ACEM Fellowship Written 2026 > ECG > Flashcards

ECG Flashcards

(66 cards)

Study These Flashcards
1
Q

A nurse presents an ECG to you showing inferior ischaemia. What additional bedside investigation should you ask them for?

A

Right sided ECG

At minimum get a V4R lead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What % of new or possible new LBBB actually have ACS?

A

< 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

STE in III >II suggest what?

A

right sided infarction

Look for STE in V1. Is specific to proximal right coronary artery occlusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Posterior infarction may be isolated or in association with what other areas of infarction?

A

lateral or
inferior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

STE in aVR and V1 suggest ischaemia in what coronar vessel?

A

LAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the modified sgarbossa criteria?

A
  • > 1mm concordant STE
  • > 1mm concordant ST depression
  • > 5mm or > 25% discordant STE

Used for those with LBBB or paced ECG
Excessive concordant STE is the weakest predictor of infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the two types of wellen’s t waves and where do you see them?

A

Usualy V2, V3. May be seen in V4, occassionaly V5, V6
75% of pts with this finding have critical LAD stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why is it important to capture an ECG with a pt in pain and when pain resolves?

A

Show if ECG is dynamic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A pt has an inferior STEMI and also ST depression in V1 and V2. Is this reciprocal changes?

A

Get a posterior ECG to ensure STEMI not extending posteriorly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Are wellen T waves present during pain or when pain free

A

When pain free
Pain can actually makes them resolve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Wellen’s syndrome

A
  • episode of angina
  • typical T wave changes that come and go depending on pain state
  • no pathological Q waves
  • no loss of R waves
  • none or minimal STE
  • none or minimal troponin elevation

Without angina ECG may have Wellen’s sign but pt does not have Wellen’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are you looking for on a syncope ECG?

A

**The obvious **
- Ischaemia
- dysrythmia
- AV blocks
Intervalopathies
– Short PR (WPW)
– Long QTc
Genetic
–HCM
–Brugada
–ARVC (ACM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the DDx of TWIs?

A
  • CAD (ischaemia, Wellens, reperfusion)
  • elevated ICP
  • Pulmonary (PE, PTx, Pulm HTN, pneumonia, hyperventilation)
  • ARVC (V1-V3), Brugada (V1-V2)
  • wide QRS (BBB, PVC, paced, WPW)
  • LVH, RVH with “strain”
  • pericarditis, myocarditis
  • hyperkalaemia, hypokalaemia
  • mitraval valve prolapse
  • normal in V1, aVR & III
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the DDx of long QTc?

.

A
  • Hypo kalaemia
  • Hypo magnasaemia
  • Hypo calcaemia
  • Sodium channel blocking drugs
  • Elevated ICP
  • Congenital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is a QTc
- too short?
- too long?

A

< 350
> 480 though most likely to get issues if > 500

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the stanadard STEMI critieria (not the other less typical STEMIs)

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the STEMI criteria for a high lateral MI

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the STEMI criteria for a posterior MI?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the STEMI criteria for a right sided MI

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe De Winter T waves and what do about them?

A

Activate reperfusion pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the causes of a right axis deviation?

A
  • ventricular ectopy
  • Right ventricular hypertrophy
  • LPFB
  • Acute pulmonary HTN (e.g PE)
  • Old lateral MI
  • WPW (type A)
  • sodium channel blocking drugs
  • HyperK+
  • Misplaced leads
  • Dextrocardia, situs inversus
  • newborn/infants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

You diagnosed pt with a NSTEMI, they are awating admission then go into a VT arrest. You get ROSC after two shocks. The ECG goes back to looking the same with ischaemia but no STE. Do they need urgent reperfusion therapy?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe this ECG

A

globlal ischaemia. Correct hypotension, hypoxia, anaemia. Consider early reperfusion if ECG findings persistent despite management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

This picture shows a normal variant, hyperacute ischaemia and hyperkaelmia. Which is which?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
What ST segments are most concerning for ischaemia?
23
What are ECG feature of hypertrophic cardiomyopathy?
- LVH - Large septal Q waves - Bifid p wave (left atrial enlargement) - poor r wave progression ## Footnote Voltage critiera LVH (V1 S wave + R wave V5 or V6 > 35mm) LV strain pattern: ST depression + TWI lateral leads
24
What are ECG features of tamponade?
- low voltage criteria - electrical alternans
25
What is the differetial for inverted P waves in lead I?
- ectopic atrial rhythm - dextrocardia - limb lead reversal
26
Describe or draw an ECG of someone with Brugada syndrome
Type 1: Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave ## Footnote his ECG abnormality must be associated with one of the following clinical criteria to make the diagnosis: Documented ventricular fibrillation (VF) or polymorphic ventricular tachycardia (VT). Family history of sudden cardiac death at < 45 years old . Coved-type ECGs in family members. Inducibility of VT with programmed electrical stimulation . Syncope. Nocturnal agonal respiration.
27
What are instability indicators in a pt with a dysrythmia?
- HYPOTENSION --systolic BP < 90 - SYSTEMIC HYPOPERSION -- altered mentation - chest pain (coronary ischaemia) - dyspnoea (pulmonary oedema) - EXTREMELY RAPID VENTRICULAR RATE: > 220bpm
28
What are causes of AF/flutter with a slow ventricular rate?
Not common - sick sinus ( bad name as actually refers to disease in entire conduction system) - AV node blocking drugs esp. DIGOXIN
29
What are the three types of 2nd degee heart block
## Footnote Mobitz II is closer to III so is the bad one 2:1 you cannot tell if benign Mobitz 1 or sinister Mobitz 2
30
What are the three reasons a supraventricular tachycardia may appear wide?
- abberant conduction - venricular pre-excitation syndrome (e.g WPW) - toxic-metabolic donction (e.g hyperkalaemia)
31
What is the dose of adenosine for SVT?
6 mg IV rapid push, repeat at 12mg
32
How do you dose IV propranolol?
1-3mg IV over 1 minute. Repeat ever 2-5 minute up to 5mg
33
How quickly can you give 10 mmol magnesium for torsades that has now self terminated?
2 minutes then infusion another 10 mmol over 1 hour
34
A pt is in an AVRT with known WPW. What features suggest an antidromic
Wide complex because impulse is travelling through ventricle accessory pathway first then through AV ## Footnote Only 5% of those with WPW Do not give AV blocking drug e.g adenosine. Can precipitate cardiac arrest DC cardiovert
35
You have a stable young pt in SVT. Adenosine at max dose has failed. What othe ultrashort acting AV nodal blocking drug can you use?
Esmolol 250 - 500mcg/kg IV over 1 minute
36
What are the possible rhythms for irrgular wide complex tachycardia?
- polymorphic VT - AF with abberant conduction
37
What are the differentials for regular wide complex tachycardia?
- VT - Antidromic AVRT - SVT with abberant conduction
38
What are the differntials for a narrow complex irregular tachycardia?
- Atrial fibrillation - Multifocal artial tachycardia (MAT) - Atrial flutter with variable block
39
What are the differentials for a narow complex regular tachycardia?
- sinus tachycardia - atrial tachycadia (single but ectopic atral pacemaker) - Orthodromic AVRT - AVnRT - Junctional tachycardia - Atrial flutter
40
How do you treat AF in a pt known to have WPW?
Cardioversion
41
When might you see non-conducted P wave that is not due to a 2nd degree or 3rd degree heart block?
Premature atrial contraction that arrive at the AV not during refractory period ## Footnote Benign
42
What is the treatment of somone with frequent PVCs?
Exclude new ischaemia, check electrolytes, treat hypoxia, exclude toxins ## Footnote Are both normal occurance but due occur more frequently with underlying coronary artery disease. If getting triplets or runs of VT increases risk of sudden death however attempts to suppress with medications doesn't improve mortality If no new AMI, then not urgent If new AMI, increasing burden of PVCs can herald arrhythmia If burden > 15-20% of heart beat, over years can cause cardiomyopathy
43
What conditions can cause a junction/accelerated junction/junctional tachyardia?
- increased vagal tone - heart failure - sick sinus syndrome - hypothyroidism - myocarditis - hypokalaemia - digitalis/beta blocker/ Ca2+ blocker toxicity - acute rheumatic fever - myocardial ischaemia ## Footnote Check TFTs, trop, electrolytes
44
You have lysed a pt for a STEMI, they have now gone into broad complex rhyth, HR 110bpm, they are slighlty lightheaded BP 95 systolic. What should you do?
Sit on your hands This is a reperfusion rhythm If you supress the rhythm with amiodarone the next one will be asystole Usually short lived. If they are symptomatic (as this is slighlty) you can pace externally but this is rarely needed
45
Atrial fibrillation is usually age related and due to ischaemic heart disease or valvular disease but what are some other causes (all are reversible)
- myocarditis - alcohol binge (holiday heart) - thyrotoxicosis - blunt chest trauma
46
You have a 50 year old pt who has gone into new AF for duration 1-2 days. They hav a hx of T2DM and heart failure. Is it safe to cardiovert them
No With diabeites or heart faiulre, even if < 48 hours risk of thromboemboic even 10%! ## Footnote Working out their CHADsVASC can help
47
Who is a candidat for rhythm control of asymptomatic AF in the ED?
youngish (age < 65) and healthy Onset < 48 hours ago If have co-morbidities, increaes failure and complication rate Most new AF will self-revert with 24 - 48 hr. Shared decision making with pt ## Footnote If urget cardioversion for unstable pt, give anticoagulation immediately before or after Could get GP to refer after 4 weeks of anticoagulation for elective cardioversion if pt chooses to go home. May be more treatment resistent then though.
48
You diagnose well pt with new AF and want to send them home. You are wondering if they need anticoagulation. What are the components of the CHADSVASC score and how do you interpret it?
- CCF - HTN - Age > 75 - Diabetes mellitus - Stroke, TIA, thromboembolis - Vascular disease (CAD, PAD) - Age 65 - 74 - Sex (female) ## Footnote Score 0 to1 low risk for thromboembolism 2 + should be on anticoagulation
49
How many joules to cardiovert atrial fibrillation?
150 to 200J
50
What does multifocal artial tachycardia (MAT) often get confused with?
Atrial fibrillation ## Footnote MAT is irregularly irregular but look closely and you should see at least 3 different P waves that are conducted. PR interval will not be consistent. Treat underlying causing Anti-arrhtymics or cadioversion have no effect
51
2nd degree heart block Mobitz 1 (wenckeback) if often a benign normal variant that is transient. However what other more sinister conditions can cause it?
- Myocardial ischaeia (esp. inferior) - medication toxicity - myocarditis - after cardiac surgery ## Footnote Given block at level of node, if symptomatic should response to atropine however caution in myocardial ischaemia, atropine will increase myocardial demand. Consider half dose.`
52
Is a 2nd degree HB mobitz II reversible?
Generally no. It implied damage (possible permament) t the conducting system ## Footnote Broad complex more sinister than narrow complex. Both may progress unpredictable to third degree heart block
53
Why is it inadvisable to try rate or rhythm control AF due to acute illness e.g hypoxia, sepsis, PE
Unlikely to work Treatment may cause side effects Best to treat the underlying cause
54
What are the most likely causes of ventricular tachycardia?
- Chronic ischaemic heart disease - Acute myocardial infarction Less commonly - cardiomyopathy - valvular heart disease - inherited channelopathies - drug toxicities
55
What are three treatment options for recurrent bursts of torsades de pointes?
- magnesium - transcutaneous pacing - isoprenaline infusion ## Footnote magnesium may also be helpful for other types of polymorphic VT
56
What is the Brugada criteria for VT? | There are four points
1) Absence of RS complex in ALL precordial leads 2) Start of R to nadir of S > 100 ms (2.5 small squares) in any precordial lead 3) AV dissociation 4) Typical VT morphology seen in V1 to V6 ## Footnote VT diagnosed if any one criteria is present
57
Describe one typical VT morphology for a RBB appearing VT and a LBB appearing VT
58
The Pava critiera for diagnosing VT is quite simple, it just looks for one factor. What is it?
59
What generally caueses VF?
Ischaemic heart disease (chronic or acute AMI) ## Footnote Less common: direct stimulation of heart, instruments, electrocution, direct blunt trauma (commotio cordis)
60
What clues are there on an ECG that a pt in AF with RVR has an underlying accessory pathway e.g WPW?
extremely rapid rate > 200bpm the AV node cannot conduct at this rate ## Footnote cardiovert pt. AV blocking drugs will favour atrial stimuli going down the accessory pathway and precipitate VF
61
Can a pt with treated WPW tachyarrhythmia go home?
Mostly. GP can refer to cardiology. If associated with AF DW cardiology ## Footnote If AV nodal recentry tachycardia (paroxysmal SVT), ie no accessory pathway. Only need to see cardiology if frequent or debilitating or dangerous episodes
62
What is the type 2 pattern of brugada?
- ST segment elevation, saddle shaped - trough in ST segment at least 1mm deep - positive or biphasic TW ## Footnote type 2 is not diagnostic but should be referred to cardiologist for further evaluation
63
What class/type of drugs mus be avoid in pts with brugada syndrome?
Sodium channel blocking drugs www.brugadadrugs.org ## Footnote educate pt to treat fevers pt needs ICD
ACEM Fellowship Written 2026
flashcards
Decks in class (65)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions