By ChugaHaeYo 6767

atrial_flutter multiple p wave -

-regular rhythm at rate 2:1 , 3:1 , 4:1 of atrial rate

-SAWTOOTH appearance

causes

Embolism -

MS & MR -

TS & TR -

Heart failure -

IHD -

Pericarditis -

After cardiac surgery -

Thyrotoxicosis-

COPD-

Alcohol -

Digoxin toxicity-

Idiopathic -

clinical picture

Palpitation -

( Fatigue & headache & dizziness & syncope ( due to ⬇CO -

Investigations

-ECG

RFT -

Serum electrolytes-

Blood glucose -

TFT-

( drug level ( if in digoxin-

(Plasma troponin ( if suspected MI-

CXR-

( ECO ( to assist function of lt & Rt ventricles-

MX

If Acute flutter*

( DC cardioversion (20-100j(

If pt stable*

procainamide-

BETA Blocker or Ca channel blocker ( to control Rate ( -

( Amiodarone ( chemical cardioversion-

Radio frequency catheter ablation to prevent recurrent*

atrial fibrillationabsence Pwave-

Irregular rhythm-

causes ( same atrial flutter (

Pulmonary embolism -

MS & MR-

-TS & TR

Heart failure-

IHD -

Pericarditis -

After cardiac surgery -

-Thyrotoxicosis

COPD -

Alcohol-

Digoxin toxicity-

Idiopathic-

clinical picture (same atrial flutter (

. Palpitation -

(Fatigue & headache & dizziness & syncope ( due to ⬇CO-

C/p of underlying cause-

Investigations

-ECG-

RFT-

Serum electrolytes-

Blood glucose-

TFT-

( drug level ( if in digoxin-

( Plasma troponin ( if suspected MI-

CXR -

( ECO ( to assist function of lt & Rt ventricles-

MX

* mx underlying cause

If Acute flutter*

( DC cardioversion (200j -

If pt stable*

( BETA Blocker or verapamil ( to control Rate-

Amiodarone ( chemical cardioversion (-

anticoagulant or antiplatelet *

( warfarin (INR 2-3-

For pt with " Risk Factors "

( VHD . HTN . IHD . CCF . age>75(

- aspirin

For pt without "Risk Factors" and pt C/I for warfarin

ventricular tachycardia

-No wave

-QRS wide >3mm

rapid regular rhythm -

No Twave-

causes

.MI-

. Myocarditis -

Dilated Cardiomyopathy-

. Hypertrophic Cardiomyopathy -

. Chronic IHD-

. -Mitral valve prolapse

. Hypokalemia-

. Digitalis toxicity-

. -CCF

investigations

.ECG-

( . CXR (Cardiomegaly-

. RFT-

. Cardiac Enzymes ( MI (-

. Serum electrolytes-

(. ABG ( Hypoxia + Acidosis-

( . ECO (assist function of Lt & Rt ventricles-

Mx

Acute hemodynamic unstable*

DC cardioversion -

Acute hemodynamic stable*

1 Sotalol or Amiodarone or Procainamid

BETA blocker or Ligoncocain 2

IV mg. Sulfate (for all pt especially if have risk of hypomagnesaemia( 3

treat underlying cause*

(for recurrent ( Radio frequency ablation and or ICD implantation*

Ventricular fibrillation

-No Pwave

NO Twave-

QRS wide >3mm-

Rapid Irregular Rhymes -

causes

MI-

Hypokalemia-

electric Shock-

clinical picture

loss of consciousness-

pulse absent-

respiratory ceases-

Mx

(Electrical defibrillation (if not available >> CPR-

- if survivor of VF & cause isn't reversible >> implantable CVD =Cardio Vascular Defibrillator

Rt_Axis_Deviation

+ >110

Causes

☆ Children

☆ Tall & Then adult

☆ PE

☆ ASD

☆ VSD

☆ ant. Lat. MI

☆ chronic lung disease

lt_Axis_Deviation->30

Causes

☆ LBBB

☆ obese

☆ hyperkalemia

☆ Emphysema

abnormal_Twave

Tall Twave

DDx >>>

▪ Acute STEMI

Hyperkalemia ▪

inverted or low flat Twave

DDx>>

IHD ▪

Myocarditis▪

Digitalis▪

Hypocalcaemia▪

Hyperkalemia ▪

Hypomagnesaemia▪

UwaveDDx>>>

▪ Hypokalemia

Drugs ( Amiodarone , Quinindine , Sotalol ...etc(▪

ECG_changes_in_HYPERKALEMIAflat Pwave - wide QRS–

- peaked Twave short QT interval-

DDx_of_STsegment_elevetion -Acute STEMI

- Prinzmetal's angina

- pericarditis

- LV aneurysm

- LBBB

- cocaine abuse

#NB

.Pericarditis diffuse in all leads

. MI and angina in some leads

طريق عن بينهم انفرق

-cardiac enzymes

في عالية تكون ح MIالي

- timing

عكس 20فقط anginaال تختفي و ساعة MIدقيقة نص حتى يستمر

imp_localization_of_MI☆ ant. MI >> V1 - V4

☆ lat. MI >> I - aVL - V5 -V6

☆ ant. Lat. MI >> I - aVL - V4 - V6

☆ inf. MI >> II - III - aVF

☆ ant. Septal >> V1- V4

☆ septal MI >> V1-V2

investigations_to_confirm_MICardiac Enzymes ( Troponin T& I ( - ⬆⬆⬆⬆ من البداية في حتى 4-2يزدادو ارتفاعهم يستمر و تقريبا 1ساعات سبوعين

Creatin kinase (CK-MB , CK-MM , CK-BB( ،،،،، CK-MB more specific-

في ⬆⬆⬆ يصل 8الى 4يزداد و بعد 24في peakساعات للطبيعي يرجع و 3الى 2ساعةايام

serum myoglobin-

AST ⬆⬆⬆-

لل خالل 48_24في peakيصل للطبيعي يرجع بعدها ساعة72ساعة

LDH ⬆⬆⬆-

لل حتى 4_3في peakيصل ويستمر يوم 14الى 10ايام

(CBC ( leukocytosis-

ECR ⬆-

-CXR

-eco

Mx_of_acute_STEMI

-call for help

- ABC

- O2 for hypoxia

- CBC

- pain relief

* IV morphine

* Nitroglycerin

* B.Blocker

- Antithrombotic

* aspirin

- reperfusion

* PCI ( percutaneous coronary Intervention ( for Stent

* Thrombolytic

* C/I of THROMBOLYTIC

☆ absolute C/I

▪active internal bleeding

▪aortic dissection suspected

▪preior ischemic stroke in last 3months

▪preior hemorrhagic stroke

▪known Intracranial Neoplasm

▪acute active pericarditis

▪pregnancy

▪sever HTN

▪recent surgery for head

DDx_of_ST_Deprssion ▪NSTEMI

▪stable & unstable angina

▪Hypokalemia

▪Digitalis

▪cardiac hypertension

Mx_of_NSTEMI -admission

- call for help

- ABC

- high O2 by mask

- Morphine IV

- Metoclopramide

- sublingual Nitrate

- aspirin chewed

- B.blocker

- Heparin

#before discharge

*Do stress ECG

* Coronary angiography

Rt_ventricular_hypertrophy☆ Rwave in V1 & V2 >5mm

DDX

-PHTN

- pulmonary stenosis

- Hypertrophic cardiomyopathy

lt_ventricular_hypertrophy☆ Rwave in V5 & V6 > 5large square

Ddx

- systemic HTN

- Aortic stenosis

- Hypertrophic cardiomyopathy

DDx_wide_QRS -RBBB

- LBBB

- ventricular extra systole

- ventricular tachycardia

- ventricular fibrillation

#RBBB☆ wide QRS complex

☆ broad notched R wave in V1& V2

( M shaped(

☆ wide and deep Swave in V5 & V6

causes

-IHD

- congenital heart disease (ASD(

- PHTN

- myocarditis

- degenerative conduction system disease

#LBBB

☆ wide QRS complex

☆ broad notched R wave in V5 & V6

( M shaped(

☆ small or absent R wave followed by deep S waves in V1 & V2

causes

It's rare and most commonly seen in IHD

Ventricular_Extrasystole = premature ventricular contraction = PVC

☆ No Pwave

☆ wide QRS (bizzare in shape(

☆ Twave inversely proportion to QRS

☆ prolonged pause after QRS

Heart_block

1st degree HB

☆ PR interval fixed prolongation

☆ No drop beat

☆ QRS normal or narrow

2nd degree HB (MOBITZ I)

☆ PR interval progressive prolongation

☆ Dropped beat (p without QRS(

☆QRS normal or narrow

2nd degree HB (MOBITZ II)= wenckebach phenomenoa

☆ Dropped beat

☆ PR interval normal before dropped beat

☆ Pwave with sinus rhythm

☆ QRS wide

rd HB (complete HB)3

☆ Pwave normal

☆ QRS wide , regular & Slow in rate

☆ PR interval variable ( AV dissociation(

causes

*Acute

- MI

- myocarditis

- Infections

- hyperkalemia

- DRUGS ( Digitalis , BETA blocker , Ca channel blocker & antiarrhythmic drugs(

*chronic

- Idiopathic conduction degeneration

- congenital complete AV block

- Cardiomyopathy

Clinical_pictures

-Asymptomatic

- symptomatic (hemodynamic and unstable(

~ chest pain

~ bradycardia

~ systolic pressure >90mmHg

~ pulmonary Edema

~ dizziness & syncope

investigations

-ECG

- RFT

- serum electrolytes

- TFT

- CXR

( - plasma troponin (MI

- drug level

- ECO

Mx☆ 1st degree HB

>> No need treatment

☆ (2nd degree ( MOBITZ I

if asymptomatic

>> No Need Treatment

if symptomatic

>> Atropine

Or

>> temporary Pacemaker

☆ complete HB

>> permanent Pacemaker

( Except when ass` with transient Inf. MI. Or Asymptomatic congenital

HB(

Supraventreicular_tachycardia

☆ No P wave

☆ QRS narrow >3mm

☆ regular rhythm

#causes

-Anixety

- ⬆⬆ caffee & tobacoo

- Hyperthyroidism

- Alcohol

#Clinical_Pictures

-palpitation

- Breathlessness

- polyuria (sometimes(

#Mx*VAGOTONIC MANEUVERS

. Carotid sinus massage

. Pressure on eyes

. Valsalva maneuver

. Self induced vomiting

. Lowering head btween knee

* DRUGs

. Adenocor

. Verapmil

. BETA blocker

. Digoxin

* DC cardioversion (in emergency

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