ECGs

Question 1

P wave?

Answer 1

Atrial depolarisation

Question 2

PR interval?

Answer 2

SAN-AVN <200 msecs

Question 3

QRS complex?

Answer 3

Ventricular depolarisation

Question 4

T wave?

Answer 4

Ventricular repolarisation

Question 5

QT interval

Answer 5

<460 msecs

Question 6

U wave?

Answer 6

Repolarisation of papillary muscles

Question 7

Causes of first degree heart block?

Answer 7

Acute MI
Hypokalaemia
Digoxin
Beta-blocker
Rheumatic fever
Lyme disease
SLE
Myocarditis

Question 8

Treatment for first degree heart block?

Answer 8

No specific treatment, treat cause

Question 9

What is first degree heart block?

Answer 9

Prolonged PR interval

Question 10

What is T1 second degree heart block?

Answer 10

Wenckebach - irregular QRS, increasing PR interval until no QRS for one cycle

Question 11

Cause of second degree heart block?

Answer 11

Fibrosis
IHD
Cardiomyopathy
Congenital
Valvular heart disease
MI
Metabolic disturbances

Question 12

What is T2 second degree heart block?

Answer 12

Regularly dropped QRS complexes e.g. every 2 or 3 beats

Question 13

What is Stokes-Adams attacks?

Answer 13

Episode of syncope caused by slowing of ventricular rate (type II,

Question 14

What is third degree heart block? ECG findings?

Answer 14

No relationship between atrial and ventricular contraction. Broad QRS, RR long, PR random, 30-40 bpm

Question 15

New onset left bundle branch block?

Answer 15

MI until proven otherwise

Question 16

Left bundle branch block?

Answer 16

WilliaM on ECG, left axis deviation, wide QRS

Question 17

Right bundle branch block

Answer 17

MarroW, prolonged QRS, t wave inversion in lead 1 and 2

Question 18

Sinus bradycardia?

Answer 18

rate <60, normal PR

Question 19

Causes of sinus bradycardia?

Answer 19

Athlete
Beta-blockers
Calcium channel
Potassium channel
Digoxin
Hypothyroid
Hypokalaemia
Hypothermia
SSS
MI
Vasovagal

Question 20

Treatment for sinus bradycardia?

Answer 20

ONLY IF SYMPTOMS

remove beta-blocker, oxygen, fluids, IV atropine or adrenaline, pacing

Question 21

Beta-blocker overdose?

Answer 21

Glucagon

Question 22

What MI causes bradycardia

Answer 22

Inferior - RCA = SAN

Question 23

Inferior MI on what leads?

Answer 23

II, III, aVf

Question 24

Lateral MI on what leads?

Answer 24

I, aVL, V5, V6

Question 25

Anterior MI on what leads?

Answer 25

V1-V6

Question 26

What is levs disease?

Answer 26

Idiopathic fibrosis of SAN - causes SSS and 3rd degree heart block

Question 27

What is SSS

Answer 27

Sick sinus syndrome - disease of the sinoatrial node - sinus bradycardia, sudden rate changes, atrial standstill, AV escape rhythms

Question 28

Cause of 3rd degree heart block?

Answer 28

Fibrosis, congenital, aortic stenosis, surgery, IHD

Question 29

Atrial fibrillation

Answer 29

Irregularly irregular heart rate, re-entry circuits

Question 30

AF caused by?

Answer 30

``` Mitral stenosis Mitral regurgitation PE IHD Hypomagnesia Digoxin toxicity Dilated atrial cardiomyopathy ```

Question 31

Paroxysmal AF?

Answer 31

Recurrent AF that terminates spontaneously within 7 days

Question 32

Persistent AF?

Answer 32

AF lasting longer than 7 days

Question 33

Long standing persistent AF?

Answer 33

more than one year

Question 34

Permanent AF?

Answer 34

refractory to cardioversion

Question 35

AF symptoms?

Answer 35

Palpitations Chest pain Syncope Pulmonary oedema

Question 36

Treatment of AF? (haemodynamically unstable)

Answer 36

Cardioversion

Question 37

Treatment of AF?

Answer 37

Beta blockers/calcium blockers or amiodarone if heart failure. Must anticoagulate

Question 38

Complications of AF

Answer 38

Stroke MI Heart failure

Question 39

When is digoxin used?

Answer 39

Older patients

Question 40

What is electrical alterans?

Answer 40

Varied QRS - pericardial effusion

Question 41

Asystole?

Answer 41

No cardiac activity

Question 42

Right atrial enlargement on ECG?

Answer 42

Peaked p wave - P Pulmonale

Question 43

Left atrial enlargement on ECG?

Answer 43

bipeaked p waves - P Mitrale

Question 44

Sign of previous MI?

Answer 44

Q waves

Question 45

Medication causing long QT?

Answer 45

``` Sotalol Amiodarone Erythromycin Clarithromycin Haloperidol Chlorpromazine ```

Question 46

What is the normal range of QRS axis?

Answer 46

-30 to +90

Question 47

Leads V1, V2 and V3 measure which direction?

Answer 47

anterior/posterior forces

Question 48

Leads I, aVr, aVl, V4, V5 and V6 measure which direction?

Answer 48

Right to left

Question 49

What forces do II, III and aVf measure?

Answer 49

Inferiorly

Question 50

Cardioversion for new-onset AF?

Answer 50

Flecainide or amiodarone if no structural or ischemic heart disease Amiodarone if structural abnormality