ecg 101 with answers
TRANSCRIPT
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ECG 101
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ECG 101
Inferior posterior STEMILikely RV infarct
Avoid GTN and morphineMay need a fluid load
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The eyes may be the window to the soul
But the ECG is the window to the heart, lungs, toxicology, electrolytes, body temperature and sometimes even the brain
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Pattern recognition
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An ECG is put under your nose
Immediately
InterpretTime
Name stamp
Covers nurse/HCA’s arseMakes you read it
We know who to educate if it’s wrong
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Be systematic
One system
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Patient’s name
Presenting complaint
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ECG machine RR interval big squares: 300, 150, 100, 75, 60, 50
total number of complexes across the page x 6
Rate
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ECG machine RR interval big squares: 300, 150, 100, 75, 60, 50
total number of complexes across the page x 6
Rate
SVT
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Rhythm
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RhythmAtrial flutter with 2:1 block
Atrial flutter with 2:1 block
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Same patient after treatment for sepsis
AAtrial flutter with variable block
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Frontal axis
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Frontal axis
Sinus tachycardia with R atrial abnormality (P pulmonary) and extreme R axis deviation
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Why else do we care about axis?
CQC
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Why else do we care about axis?
CQC
Incomplete Trifasicular block:RBBB, LAD and 1˚HB
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Incomplete trifascilar blockRBBB, LAD and 1˚HB
1 myocyte away from complete heart blockDon’t send this post syncope patient home
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Then proceed through the complexes
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p waves
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p waves
P mitrale: mitral stenosis
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PR interval
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PR interval
1˚HBLown-Ganong-Levine syndrome
with short PR interval
Mobitz type 2 2˚HB
PR depression II, V5, V6,PR elevation aVR
Saddle shaped ST elevation II, v5, V6Inverted saddle shaped ST elevation aVR
= pericarditits
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QRS complex
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QRS complexWide complex tachy, probably VT
LBBB
RBBB
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QRS complex
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QRS complex
Hyperkalaemia
Sodium channel blockadeeg tricyclic overdose
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QRS complex
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QRS complexSevere hyperkalaemia
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Killer Qs
Pathological Qs
> 40 ms (1 mm) wide > 2 mm deep > 25% of depth of QRS complex Seen in leads V1-3
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Killer Qs
Pathological Qs
> 40 ms (1 mm) wide > 2 mm deep > 25% of depth of QRS complex Seen in leads V1-3
Q waves 2˚ to MIMay still be thrombolysable
HOCM
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ST segment
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ST segment
LBBB
LVHBrugada
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ST segment
R
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ST segment
R
Right ventricular infarct
Posterior STEMI
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ST segment
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ST segment
Inferior-posterior-high lateral STEMI
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ST segment
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ST segment
Paced rhythm with Sgarbossa+ve anterior ST depression and
> 5mm ST elevation in III
LBBB
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Original Sgarbossa Criteria
Concordant ST-segment elevation ≥ 1 mm in any lead (5 points) Concordant ST-segment depression ≥ 1 mm in lead V1 – V3 (3 points)
Discordant ST-segment elevation ≥ 5 mm in any lead (2 points)
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ST segment
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ST segment
Critical left main coronary occlusion or extensive triple vessel disease
avoid clopidogrel
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T waves
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T waves
Hyperactue Ts in ischaemia
Wellens’ Type A
Wellen’s type B
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Repeat ECGs
13 minutes later, pain free:
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Repeat ECGs
Same patient 13 minutes later, pain free:
Biphasic T in V2T wave inversion aVL
Deep anterior T wave inversionWellen’s syndrome (type B)
Don’t put a Wellen’s patient on a treadmillthey tend to drop dead
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T waves
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T wavesAnterior and inferior TWIRight heart strain
PE
Lateral T wave inversion due to LVH
Lateral T wave inversion due to LBBB
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T waves
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T wavesAnterior and lateral T wave inversion
HOCM
Flattened T wavesIschaemia
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T waves
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T wavesLateral and high lateral
T wave inversion due to ischaemia
T wave inversion due to subarachnoid haemorrhage
(rare)Hyperkalaemia
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QTc
Long QT syndrome (genetic)
Drugs incl amiodarone, digoxin, macrolides, antipsychotics, tricyclics, SSRIs, loratidine
HypothermiaHyperCaHypoK, hypoMag
Myocardial ischaemiaICH
+ others
> 440ms in men or > 460ms in women
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QTc
Long QT syndrome (genetic)
Drugs incl amiodarone, digoxin, macrolides, antipsychotics, tricyclics, SSRIs, loratidine
HypothermiaHyperCaHypoK, hypoMag
Myocardial ischaemiaICH
+ others
> 440ms in men or > 460ms in women
Prolonged QT
Prolonged QTleading to
Torsades de pointes
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Just to reinforce …
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Just to reinforce …
Anterior-septal marked ST depression(reciprocal ST elevation)
and prominent S R waves (reciprocal Qs)
=probable posterior STEMI
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Posterior STEMI
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Posterior STEMI
Confirm by moving V4-6 to the posterior chest
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Methodical readRecord your interpretationTimeName stampFurther actions esp repeat ECGs q10min x 3 for CP
eg Trodat Printy 4910 http://www.selfinkingstamps.co.nz/shop/trodat-4910-26x9mm/
$20 delivered
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References and images
Most facts checked with and images obtained from
Life in The Fast Lanehttp://lifeinthefastlane.com/