ECG

Question 1

outline the artery territories and what position they supply

Answer 1

• Left coronary artery
  
  • ANTEROLATERAL
• Right coronary artery
  
  • INFERIOR
• Circumflex
  
  • LATERAL
• LAD
  
  • ANTERIOR/SEPTAL

Question 2

what does each artery supply

Answer 2

• RCA
  
  • RA
  • RV
  • inferior aspect of LV
  • posterior septal area
• Circumflex
  
  • left atrium
  • posterior aspect of LV
• LAD
  
  • anterior aspect of LV
  • anterior aspect of septum

Question 3

outline ECG territories

• lateral
• anterior
• inferior
• septal

Answer 3

• Lateral
  
  • aVL, I, V5, V6
• Anterior
  
  • V4, V3
• Septal
  
  • V1, V2
• Inferior
  
  • II,III, aVF

Question 4

what is a normal axis?

Answer 4

both I and II +ve

Question 5

how is left axis deviation seen?

Answer 5

I +ve and II -ve

Question 6

how is right axis deviation seen?

Answer 6

I -ve and II +ve

Question 7

what does left axis deviation indicate?

Answer 7

• inferior MI
• LVH

Question 8

what does Right axis deviation indicate?

Answer 8

• anterolateral MI
• RVH, PE

Question 9

summary table of artery, heart area it supplies and ECG leads

Answer 9

Question 10

outline ECG changes in RBBB

Answer 10

MaRRooN

• M shape in V1
• N shape in V6
  
  • N=Normal QRS, just a bit wider

(rSR= small rise, big drop, and even bigger rise)

Question 11

outline ECG changes in LBBB

Answer 11

ViLLhelM

• V shape in V1
• M shape in V6

Question 12

outline the waves in the JVP and what they signify

Answer 12

• a wave= atrial systole
• c wave= tricupsid valve closing
• v wave= passive atrial filling

Question 13

in what instance would you have a raised JVP?

Answer 13

• RHF
• fluid overload
• SVC obstruction
• pericardial tamponade
• constrictive pericarditis

Question 14

in what pathology would large JVP A waves be seen?

Answer 14

• PHT
• Tricuspid stenosis
• Pul stenosis

Question 15

when would JVP a waves be absent?

Answer 15

AFib

Question 16

in what pathology would you see large JVP V waves?

Answer 16

tricuspid regurgitation

Question 17

in what pathologies would you see cannon A waves on JVP

Answer 17

• complete heart block
• certain arrythmias

Question 18

causes of LBBB

Answer 18

• IHD
• LVH
• Aortic valve disease
• Cardiomyopathy
• Myocarditis

Question 19

causes of RBBB

Answer 19

• normal variant
• RVH/RV strain
• IHD
• Myocarditis
• congenital heart disease

Question 20

what is bundle branch block?

Answer 20

delay or blockage along the pathway that electrical impulses travel to make heart beat

Question 21

ECG findings in RVH

Answer 21

• right axis deviation
• +ve right wave in V1

Question 22

causes of a low voltage ECG? ie small complexes

Answer 22

• COPD
• hypothyroidism
• pericardial effusion
• dextrocardia
• cardiomyopathy

Question 23

causes of ST depression?

Answer 23

• NSTEMI
• Digoxin

Question 24

causes of ST elevation?

Answer 24

• MI
• Pericarditis
• Hyperkalaemia
• Prinzmental’s angina
• LV aneurysm
• takotsubo cardiomyopathy
• normal variant - high take off

Question 25

causes of T wave inversion?

Answer 25

* Ischaemia * Digoxin * PE * Ventricular hypertrophy * Cardiomyopathy

Question 26

mnemonic to read ecg

Answer 26

ARI BAR TIME CAN'T WAIT IN A STEMI Any electrical activity? Rate? Irregular or regular rhythm? Broad QRS? Any P waves? Relationship between P waves and QRS T/Q waves Cardiac axis (LAD/RAD) Wave morphology (P waves + QRS wave- LBBB/RBBB?) ST segment / PR interval / QT interval

Question 27

Causes of PR interval lenghtening

Answer 27

Heart Block

Question 28

Causes of PR interval shortening?

Answer 28

* HOCM * Accessory condiction ie WPW

Question 29

Normal PR interval?

Answer 29

120-200ms

Question 30

Normal QT interval?

Answer 30

380-420 ms

Question 31

Causes of QT lengthening?

Answer 31

**T**oxins - TCA - Anti-arrhythmics (amiodarone, quinidine) - Anti-histamine - Macrolides **I**schaemia / Inherited conditions **M**yocarditis **M**itral valve prolapse **E**lectrolytes: ↓ Mg, Ca, K, reduced temp

Question 32

Causes of QT shortening? (\<380ms)

Answer 32

* Digoxin * B-Blockers * Phenytoin

Question 33

in which leads are inverted T waves an abnormal finding?

Answer 33

I, II and V4-6