ECG Revision Quiz

1
ECG Revision Quiz
Aaron Pennell MSc MBBS Student UEA, Norwich
2

• The 10 point system for reading an ECG
• Clinical state of the patient (vital signs,
  acute presentation, haemodynamic compromise etc)
• Rate (ventricular rate number of R waves in 10
  seconds X 6 or 300 number of large squares in
  between two Rs)
• Rhythm (is it a sinus rhythm p waves, atrial,
  junctional, ventricular, paced etc
• Regularity (check by equal distance between QRS)
• Axis (normal, LAD or RAD or extreme axis
  deviations)
• P waves (present / absent, normal size, P
  mitrale or P pulmonale)
• QRS Complex (Q waves, size ? Hypertrophy,
  width, signs of BBB etc)

3
Questions

• What is the axis Normal (both leads I and AVF
  are positive)
• Is it regular Yes
• What is the rhythm Sinus (regular P wave
  atrial control)
• Is the PR interval normal Yes (normal less than
  0.2 seconds 1 large square)

4
Questions

• What is the axis Normal
• What is the rhythm Sinus
• What are the changes seen in the shaded area ST
  segment elevation in V1-V5
• Where else should you look for changes Inferior
  reciprocal leads II, III and AVF ST depression
• What is the diagnosis Acute anterior MI

5
Questions

• What is the rhythm Atrial Fibrillation (no P
  waves, irregularly irregular)
• What QRS changes can you see Pathological Q
  waves in II, III and AVF
• Where and what is the likely problem Old inferior
  MI

6
Questions

• What is the axis Normal
• What is the rhythm Sinus
• Is there an MI No not on ECG evidence
• What other changes do you see Large QRS waves in
  V3 V5
• What do these changes represent LVH
• What are the criteria for diagnosis SV1 and RV5
  or RV6 gt35mm LVH

7
Questions

• What is the rhythm Sinus
• What is the axis Normal
• What is the abnormality where ST elevation
  II,III and AVF
• What other changes are there ST depression
  V2-V4 (reciprocal)
• What is the diagnosis Inferior MI
• What may happen to the T waves in a day or
  two They may invert

8
Questions

• What is the axis Left Axis deviation (ve lead I
  and ve AVF)
• What is the rhythm Sinus
• What is the abnormality prolonged PR interval
  (look at the bottom rhythm strip)
• What is the diagnosis First degree heart block

9
Questions

• What is the axis Left Wayward
• What do you note about the QRS Widened, step in
  terminal portion of R wave
• What are the relationship abnormalities P waves
  do not associate with QRS
• What is the diagnosis Complete heart block
• The P waves are indicated above and show no
  relation to the QRS complexes. They 'probe' every
  part of the ventricular cycle but are never
  conducted.

10
6 large squares width
Questions

• What is the rate (time given) 300 6 50 beats
  per minute (bradycardia)
• What is the rhythm Sinus
• What are the inferior lead abnormalities ST
  elevation in II, III and AVF
• What are the chest lead abnormalities Reciprocal
  changes in V2 V4
• What is the diagnosis Inferior MI with
  bradycardia

11
5 second strip
Questions

• What is the axis Normal
• What is the rate 10 beats in 5 seconds 20 in
  10 seconds X 6 120
• What is the rhythm Sinus
• What is the diagnosis Sinus tachycardia

12
Questions

• What is the axis Left / left wayward
• What is the rhythm Atrial Fibrillation
• There is a BBB is it left or right Left (W
  pattern in V1, M pattern in V6 WiLLiaM

13
Questions

• What is this characteristic sign
  called Sawtooth pattern
• What is the diagnosis Atrial Flutter
• What type of arrhythmia is this Atrial re-entry
  (about 300 in this case)

14
Questions

• What are the large waves highlighted
  yellow Premature Ventricular beats
• What can you say about the waves marked red Long
  QT interval (normal lt0.42 seconds corrected)
• What is the risk with this condition Ventricular
  tachyarrhythmisa Torsade De Pointes)

15
Questions

• What is the rhythm Ventricular
• What is the diagnosis Ventricular tachycardia
  (polymorphic)
• What has occurred in the shaded
  area Defibrillation (in this case an implanted
  one)

16
Questions

• What is the rhythm Ventricular Fibrillation
  (this is life threatening)
• What is the axis Does not matter
• What about the ST segment Does not matter
• What is the treatment Immediate defibrillation
• You MUST know this rhythm and how to treat it

17
Questions

• What abnormality is seen in the shaded area Delta
  wave
• What is the diagnosis Wolf Parkinson-White
  syndrome
• What are the other features of this
  condition Short PR interval broad QRS
  secondary ST and T
• wave changes

18
Questions

• What is the axis Normal / right wayward
• What is there to note about the T waves Tall,
  tented / peaked
• What may this represent Hyperkalaemia (high
  potassium)
• What would be the immediate treatment Calcium to
  protect the myocardium

19
Questions

• What is the axis LAD
• What is the rhythm Sinus tachycardia
• What acute changes are present ST elevation in
  II, III and AVF and ST depression in
• I and AVL (reciprocal change) also ST
  elevation in V1
• 4. What do these represent Acute inferior MI, ?
  Anterior ischemia or infarct
• 5. What other change can you see RBBB (bi
  fasicular block in this case)

20
Questions

• What is the rhythm Ventricular
• What is the diagnosis Ventricular tachycardia
  (VT)
• Where are the p waves Cannot be seen
• What is the treatment Depends on pulse
• Present amiodarone, syncronised
  cardioversion
• Absent defibrillation

21
Questions

• What is the axis LAD
• What is the rhythm Atrial Fibrillation
• What is the BBB RBBB

22
5 second strip
Questions

• What is the rate 22 beats in a ten second strip
  22 X 6 132 BPM
• What is the rhythm Supra ventricular
• Is the QRS broad or narrow Narrow, (this is how
  you know it is not ventricular)
• What is the diagnosis Supra ventricular
  tachycardia (SVT)

23
Questions

• What is the axis LAD
• What is the significance of the shaded
  parts Implanted pacemaker
• What is the rhythm Paced rhythm