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Cardiology > ECGs > Flashcards

ECGs Flashcards

1
Q

Which leads look at the lateral aspect of the heart

A

I, aVL, V5, V6

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2
Q

Which leads look at the inferior aspect of the heart

A

II, III, avF

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3
Q

Which leads look at septum of the heart

A

V1, V2

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4
Q

Which leads look at the anterior aspect of the heart

A

V3, V4

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5
Q

What are the 3 main coronary arteries

A

RCA, LCx, LAD

Note: The LCA becomes the LCx and LAD

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6
Q

What regions of the heart does the RCA supply

A

Right Atrium
Right Ventricle
Inferior aspect of the left ventricle
Posterior septal area

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7
Q

What regions of the heart does the LCx artery supply

A

Left Atrium

Posterior aspect of the left ventricle

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8
Q

What regions of the heart does the LAD artery supply

A

Anterior aspect of the left ventricle

Anterior aspect of septum

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9
Q

Note- Do further research on where and why different MIs show up an ECGs

A

-

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10
Q

What is the first downward deflection after a P wave called if there is no R wave? why?

A

QS wave

Because its impossible to say if its a Q or S wave

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11
Q

How long should the P-R interval be

A

0.12- 0.2 seconds

3-5 small squares

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12
Q

How long should the QRS complex be

A

<0.12 seconds

<3 small squares

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13
Q

How long should the QT interval be

A

0.36-0.44 seconds

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14
Q

What are the 2 methods for calculating HR from an ECG rhythm strip

A

300/ No. of small squares between 2 R waves

No. of R waves in 30 large squares x10

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15
Q

What is the usual HR seen in atrial flutter

A

150

Check Nick Smith video on this

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16
Q

What is first agree heart block

A

Increased P-R interval

17
Q

Causes of First Degree Heart Block

A 
Increased vagal tone
Athletic training
Inferior MI
Mitral valve surgery
Myocarditis (e.g. Lyme disease)
Electrolyte disturbances (e.g. Hyperkalaemia)
AV nodal blocking drugs (beta-blockers, calcium channel blockers, digoxin, amiodarone)
May be a normal variant
18
Q

What is Mobitz type I also know as and what is it

A

Wenckebach

Progressively lengthening P-R interval until an atrial impulse is completely blocked

19
Q

Causes of Wenckebach?

A

Produced by progressive fatigue of the AV nodal cells

Usually due to a functional suppression of AV conduction (e.g. due to drugs, reversible ischaemia)

Drugs: beta-blockers, calcium channel blockers, digoxin, amiodarone
Increased vagal tone (e.g. athletes)
Inferior MI
Myocarditis
Following cardiac surgery (mitral valve repair, Tetralogy of Fallot repair)

20
Q

What is Mobitz type II

A

Dropped QRS complex with otherwise regular P-R intervals

Can be in a pattern or random

21
Q

What are the causes of Mobitz II

A

Mobitz II is usually due to failure of conduction at the level of the His-Purkinje system (i.e. below the AV node).

Anterior MI (due to septal infarction with necrosis of the bundle branches).
Idiopathic fibrosis of the conducting system (Lenegre’s or Lev’s disease).
Cardiac surgery (especially surgery occurring close to the septum, e.g. mitral valve repair)
Inflammatory conditions (rheumatic fever, myocarditis, Lyme disease).
Autoimmune (SLE, systemic sclerosis).
Infiltrative myocardial disease (amyloidosis, haemochromatosis, sarcoidosis).
Hyperkalaemia.
Drugs: beta-blockers, calcium channel blockers, digoxin, amiodarone.

22
Q

What is the clinical significance of Mobitz II

A

Mobitz II is much more likely than Mobitz I to be associated with haemodynamic compromise, severe bradycardia and progression to 3rd degree heart block.
Onset of haemodynamic instability may be sudden and unexpected, causing syncope (Stokes-Adams attacks) or sudden cardiac death.
The risk of asystole is around 35% per year.
Mobitz II mandates immediate admission for cardiac monitoring, backup temporary pacing and ultimately insertion of a permanent pacemaker.

23
Q

What is 3rd degree / complete heart block?

A

there is complete absence of AV conduction – none of the supraventricular impulses are conducted to the ventricles

The atrial rate is approximately 100 bpm.
The ventricular rate is approximately 40 bpm.
The two rates are independent; there is no evidence that any of the atrial impulses are conducted to the ventricles.

it is essentially the end point of either Mobitz I or Mobitz II AV block.

24
Q

What are the causes of 3rd degree heart block

A

Inferior myocardial infarction
AV-nodal blocking drugs (e.g. calcium-channel blockers, beta-blockers, digoxin)
Idiopathic degeneration of the conducting system (Lenegre’s or Lev’s disease)

25
Q

What is the clinical significance of third degree heart block

A

Patients with third degree heart block are at high risk of ventricular standstill and sudden cardiac death.
They require urgent admission for cardiac monitoring, backup temporary pacing and usually insertion of a permanent pacemaker.

26
Q

Define ‘cardiac axis’

A

The average direction of flow of electrical activity in the heart

27
Q

What is the normal cardiac axis

A

Normal Axis = QRS axis between -30° and +90°.
Left Axis Deviation = QRS axis less than -30°.
Right Axis Deviation = QRS axis greater than +90°.

28
Q

What is classed as extreme axis deviation

A

Extreme Axis Deviation = QRS axis between -90° and 180° (AKA “Northwest Axis”).

29
Q

why is lead 2 often used as the rhythm strip

A

the majority of the impulse of the heart will be traveling directly towards it

30
Q

what causes a positive or negative deflection in a lead

A

the more an impulse travels towards a lead then the the greater the deflection will be

if electrical activity is moving directly 90* downwards they’ll be no difference between aVR and aVF (known as isoelectric)

31
Q

Which leads becomes more negative in LAD and vice versa

A

Lead II

Left TWO the right ONE

32
Q

which electrode is classed as ‘the view point’ for its lead

A

The positive electrode is the view point

the line connecting the two electrodes is the line of sight

33
Q

how is the negative electrode used by the chest leads derived

A

the negative electrode is calculated by taking an average of the three limb leads

34
Q

what are the 3 rules of 4 that are used to interpret an ECG

A 
4 features 
Demographic/ history 
Rate 
Rhythm 
Axis 
4 Waves 
P wave 
QRS 
T wave 
U wave 
4 intervals 
P-R
QRS 
S-T
Q-T
35
Q

When is ST elevation significant

A

> 2mm in leads V1, V2 or V3
1mm in any other leads
two or more contiguous leads

Cardiology (1 decks)

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