4.1 Medicine Cardiovascular Ecg

Front 1

Which is not a typical finding on ECG for Hypertrophic cardiomyopathy (HOCM).
A. Peaked P waves of Left atrial enlargement
B. Pathological Q waves in the lateral leads.
C. Deep T inversions in the precordial / lateral leads
D. High precordial voltages.

Back 1

A. Left atrial enlargement = broad, bifid P waves .

Peaked P waves = Right atrial enlargement

Front 2

Which is not a typical ECG finding for Arrhthymogenic Right Ventricular Cardiomyopathy (ARVC) ?
A. Flipped T waves
B. Epsilon waves
C. QRS prolongation > 0.11 in the precordial and lateral leads.
D. Prolonged S-wave upstroke in V1-3

Back 2

C. QRS prolongation is localised to V1-V3

Front 3

Which of the 3 Sgarbossa Crtieria has the most specificity associated with it ?

Back 3

Concordant ST Elevation > 1mm in leads with a positive QRS complex.

Front 4

In regards to Benign Early depolarisation (BER), which of the following is not a main feature ?
A. J point elevation.
B. T wave is peaked and symmetrical
C. ST segment and the ascending limb of T wave form an upward concavity ( not convex upward)
D. The descending limb of the T wave is straighter and steeper than the ascending limb.

Back 4

B. T wave is peaked and * Assymetrical *

Front 5

List the Ischaemic STEMI equivalents that are found on ECG that are not of the classical variety ( 5).

Back 5

1. Posterior MI
2. Left main occlusion ( STE aVR + inferolateral ST depression)
3. Wellens Syndrome
4. deWinter ST/T wave complex
5. LBBB -Sgarbossa criteria

Front 6

List the causes of ST Elevation on the ECG that are non-ischaemic.

Back 6

1. Benign Early Repolarisation (BER)
2. Acute myopericarditis
3. Left ventricular aneurysm
4. Brugada Syndrome (V1-V3)
5. Cardiomyopathy
6. Hyperkalaemia
7. Subarachnoid Haemorrhage
8. Bundle Branch Block
9. Pacemaker
10. Pre-excitation
11. Normal variant

Front 7

What are the ECG criteria for reperfusion in AMI ?

Back 7

1. ST segment elevation > 1mm in 2/more contiguous LIMB LEADS
2. ST segment elevation > 2mm in 2 / more contiguous CHEST LEADS

Front 8

Which Prolonged QT Syndrome is associated with deafness ?

Back 8

Jervell-Lange-Nielsen Syndrome.

Front 9

What are the ECG features for Hypokalemia with K+ < 2.7 mmol / L ?

Back 9

1. P wave - peaking
2. PR interval -prolonged **
3. ST depression
4. T wave flattening
5. U waves
6. QT prolongation

plus : Arrhythmias - SVT / Torsades / VT / VF

Front 10

What are the ECG features of Hyperkalaemia with K+ > 5.5 mmol / L ?

Back 10

1. P wave - loss of
2. PR interval - prolonged **
3. QRS widening
4. T waves tall and peaked
5. Sine wave
6. ventricular arrhythmias
7. Asystole.

Front 11

In regards to the QT nomogram, at what uncorrected QT interval of 500 msec does the heart rate have to be to have an increased likelihood of arrhythmia ?

Back 11

less than 60 bpm.

Front 12

What is Bazett's Formula for the corrected QT interval ?

Back 12

QT (milliSeconds) / Square root RR interval (seconds )

Male = 450 msec ( 0.45 sec)
Female = 470 msec.

Front 13

What is the length of 1 small square on the ECG ?

Back 13

40 msec ( 0.04 sec)

Front 14

What is the length of 1 large square on the ECG ?

Back 14

200 msec ( 0.2 sec)

Front 15

What is the normal speed of the paper for the 12 lead ECG ?

Back 15

25 mm/sec.

Front 16

List the ECG features of Hypothermia .

Back 16

1. Tremor artefact
2. Prolongation of intervals :
a. PR
b. QRS
c. QT
3. Bradycardias
a. Junctional
b. AF (slow)
4. Osborne Waves - J waves
"positive deflection in the terminal portion of the QRS + elevation of the J point"
5. Premature Ventricular beats (PVB)
6. Ventricular arrhythmias ( VT / VF )
7. Asystole

Front 17

Which is incorrect regarding Osborn J waves in Hypothermia?
A. They can occur in a single lead only, but tend to be seen in the precordial + lateral leads.
B. They tend to occur at temperatures < 30 degrees.
C. As the temperature drops below 30 degrees, Osborn waves increase in amplitude.
D. They are a " positive deflection in the terminal portion of the QRS".

Back 17

B. Temperature < 32 degrees.

Front 18

What are the ECG features that increase the likelihood of a rapid wide complex tachycardia being VT rather than SVT with aberrancy ? ( 9 )

Back 18

1. Wide complex tachycardia
- > 160 msec
- HR 140-200 bpm
2. Extreme axis deviation
( "Northwest axis " ; + QRS in aVR and negative in I and
aVF)
3. AV dissociation (25%)
4. Capture beats
5. Fusion beats "hybrid complex"
6. Concordance ( + or - in precordial leads )
7. Brugada's sign
( > 100msec distance from QRS onset to nadir of S wave )
8. Josephson's Sign
( notching near nadir if S wave in V1V2 )
9. RSR complex has taller left R wave ( Rsr)

Front 19

In regards to comparing benign early depolarisation (BER) with myopericarditis, what is the name of the ratio, and what does the ratio correspond to when viewing the ECG ?

Back 19

The ST / T wave ratio in V6
( or precordial leads)

If ST / T wave ratio is > 0.25 = Pericarditis

Front 20

Which of the 4 ECG stages of pericarditis has the most prominently recognised ECG findings?

Back 20

Stage I :

1. Diffuse ST elevation
2. PR depression
3. Spodick's sign

Front 21

What conditions cause prominent P wave changes ?

Back 21

Hypokalaemia : peaked P wave

Hyperkalaemia : Flat P wave

Front 22

What of the following conditions does not cause PR interval lengthening ?
A. Hypothermia
B. Hypocalcaemia
C. Hypokalaemia
D. Hyperkalaemia

Back 22

B. Hypocalcaemia

Front 23

Which Environmental / Electrolyte / drug-induced conditions does not cause QRS widening ?
A. Hypothermia
B. Hyperkalaemia
C. Hypomagnesaemia
D. Hypercalcaemia

Back 23

D.

Front 24

Which Conditions / drugs / electrolytes does not cause QT interval shortening ?
A. Hyperkalaemia
B. Hypokalaemia
C. Hypercalcaemia
D. Digoxin effect

Back 24

B.

Front 25

Which conditions / drugs / electrolytes does not cause QT interval prolongation ?
A. Hypocalcaemia
B. Hyperkalaemia
C. Hypokalaemia
D. Hypothermia and Hyperthermia

Back 25

B.

Front 26

What are the differentials for ST elevation in aVR ? (5)

Back 26

1. Left main coronary occlusion
2. Ventricular tachycardia (VT)
3. Hyperkalaemia
4. Na+ channel blockade
5. Lead placement **

Front 27

What are the ECG features of Hypercalcaemia ?

Back 27

ST segment depression
ST segment shortening
T wave widening
QT interval shortening

"The 3 B's" :
Bradyarrhythmias
Bundle Branch Blocks (BBB)
Block (CHB)

Front 28

List the 7 main categories of causation of a Prolonged QT interval.

Back 28

1. Electrolytes
2. Endocrine
3. Environmental
4. Drugs / Toxins
5. Cardiovascular disease
6. Cerebrovascular disease
7. Hereditary

Front 29

List the electrolyte causes of a Prolonged QT interval.

Back 29

1. Hypokalaemia
2. Hypomagnesaemia
3. Hypocalcaemia

Front 30

List the Endocrine and Environmental causes of a Prolonged QT interval .

Back 30

Endocrine
1. Hypothyroidism

Environmental
1. Hypothermia

Front 31

List the 6 drug / toxin categories that cause a prolonged QT interval.

Back 31

1. Antiarrhythmics ( Ia ; Ic ; III )
2. Antidepressants ( venlafaxine ; TCA )
3. Antipsychotics ( Haloperidol ; quetiapine )
4. Antihistamines (loratidine)
5. Antibiotics ( Flouroquinolones ; erythromycin )
6. Antimalarials ( Chloroquine ; quinine )