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50 Cards in this Set
- Front
- Back
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Chest leads: how many?
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v1-v6
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Where does V1 go?
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Right sternal edge, 4th ICS
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Where does V2 go?
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Left sternal edge, 4th ICS
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Where does V3 go?
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Between V2 and V4
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Where does V4 go?
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On the apex beat (e.g. 5th ICS, midclavicular line)
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Where does V5 go?
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Between V4 and V6
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Where does V6 go?
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5th ICS, mid-axillary line
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How do you calculate the rate?
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A) look at the rhythm strip and 6x number of QRS complexes B) 300 divided by number of big squares between 2 QRS complexes
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How do you know if rhythm is sinus?
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P -> QRS -> T
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As you breathe in, HR
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increases
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Left axis deviation: what leads are +ve/-ve?
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1+, 2-, 3- (left is leaving)
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Right axis deviation: what leads are +ve/-ve?
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1-, 2+, 3+ (right is reaching)
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P wave is positive in which leads and best seen in which leads?
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Positive in I and II. Best seen in II and V1
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The height of a P wave should be less than:
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2.5 small squares
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An enlarged P wave =>
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RA enlargement (P pulmonale)
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A bifid P wave =>
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LA enlargement caused by e.g. mitral valve disease (P Mitrally)
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PR interval is normally
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0.12 to 0.20 seconds
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A short PR interval =>
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abnormal accessory pathway or catecholamines
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A prolonged PR interval =>
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AV block
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QRS amplitude is normally
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<35mm combined (R<27mm and S<30mm individually)
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Is a Q wave always present?
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no
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What is R wave progression?
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transitional zone is usually between v3 and v4 (where QRS goes from negative to positive). A poor transitional zone suggests bad LV function
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Low amplitude QRS may be masked by
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obesity
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The duration of QRS is normally
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<120ms
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What are the three causes of broad complex QRS?
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LBB, RBB, ventricular rhythm
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LBBB: where would you see an RSR complex?
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V6 (wiLLiaM marrow)
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LBBB: where would you see an inverted T wave?
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V5 and V6
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What are the causes of LBBB?
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MI, HTN, cardiomyopathy, post-cardiac surgery, age->conduction system fibrosis
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RBBB: where would you see an RSR complex?
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V1 and V2
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RBBB: Where would you see an inverted T wave?
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V1 to V3
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RBBB: Where would you see a deep S wave?
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V6
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What are the causes of RBBB?
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normal variant, cor pulmonale, MI, CHD
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ST segment should lie
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on the isoelectric line
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Causes of ST elevation:
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STEMI, acute periarditis, subarachonoid haemorrhage, Brugada syndrome (cause of sudden death)
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Causes of ST depression:
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NSTEMI, digoxin (reverse tick), hypokalaemia, BBB
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What if there is ST elevation and depression?
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Elevation trumps depression (depression may be just elevation from the other side)
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When is ST elevation significant?
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>2mm in 2 consecutive chest leads (or >1mm in limb lead)
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If there is ST elevation in >1 territory, what is this conistent with? What else would you see?
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pericarditis. You would also see scoop shape and PR segment depression
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ST depression seen in V1-V3 (very abrupt/horizontal) suggests
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posterior MI
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Inferior territory of the heart is supplied by:
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right coronary artery (leads II, III, aVF)
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Anterior territory of the heart is supplied by:
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left anterior descending coronary artery (leads V1 to V4)
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Lateral territory of the heart is supplied by:
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lef circumflex coronary artery (leads I, aVL, V5, V6)
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QT interval is normally
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0.35 to 0.45 seconds (depends on heart rate) Look at corrected QT on strip
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T wave inversion are normal on
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aVR, III, V1.
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T wave inversion can be a sign of
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ischaemia, Wellen's syndrome (LAD stenosis/occlusion), LV hypertrophy, CNS disorder
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U waves are
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an extra bump after T. Seen in athletes? QT interval cannot be calculated. Hypokalaemia or hypercalaemia
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What are two causes of irregularly irregular beats?
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VF and AF
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Atrial flutter atrial rate is usually
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300/minute -> ventricular rate = 75/minute if 4:1 AV conduction
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What medicine blocks AV node to reset rhythm?
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adenosine
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What are the different degree heart blocks?
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1st; 2nd (Mobitz 1/W and 2); 3rd (complete)
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