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MD3001 - Cardiology Clinical > ECG Interpretation > Flashcards

ECG Interpretation Flashcards

1
Q

What is important when idetifying an ECG?

A

Confirm the patients name and age along with the ECG date

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2
Q

What is the standardisation of an ECG?

A
  • 1cm = 1mV
  • Paper speed = 25mm/sec
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3
Q

How is the rate of an ECG calculated?

A

300 divided by the number of big squares per R-R interval

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4
Q

What ECG lead is used to calculate the rate?

A

Lead II

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5
Q

What is normal rate?

A

60-100bpm

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6
Q

Bradycardia

A

<60 bpm

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7
Q

Tachycardia

A

>100 bpm

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8
Q

What does an ECG record?

A

electrical impulses start and how they flow through the heart.

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9
Q

Where does the elctrical activity of the heart start?

A

“internal pacemaker” called the sinoatrial node

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10
Q

What is normal rhythm referred to as?

A

sinus rhythm

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11
Q

What is conduction?

A

The way electrical impulses floe through the heart

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12
Q

When should you take an ECG?

A
  • Chest pain
  • Palpitations
  • breathlessness
  • dizziness
  • an episode of synocope (blackout)
  • unexplained fall
  • Stroke
  • TIA
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13
Q

What plane do the chest leads look at the heart from?

A

horizontal

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14
Q

What plane do the 6 limb leads look at the heart from?

A

vertical

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15
Q

What is sinus rhythm?

A
  • Normal P waves (2.5 boxes)
  • Normal QRS complex (3 boxes)
  • One P wave followed by one QRS complex
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16
Q

How do you check if rhythm is regular?

A

Mark position of 3 successive R waves.

Slide the mark forward and check that intervals are equal

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17
Q

Characteristics of Atrial Fibrillation

A
  • No discernible P waves
  • Irregular QRS complex
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18
Q

Charactertistics of Atrial Flutter

A
  • P waves can be seen at a rate of 300bpm, giving a saw-toothed appearance
  • 4 P waves per QRS complex
  • Ventricular activation is regular
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19
Q

Characteristics of Nodal Rhythm

A
  • Normal QRS complex
  • P waves are absent
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20
Q

Another name for nodal rhythm

A

Junctional Tachycardia

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21
Q

Characteristics of Ventricular Rhythm

A
  • two sinus beats and the rate increases to 150bpm
  • QRS complex becomes broad and T waves are difficult to identify
  • Final beat shows a return to sinus rhythm
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22
Q

What does the P wave represent?

A

Atrial depolarisation

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23
Q

In what leads in the P wave upright?

A
  • II
  • III
  • AVF
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24
Q

In what conditions are P waves absent?

A
  • Atrial fibrillation
  • Nodal (junctional) rhythm
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25
Q

What is the maximum height of a P wave?

A

2.5 boxes

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26
Q

What occurs in abnormal P wave; P-Mitrale

A

2 P waves per QRS complex

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27
Q

What causes a bifid P wave?

A

left atrial hypertrophy

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28
Q

What occurs in abnormal P waves; P-Pulmonale

A

P wave is too tall

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29
Q

What causes a peaked P wave?

A

Right atrial hypertrophy

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30
Q

What is the P-R interval

A

Bgeining of P wave to the beginning of Q wave

31
Q

What is the normal range of the PR interval?

A

120-200ms (3-5 boxes)

32
Q

What does the PR interval represent

A

time between atrial and ventricular depolarisation

33
Q

What does a prolonged PR interval imply?

(>0.2s)

A

delayed AV conduction

34
Q

What is defined as the QRS complex?

A

Beginning of Q to the end of S wave

35
Q

What is the normal duration of the QRS complex?

A

0.12s (3 boxes)

36
Q

What is the normal length and depth of a Q wave?

A

length = 0.4s

depth = <2mm

37
Q

What condition(s) are suggested if the QRS complex is 120ms?

A
  • Ventricular conduction defects
    • Bundle branch block: left and right
38
Q

What condition(s) are likely in a low voltage <5mm QRS complex?

A
  • Hypothyroidism
  • Chronic obstructuve airway disease
  • myocarditis
  • pericarditis and pericardial effusion
39
Q

What are the main features of Left Ventricular Hypertrophy

A
  • R wave in V5 >25mm
  • Sum of S in V1 and R wave in V5 or V6 >35mm
    • Sokolow-Lyon index

**V5 must not be >25mm

40
Q

What are the main features of right ventricular hypertrophy?

A
  • Dominant R wave in V1
  • T wave inversion in V1-V3 or V4
  • Deep S wave in V6
41
Q

What is a singificant Q wave?

A
  • >40ms (wider than 1 box)
  • Depth >2m
42
Q

When is a significant Q wave present?

A
  • Present couple of hours/day after acute MI
  • If present in lead III consider PE
43
Q

Where is the QT interval measured?

A

From the start of the QRS compelx to the end of the T wave

44
Q

QTc =

A

QT

/RR

45
Q

What are the causes of a prolonged QT interval?

A
  • Acute myocardial iscaemia
  • Myocarditis
  • Bradycardia
  • Head injury
  • Hypothermia
  • U&E imbalance
  • Congenital
  • Drugs
46
Q

What is the ST segment?

A

Time from the end of ventricular depolarisation to the start of ventricular repolarisation

47
Q

What marks the ST segment?

A

From the end of the QRS complex to the start of the T wave

48
Q

What is an abnormal ST segemnt

A
  • Elevation >2mm in 2 adjacent chest leads

OR

  • Elevation >1mm in 2 adjacent limb leads
49
Q

What does elevation of the ST segment usually indicate?

A

INFARCTION

50
Q

Is the ST segment isoelectric?

A

Yes

51
Q

What does the T wave represent?

A

Ventricular repolarisation

52
Q

In what leads is the T wave normally inverted?

A

aVR, V1 and V2 in the young

53
Q

Where it it abnormal for a T wave to be inverted?

A

I, II and V4-V6

54
Q

What does inversion of a T wave indicate?

A

Ischaemia or infarction

55
Q

What effect does digoxin have on the T wave?

A
  • T wave inversion
  • ST segment sloping depression
56
Q

Between what axis is the heart normal?

A

-30 - +90

57
Q

In what leads are upward deflections present in normal axis

A

I, II and III

58
Q

What occurs in left axis deviation and what condition does this indicate?

A

Negative QRS deflection in II and II

LV hypertrophy and MI

59
Q

What occurs in right axis deviation and what conditions does this indicate?

A

Negative QRS deflection in lead I

RV hypertrophy, PE and MI

60
Q

What 3 changes occur in an ECG during an MI?

A
  • T wave peaking following T wave inversion
  • ST segment elevation
  • Appearance of new Q waves
61
Q

What develops in the ECG during a STEMI

A
  1. St elevation
  2. Q wave abnormal, R shortened, T inversion
  3. ST resolved
  4. T reverts, Abnormak Q persists
62
Q

Where can an anterior infract be located?

A

Any of the percordial leads (V1-V6)

63
Q

Where can a lateral infarct be located?

A

Leads I, AVL, V5 and V6

64
Q

Where can an inferior infarct be located?

A

Leads II, III, AVF

65
Q

Where can a posterior infract be located?

A

Reciprocal changes in lead V1 (ST depression, tall T wave)

66
Q

Features of an anterior infarction

A
  • Sinus rhythm
  • Q waves in leads V2-V4
  • Inverted T waves in leads V4-V6
67
Q

Features of an antero-lateral infarct

A
  • Sinus rhythm
  • Q waves in leads I, II, AVL, V3-V5
  • Rasied ST segments in leads V2-V6
68
Q

Features of an inferior infarction

A
  • Sinus rhythm
  • Q waves in leads III and AVF
  • Depressed ST segments on leads AVL and V6
69
Q

Features of a PE on an ECG

A
  • LArge S wave in lead I
  • Deep Q wave in lead III
  • Inverted T wave in lead III
70
Q

Hyperkalaemia

A

Tall, tented T wave, widened QRS

71
Q

Hypokalaemia

A

Small T waves, prominant U waves

72
Q

Hypercalcaemia

A

Short QT interval

73
Q

Hypocalcaemia

A

Long QT interval, small T waves

MD3001 - Cardiology Clinical (4 decks)

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