ECGs

Question 1

presentation of heart block

Answer 1

syncope
heart failure
regular bradycardia
wide pulse pressure
JVP - cannon waves in neck
variable intensity of S1

Question 2

1st degree heart block

Answer 2

PR >0.2s

Question 3

2nd degree heart block, mobitz type 1

Answer 3

progressive prolongation of PR interval until dropped beat occurs

(Wenckebach)

Question 4

2nd degree heart block, mobitz type 2

Answer 4

PR interval is CONSTANT but P wave is often not followed by QRS

Question 5

3rd degree heart block

Answer 5

no assoc between Pwaves + QRS

Question 6

management of torsades de pointes

Answer 6

haemodynamically unstable = DC cardioversion

stable = IV magnesium sulphate 2g over 1-2mins

Question 7

ST elevation in II, III, aVF

Answer 7

inferior -> right coronary artery

Question 8

ST elevation in V1-4

Answer 8

anterior -> LAD

Question 9

ST elevation in I, aVL +/- V5-6

Answer 9

left circumflex

Question 10

signs of haemodynamically instability

Answer 10

shock - suggests organ hypoperfusion
syncope - brain hypoperfusion
chest pain - myocardial ischaemia
pulmonary oedema - evidence of heart failure

Question 11

when can sinus bradycardia be normal

Answer 11

adults aged over65
young athletes

Question 12

how can heart rate in patient with regular rhythm on ECG be calculated?

Answer 12

dividing 300 by the numbers of squares in between the QRS compleses

Question 13

PE ECG findings

Answer 13

sinus tachycardia = commonest + sometimes only feature
RBBB
right axis deviation

Question 14

atrial fibrillation ECG features

Answer 14

absent P waves
narrow QRS complex
irregularly irregular rhythm

Question 15

when should rate control not be given in AF

Answer 15

a reversible cause
new onset (in last 48hrs)
heart failure
symptoms despite being effectively rate controlled

Question 16

rate control options in AF

Answer 16

beta-blocker
CCB
digoxin - only in sedentary with persistent AF, require monitoring

(give rhythm control)

Question 17

rhythm control

Answer 17

cardioversion
- pharma -> felcainide, amiodarone
- electrical

long term rhythm control
- betablockers =1st line
- dronedarone
- amiodarone

Question 18

general treatment of atrial fibrillation

Answer 18

betablocker - rate control
DOAC - for anticoag

Question 19

ECG features in Wolff-Parkinson white

Answer 19

short PR interval <0.12s
wide QRS >0.12s
delta wave

definitive treatment = ablation of accessory pathway

Question 20

acute management of supraventricular tachycardias

Answer 20

1. vagal manoeuvres - valsalva, carotid sinus massage
2. adenosine (rapid bolus)
3. verapamil or beta blocker
4. synchronised DC cardioversion

Question 21

when is adenosine avoided

Answer 21

asthma, COPD
heart failure
heart block
severe hypotension

Question 22

causes of bradycardia

Answer 22

medications - betablockers
heart block
sick sinus syndrome

Question 23

management of bradycardia

Answer 23

IV atropine
inotropes - adrenaline
temp. cardiac pacing
pacemaker

Question 24

P wave

Answer 24

atrial depolarization

0.08-0.10 secs

Question 25

QRS complex

Answer 25

ventricular depolarisation <0.10s

Question 26

T wave

Answer 26

ventricular repolarisation

Question 27

PR interval

Answer 27

largely AV node delay 0.12-0.20sec

Question 28

ST segment

Answer 28

ventricular contraction (systole) occurs in the ST segement

Question 29

TP interval

Answer 29

ventricular relaxation (diastole) occurs in the TP interval

Question 30

what does a large box vs a small box represent on an ECG?

Answer 30

large = 0.2 secs

small = 0.04secs

Question 31

left axis deviation signs on ECG

Answer 31

lead I = positive (left thumbs up)

lead II/aVF = negation

Question 32

right axis deviation signs on ECG

Answer 32

lead I = negative

lead II/aVF = positive (right thumbs up)