ECG

Question 1

LBBB Morphology

Answer 1

Broad S-waves in leads V1 and V2 and broad, frequently notched, R-wave in V5 and V6

Question 2

RBBB vs ischaemia - ST Changes

Answer 2

In RBBB, T wave inversions and ST segment depression are typically expected in leads V1-V3 (anterior chest leads).

Question 3

Posterior STEMI ECG Changes

Answer 3

1. ST-depression in the anterior leads, which may be deep (over 2 mm) and flat
2. Large and upright anterior T waves

Question 4

AVL ST elevation

Answer 4

ST elevation in lead aVL, especially when accompanied by ST depression in other leads, can indicate a critical Left Main Coronary Artery (LMCA) occlusion,

Question 5

T wave normal variant vs hyperacute/tented

Answer 5

Question 6

Hyperkalaemia ST Changes

Answer 6

V1 V2 ST elevation

Question 7

Brugada Syndrome ECG changes

Answer 7

Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave.

Question 8

Answer 8

Wellen’s Syndrome
Deeply inverted or biphasic T waves in leads V2-V3

critical proximal left anterior descending coronary artery stenosis

Question 9

Crochetage Sign

Answer 9

Notch near the apex of the R wave of inferior leads (II, III, aVF) seen in a large proportion of patients with an ostium secundum atrial septal defect (ASD), the most common form of ASD

Question 10

Indications for PPM

Answer 10

• Symptomatic Sinus node dysfunction (SND)
• Acquired AV blocks in adults- Advanced 2nd degree(Mobitz Type II) or 3rd degree heart block (symptomatic/asymptomatic).
• Chronic bifascicular block
• Persistent and symptomatic 2nd or 3rd degree AV block after STEMI.
  Symptomatic Hypersensitive carotid sinus syndrome and neurocardiogenic syncope
  Persistent inappropriate or symptomatic bradycardia not expected to resolve after cardiac transplantation
  Sustained pause dependent VT with or without QT prolongation.

Question 11

Sinus rhythm

Answer 11

P waves should be upright in leads I and II, inverted in aVR

Question 12

Bifasicular Block

Answer 12

RBBB with either LAD (indicating left anterior fascicular block) or RAD (indicating left posterior fascicular block).

Question 13

Lown-Ganong-Levine syndrome ECG changes

Answer 13

The hallmark ECG finding in LGL syndrome is a significantly shortened PR interval, typically less than 120 milliseconds (ms).

Lown-Ganong-Levine (LGL) syndrome is a rare cardiac conduction disorder characterized by an accessory pathway that bypasses the atrioventricular (AV) node and connects the atria and ventricles.