ECG Interpretation Basics
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Questions and Answers

Which ECG finding is commonly associated with hyperkalaemia?

  • Shortened QT interval
  • Flat T waves
  • Tented T waves (correct)
  • Absent QRS complex

What is the primary cause of stable angina?

  • Coronary artery disease (correct)
  • Valvular heart disease
  • Hypertension
  • Coronary artery spasm

In hypokalaemia, which of the following ECG changes is expected?

  • Elevated ST segment
  • Shortened PR interval
  • Absent QRS complex
  • Long PR interval (correct)

Which class of angina occurs at rest?

<p>Unstable angina (D)</p> Signup and view all the answers

Which artery supplies the sinoatrial node in 60% of individuals?

<p>Right coronary artery (B)</p> Signup and view all the answers

What does a sine wave pattern on an ECG suggest?

<p>Hyperkalaemia (A)</p> Signup and view all the answers

Which class of angina includes symptoms upon mild exertion?

<p>Class III (B)</p> Signup and view all the answers

Which finding is NOT typically associated with hypokalaemia on an ECG?

<p>Tented T waves (D)</p> Signup and view all the answers

What is the expected ST segment change during a vasospastic angina episode?

<p>ST elevation (D)</p> Signup and view all the answers

Which of the following describes the symptoms of Class IV angina?

<p>Symptoms only during rest (C)</p> Signup and view all the answers

Which of the following conditions does NOT typically cause a rise in troponin levels?

<p>Unstable angina (B)</p> Signup and view all the answers

What is the normal range for a PR interval in ECG readings?

<p>0.12-0.20 seconds (D)</p> Signup and view all the answers

Which condition is indicated by a peaked P wave?

<p>Mitral stenosis (A), Pulmonary hypertension (D)</p> Signup and view all the answers

What is the recommended time frame for arrival to ECG in suspected acute coronary syndrome?

<p>10 minutes (A)</p> Signup and view all the answers

What does a prolonged QRS complex indicate?

<p>Bundle branch block (D)</p> Signup and view all the answers

What does the 'M' in the treatment ‘MONAC’ stand for?

<p>Morphine (A)</p> Signup and view all the answers

What complication can arise between 3 to 14 days following an acute coronary event?

<p>Ventricular septal rupture (D)</p> Signup and view all the answers

Which of the following is indicative of a left axis deviation?

<p>I positive and II negative (D)</p> Signup and view all the answers

Which of the following is associated with new left bundle branch block (LBBB) in the context of acute coronary syndromes?

<p>Myocardial infarction (D)</p> Signup and view all the answers

Which condition could cause a shortened QT interval?

<p>Hypercalcaemia (B)</p> Signup and view all the answers

What is a common characteristic of atrial fibrillation on an ECG?

<p>Absent P waves (B)</p> Signup and view all the answers

Which statement regarding cardiac complications in the first 24 hours following ACS is correct?

<p>Cardiac arrest due to VF is possible. (A)</p> Signup and view all the answers

A J wave on an ECG typically indicates:

<p>Hypothermia (C)</p> Signup and view all the answers

Which is NOT a common cause of persistent ST elevation on ECG following an ACS?

<p>Severe hypertension (A)</p> Signup and view all the answers

What characteristic of Wolff-Parkinson White syndrome is significant?

<p>Accessory pathway between atria and ventricles (D)</p> Signup and view all the answers

Which drug class is associated with QT interval prolongation?

<p>Antimicrobials (C)</p> Signup and view all the answers

An inverted T wave may indicate which of the following?

<p>Acute myocardial infarction (A), Digoxin effect (C)</p> Signup and view all the answers

What should be used for treatment if a patient is hypoxic in acute coronary syndrome?

<p>Oxygen (A)</p> Signup and view all the answers

Which of the following would be considered an irregularly irregular rhythm?

<p>Atrial fibrillation (C)</p> Signup and view all the answers

Which of the following is indicative of high risk in acute coronary syndrome management?

<p>Coronary angiography likely needed (C)</p> Signup and view all the answers

Flashcards

PR Interval

The time between the start of the P wave and the start of the QRS complex. It represents the time taken for electrical impulse to travel from the atria to the ventricles.

Q Wave

The first part of the ventricular depolarization. It can appear as a downward deflection (negative) or an upward deflection (positive). It's typically present after an MI but can also be a normal variant.

QRS Duration

The duration of the QRS complex reflects the time it takes for the ventricles to depolarize. A prolonged QRS suggests a delay in ventricular activation.

ST Segment Elevation

The elevation of the ST segment is a classic sign of an MI (STEMI). It can also indicate other conditions like pericarditis or vasospastic angina.

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T Wave Inversion

The T wave represents ventricular repolarization. An abnormal T wave inversion may indicate a variety of cardiac issues.

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QT Interval

The time between the start of the QRS complex and the end of the T wave. A prolonged QT interval can be associated with various conditions, including electrolyte abnormalities, medications, and hypothermia.

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Irregularly Irregular Rhythm

A heart rhythm that is irregularly irregular, meaning the intervals between beats are not consistent.

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Wolff-Parkinson-White Syndrome

An ECG pattern with a characteristic 'delta' wave, indicating that electrical impulses are traveling through an abnormal pathway., which can lead to faster heart rates.

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Atrial Fibrillation

A high-frequency electrical activity in the atria, which does not result in coordinated contraction. It can be categorized as irregular or regular.

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Bradycardia

An abnormally slow heart rate (less than 60 beats per minute). It can be caused by a variety of factors.

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Hyperkalaemia ECG pattern

An electrocardiogram (ECG) pattern characterized by tall, tented T waves; a prolonged QRS complex; absent P waves; and a 'sine wave' pattern.

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Hypokalaemia ECG pattern

An ECG pattern associated with hypokalemia. It demonstrates a flattened or inverted T wave, a prolonged QT interval, a prolonged PR interval, and U waves.

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ECG Chest Lead Placement

The electrocardiogram (ECG) lead placement on the chest, where V1, V2, V3, V4, V5 and V6 are placed across the anterior, lateral and septal regions of the heart.

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SAN Blood Supply

The sinoatrial node (SAN) is the primary pacemaker of the heart and is primarily supplied by the right coronary artery (RCA) in 60% of people.

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AVN Blood Supply

The atrioventricular node (AVN) is a vital part of the electrical conduction system of the heart and receives its blood supply primarily from the right coronary artery (RCA).

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Angina

A condition characterized by chest pain or discomfort caused by insufficient oxygen supply to the heart muscle, typically due to coronary artery disease. It can be stable, unstable or vasospastic.

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Stable Angina

A type of angina that occurs with exertion or stress, and is relieved by rest or Nitroglycerin within 5 minutes.

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Unstable Angina

A type of angina that occurs at rest or with minimal exertion, or represents a sudden worsening of stable angina. It is considered a medical emergency.

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Vasospastic Angina

A rare type of angina caused by spasms of the coronary arteries, often occurring at rest. It is characterized by ST elevation on the ECG.

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Canadian Cardiovascular Society Angina Grading

A classification system for angina based on the severity and frequency of symptoms. Class I - sx on strenuous exertion, Class II - sx on moderate exertion, Class III - sx on mild exertion, Class IV - sx at rest.

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STEMI

A type of acute coronary syndrome (ACS) characterized by a complete blockage of a coronary artery, leading to a heart attack. ECG shows ST elevation in two or more contiguous leads.

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NSTEMI

A type of acute coronary syndrome (ACS) where there is a partial blockage of a coronary artery, leading to a range of symptoms. ECG shows ST depression or T wave inversion without ST elevation.

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Morphine

A medication used in the treatment of acute coronary syndromes (ACS) to relieve chest pain.

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Metoclopramide

A medication used in the treatment of acute coronary syndromes (ACS) to prevent nausea and vomiting.

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Acute Heart Failure

A complication of acute coronary syndromes (ACS) that occurs when the heart muscle weakens and cannot pump blood effectively. This can lead to shortness of breath, fatigue, and swelling.

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Cardiogenic Shock

A complication of acute coronary syndromes (ACS) that occurs when the heart muscle is severely damaged and the blood pressure drops significantly. This is a life-threatening condition.

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Tachycardia

A complication of acute coronary syndromes (ACS) that occurs when the heart rate is significantly faster than normal.

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Regular Narrow Complex Tachycardia

A type of tachycardia where the heart rate is regular and the EKG shows a narrow QRS complex.

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AVRT

A type of tachycardia caused by an abnormal electrical pathway between the atria and ventricles. This pathway can bypass the normal conduction system.

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Study Notes

ECG

  • Rate: Number of large squares between consecutive R waves
  • Rhythm: Regular or irregular. Sinus arrhythmia, atrial flutter or fibrillation, 2nd degree heart block.
  • Axis: I positive, II positive is normal. I positive and II negative is left axis deviation. I negative, III (± II) positive is returning.
  • P wave: Precedes QRS complex, upright in II, III, and aVF, inverted in aVR. Absent in atrial fibrillation, present in hyperkalemia.
  • PR interval: 3-5 small squares (0.12-0.2s). Shortened with faster AV conduction (Wolff-Parkinson-White syndrome) and prolonged with slower AV conduction (1st degree heart block, hypokalemia).
  • QRS complex: < 3 small squares (<0.2s). Shortened with supraventricular origin, prolonged with ventricular origin or aberrant conduction of supraventricular complexes (bundle branch block, hyperkalemia).
  • Pathological Q waves: Within few days of MI.
  • QT interval: Shortened with hypercalcemia, prolonged with hypokalemia, hypocalcemia, hypothermia, and anti-arrhythmics.
  • ST segment: Isoelectric. Elevated (normal variant, high take-off), STEMI, vasospastic/variant/Prinzmetal angina, acute pericarditis (saddle-shaped). Depressed (normal variant, upward sloping), NSTEMI, posterior MI (V1-V3), unstable angina, digoxin effect.
  • T wave: Inverted in aVR, sometimes aVL, III, V1, V2, V3. Abnormal if inverted in I, II, aVF, V4-6. Peaked with hyperkalemia, TCA overdose, or within hours of MI. Flattened with hypokalemia, hypocalcemia, or within hours of MI.
  • Other waves: J wave with hypothermia, U wave with hypokalemia. Delta wave in WPW syndrome.
  • Hyperkalemia: Tall, tented T waves, prolonged QRS complex, absent P waves.
  • Hypokalaemia: "In hypokalaemia U have no Pot and no Tea, but a long PR and a long QT”.

Other

  • SAN: Sinoatrial node (RCA 60%, circumflex 40%)
  • AVN: Atrioventricular node (RCA 80%, circumflex 20%)
  • Angina: Constrictive chest discomfort, insufficient blood supply to the heart, relieved by rest or GTN. Stable angina occurs with exertion/stress. Unstable angina occurs at rest, or abruptly deteriorates.
  • Vasospastic angina: Spasm.
  • Acute Coronary Syndromes (ACS): STEMI and NSTEMI have troponin rise due to myocardial cell death. Unstable angina does not.
  • ST elevation, T wave inversion: Classically hyperacute T waves; then ST elevation, T wave inversion, then pathological Q waves.
  • NSTEMI and unstable angina: GRACE score. If low risk, fondaparinux. If high risk, glycoprotein IIb/IIIa and UH.
  • Complications of ACS: Cardiac arrest, AV block, acute heart failure, cardiogenic shock, pericarditis.
  • Tachycardia: Stable and Irregular. Regular narrow complex tachycardia (sinus tachycardia, AVRT, Wolf-Parkinson White). Irregular narrow complex tachycardia (sinus arrhythmia, atrial fibrillation, atrial flutter).
  • Bradycardia: Sinus, 1st, 2nd degree (Mobitz I and II), 3rd degree AV block.
  • Heart Failure: Left sided or Right sided with NYHA functional classification (I, II, III. IV).
  • Valvular Heart Disease: Mitral regurgitation, mitral stenosis (rheumatic fever), aortic stenosis, aortic regurgitation.
  • Congenital Heart Disease: Atrial septal defect (ASD), Ventricular septal defect (VSD), Patent ductus arteriosus (PDA), Tetralogy of Fallot (TOF), Transposition of the great arteries.
  • Pericarditis: Sharp chest pain (worse lying flat, better sitting), fever, pericardial rub. Diagnosed by ECG.
  • Infective Endocarditis: Fever + new murmur = infective endocarditis until proven otherwise.
  • Rheumatic fever: Strep pyogenes, acute pharyngitis. (Jones Criteria).
  • Hypertrophic obstructive cardiomyopathy: LV hypertrophy, leads to decreased compliance and decreased CO.
  • Pacemakers: Transcutaneous (temporary) or Transvenous (permanent) pacing. Defibrillation.
  • Antiarrhythmics
  • Antiplatelets
  • Thrombolytics

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Description

This quiz covers essential concepts in ECG interpretation, including heart rate calculation, rhythm abnormalities, and normal axis alignment. It also explores the significance of various components of the ECG trace, such as P waves, PR intervals, and QRS complexes. Understand key pathological indicators for improved clinical assessment.

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