12.12.18 ECG teaching

The key thing

    • ECGs are useless without a good HISTORY

      • TAKE A HISTORY!!

      • Make sure you don't thrombolyse someone with pericarditis

Regular rhythm

    • R-R constant

    • P waves before each QRS

    • P-R constant

Atrial flutter types

    • Regular

    • Variable block

P wave abnormalities

    • Should be 3 x 2.5 squares

    • P pulmonale

      • From pulmonary HTN

    • P mitrale

      • From mitral stenosis

      • Can flip into AF and therefore won't be seen!


    • Most common cause of 1st degree block

      • Beta blockers, CCBs

    • Most common cause of long QT

Aortic stenosis

    • Bulky ventricles, long systole => Ischaemia

    • Gradually decreasing exercise tolerance

Locations + vessels

    • LAD

      • Septal - V1, V2

      • Anterior - V3, V4

    • Circumflex

      • Lateral - V5, V6, I, AVL

    • Right

      • Inferior - II, III, AVF


    • Diffuse saddle-shaped ST elevation

      • Pattern does not sensibly correspond to arteries

    • PR depression

    • Pain relieved by leaning forwards

    • History of viral illness

    • They'll tamponade if you thrombolyse them!

      • Give NSAIDs


    • V4R sometimes useful for right heart stuff

    • Physiological sinus arrhythmia from deep breathing

    • WPW is not dangerous in itself - only when palpitations occur for some other reason

      • As they all get transmitted

    • New-onset BBB is a criteria for MI

    • Look at the vessels affected and see if it can possibly be an MI, or is it more likely pericarditis

    • Pathological Q is >2 mm

    • Posterior MI => Big R waves in V1, V2 due to unopposed vector

    • QT should be approximately less than 2 large squares