ECG diagnoses Flashcards

Question

Prolong QT Causes

Answer 1

1. HYPOS: - Hypokalaemia - Hypomagnesaemia - Hypocalcaemia - Hypothermia 2. Raised intracranial pressure 3. Drugs 4. Congenital: - Romano Ward syndrome (AD) - Jervell and Lange Nielsen syndrome (AR) - bilateral sensorineural hearing loss -

Answer 2

- Antipsychotics - TCAs - SSRIs: Citalopram, Escitalopram - SNRIs: Venlafaxine - Apitypical Antidep: Bupropion - MAOIs: Moclobemide - Antihistamines - Antiarrhythmics: Quinidine, procainamide, flecainide, sotalol, and Amiodarone. - Antimalarial: Chloroquine, Hydroxychloroquine, and quinine - Macrolides: Erythromycin, and Clarithromycin Digoxin

Answer 3

1. Correct underline causes 2. B-Blockers 3. Implantable cardioverter-defibrillator (ICD) UNSTABLE: Torsade de Pointes Treatment

Answer 4

Widespread giant T-wave inversions (“cerebral T waves”) QT prolongation Bradycardia

Answer 5

HYPERS: Hypercalcemia Hyperkalemia Hyperthermia Digoxin: Salvador Dali Sign

Answer 6

S1 Q3 T3 : Cor Pulmonale * Deep S in Lead I * Q in Lead III * T inverted In Lead III ✓ SINUSAL TACHICARDIA ✓ RBBB can be associated

Answer 7

* Being an MI until proven otherwise * Pericarditis * Ventricular aneurysm

Answer 8

* Myocardium Ischaemia – Non-Stemi * Unstable Angina

Answer 9

ST-segment elevation with reciprocal PR-segment depression in all leads except V1 and AVR

Answer 10

V1 - V3 ST elevation with concave morphology Deep Q waves

Answer 11

ST-segment elevation V1-V3 followed by a negative T wave. Association with clinical criteria: - Family history of sudden cardiac death at <45 years old . - Young, Male, Southeast Asian patient - Syncope

Answer 12

Same ECG that STEMI: T wave inversion leads II, III, aVF, V3-6 In the context of: - Pregnancy with CHF - Sepsis with CHF - Alcohol Cardiomyopathy

Answer 13

Leads Affected: V2 to V4 Vessel Involved: Left Anterior Descending artery (LAD) – Diagonal branch

Answer 14

Leads Affected: V1 and V2 Vessel Involved: Left Anterior Descending artery (LAD) – Septal branch

Answer 15

Leads Affected: I, aVL, V5, V6 Vessel Involved: Left Coronary Artery (LCA) – Circumflex branch

Answer 16

Leads Affected: II, III, aVF Vessel Involved: Right Coronary Artery (RCA) – Posterior descending branch

Answer 17

Leads Affected: V1 to V4 Mirror image ST depression V7-V9 Vessel Involved: *Left Coronary Artery (LCA) – Circumflex branch *Right Coronary Artery (RCA) – Posterior descending branch

Answer 18

5.5 - 6.5 *Peaked T waves 6.5 - 7 *P waves widening, flattening or absent *Prolong PR interval 7 - 9 *Bradyarrhythmias *Prolonged QRS > 9 *Asystole *Ventricular fibrillation *PEA

Answer 19

K < 2.7 mmol/L * Increased P wave amplitude (>2,5 mm) * Prolongation of PR interval (> 1 big square) * Widespread ST depression and T wave flattening/inversion * Prominent U waves - PVC (best seen in V2-V3) * Apparent long QT interval due to fusion of T and U waves (= long QU interval)

Answer 20

1. ST depression and T wave inversion in V5-6 in a reversed tick pattern. 2. Bradycardia 3. Prolonged PR 4. Shortened QT 5. Arrhythmias, especially heart block or bigeminy

Answer 21

Widening of QRS complex Prolongation of the PR and QT intervals Ventricular tachycardia and ventricular fibrillation

Answer 22

Widening of QRS complex Prolongation of the PR and QT intervals Ventricular tachycardia and ventricular fibrillation

Answer 23

- Sinus tachycardia (ST) - Atrial tachycardia (AT) - Atrial flutter

Answer 24

- Atrial fibrillation (AF) - Atrial flutter with variable block - Multifocal atrial tachycardia (MAT)

Answer 25

A rapid atrial rate overrides the SA Node and becomes the dominant pacemaker Rhythm arround 150 bpm In a px that has Hx of Heart disease (long standing AHT, valvar deseas, etc) or cocaine use Paroxysmal: SVT and then stop

Answer 26

Prevalence: < 55 yo = 0.1% > 80 yo = 10% Risk Factors: - HTA (Most important 20%) - Ischaemic heart disease - Tirotoxicosis - Reumatic fever (aboriginal and in developing countries) Complications: 1) Stroke - Risk: < 65 yo 2.5 - 3% > 65 yo 10% 2) Femoral artery embolism

Answer 27

Spontaneous ends in less than 7 days (usually in 24 h) After heavy alcohol, drugs

Answer 28

Rapid = Convert No rapid = No convert NEEDS BETTER EXPLANATION

Answer 29

Fails to revert within 7 days Usually converts with syncronized cardioversion Elderly with previous heart conditions, just rate control and anticoagulants. Definitive treatment: AV node ablation + permanent pacemaker

Answer 30

1. Rate control (Aim < 110 bpm): A) B-Blockers or CCB (Verapamil. Contraindicated EF<40) B) EF<40 = Amiodarone C) If the previous didn't work or contraindications: Add Digoxin If pharmacological failure WITHOUT left Ventricle systolic dysfunction: Pharmacological cardioversion with Flecainide (EF<40)/Amiodarone or Synchronized CV - CHA2DS2VaSc - Definitive treatment: AV ablation + permanent pacing (pacemaker)

Answer 31

1. Rate control (Aim < 110 bpm): A) B-Blockers or CCB (Verapamil. Contraindicated EF<40) B) EF<40 = Amiodarone C) If the previous didn't work or contraindications: Add Digoxin 2. Anticoagulation: LMWH x 5 days. Add Warfarine (INR 2-3) FOR 1 MONTH 3. Synchronized Cardioversion

Answer 32

Synchronized Cardioversion

Answer 33

CHF (EF<40%) Hypertension Age > 65 yo /// Age > 75 yo = 2 Diabetes mellitus Stroke, TIA, another Thromboembolism (PE) = 2 Vascular disease (PAD, MI)

Answer 34

0: No anticoagulation or aspirin 1: Antiplatelets 2 or more: Anticoagulation is recommended if not at high risk of bleeding.

Answer 35

AV Node conducts impulses to the Ventricle at a 2:1, 3:1, 4:1 or more. * Degree may be consistent or variable * The foci do not have enough electricity to conduct and produce a Ventricular contraction. * Ps of the foci and the P of SA node that is conducted. * Can be quick rate or normal rate

Answer 36

Rhythm= Regular P= 4:1 – only P conducted from SA node (Saw-tooth) PR = short QRS= width normal

Answer 37

Same as AF STABLE < 48H Permanent: - Radiofrequency ablation - Medical: Sotalol, amiodarone

Answer 38

Rhythm= Irregular P= DIFFERENTS but all conducted PR= normal QRS= width normal 3 or more P waves, each different in the same ECG

Answer 39

- Atrioventricular re-entry tachycardia (AVRT WPW) - AV nodal re-entry tachycardia (AVNRT)

Answer 40

* Rhythm: Regular * P: PR is short * W: wide QRS * S: slurring of upstroke (delta wave) (+ FA Irregular rhythm)

Answer 41

Valsava maneuver are effective in the termination of AVRT NOT to AVNRT REVIEW!!!!!!

Answer 42

Refer to cardiologist. Definitive Therapy: Ablation of the accessory pathway. AVOID: - Adenosine - CCB

Answer 43

AVNRT More common (> 60%) than AVRT Heart rate: Regular 150-160 bpm. P waves hidden in T waves QRS: Narrow complex

Answer 44

Step 1: Carotid massage/Valsalva manoeuvre Step 2: Adenosine x 2 (2min) Step 3: Verapamile x 2 (30 min) Step 3: Direct current (DC) cardioversion or pharmacological cardioversion (amiodarone or overdrive pacing may be required. Recurrent: Ablation or amiodarone

Answer 45

Irregular and wide complex tachi with delta wavw

Answer 46

Regular and narrow but abnormal QRS

Answer 47

- Ventricular tachycardia (VT) - Regular SVT with bundle branch block or aberrant.

Answer 48

- Ventricular fibrillation (VF) - Polymorphic VT (PVT) - Torsade de Pointes - AF with Wolff-Parkinson-White syndrome - Irregular SVT with bundle branch block.

Answer 49

* Premature ventricular contractions (PVCs) * Accelerated idioventricular rhythm * Monomorphic ventricular tachycardia * Polymorphic ventricular tachycardia * Ventricular fibrillation * Torsades de pointes * Arrhythmogenic right ventricular dysplasia * Re-entry ventricular arrhythmia

Answer 50

* PVC or Ventricular extrasystoles (95% benign) * Patient feels like he skipped a beat. * The PVC does not generate a beat, because the ventricles are half-filed.

Answer 51

P= normal P conducted PR = normal QRS= normal and a PVC following a T, Then a compensatory pause (always)

Answer 52

Premature ventricular beats occurring after every normal beat are termed (1:1) 1 Normal QRS 1 PVC (repeat)

Answer 53

PVCs that occur at intervals of 2 normal beats to 1 PVC (1:2)

Answer 54

Normal QRS + PCV + PVC (repeat)

Answer 55

Normal QRS + PVC + PVC + PVC (Repeat)

Answer 56

Groups of three PVCs (Couplets or Paired PVCs) and last less than 30 seconds (> 30 sec = VT)

Answer 57

◦ First line: metoprolol (BB) ◦ Second line: Verapamil (CCB) or flecainide if BB are Contraindicated. NO OPTION FOR EF <40 ◦ If symptoms persist: amiodarone. ◦ Last option: catheter ablation.

Answer 58

QRS = Same shape and amplitude T = WIDE COMPLEX * Pulseless or perfusing * Can deteriorate into VF or unstable VT if sustained and not treated. Mechanism: Re-entry loop from one ectopic area so all the QRS look the same.

Answer 59

MI (ischaemia) in 1 area

Answer 60

Sustained VT w/ no structural heart disease: * First Line: beta-blockers (never a BB is acute left heart failure) (eg: atenolol, metoprolol tartrate/IV) * Second Line or if CI to BB: flecainide or verapamil. ◦ Sustained VT w/ structural heart disease * First line: Amiodarone or sotalol.

Answer 61

QRS = Different shape and amplitude * Can be non-perfusing or perfusing * Consider electrolyte abnormalities or drugs toxicity as the possible etiology * Re-entry loop from multiple ectopic areas, different areas with different morphology on ECG.

Answer 62

* QRS reverses polarity and the strips shows a spindle effect. * It is a variant of polymorphic VT with normal or long QT intervals * Can deteriorate to VT or VF * Drugs that causes prolonged QT and electrolyte abnormalities like hypomagnesemia can cause Torsade de points.

Answer 63

Magnessium Sulphate 10 mmol in slow IV bolus NEVER Sodium Bicarbonate!!!

Answer 64

UNSYNCRONIZED (DC) CARDIOVERSION

Answer 65

Drugs toxicity (QT prolonging medications)

Answer 66

* Chaotic electrical activity with no ventricular depolarization or contraction. * There is no pulse or cardiac output. * Small amplitude – no pulse is possible or rhythm

Answer 67

UNSYNCRONIZED CARDIOVERSION Adrenaline 1 mg after 2nd shock Amiodarone 300 mg after 3rd shock Note: CPR X 2 min between shocks

Answer 68

* Electrical rhythm, with no pulse detected. * PEA can be called electromechanical dissociation * CONSIDER AND CORRECT: “4H and 4T"

Answer 69

PEA Asystole SINUS BRADY + NO PULSE

Answer 70

Adenaline 1 mg inmediatly Then every 2 CPR (X 2 min) Adrenaline again.

Answer 71

1. Sinus bradycardia 2. Sinus node dysfunction a) Sinus Pause. b) Sinus Arrest. c) SA Nodal Exit Block. 4. AV Blocks (I, II, III)

Answer 72

Normal in athletes and during sleep. In acute MI it may be protective and beneficial. B-blockers can cause sinus bradycardia

Answer 73

Rhythm= Irregular P= all same PR= constant - Normal QRS= width normal Mechanism: SA node discharges irregularly * The pacing rate of SA node varies with respiration, specially in children and elderly

Answer 74

Tension Pneumothorax Cardiac Tamponade NO SHOCKABLE!!!!

Answer 75

Rhythm= irregular P= all same - dropped beat PR= Normal QRS= width normal. After the dropped beat, cycles continue on time. * Cardiac output may decrease causing syncope or dizziness.

Answer 76

People with asymptomatic bradycardia usually need no treatment A) Correction of the cause (cardiac infections, Ischaemia, hypos, drugs: digoxin, beta-blockers, CCB, amiodarone) B) Pharmacological: 1. Atropine 0.5 mg bolus IV (Repeat every 3-5 min - MAX 3 mg) 2. Isoprenaline 3. Adrenaline / Epinephrine (Hypotension) 4. Dobutamine (CHF) C) Transcutaneous Pacemaker (If ineffective pharmacological or MOBITZ 2 / 3rd degree AV Block)

Answer 77

Verapamil + Beta-blocker

Answer 78

First-line antidote: Glucagon Second-line: Inotropes (adrenaline, dobutamine, isoprenaline)

Answer 79

First-line antidote: Calcium gluconate Second-line: Glucagon

Answer 80

Digoxin-specific antibodies (Fab fragments) Allergenic and expensive. Only to be used in life-threatening arrhythmias attributed to digoxin.

Answer 81

The most common cause of bradycardia. Mechanism: AV node dysfunction * First-degree heart block, which manifests as PR prolongation * Second-degree heart block * Type 1 Second-degree heart block, also known as Mobitz I or Wenckebach * Type 2 Second-degree heart block, also known as Mobitz II or Hay * Third-degree heart block, also known as complete heart block

Answer 82

Rhythm= Regular P= Normal - all conducted PR= PROLONGED QRS= width normal - Benign - If associated with MI, it can lead to AV defects. - Usually caused by drugs.

Answer 83

Antiarrhythmics: Quinidine, procainamide, disopyramide, flecainide, encainide, propafenone, beta-blockers, amiodarone, sotalol, calcium channel blockers Digoxin Magnesium

Answer 84

Rhythm= Irregular P= normal – a P is blocked PR = Progressively longer until one P wave is totally blocked and produces no QRS. QRS= width normal

Answer 85

1. B-blockers 2. Digoxin 3. Calcium channel blockers 4. Ischaemia involving the right coronary artery.

Answer 86

Rhythm= Regular P = Look normal at the same pace, all regular. Some P’s are blocked (Eg 3:1) PR = Normal in the conducted P QRS= Width normal Mechanism: Conduction error in the bubble of His.

Answer 87

ALWAYS SYMPTOMATIC: Dizziness, palpitations, weakness, and syncope. ALWAYS URGENT REFER AND PACEMAKER

Answer 88

Rhythm= Regular 25 - 50 rpm P= look normal at a regular pace – none conducted PR = Absent QRS= abnormal

Answer 89

Mechanism: Lack of conduction of atrial impulse to ventricle leading to independent contractions. Signs & Symptoms: - Hypotension - Large volume pulse - Increased JPV (CANNON WAVE) - Systolic murmur Can lead to asystole and cardiac arrest. ALWAYS PACEMAKER

Answer 90

Spike + QRS + T No p wave

Answer 91

Hypoxia Hypokalaemia/hyperkalaemia Hypothermia/hyperthermia Hypovolaemia Tension pneumothorax Tamponade Thrombosis Toxins

ECG diagnoses Flashcards

(118 cards)