Electrocardiography (ECG) Flashcards Preview

01 CARDIOVASCULAR MEDICINE > Electrocardiography (ECG) > Flashcards

Flashcards in Electrocardiography (ECG) Deck (30):
1

Atrial fibrillation?

Irregularly irregular

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PVC?

Premature Ventricular Complex: Wide QRS

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Ventricular aneurysm?

ST elevation

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Ischemia?

ST elevation/ST depression/flipped T waves

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Infarction?

Q waves

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Pericarditis?

ST elevation throughout leads

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RBBB?

Right Bundle Branch Block: wide QRS and “rabbit ears” or R-R in V1 or V2

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LBBB

Associated with absent Q waves in leads I, aVL, and V6; a large, wide, and positive R wave in leads I, aVL, and V6; Wide QRS and “rabbit ears” or RSR' in V5 or V6.

and prolongation of the QRS complex to greater than 0.12 seconds.

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Wolff-Parkinson-White?

Delta wave = slurred upswing on QRS

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First degree A-V block?

Prolonged P-R interval (0.2 second)

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Second degree A-V block?

Dropped QRS; not all P waves transmit to produce ventricular contraction

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Wenckebach phenomenon?

Second-degree block with progressive delay in P-R interval prior to dropped beat

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Third-degree A-V block?

Complete A-V dissociation; random P wave and QRS

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Long QT

Prolongation of QT interval on ECG (QTc >450 msec in males or >470 msec in females). 

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Acute Pericarditis

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Ischemic changes in the anterolateral leads (ST-segment depression and T-wave inversion).

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Third-degree atrioventricular block, or complete heart block, refers to a lack of atrioventricular conduction (characterized by lack of conduction of all atrial impulses to the ventricles), 

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Acute myocardial infarction manifesting as a new left bundle branch block on electrocardiogram and complicated by ischemic mitral regurgitation and heart failure. Electrocardiographically, left bundle branch block is associated with absent Q waves in leads I, aVL, and V6; a large, wide, and positive R wave in leads I, aVL, and V6; and prolongation of the QRS complex to greater than 0.12 seconds. Repolarization abnormalities are present and consist of ST-segment and T wave vectors directed opposite to the QRS complex.

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Second-degree atrioventricular block is diagnosed by the presence of isolated P waves that are not followed by a QRS complex. There are two possible forms: Mobitz type I (Wenckebach), with progressive prolongation of the PR interval until the dropped beat, and Mobitz type II, with a constant PR interval and periodic dropped beats.

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Atrial fibrillation is caused by rapid and uncoordinated electrical activation within the atria. The electrocardiogram shows an absence of P waves and an irregular ventricular response. 

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Ventricular preexcitation by an accessory atrioventricular connection, with a short P-R interval, prolonged QRS duration, and slurred onset of the QRS (delta wave) interval. With paroxysmal tachyarrhythmias, this pattern is diagnostic for Wolff-Parkinson-White syndrome.

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Atrial flutter is characterized by a saw-tooth pattern on electrocardiogram that is most noticeable in the inferior leads.

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Multifocal atrial tachycardia is characterized on electrocardiograms by three or more P wave morphologic patterns and variable P-R intervals.

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In a patient with a wide-complex tachycardia with a history of coronary artery disease or cardiomyopathy, ventricular tachycardia is the most likely diagnosis.

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Previous inferior wall myocardial infarction on electrocardiogram (Q waves in leads II, III, and aVF).

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Atrial tachycardia is distinguished from atrial flutter by:

Its somewhat slower atrial rate (150-250 bpm as opposed to 250-350 bpm).  

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Electrocardiogram showing abnormal Q waves in leads V3-V5 and ST-segment elevation in leads V2-V5.

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ECG Leads and Anatomic Correlates

II, III, aVF Inferior - RCA

V1-V3 Anteroseptal - LAD

V4-V6; possible elevations in I and aVL Lateral and apical - LCx

V1-V3 (ST depression) Posterior walla - “Dominant” vessel (RCA or LCx)

V4R Right ventriclea - Right coronary artery

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ECG Criteria for STEMI

Two or More Contiguous ECG Leads

ST-segment elevation

II, III, aVF ≥0.1 mVa at J-point for most leads

V1-V3 ≥0.15 mV for V2-V3 for women

V4-V6 ≥0.2 mV for V2-V3 for men ≥ 40 y

I, aVL ≥0.25 mV for V2-V3 for men <40 y

ST-segment depression (indicates true posterior wall MI)

V1-V3 ≥0.1 mV  (Often has tall R waves in V1-V3)

New LBBB  New finding or presumed new

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Reading

Rate, Rhythm (P before each QRS)

Axis

Intervals

P-R (120-200ms or 3-5 little boxes)

QRS < 120ms (3 little boxes)

Segments

QT (50-500ms or < .5 R-R 

Hypertrophy

P wave for atrial

R wave for ventricular

Infarction

Q waves

Inverted T

ST elevation/depression