Med Term 3 > ECGs > Flashcards

ECGs Flashcards

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1
Q

What is it showing?

A

coronary sinus rhythm

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2
Q

What is this ECG showing?

A

typical atrial flutter

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3
Q

A 67-year-old male presents to the emergency department with chest pain lasting for 30 minutes, associated with
nausea and vomiting. The chest pain is described as tight and radiates to the left shoulder and jaw. He has a history
of hypertension, diabetes, and hyperlipidemia. His troponin is positive.

What is the ECG showing and how do you know?

A

ST depression in leads V2, V3, V4, V5 and V6 as well as in leads I, II and aVL

globally inverted T waves = heart strain ?? ischaemia??

NSTEMI ??

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4
Q

Which ion is primarily responsible for the rapid depolarisation (phase 0) of the ventricular action potential?

A

sodium (Na+ influx via fast voltage-gated Na+ channels)

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5
Q

What ion movement mainly causes the plateau phase (phase 2)?

A

calcium influx through calcium channels - balanced by K+ efflux

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6
Q

Why does the plateau phase (phase 2) matter for cardiac function?

A

plateau phase prolongs depolarisation, allowing sustained Ca2+ entry, which couples electrical activity to contraction

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7
Q
A
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8
Q
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9
Q
A
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10
Q

At the level of the cardiac myocyte, what happens to the RMP in this abnormality?

What immediate management step protects the heart from arrhythmia?

A

severe hyperkalaemia - becomes less negative (depolarised closer to threshold)

IV calcium gluconate stabilises the cardiac membrane by restoring the threshold-RMP difference

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11
Q
A

lead I

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12
Q

Which leads are best to get the view of the heart’s inferior wall?

A

lead II
lead III
lead aVF

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13
Q

Which lead will you see a negative deflection when the impulse moves away from the right arm?

A

aVR

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14
Q

Which lead will you see electrical activity moving toward the left shoulder?

A

aVL

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15
Q

Which lead will you see the most upright P waves in sinus rhythm?

A

lead II

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16
Q

Which leads can you measure the heart’s main vertical axis (downward)?

A

leads II, III and aVF

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17
Q

Which lead is the QRS mostly negative because depolarisation moves away from this lead, but P waves are still visible?

A

aVR

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18
Q

What is this ECG showing?

A

RBBB

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19
Q

What is shown on the ECG?

A

SVT

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20
Q

What do ‘palpitations’ mean?

A
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21
Q

What are some possible causes of palpitations in a 19-year-old with no past medical history?

A
  • SVT
  • AF
  • anxiety
  • thyroid disease
  • electrolyte abnormalities or structural heart disease
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22
Q

What immediate observations and bedside tests would you perform in the ED if someone came with palpitations?

A
  • pulse
  • o2 sats
  • ECG
  • BM
  • U&Es
  • thyroid function tests if indicated
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23
Q

Interpret this patient’s ECG.

What is the underlying electrophysiological abnormality that causes this condition?

A
  • sinus rhythm
  • DELTA WAVE present in all leads
  • tall R wave in right-sided precordial leads

WOLFF-PARKINSON-WHITE (WPW) syndrome

an accessory conduction pathway (Bundle of Kent) that bypasses the AV node, leading to early ventricular activation

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24
Q

In WPW syndrome - why are patients more prone to tachy-arrhythmias?

Why is AF particularly dangerous in Wolff-Parkinson White syndrome?

A

the accessory pathway can form part of a re-entrant circuit, causing AVRT or can rapidly conduct atrial arrhythmias (like AF) to the ventricles

the accessory pathway can conduct atrial impulses very rapidly to the ventricles -> extremely fast ventricular rates -> risk of ventricular fibrillation and sudden death

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25
If a patient presents with a stable episode of narrow complex tachycardia at 180bpm, how would you manage acutely?
vagal manoeuvres first (valsava, carotid massage if no contra-indication) - if unsuccessful -> IV adenosine
26
What is the long-term curative treatment for WPW?
radiofrequency catheter ablation of the accessory pathway
27
What are the possible causes of sudden severe abdominal or back pain in this patient?
differentials diagnoses include renal colic, pancreatitis, perforated peptic ulcer, MI, abdominal aortic aneurysm, musculoskeletal back
28
You are working in the Emergency Department. A 74-year-old man is brought in by ambulance with sudden onset of severe abdominal pain radiating to his back. He feels faint and sweaty. He has a history of hypertension and smokes 20 cigarettes a day. 1. What risk factors in his history might point toward a vascular cause? 2. On arrival, his BP is 80/50, HR 120bpm, and he looks pale and clammy. What does this tell you? 3. What does the ECG suggest? 4. On examination, you feel a pulsatile abdominal mass. What diagnosis does this suggest?
1. hypertension and smokes 20 cigarettes a day 2. hypovolaemic shock 3. sinus tachycardia 4. AAA
29
What is the definition of a AAA? Why do aneurysms tend to form in the abdominal aorta? How is AAA screened for in the UK?
localised dilation of the abdominal aorta >3cm in diameter, usually due to degeneration of the vessel wall the abdominal aorta has less elastin than thoracic aorta and is subject to higher mechanical stress, especially at branch points one time abdominal USS offered to men at age 65
30
What would be the immediate management for a suspected ruptured AAA in this unstable patient? How are small and asymptomatic AAAs usually managed?
- regular USS surveillance - risk factor modification - elective repair is >5.5cm in men or rapidly expanding
31
What are the ECG features of normal sinus rhythm?
32
Where are P waves normally upright, where is it normally inverted - and why is this?
in lead I, II and inverted in aVF - because the atrial depolarisation vector (down and left) is moving toward those leads = positive deflection = upright P aVF - looks straight up from feet, atrial depolarisation is moving toward those leads = positive deflection aVR looking from opposite direction (right shoulder), atrial depolarisation wave is moving away from aVR = negative P
33
What happens to the P wave in right atrial enlargement?
34
What happens to the P wave in left atrial enlargement?
35
What is shown in the image (regarding the P wave)?
36
What is the ECG showing?
"M" in V1 + "W" in V6 = RBBB - appropriately discordant ST-segment and T-wave change
37
What is the ECG showing?
INFERIOR STEMI - STE in inferior leads II, II, aVF - reciprocal STD in lateral leads I, aVL, V6 signs of associated right ventricular infarction: - STE in III > II (lead III is more right-facing) - STE in V1-V2 (V1 = only lead that looks directly at RV) (RCA supplies both inferior wall of LV and RV, when inferior STEMI is seen - immediately wonder if the RV is involved)
38
What does this ECG show?
39
What is the ECG showing? What is the diagnosis?
40
70 year old patient presenting with chest pain, SOB and dizziness. BP 90/50, sats 83% on room air. What does the ECG show and what is the most likely diagnosis?
- sinus tachycardia: 100bpm - anterior T wave inversion in V1-V4 - inferior T wave inversion in III and aVF T wave inversion in right precordial leads V1-4 PLUS inferior leads = RIGHT VENTRICULAR STRAIN diagnosis: patient presenting with acute SOB + sinus tachy + RV strain = acute cor pulmonale due to PULMONARY EMBOLISM
41
Young male found collapsed at home, apparently intoxicated. What does the ECG show? What is your top diagnosis for this patient and a differential?
- giant T wave inversions in multiple leads, most prominent in V2-V6 - QT prolongation >600ms (about 15 small squares and normal range is 8-11) top diagnosis due to patient collapsing due to alcohol: ELECTROLYTE IMBALANCE and differential: raised ICP seen in the context massive intracranial haemorrhage so would need to rule that out
42
Middle aged patient presenting with central chest pain. Posterior leads V7-9. What does the ECG show?
- ST elevation in inferior leads II, III, aVF - ST elevation in lateral leads I, V5, V6 - ST elevation in posterior leads V7-V9 inferio-lateral STEMI with posterior wall infarction
43
A 62 years old female with a history of hypertension, diabetes comes to a cardiologist for three days of intermittent palpitations and SOB. What is the ECG showing? Explain why.
AV block 2:1 - every other P wave is not followed by a QRS complex - QRS complexes may be narrow or wide depending on the site of the AV block
44
59 year old male was admitted to ICU after a sudden collapse. What is the ECG showing?
torsades de pointes
45
48 years old female with a PMH of mitral valve replacement comes to the cardiologist for a check up. What does the ECG show?
left atrial enlargement
46
75 year old female presents with sudden long lasting chest pain. What is the ECG showing?
inferolateral STEMI
47
60 year old male comes to the ED with palpitations and SOB lasting 3 hours. What is the ECG showing?
AF
48
43 year old female with a history of migraines and was recently diagnosed with hypertension came to the doctor complaining about severe headache. What is the ECG showing?
subarachnoid haemorrhage
49
A 45-year-old patient is admitted to the cardiology department with infective endocarditis. During the examination of the patient's hands, the doctor identifies a collapsing pulse. What further finding might you expect to find in your examination?
diastolic murmur in the aortic area (collapsing pulse is a clinical sign typically indicative of aortic regurgitation, in aortic regurg, the aortic valve allows blood to follow back into the left ventricle when the heart relaxes i.e is in diastole - because this happens a murmur can be heard when auscultating the aortic area)
50
A collapsing pulse is clinical sign typically indicative of what? What would you find on auscultation?
aortic regurgitation - diastolic murmur in the aortic area
51
A 65-year-old man presents to the emergency department with sudden-onset chest pain radiating to his left arm. He describes the pain as “tight” and rates it 9/10 in intensity. His past medical history includes hypertension, stable angina, and type 2 diabetes mellitus. On examination, he is pale, diaphoretic, and tachycardic with a heart rate of 110 beats per minute and blood pressure of 110/60 mmHg. He is administered sublingual glyceryl trinitrate (GTN), and the patient reports a significant reduction in chest pain within minutes. What mechanism best explains the reduction in his symptoms?
nitrates cause a decrease in intracellular calcium leading to smooth muscle relaxation (GTN is converted to nitric oxide in vascular smooth muscle cells - stimulates guanylate cyclase to increase cyclic GMP -> decreases intracellular calcium levels and reduces smooth muscle contraction and causes vasodilation)
52
A 79-year-old man presents to the emergency department with central crushing chest pain that radiates into his left arm. The pain is associated with nausea and profuse sweating. You perform an ECG, which shows ST-segment elevation in leads II, III and aVF. You diagnose an inferior ST-elevation MI. Which coronary vessel is the major blood supply the base of the heart?
RCA
53
What does this ECG show?
anteroseptal STEMI
54
What does this ECG show?
AF
55
What does the ECG show?
hyperkalaemia
56
What does the ECG show?
first degree heart block - sinus bradycardia with 1st degree AV block - PR interval >300ms
57
What does the ECG show?
AV block 2nd degree: mobitz I - progressive prolongation of PR interval with a subsequent non-conducted P wave - repeating 5:4 conduction ratio of P waves to QRS complexes - relatively constant P-P interval despite irregularity of QRS complex
58
What does the ECG show?
complete heart block
59
What does the ECG show?
typical AVNRT
60
What is the most common cause of sustained arrhythmias in young healthy adults? What can this be triggered by? Who is it more common in? List 5 associated symptoms and explain the pathophysiology.
AV nodal re-entry tachycardia (AVNRT) exertion, caffeine, alcohol, beta-agonists or amphetamines more common in young women than men - sudden onset of rapid, regular palpitations - presyncope or syncope due to fall in BP - chest pain - SOB - anxiety short cycle length = rapid heart rate
61
What is the hallmark of AVNRT and why do you get this?
1. NO VISIBLE P WAVE - atrial and ventricular activation happens almost simultaneously because of the re-entry loop in the AV node - atria depolarises retrogradely (backs up in atria) at nearly the same time as the ventricle depolarises forward - P wave get buried inside QRS complex 2. PSEUDO R WAVES in V1 and V2 - retrograde atrial depolarisation sometimes pokes its head out just after QRS - in V1 and V2 this can look like a tiny extra upward flection - not a true R wave just the retrograde P wave sitting on top of the terminal QRS 3. NARROW COMPLEX TACHYCARDIA (see image)
62
What does the ECG show?
WPW (accessory pathway is used so pre-excitation of ventricular depolarisation occurs)
63
What does this ECG show?
hypokalaemia - widespread ST depression and T wave inversion - prominent U waves
64
What does this ECG show?
subarachnoid haemorrhage - widespread giant T wave inversion ("cerebral T waves") - prolonged QT
65
What is this ECG showing?
lateral STEMI
66
What is shown on this ECG?
LBBB - broad notched R waves are best appreciated in leads aVL and I - absence of Q waves in leads V5-V6
67
What is shown on the ECG?
LVH
68
What does the ECG show?
subendocardial ischaemia (NSTEMI if troponin high, unstable angina if trop is okay)
69
What is shown on the ECG?
TdP (PVT) secondary to hypokalaemia
70
What is shown on the ECG?
massive bilateral PE - sinus tachycardia (most common abnormality seen in 44% patients with PE) - RBBB (V1-V2 you can see an rSR type morphology - small r then deep S then tall second R = "M" pattern) - T-wave inversions in the right precordial leads (V1-V3) as well as lead III (right ventricular strain) (simultaneous T wave inversions in the inferior and right pre-cordial leads is the most specific finding in favour of PE)
71
What is shown on the ECG?
right atrial enlargement - cor pulmonale - P wave amplitude >2.5mm in leads II, III and aVF
72
What is shown on the ECG?
RBBB
73
What is shown on the ECG?
RVH
74
What is shown on the ECG?
anterior STEMI
75
What is shown on the ECG?
inferior STEMI
76
What is shown on the ECG?
lateral STEMI
77
What is shown on the rhythm strip?
VF
78
What is shown on the ECG?
ventricular bigeminy (PVC - ventricular ectopics) (bigeminy = every other beat is a PVC)
79
What is shown on the ECG?
monomorphic VT
80
What is shown on the ECG?
WPW
81
What is shown on the ECG?
anterior STEMI
82
What is shown on the ECG?
AF
83
What is shown on the ECG?
84
What is shown on the ECG?
1st degree AV block PR interval 260ms
85
What is shown on the ECG?
mobitz I AV block
86
What is shown on the ECG?
complete heart block
87
What is shown on the ECG?
AVNRT (slow fast)
88
What is shown on the ECG?
hypokalaemia
89
What is shown on the ECG?
90
What is shown on the ECG?
91
What is shown on the ECG?
LBBB
92
What is shown on the ECG?
LVH
93
What is shown on the ECG?
bilateral PE
94
What is shown on the ECG?
RBBB
95
What is shown on the ECG?
RVH
96
What is shown on the ECG?
anterolateral STEMI
97
What is shown on the ECG?
inferior STEMI
98
What is shown on the ECG?
VF
99
What is shown on the ECG?
monomorphic VT
100
What is shown on the ECG?
anterior STEMI ("tombstoning" pattern)
101
What is seen on the ECG?
AF
102
What is shown on the ECG?
hyperkalaemia
103
What is shown on the ECG?
AVNRT (uncommon)
104
What is shown on the ECG?
subarachnoid haemorrhage
105
What is shown on the ECG?
anterolateral STEMI
106
What is shown on the ECG?
LBBB
107
What is shown on the ECG?
results consistent with PE
108
What is shown on the ECG?
RBBB
109
What is shown on the ECG?
inferior STEMI
110
What is shown on the ECG?
monomorphic VT
111
What is shown on the ECG?
AF with rapid ventricular response
112
What is shown on the ECG?
hyperkalaemia
113
What is shown on the ECG?
inferolateral STEMI
114
What is shown on the ECG?
saddle embolus
115
What is shown on the ECG?
inferolateral STEMI
116
What is shown on the ECG?
hyperkalaemia
117
What is shown on the ECG?
Med Term 3
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