ECGs Flashcards
(13 cards)
What is the ECG Diagnosis?
What are the supportive ECG findings +/- Criteria?
Left Ventricular Hypertrophy
LVH requires voltage + non-voltage criteria:
Voltage criteria
- Sokolow-Lyon criteria suggest S wave in V1 + R wave in V5 or V6 ≥35mm
Non-Voltage Criteria
- R wave peak time >50ms in V5 or V6
- strain pattern (increases specificity) and includes ST depression and asymmetric T wave inversions in left sided leads (I, aVL, V4-V6 +/- II and aVF); appropriately discordant ST segment elevation in V1-V3 (+/- aVR), and QRS widening (non-specific IVCD)
What is the ECG Diagnosis?
What are the supportive ECG findings?
Bifascicular Block
ECG Findings:
* RBBB
* LAFB (appears as left axis deviation)
Note: this is most common pattern of bifascicular block
What is the ECG Diagnosis?
What are the supportive ECG Findings?
Bifascicular Block
ECG Findings:
* RBBB
* LPFB (appears as right axis deviation)
Note: this is an uncommon form of bifascicular block
What is the ECG Diagnosis?
What are the supporting features?
Atrial Flutter with Variable Conduction
Findings:
* Inverted flutter waves in II, III, aVF
* Positive flutter waves in V1
* AV block that varies 2:1 to 4:1
- RR interval = multiple of PP interval (look for identical R-R intervals and determine if mathematical relationship present)
What is the ECG Diagnosis?
What are the supporting features?
Atrial Flutter with 2:1 Block
Features:
* Inverted flutter waves in II, III, aVF at rate 300bpm (1 per big square)
* Upright flutter waves in V1
* 2:1 block with ventricular rate of 150bpm (always suspect in narrow complex tachycardia 130-170bpm)
What is the ECG Diagnosis?
What are the supporting features?
Dual Chamber Paced Rhythm
- Atrial pacing spikes before each P wave with 100% atrial capture
- Ventricle pacing spikes before each QRS with 100% ventricle capture
- Broad QRS complexes with LBBB morphology, indicating right ventricle pacing
What is the ECG Diagnosis?
What are the supporting features?
Atrial Paced Rhythm with 1st degree heart block
* Pacing spikes at a rate of 90bpm with 100% atrial capture (P wave following each pacing spike)
* P waves are conducted to ventricles with a prolonged PR interval (~280ms)
What is the ECG Diagnosis?
What are the supporting features?
De Winter Pattern
* Tall, prominent, and symmetrical T waves that arise from upsloping ST segment depression >1mm at the J point in precordial leads (V1.- V6)
* 0.5-1mm ST segment elevation in aVR
Relevance = Anterior STEMI equivalent (may or may not be preceded or followed by classic STEMI morphology)
What is the ECG Diagnosis?
What are the supporting features?
Posterior STEMI (Stemi Equivalent)
* ST depression in anterior leads (V2-V3)
* Tall broad R waves in V2-V3 (>30ms)
* Upright T waves
* Dominant R wave (R/S Ratio >1) in V2
Confirmed with Posterior Lead ECG
What is the ECG Diagnosis?
What are the supporting features?
Global subendocardial ischaemia of left ventricle
* may be STEMI equivalent (in the RIGHT clinical context)
* more likely due to severe triple vessel disease, or secondary to pathology creating demand/supply mismatch (hypotension/hypoxia)
Features:
* ST elevation in aVR
* Multi-lead ST depression (I, II, V5-V6)
* ST elevation and Q waves in V1-V2 (indicate proximal LAD occlusion in this circumstance)
What is the ECG Diagnosis?
What are the supporting features?
LBBB with Smith-Modified Sgarbossa Criteria (STEMI Equivalent)
* Proportionally excessive discordant ST elevation (>25%) in V4
* Slight concordant ST elevation in V5
What is the ECG Diagnosis?
What are the supporting features?
Benign Early Repolarisation (BER)
* ST elevation with concave ST morphology (most prominent in V2 - V5)
* No reciprocal ST Depression
* J point notching (most prominent in V4)
* Absence of Terminal QRS Distortion
What is the ECG Diagnosis?
What are the supporting features?
Right Bundle Branch Block (RBBB)
* Widened QRS (≥3 small squares)
* RSr’ pattern in V1-V3
* Large slurred S wave in lateral leads (I, V5, V6)
* Discordant ST depression in V1-V3
