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ECGs Flashcards

1
Q

which are discordant/concordant and what is normal or suggestive of AMI?

discordant/concordant, normal or AMI?

A

A. discordant ST segment depression: normal
B. discordant ST segment elevation: normal
C. concordant ST elevation (suggestive of AMI)
D. concordant ST depression (suggestive of AMI)
E. excessive >5mm discordant ST segment elevation (weakly suggestive of AMI)

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2
Q
A

Diagnosis of Inferior STEMI

ST elevation in II, III, aVF; reciprocal ST depression in I, aVL.

Activate cath lab immediately.

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3
Q
A

Diagnosis of Anterior STEMI

ST elevation in V1-V3
>1mm STdepression 2,3,aVF
left anterior descending (LAD) occlusion

Likely LAD occlusion; urgent PCI required.

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4
Q
A

Diagnosis of Lateral STEMI

ST elevation in I, aVL, V5-V6; reciprocal changes in II, III, aVF.

Cath lab activation.

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5
Q
A

Posterior MI

ST depression in V1-V3; tall R waves and upright T waves in V2-V3

Often with inferior STEMI; check posterior leads (V7-V9).

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6
Q
A

Diagnosis of Right Ventricular MI: makes up 40% of inferior STEMIs

ST elevation in V1,
St elevation in lead 3 > lead 2
V4R with inferior STEMI

preload sensitive! treat with fluid loading and nitrates contraindicated.

Avoid nitrates; fluid bolus if hypotensive.

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7
Q
A

Wellens’ Syndrome: type A pattern.

biphasic T waves in V2-V3.

hx of chest pain, now resolved. highly specific for critical stenosis of LAD artery.

Critical LAD stenosis; urgent cardiology consult.

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8
Q
A

Winter’s T Waves

Upsloping ST depression in precordial leads (>1mm at J point)
peaked T waves in V1-V4
subtle ST elevation in aVR >0.5mm

STEMI equivalent; immediate cath lab.

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9
Q

how do you diagnose Sgarbossa Criteria and when?

A

With LBBB or ventricular paced rhythm infarct can be difficult. - –Concordant ST elevation > 1mm in leads with a positive QRS complex (score 5)
Concordant ST depression > 1 mm in V1-V3 (score 3)
Excessively discordant ST elevation > 5 mm in leads with a -ve QRS complex (score 2)

Treat as STEMI.

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10
Q

Diagnosis of Hyperacute T Waves

A

Tall, symmetric T waves in V1-V4.
seen in early stages of STEMI and preceed ST elevation and Q waves.

Early MI sign; monitor for ST elevation.

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11
Q
A

ST elevation in aVR and widespread ST depression.
This ECG pattern simply tells us there is an oxygen supply/demand mismatch causing subendocardial ischaemia. In a clinical context, this can be due to:

Hypotension
Hypoxia
Fixed stenosis limiting flow

Consider demand ischaemia or NSTEMI.

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12
Q
A

Acute Pericarditis Mimicking STEMI

Widespread concave ST elevation and PR depression is present throughout the precordial (V2-6) and limb leads (I, II, aVL, aVF).
There is reciprocal ST depression and PR elevation in aVR.

NSAID treatment; not cath lab.

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13
Q
A

Left Main Occlusion

ST elevation in aVR and V1 of similar magnitude
Widespread ST depression (V3-6, I, II, III, aVF)

Critical; immediate PCI.

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14
Q
A

Spiked Helmet

SignST elevation mimicking STEMI but with upsloping baseline.
major critical illness and high risk of death.

Seen in critical illness (e.g., sepsis); not MI.

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15
Q

Diagnosis of Ventricular Tachycardia (Monomorphic)

A

Wide QRS (>120 ms), regular, rapid rate; AV dissociation.

Defibrillate if unstable; amiodarone if stable.

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16
Q

Diagnosis of Ventricular Fibrillation

A

Chaotic, irregular waveforms; no discernible QRS.

Immediate defibrillation and CPR.

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17
Q

Diagnosis of Torsades de Pointes

A

Polymorphic VT with twisting QRS axis; prolonged QT precedes.

Magnesium IV stat.

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18
Q

Diagnosis of Supraventricular Tachycardia (SVT)

A

Narrow QRS, regular, rate >150 bpm; P waves absent or retrograde.

Vagal maneuvers, then adenosine.

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19
Q

Diagnosis of Atrial Fibrillation (New Onset)

A

Irregularly irregular rhythm; no distinct P waves, fibrillatory waves.

Rate control; anticoagulation if >48h.

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20
Q

Diagnosis of Atrial Flutter

A

Sawtooth flutter waves in II, III, aVF; regular atrial rate ~300 bpm.

Rate control or cardioversion.

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21
Q

Diagnosis of Multifocal Atrial Tachycardia

A

Irregular rhythm; ≥3 distinct P wave morphologies.

Treat underlying cause (e.g., COPD).

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22
Q

Diagnosis of Junctional Rhythm

A

Narrow QRS; absent or retrograde P waves; rate 40-60 bpm.

Usually benign; check reversible causes.

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23
Q

Diagnosis of Ventricular Bigeminy

A

Alternating normal QRS and PVCs.

Assess electrolytes; benign unless frequent.

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24
Q

Diagnosis of Complete Heart Block (3rd Degree)

A

No AV conduction; independent P waves and QRS; wide QRS if ventricular escape.

Pacing if symptomatic.

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25
Diagnosis of Accelerated Idioventricular Rhythm (AIVR)
Wide QRS, regular, rate 50-100 bpm. ## Footnote Post-reperfusion; observe unless unstable.
26
Diagnosis of Atrial Tachycardia
Narrow QRS, regular, abnormal P waves before QRS. ## Footnote Adenosine ineffective; rate control.
27
Diagnosis of Premature Atrial Contractions (PACs)
Early P waves with variable morphology. ## Footnote Benign; frequent PACs may precede AF.
28
Diagnosis of Premature Ventricular Contractions (PVCs)
Wide, bizarre QRS not preceded by P wave. ## Footnote Assess frequency and cause.
29
Diagnosis of Sinus Tachycardia
Normal P-QRS-T, rate >100 bpm. ## Footnote Treat underlying cause (e.g., pain, hypoxia).
30
Diagnosis of Sinus Bradycardia
Normal P-QRS-T, rate <60 bpm. ## Footnote Symptomatic requires atropine or pacing.
31
Diagnosis of Wandering Atrial Pacemaker
Variable P wave morphology; rate <100 bpm. ## Footnote Benign; seen in young or lung disease.
32
Diagnosis of Asystole
Flat line; no electrical activity. ## Footnote Confirm in two leads; start CPR.
33
Diagnosis of Pulseless Electrical Activity (PEA)
Organized rhythm without pulse. ## Footnote Treat reversible causes (H’s and T’s).
34
Diagnosis of Atrial Fibrillation with Rapid Ventricular Response
Irregularly irregular, rate >100 bpm. ## Footnote Rate control urgent if unstable.
35
Diagnosis of Left Bundle Branch Block (LBBB)
Wide QRS (>120 ms); broad R waves in I, V5-V6; no Q in V5-V6. ## Footnote New LBBB + chest pain = MI until proven otherwise.
36
Diagnosis of Right Bundle Branch Block (RBBB)
Wide QRS; rSR’ in V1-V2; wide S in I, V5-V6. ## Footnote Assess for acute cause if new.
37
Diagnosis of First-Degree AV Block
PR interval >200 ms; all P waves conducted. ## Footnote Usually benign; monitor in acute setting.
38
Diagnosis of Mobitz I (2nd Degree AV Block)
Progressive PR lengthening until a P wave is dropped. ## Footnote Often vagal; observe unless symptomatic.
39
Diagnosis of Mobitz II (2nd Degree AV Block)
Fixed PR interval with intermittent dropped QRS. ## Footnote High risk; prepare for pacing.
40
Diagnosis of Left Anterior Fascicular Block (LAFB)
Left axis deviation; qR in I, aVL; rS in II, III, aVF. ## Footnote Common in elderly; check for MI.
41
Diagnosis of Left Posterior Fascicular Block (LPFB)
Right axis deviation; rS in I, aVL; qR in III, aVF. ## Footnote Rare; consider structural heart disease.
42
Diagnosis of Bifascicular Block
RBBB + LAFB or LPFB; wide QRS and axis deviation. ## Footnote Risk of progression to complete block; monitor.
43
Diagnosis of Trifascicular Block
Bifascicular block + 1st-degree AV block. ## Footnote High risk for complete block; pacing may be needed.
44
Diagnosis of Brugada Pattern
RBBB-like morphology; ST elevation in V1-V3 (coved-type). ## Footnote Risk of sudden death; cardiology referral.
45
Diagnosis of RBBB with ST Elevation
RBBB with ST elevation in V1-V3. ## Footnote Consider acute RV strain or Brugada mimic.
46
Diagnosis of LBBB with Hyperkalaemia
Wide QRS with peaked T waves. ## Footnote Treat potassium urgently.
47
Diagnosis of Intraventricular Conduction Delay (IVCD)
Wide QRS, non-specific pattern. ## Footnote Assess for toxins or ischaemia.
48
Diagnosis of Sinoatrial Exit Block
Intermittent absent P waves; normal QRS follows. ## Footnote Benign unless symptomatic.
49
Diagnosis of AV Dissociation (Non-VT)
Independent P and QRS; narrow QRS. ## Footnote Seen in junctional rhythm; assess cause.
50
Diagnosis: Hyperkalaemia (Severe)
Description: Peaked T waves, wide QRS, absent P waves, sine wave. ## Footnote Calcium gluconate stat; treat urgently.
51
Diagnosis: Hypokalaemia
Description: Flattened T waves, prominent U waves, ST depression. ## Footnote Replace potassium; monitor for arrhythmias.
52
Diagnosis: Hypercalcaemia
Description: Shortened QT interval; normal T waves. ## Footnote Check calcium levels; treat underlying cause.
53
Diagnosis: Hypocalcaemia
Description: Prolonged QT interval; normal T wave morphology. ## Footnote Replace calcium; assess for tetany.
54
Diagnosis: Digoxin Toxicity
Description: Scooped ST depression (reverse tick sign); atrial tachycardia with block. ## Footnote Stop digoxin; consider Digibind if severe.
55
Diagnosis: Hyperkalaemia (Mild)
Description: Peaked T waves only. ## Footnote Early sign; check K+ level urgently.
56
Diagnosis: Hypomagnesaemia
Description: Prolonged QT; may mimic torsades risk. ## Footnote Replace magnesium; common with hypokalaemia.
57
Diagnosis: Tricyclic Antidepressant Toxicity
Description: Wide QRS, right axis deviation, prominent R in aVR. ## Footnote Sodium bicarbonate; urgent if unstable.
58
Diagnosis: Hypothyroidism
Description: Sinus bradycardia, low voltage QRS, flattened T waves. ## Footnote Check TSH; treat underlying cause.
59
Diagnosis: Hyperthyroidism
Description: Sinus tachycardia or atrial fibrillation; normal QRS. ## Footnote Beta-blockers for rate control; check thyroid function.
60
Diagnosis: Sodium Channel Blocker Toxicity
Description: Wide QRS, prolonged QT, rightward axis. ## Footnote Sodium bicarbonate; consider tox history.
61
Diagnosis: Metabolic Acidosis (Compensated)
Description: Sinus tachycardia; normal QRS/T waves. ## Footnote Non-specific; check ABG and cause (e.g., DKA).
62
Diagnosis: Hypoglycaemia Mimic
Description: Sinus tachycardia or non-specific ST-T changes. ## Footnote Check glucose; treat if low.
63
Diagnosis: U Wave Prominence
Description: Distinct U waves after T waves; normal QRS. ## Footnote Seen in hypokalaemia or bradycardia; assess electrolytes.
64
Diagnosis: Digoxin Effect (Non-Toxic)
Description: Scooped ST depression without arrhythmia. ## Footnote Expected with therapeutic levels; monitor.
65
Diagnosis: Pulmonary Embolism (S1Q3T3)
Description: S wave in I, Q wave and inverted T in III; sinus tachycardia. ## Footnote Non-specific; urgent CTPA if suspected.
66
Diagnosis: Pericarditis
Description: Diffuse concave ST elevation; PR depression in multiple leads. ## Footnote NSAID treatment; echo for effusion.
67
Diagnosis: Cardiac Tamponade
Description: Low-voltage QRS; electrical alternans (QRS amplitude variation). ## Footnote Urgent echo; pericardiocentesis if unstable.
68
Diagnosis: Tension Pneumothorax (Mimic)
Description: Sinus tachycardia; low voltage or axis shift. ## Footnote Clinical diagnosis; decompress, not ECG-specific.
69
Diagnosis: COPD Exacerbation
Description: Right axis deviation; poor R wave progression; multifocal atrial tachycardia. ## Footnote Treat hypoxia; avoid over-sedation.
70
Diagnosis: Acute Right Heart Strain
Description: RBBB, right axis deviation, ST-T changes in V1-V3. ## Footnote Seen in massive PE; urgent imaging.
71
Diagnosis: Pneumonia (Non-Specific)
Description: Sinus tachycardia; no specific QRS changes. ## Footnote Treat infection; ECG not diagnostic.
72
Diagnosis: Pulmonary Oedema (LVF)
Description: Sinus tachycardia; LVH or ST-T changes. ## Footnote Diuretics and nitrates; urgent CXR.
73
Diagnosis: Chronic Pulmonary Hypertension
Description: Right axis deviation; tall R in V1; RVH pattern. ## Footnote Echo confirmation; not acute management.
74
Diagnosis: Hypoxia (Non-Specific)
Description: Sinus tachycardia or atrial arrhythmias. ## Footnote Oxygen therapy; check SpO2.
75
Diagnosis: Pericardial Effusion (Subtle)
Description: Low voltage QRS without alternans. ## Footnote Echo to confirm; monitor for tamponade.
76
Diagnosis: Asthma Exacerbation (Mimic)
Description: Sinus tachycardia; no specific QRS changes. ## Footnote Clinical diagnosis; bronchodilators.
77
Diagnosis: Massive PE (Sinus Tachycardia)
Description: Sinus tachycardia only; no S1Q3T3. ## Footnote Most common PE finding; urgent imaging.
78
Diagnosis: Cor Pulmonale
Description: Right axis deviation; P pulmonale; RVH. ## Footnote Chronic finding; manage underlying lung disease.
79
Diagnosis: Acute Respiratory Distress Syndrome (ARDS)
Description: Sinus tachycardia; non-specific ST-T changes. ## Footnote Supportive care; ECG not diagnostic.
80
Diagnosis: Takotsubo Cardiomyopathy
Description: ST elevation in V1-V4; later deep T wave inversion. ## Footnote Supportive care; echo confirmation.
81
Diagnosis: Myocarditis
Description: Diffuse ST elevation or T wave inversion; sinus tachycardia. ## Footnote Supportive care; echo and troponin.
82
Diagnosis: Hypothermia
Description: Osborn (J) waves; prolonged PR, QRS, QT; bradycardia. ## Footnote Warm patient; avoid aggressive rewarming if unstable.
83
Diagnosis: Wolff-Parkinson-White (WPW)
Description: Short PR; delta wave; wide QRS. ## Footnote Avoid AV nodal blockers in AF; cardiovert if unstable.
84
Diagnosis: Prolonged QT Syndrome
Description: QTc >480 ms. ## Footnote Remove QT-prolonging drugs; magnesium if torsades.
85
Diagnosis: Paced Rhythm
Description: Pacing spikes before QRS; wide QRS; LBBB-like morphology. ## Footnote Check pacemaker function if new symptoms.
86
Diagnosis: Left Ventricular Hypertrophy (LVH)
Description: High voltage R waves in V5-V6; ST depression/T inversion. ## Footnote Common in hypertension; assess for strain.
87
Diagnosis: Right Ventricular Hypertrophy (RVH)
Description: Tall R in V1; right axis deviation; ST-T changes. ## Footnote Consider pulmonary hypertension.
88
Diagnosis: Aneurysmal SAH (Cerebral T Waves)
Description: Deep, wide T wave inversion; prolonged QT. ## Footnote Neurogenic; treat underlying bleed.
89
Diagnosis: Artifact (e.g., Tremor)
Description: Irregular baseline mimicking VF; normal rhythm underneath. ## Footnote Check leads; reassure if clinical mismatch.
90
Diagnosis: Left Ventricular Aneurysm
Description: Persistent ST elevation in V1-V4; Q waves present. ## Footnote Post-MI; no acute intervention unless symptomatic.
91
Diagnosis: Cardiac Contusion
Description: Non-specific ST-T changes or RBBB. ## Footnote Trauma-related; monitor troponin and echo.
92
Diagnosis: Hypertrophic Cardiomyopathy (HCM)
Description: Deep Q waves in inferior/lateral leads; LVH pattern. ## Footnote Risk of sudden death; echo confirmation.
93
Diagnosis: Amyloidosis (Cardiac)
Description: Low voltage QRS; pseudo-infarct Q waves. ## Footnote Rare; echo and biopsy for diagnosis.
94
Diagnosis: Dextrocardia
Description: Reversed R wave progression; right axis deviation. ## Footnote Confirm with CXR; adjust lead placement.
95
Diagnosis: Ebstein’s Anomaly
Description: Tall P waves; RBBB; right axis deviation. ## Footnote Congenital; echo confirmation.
96
Diagnosis: Athlete’s Heart
Description: Sinus bradycardia; early repolarization ST elevation. ## Footnote Benign; history distinguishes from pathology.
97
Diagnosis: Early Repolarization
Description: J-point elevation with notched T waves in V3-V6. ## Footnote Benign; common in young males.
98
Diagnosis: Lead Misplacement
Description: Inverted P waves in I or bizarre axis. ## Footnote Recheck leads; repeat ECG.
99
Diagnosis: Normal Variant (Juvenile T Waves)
Description: T wave inversion in V1-V3; normal QRS. ## Footnote Benign in young patients; no intervention.
100
outline ECG territories
101
Normal sinus rhythm in a healthy 18-year old male: Regular rhythm at 84 bpm. Normal P wave morphology and axis (upright in I and II, inverted in aVR) Narrow QRS complexes (< 100 ms wide) Each P wave is followed by a QRS complex The PR interval is constant
102
Wellen's Syndrome: type B pattern. There are deep, symmetrical T wave inversions throughout the anterolateral leads (V1-6, I, aVL)
103
Positive Sgarbossa criteria in a patient with a ventricular paced rhythm: There is concordant ST depression in V2-5 (= Sgarbossa positive). The morphology in V2-5 is reminiscent of posterior STEMI, with horizontal ST depression and prominent upright T waves. This patient had a confirmed posterior infarction, requiring PCI to a completely occluded posterolateral branch of the RCA.
104
Tall, narrow, symmetrically peaked T-waves are characteristically seen in hyperkalaemia
105
Hyperacute T waves (HATW) Broad, asymmetrically peaked or ‘hyperacute’ T-waves (HATW) are seen in the early stages of ST-elevation MI (STEMI), and often precede the appearance of ST elevation and Q waves. Particular attention should be paid to their size in relation to the preceding QRS complex
106
Inverted T-waves in the right precordial leads (V1-3) are a normal finding in children, representing the dominance of right ventricular forces
107
Anterior T wave inversion with Q waves due to recent MI
108
Inverted T waves are seen in the following conditions:
Normal finding in children Persistent juvenile T wave pattern Myocardial ischaemia and infarction (including Wellens Syndrome) Bundle branch block Ventricular hypertrophy (‘strain’ patterns) Pulmonary embolism Hypertrophic cardiomyopathy Raised intracranial pressure
109
110
ST elevation seen > 2 weeks following an acute myocardial infarction
ECG Features of Left Ventricular Aneurysm Most commonly seen in the precordial leads May exhibit concave or convex morphology Usually associated with well-formed Q- or QS waves T-waves have a relatively small amplitude in comparison to the QRS complex (unlike the hyperacute T-waves of acute STEMI)
111
rate of SA node spontaneous deplorisation?
60-100bpm
112
rate of Atria node spontaneous deplorisation?
<60bpm
113
rate of AV node spontaneous deplorisation?
40-60bpm
114
rate of ventricular spontaneous deplorisation?
20-40bpm
115
Sinus arrest with a ventricular escape rhythm Sinus pause / arrest (there is a single P wave visible on the 6-second rhythm strip). Broad complex escape rhythm with a LBBB morphology at a rate of 25 bpm. The LBBB morphology (dominant S wave in V1) suggests a ventricular escape rhythm arising from the right bundle branch.
116
Fusion beats due to VT – the first of the narrower complexes is a fusion beat (the next two are capture beats)
117
Apical hypertrophic cardiomyopathy (AHC) - giant T-wave inversion in the precordial leads. - Inverted T waves are also commonly observed in the inferior and lateral leads
118
Atrial Flutter with 2:1 Block This is the classic appearance of anticlockwise flutter: Inverted flutter waves in II, III + aVF at a rate of 300 bpm (one per big square) Upright flutter waves in V1 simulating P waves 2:1 AV block resulting in a ventricular rate of 150 bpm Note the occasional irregularity, with a 3:1 cycle seen in V1-3
119

paul acem (13 decks)

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