ECG QUIZ

1. What is a common cause of right axis

deviation?

. Right ventricular hypertrophy

. Atrial septal defect

. Left ventricular hypertrophy

. Ventricular septal defect

. Question 1 Explanation:
. In right ventricular hypertrophy the increased
muscle mass of the right ventricle causes
increased signal on the ECG. As a result the axis
of the heart is shifted to the right with lead III
becoming more positive and lead I & II becoming
less positive.
 2. If ST-elevation was seen in leads II, III &
aVF what would it suggest?

A septal myocardial infarction

An inferior myocardial infarction

An anterior myocardial infarction

A posterior myocardial infarction

Question 2 Explanation:
Leads II, III & aVF all look at the heart in the
inferior plane. Therefore ST-elevation in only
these leads suggests that the inferior portion of
the heart has had an infarction.
3. Which artery is most likely to be affected if
ST elevation in seen in leads V3 & V4?

Left circumflex coronary artery

Left anterior descending coronary artery

Right coronary artery

All of the above

Question 3 Explanation:
Leads V3 & V4 view the heart anteriorly. Therefore
ST elevation in these leads suggests an anterior
infarct. The anterior portion of the heart is
supplied mainly by the left anterior descending
artery therefore this is most likely to have been
affected.
 4. What is the common cause of left axis
deviation?

Right ventricular hypertrophy

Defects of the conduction system

Atrial septal defects

Left ventricular hypertrophy

Question 4 Explanation:
Left axis deviation is rarely the result of left
ventricular hypertrophy and more often due to
defects in the conduction system of the heart.
5. The absence of P-waves and an irregular rhythm
would suggest a diagnosis of.....

2nd degree heart block

Ventricular tachycardia

Atrial fibrillation

1st degree heart block

Question 10 Explanation:
In atrial fibrillation the atria no longer conduct
electricity from the SA in an orderly fashion. Therefore
P-waves are lost and often show a characteristic
'sawtooth' pattern. As a result of disordered atrial
activity only occasional waves of depolarisation pass
through to the AV node and cause ventricular
activation. This causes the typical irregular rhythm.
6. If there were 3 large squares in an R-R
interval what would the heart rate be?

90 bpm
70 bpm

100 bpm

80 bpm

Question 6 Explanation:

To calculate heart rate from an ECG you; - Count

the number of large squares in an RR-interval -
Divide 300 by this number Therefore 300/3 = 100
bpm
7. What is the duration of a normal PR-
interval?

0.12 - 2.0 seconds (3-5 small squares)

0.04 - 0.08 seconds (1-2 small squares)

0.04 - 0.12 seconds (1-3 small squares)

0.08 -0.12 seconds (2-3 small squares)

Question 7 Explanation:
n normal individuals the PR-interval is between
0.12-2.0 seconds. A PR interval longer than this
can suggest the presence of heart block and a
short PR-interval can suggest an accessory
pathway between the atria & ventricles
 8. What is often the earliest ECG change
seen during myocardial infarction?
Tall peaked T-waves

ST-elevation

ST-depression

Tall P-waves

Question 8 Explanation:

Tall peaked T-waves can suggest a number of

abnormalities. If seen in all leads then they

usually suggest the individual has
hyperkalaemia. However if tall T waves are seen
in a particular group of leads it suggests early
MI. The tall T waves are due to potassium
leaking through the damaged membrane over the
infarcted area
9. What is the normal duration of a QRS
complex?

0.04 seconds (1 small square)

0.12 seconds (3 small squares)

0.16 seconds (4 small squares)

0.08 seconds (2 small squares)

Question 9 Explanation:

In most healthy individuals you would expect

QRS complexes to be around 0.12 seconds or
slightly less. If a QRS complex lasts longer it is
described as a "wide QRS" and can be a sign of
inefficient conduction of the ventricles such as
bundle branch block.
10. NAME THE RHYTHM
Atrial fibrillation

occurs when action potentials fire very

rapidly within the pulmonary veins or atrium in
a chaotic manner. The result is a VERY fast
atrial rate (about 400-600 beats per minute).
Since the atrial rate is so fast and the action
potentials produced are of such low amplitude, P
waves will NOT be seen on the ECG in patients
with atrial fibrillation.
POST TEST
 Question 1: What is the diagnosis of the FLB
(funny-looking-beat) in this Lead V1 ECG rhythm
strip?
 A.It's a PAC with LBBB aberration
B.It's a PAC with RBBB aberration

C.It's a PVC from the right ventricle

D.It's a PVC from the left ventricle

Notice the rsR' complex and the preceding

premature P-wave.
QUESTION 2: IN THIS V1 RHYTHM STRIP, WHAT
DOES THE 'F' IMPLY?
 A.'F' is for "Funny-looking-beat"
B.'F' is for "failure-to-capture" which implies the

sinus P wave can't get into the ventricles.

C.'F' is for "fusion beat"; i.e. the fusion of a right

ventricular PVC with the sinus initiated QRS

complex.
D.'F' is for "fusion beat"; i.e. the fusion of a left
ventricular PVC with the sinus initiated QRS
complex.

he subsequent ventricular ectopics are upgoing

(anterior oriented) QRSs, suggestion origin from
the LV.
QUESTION 3: IN THIS V1 RHYTHM STRIP THERE ARE 4 FLB'S
(FUNNY-LOOKING-BEATS) IN ADDITION TO THE NORMAL SINUS
BEATS. WHAT ARE THEY?
 A.These are multifocal PVCs
B.The first FLB is a late onset PVC, and the
other three are fusion beats.
C.Intermittent right bundle branch block
(RBBB)
D.Intermittent WPW type preexcitation

Late PVCs often occur coincidentally with sinus

activation of the ventricles. The degree of fusion
may vary as seen in this example.
QUESTION 4: WHAT LEAD PRIMARILY MEASURES FORCES
MOVING FROM THE HEAD TO THE FEET (INFERIORLY)?

A.Lead I
B.aVF

C.aVL

D.V1

E.V6

Lead aVF places the positive electrode on the

left foot. The negative electrode is the
combination of the right and left arms. Leads II
and III also measure this approximate direction
of current.
QUESTION 5: ALL OF THE FOLLOWING MUST BE
INCLUDED IN ECG INTERPRETATION EXCEPT:

A.Conduction Analysis
B.PU interval

C.Waveforms

D.Rhythm Analysis

E.QT interval

B was the correct answer.PU is not one of the

measurements made. Commonly made measurements
include heart rate, PR, QRS, QT, and QRS axis. In
addition to the answers mentioned to the left, one
should interpret the ECG as normal or abnormal and
then compare it to any previous ECGs in the patient's
file.
QUESTION 6: WHAT CAN HELP TO DIFFERENTIATE BETWEEN THE
NORMAL SEPTAL Q WAVE AND A PATHOLOGIC Q WAVE?

A.The width
B.The height

C.Both width and height

D.The QRS axis

E.The specific ECG leads involved

C was the correct answer.Pathologic Q waves

are the most characteristic ECG finding of
myocardial infarction.

They can be either wide (> 0.04s) or deep (>30% of

QRS height).
QUESTION 7: IN AN ACUTE ST SEGMENT ELEVATION MI (STEMI)
WHICH ECG FINDING IS USUALLY THE FIRST TO APPEAR?

A.Q wave
B.Hyperacute T wave

C.increases in both amplitude and duration

D.shows terminal P negativity in lead I

E.all of the above

B was the correct answer.hyperacute T waves usually

preceed ST segment elevation. However, this ECG finding
may never be seen due to delays in obtaining the initial
ECG.

The ST segment is usually the earliest change back to

normal, followed by the T wave. The Q wave may remain
indefinitely.
8-10 NAME THE COLOR FOR EACH CHEST LEADS
V1 red
V2 yellow
V3 green
V4 brown
V5 black
V6 violet