
Q

How can the PR interval go wrong?

A
  1. Prolonged
  2. Not flat
  3. Short
53
Q

How long should the QRS be?

A
  1. Should be narrow <0.12s (less than 3 small squares)

2. Shouldn’t be too big/small

54
Q

How can you tell if QRS complex is too big/small?

A

S wave depth in V1 and tallest R wave in V5/6 should be <35mm

55
Q

How does the QRS complex act as a transition point?

A

transition point to negative to positive between V3 and V4 (as usually negative in V1,V2 and very positive in V5 and V6) – and if not the case, poor R wave progression

56
Q

How can the QRS complex go wrong?

A
  1. Wide QRS complex

2. Absent: cardiac arrest

57
Q

What is it called when there is alternating bigger and smaller QRS?

A

electrical alternans

58
Q

How can you tell poor R wave progression?

A

V5 and V6 QRS still negative

59
Q

If the QRS is too big what may this suggest?

A

left ventricular hypertrophy

60
Q

What is the J point?

A

region where QRS complex becomes ST segment

61
Q

What is the J point usually?

A
  • should normally be isoelectric

- some patients have raised J point as a normal variant

62
Q

What can happen to the J point?

A

can be raised or lowered can help see ST segment elevation and depression

63
Q

What is an osborne wave?

A

(straight after QRS): hypothermia

64
Q

What is an ST segment?

A

bit between QRS complex and T wave

65
Q

What should the ST segment be usually?

A

isoelectric

66
Q

What does the ST segment represent?

A

pause between ventricular depolarisation and repolarisation

67
Q

How can the ST segement change?

A
  1. Elevated
  2. Depressed
  3. Morphology
68
Q

What must you include with ST segment change?

A
  1. Flat elevation
  2. Upsloping
  3. Downsloping
  4. Convex
  5. Concave
69
Q

What is the T wave?

A

usually last deflection of heart cycle

70
Q

What should the T wave be usually?

A

be positive in all leads except aVR and V1

71
Q

How big is the T wave normally?

A
  • Fairly small:
    1. <5mm in limb leads
    2. <10mm in praecordial leads
    3. Should be smaller than QRS
72
Q

What could go wrong in the T wave?

A
  1. Inverted
  2. Taller/tented
  3. Flattened
  4. Biphasic
73
Q

What do you need to say with biphasic T wave?

A

(starts inverted or upright make it clear!)

74
Q

What is a U wave?

A

Waveform after the T wave

75
Q

What does the U wave suggest?

A

usually pathological but can be normal (easier to see in bradycardia) – young fit athletic person can be normal in

76
Q

What is the normal size and direction of the U wave?

A
  1. Usually same direction as T wave

2. 1/4 size of T wave

77
Q

What does the U wave represent?

A

Could represent repolarisation of Purkinje fibres

78
Q

What are possible issues with U waves?

A
  1. Obvious U waves

2. Inverted U waves, opposite direction to T wave (indicates heart disease often)

79
Q

What is the QT interval?

A

from start of QRS to end of T wave

80
Q

What is the normal QT interval?

A
  1. QTc <0.44s in men and <0.46s in women

2. QTC>35s

81
Q

What does the QT interval vary with?

A

with HR; gets shorter at faster HR, longer at slower HR – therefore needs to be corrected for heart rate (hence the c).

82
Q

How can you QT be wierd and why?

A
  1. Long (hypocalcaemia, drugs and genetic syndrome)

2. Short (hypercalcaemia)

Z Year3 Clinical Skillz (9 decks)

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