ECG

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Questions and Answers

What is the intrinsic firing rate of the Sinoatrial Node (SA)?

20 - 40 bpm

60 - 80 bpm

80 - 110 bpm (correct)

40 - 60 bpm

What does the T Wave represent in an ECG?

Ventricular Depolarization

Delay at AV Node

Atrial Depolarization

Ventricular Repolarization (correct)

Which of the following intervals is considered normal for the P-R Interval?

0.35 to 0.44 sec

0.06 to 0.11 sec

0.05 to 0.15 sec

0.12 to 0.20 sec (correct)

What is the primary feature of Dextrocardia?

The heart is located on the right side of the chest Signup and view all the answers

How many small squares are equal to one large square on an ECG?

5 small squares Signup and view all the answers

What is the normal heart rate range for Normal Sinus Rhythm?

60-100 bpm Signup and view all the answers

Which characteristic is NOT true for Atrial Fibrillation?

Presence of organized P waves Signup and view all the answers

What defines 1st Degree AV Block in terms of the PR Interval?

Prolonged >0.20 sec Signup and view all the answers

In which condition is the P:QRS Ratio not equal to 1:1?

Atrial Fibrillation Signup and view all the answers

What characterizes a unifocal PVC?

Identical PVCs from a single ectopic focus Signup and view all the answers

Which of these conditions typically shows a regular rhythm with a heart rate greater than 100 bpm?

Sinus Tachycardia Signup and view all the answers

Which type of PVC occurs every third beat?

Trigeminy Signup and view all the answers

Which of the following describes the P:QRS ratio in PVCs?

No P waves Signup and view all the answers

What indicates a variable PR Interval in 2nd Degree AV Block Type 1?

Variable durations with grouping Signup and view all the answers

Which feature distinguishes Wolff-Parkinson White syndrome?

Shortened PR Interval Signup and view all the answers

What is a possible consequence of reperfusion after a heart attack?

Reperfusion arrhythmias Signup and view all the answers

Which arrhythmia is considered the most common after reperfusion?

Atrial fibrillation Signup and view all the answers

What defines the characteristic features of Sinus Pause?

P waves present except during pauses Signup and view all the answers

How does the QRS width in PVCs typically present?

<blockquote> 0.12 sec, atypical </blockquote> Signup and view all the answers

What type of heart rhythm results from sinus bradycardia?

Slow heart rhythm Signup and view all the answers

During which condition does the electrical signal controlling the heartbeat become blocked?

Atrioventricular block Signup and view all the answers

What is the reason for the faster heart rate observed in neonatal patients?

Noncompliant heart relying on heart rate for cardiac output Signup and view all the answers

At what age does the left ventricle to right ventricle (LV to RV) ratio reach adult proportions?

By 1-2 months of age Signup and view all the answers

How does the QT interval change with age in pediatric patients?

QT interval increases as heart rate decreases with age Signup and view all the answers

What happens to the PR interval in pediatric patients from neonatal to adult age?

It lengthens from approximately 100 ms to 160 ms Signup and view all the answers

Why are neonatal voltages typically smaller on an ECG?

They utilize a different scale to optimize ECG display Signup and view all the answers

What characteristic of pediatric hearts affects the electrical impulse timing?

Smaller heart size leads to faster impulse travel Signup and view all the answers

Which physiological change allows the pediatric heart rate to decrease with age?

Development of more compliant heart muscles Signup and view all the answers

What is the normal sinus heart rate for a child who is 10 years old?

90 bpm Signup and view all the answers

What is characterized by a regular rhythm, a rate of 100-120 bpm, and dissociated atrial rate?

Ventricular Tachycardia (Picket Fence) Signup and view all the answers

What is the distinguishing feature of Torsade De Pointes compared to other arrhythmias?

Grouping sinusoidal pattern Signup and view all the answers

Which of the following conditions is associated with chaos in rhythm and indistinguishable QRS complexes?

Ventricular Fibrillation (Coarse) Signup and view all the answers

Which condition is characterized by a rate of 20-40 bpm and a regular rhythm with wide QRS?

Idioventricular Signup and view all the answers

Which medication is NOT typically associated with the development of Long Q T Syndrome?

Statins Signup and view all the answers

Which statement is true regarding the characteristics of a Right Bundle Branch Block?

Presence of Rabbit Ears in V1 Signup and view all the answers

What genetic condition is characterized by mutations in the cardiac sodium channel gene?

Brugada Syndrome Signup and view all the answers

Which of the following conditions is characterized by an absence of P Waves and a chaotic rhythm?

Ventricular Fibrillation (Medium) Signup and view all the answers

Study Notes

ECG Masterclass

Learning Outcomes: Overview of the heart, electrical conduction system, lead placement, lead views, how to read an ECG, 32 ECG arrhythmias.
The Heart: Detailed anatomical structure and components including arteries such as the aorta, pulmonary artery, and coronary arteries, as well as veins like the superior vena cava. Includes the atria, ventricles, valves (e.g., mitral, tricuspid), and the conduction system components.
Electrical Conduction System: Includes components and their intrinsic firing rates. Sinoatrial (SA) node (80-110 bpm), Atrioventricular (AV) node (40-60 bpm), Purkinje fibers (20-40 bpm).
Lead Placement: Specific anatomical locations for V1-V6.
- V1: 4th intercostal space to the right of the sternum.
- V2: 4th intercostal space to the left of the sternum.
- V3: Directly between V2 and V4.
- V4: 4th intercostal space at the left midclavicular line.
- V5: 5th intercostal space at the midclavicular line.
- V6: Level with V5 at the left anterior axillary line.
Lead Placement (Dextrocardia): Heart on the right, needs treatment only if other heart problems/genetic issues occur. The leads are reversed in such cases.
Limb Lead Placement: Placement on the limbs, symmetrically. Right arm (RA), Left arm (LA), Right leg (RL), Left leg (LL).
Einthoven's Triangle: Describes the arrangement of limb leads for recording the electrical activity of the heart.
Polarity: Used to describe if an electrical event is approaching or distancing from the electrode leads (proximity to the recording source affects what signal is measured).
ECG Beat Components: P wave (atrial depolarization), PR segment (delay at AV node), QRS complex (ventricular depolarization), T wave (ventricular repolarization), Isoelectric line (no electrical activity).
ECG Printer: Includes intervals like P-R (0.12 to 0.20 sec), Q-T (0.35 to 0.44 sec), S-T (0.05 to 0.15 sec), QRS (0.06 to 0.11 sec). Explains the measurement of time using squares on an ECG trace (1 small square = 0.04 seconds, 1 large square = 0.2 seconds).
Steps for Reading an ECG: Questions to consider when analyzing an ECG, including presence of P waves, PR intervals, QRS complex, T waves, ST intervals, rate, and rhythm.
Normal Sinus Rhythm: 60-100 beats per minute, Regularity, Present P wave, P:QRS ratio 1:1, Normal PR interval, Normal QRS width. Also includes other sinus rhythms like Sinus Tachycardia (rate > 100bpm), Bradycardia (< 60bpm), Sinus Pause (heart temporarily stops).
Arrhythmias: Various types of arrhythmias, including Sinus Tachycardia, Sinus Bradycardia, 1st Degree AV block, 2nd Degree AV blocks (Type 1 & Type 2), and 3rd Degree AV block, Atrial fibrillation, Ventricular fibrillation, Ventricular tachycardia, Idioventricular Rhythm and Asystole. Each arrhythmia includes its associated rate, regularity, P wave, PR interval, QRS width, along with details about any diagnostic features or abnormalities in the specified rhythm.
Long QT Syndrome: Genetically related, prolonged QT interval, common symptoms are sudden blackouts, seizures or palpitations, prolonged episodes can lead to Torsades de-Pointes.
Brugada Syndrome: Cardiac sodium channel gene mutation, often referred to as a sodium channelopathy, different mutations, spontaneous mutations, familial clustering.
PVCs (Premature Ventricular Contractions): Unifocal, Multifocal, Bigeminy, Trigeminy, Quadrigeminy, Couplet. Defining features of each.
ST Depression and Elevation: The location of ST depression on the ECG, causes.
Areas of Infarction: Locations for different types of heart attacks (anterior, inferior, lateral), indicating which leads specifically would be utilized for detecting them.
MI (Myocardial Infarction) Evolution: Sequence of changes on ECG in a non-reperfused heart attack, from initial peaked T waves, to development of Q waves, T-wave inversions, and eventual normalization.
Reperfusion Arrhythmias: Cardiac dysrhythmias linked to reperfusion events post heart attacks.
Paediatric ECG Differences: Heart rate variations across different age groups, differing QT intervals, and reduced voltages in children compared to adults.

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