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Flashcards in ECGs Deck (28)
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1

LMCA occlusion

Widespread ST depression
ST elevation > 1mm aVR
ST elevation in aVR > V1

Can also be due to post cardiac arrest, severe anaemia/hypoxia, triple vessel disease

2

LAD occlusion

ST elevation aVR > 1mm
ST elevation often also in V1-3
Widespread ST depression

Can also be severe triple vessel disease

3

Raised ICP

Giant cerebral T wave inversion in multiple leads
QT prolongation
Bradycardia

Diffuse ST elevation (STEMI mimic)
General rhythm disturbance

4

Right heart strain pattern

Right axis deviation
RBBB
S1 Q3 T3
Dominant R wave in V1
T wave inversion V1-4 and III
Persistent S wave V6

5

PE changes

Sinus tachycardia most common 44%
Right ventricular strain - T wave inversion V1-4 and inferior leads 34%
S1 Q3 T3 20%
RBBB associated with increased mortality 18%
RAD 16%
P pulmonale 9%
Persistent S wave V6 8%
Atrial tachycardias 8%
Dominant R wave V1
Non specific ST and T wave changes in 50%

6

Wolff Parkinson White

Delta waves (look in inferior leads)
Short PR interval < 120
QRS prolongation > 110
ST segment and T wave discordant changes
Pseudo infarction pattern due to negatively deflected delta waves

7

Hypertrophic cardiomyopathy

Left ventricular hypertrophy
Deep narrow dagger like Q waves lateral +/- inferior leads (1, aVL, V5-6)
Often non specific ST/T wave abnormalities

Clinical features - presyncope/syncope, palpitations, chest pain, pulmonary congestion

8

Brugada

Coved ST elevation > 2mm in > 1 of V1-3 followed by negative T wave
Must also have one of the following clinical criteria:
- documented VF or polymorphic VT
- FH sudden death < 45
- syncope
- nocturnal agonal respiration
- other family members with ECG changes
- VT induced

Can be unmasked by fever, hypothermia, ischaemia, hypokalaemia, alcohol, cardiac drugs

9

Irregular supraventricular tachycardia

Atrial origin, narrow complex
- atrial fibrillation - no p waves, variable rate
- atrial flutter with variable block - no p waves, saw tooth pattern
- multifocal atrial tachycardia - at least 3 distinct p wave morphologies in same lead

10

Regular supraventricular tachycardia

Sinus tachycardia
Atrial tachycardia
Atrial flutter with fixed AV block
AV nodal re-entrant tachycardia (classical SVT - regular 140-280, narrow complex, buried p waves so appear absent)
AV re-entrant tachycardia (WPW)

11

Regular broad complex tachycardia

VT
SVT with aberrant conduction due to BBB
SVT with aberrant conduction due to WPW

12

VT vs SVT ECG features (if clinical features/doubt then treat as VT!!)

Absence typical LBBB or RBBB morphology
Extreme axis deviation
Very broad complexes > 160
AV dissociation
Capture beats
Fusion beats
Positive concordance throughout precordial leads
Negative concordance throughout precordial leads
RSR complexes with taller left rabbits ear
Brugada sign
Josephson sign

13

Irregular broad complex tachycardia

VF
Torsdaes de pointes
Polymorphic VT
AF with WPW
AF with BBB

14

Mobitz I

Wenckebach
Progressive prolongation PR interval culminating in non conducted P wave
P-P ratio remains constant

15

Mobitz II

Intermittent non conducted P waves with PR interval remaining normal

16

Inferior STEMI

ST elevation II, III, aVF
Reciprocal depression aVL

40% STEMIs
20% associated 2nd/3rd degree HB

Avoid nitrates, give fluid, preload dependent
May need paced

17

Right coronary artery lesion

Inferior STEMI
STE III > II
STE also in V1
ST depression > 1mm aVL
ST depression I

- do right sided leads, ST elevation V4R most specific

18

Posterior STEMI

ST depression V1-3 with upright T waves
Tall broad R waves V1-3
Dominant R wave V2

Do posterior leads - STE can be 0.5mm

19

What to think if narrow complex tachycardia rate 150

Atrial flutter with 2:1 block (elderly, IHD)
SVT
AV reentry in WPW
Sinus tachycardia

20

What to look for in syncope

- Too fast - VT, VF, torsades
- Too slow - sinus bradycardia, pauses, heart block (Mobitz II or 3rd degree)
- Pump failure - MI, PE
- Electrical problems - electrolytes (hypo/hyperkalaemia), pacemaker failure
- Syncope syndromes - long QT, short QT, WPW, Brugada, HOCM, ARVD

21

Digoxin effect (not toxicity)

Down sloping ST depression (reverse tick)
Flattened, inverted or biphasic T waves
Shortened QTc
PR prolongation
Prominent U waves

22

ECG in digoxin toxicity

Can have supra ventricular tachycardia due to increased automaticity or slow ventricular response due to decreased AV conduction or features of both

Most commonly
- frequent PVCs/bigeminy/trigeminy
- sinus bradycardia
- slow AF
- AV block of any type
- VT

23

Left axis deviation

QRS positive lead I and negative in lead aVF (also in II and III)

Causes
LBBB
inferior MI
LVH
Left anterior fasicular block
Paced rhythm
WPW

24

Right axis deviation

QRS positive in aVF (also II and III), negative in I

Causes
Right ventricular hypertrophy
PE
COPD
Left posterior fasicular block
WPW
Hyper kalaemia
Sodium channel blocker toxicity

25

Paediatric ECG

Dominant R in V1 (RSR pattern)
T wave inversion V1-3
May have right axis deviation
Often shorter PR
Can have sinus arrhythmia

26

STEMI mimics

Benign early early repolarisation
LVH
LBBB
Paced rhythm
Pericarditis
Left ventricular aneurysm
Brugada
Takatsubo
Increased intracranial pressure

27

Causes of long QTc

Hypokalaemia
Hypomagnesaemia
Hypocalcaemia
Hypothermia
Myocardial ischaemia
Post ROSC
Raised ICP
Congenital
Drugs - antipsychotics, TCAs, type Ia (procainimide), Ic (flecanide), III (sotalol, amiodarone), citalopram, venlafaxine, quinine, macrolides

28

Arryhthmogenic right ventricular dysplasia

Autosomal dominant, second most common sudden cardiac death in young people (after HCM), often associated FH

T wave inversion V1-3 without RBBB
Epsilon wave
QRS widening V1-3
Frequent PVCs
Paroxysmal VT with LBBB morphology (right ventricular outflow tract obstruction)