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Sem. B - ECG > Rhythms > Flashcards

Flashcards in Rhythms Deck (26)
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1

Cardiac Conduction

2

Leads

  • Anterior - V1 - V4
  • Lateral  - I / aVL / V5 / V6
  • Inferior - II / III / aVF

3

Normal Sinus Rhythm

Must meet these criteria:

  • Regular
  • Rate 60-100 bpm
  • PR interval is normal & constant
  • A P wave precedes each QRS complex
  • QRS width <120msecs

4

Inferior MI

  • ST elevation eq/gr 1mm Lead II / III / aVF
  • Progressive development of Q waves in leads II / III / aVF
  • Reciprocal ST depression in aVL (+/- lead I)

5

Inferior MI - Right Ventricular (RVMI)

  • If elevation in II / III / aVF then check V4R - look for elevation >0.5mm
  • If elevated in V4R and hypotensive give fluid bolus (250ml) to improve preload/improve cardiac output
  • If RVMI confirmed then avoid repeat GTN

6

Left Main (Widow Maker)

  • ST depression eq/gr 1mm in 6 or more leads
  • coupled with ST elevation in aVR and/or V1
  • Suggestive of multi-vessel ischaemia or LMS insufficiency

7

ST depression / T wave inversion in aVL

  • Can be reciprocal changes to an impending inferior MI
  • Get serial ECG's

8

Sinus Bradycardia

  • Regular
  • Rate <60 bpm
  • Popping P waves
  • Each P followed by a QRS
  • PR normal & constant

9

Sinus Tachycardia

  • Regular
  • Rate >100 bpm <150 bpm
  • Popping P waves
  • Each P followed by QRS
  • PR normal & constant

10

Atrial Fibrilation

  • Irregularly irregular
  • No POPPING P waves
  • Rate may be slow, normal or fast
  • QRS usually normal

 

High Risk of Stroke, anticoagulation therapy is commonly used.

11

Atrial Flutter

SA node signal blocked, so fired around atria:

  • Usually regular
  • No POPPING P waves
  • FLutter (F) waves - saw tooth appearance
  • Atrial rate around 300 bpm
  • Relationship between atrial & ventricles is expressed as a ratio
  • If the block is constant - rhythm regular
  • Varying block - Rhythm irregular

12

Atrial Ectopics

  • Originates from a focus in the atria
  • Usually P wave is abnormal in shape - NOT POPPING!
  • Usually normal QRS
  • Followed by compensatory pause

13

Ventricular Ectopic Origin Points

14

Sinus Rhythm with Multifocal Ventricular Ectopics

Sinus Rhythm with Multifocal Ventricular Ectopics

  • Rhythm irregular
  • PR interval normal
  • QRS normal
  • Excitable myocardium - increased risk of ventricular arrythmias

15

Sinus Rhythm with Unifocal Ventricular Ectopics

Sinus Rhythm with Unifocal Ventricular Ectopics

  • Rhythm regular
  • PR interval normal
  • QRS normal
  • If associated with an MI - increases mortality
  • Usually benign

16

Sinus Rhythm with R on T Ectopics

Sinus Rhythm with R on T Ectopics

  • Regular rhythm
  • PR interval normal
  • QRS normal
  • May precipitate a fatal arrythmia (usually VF)
  • If >10  per minute concern should be greater

17

Ventricular Tachycardia

18

Narrow Complex Tachycardia

Narrow Complex Tachycardia

  • Rate >100 (usually >150 bpm)
  • Regular
  • QRS normal - narrow (<120msecs)
  • Absence of P waves

19

Left Axis Deviation

Left Axis Deviation

  • Leads I & aVL are +
  • Leads II, III & aVF are -

20

Right Axis Deviation

Right Axis Deviation

  • Leads I & aVL are -
  • Leads II, III & aVF are +

21

Brugada

Brugada

RBBB

+

V1/2 has cone shaped elevation extending into inverted T wave

22

Wolf Parkinson White (WPW)

Wolf Parkinson White (WPW)

  • Slurred upstroke of QRS (delta wave)
  • Short PR interval

23

Hypertrophic Cardiomyopathy

Hypertrophic Cardiomyopathy

  • Deep Q waves in lateral (V5/6,I,aVL) & inferior (II,III,aVF)
  • Tall QRS
  • Inverted T waves

24

High Risk ACS

T wave inversion

or

ST depression

(any 2 leads)

+

PT looks unwell AND has ACS pain

 

25

Sudden Cardiac Death

Sudden Cardiac Death

Long QT

- Male >440

- Female > 460

Polarisation abnormality leads to VT

(Worry when QTc exceeds >500msecs)

26

Posterior MI

Posterior MI

  • ST depression & tall, broad R waves in V1-V3
  • Dominant R wave in V2
  • Upright T waves
  • Remove leads V5 & V6 and re-site below left scapula
  • This is now posterior ECG - V5 & V6 have now become V7 & V8
  • >1mm ST elevation in both V7 & V8 + pain & symptoms is confirmation to treat as STEMI