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The ECG - Examples

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by

Hussam Ro

on 24 April 2013

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Transcript of The ECG - Examples

Common ECG abnormalities - Examples MI First few hours: peaked T waves, ST elevation ('tombstoning')
24 hours: ST resolution, T wave inversion (may persist)
Days: Q waves (usually persist) PE Most commonly a normal ECG
Sinus tachycardia most common abnormality
Others: RAD, RBBB, RV strain
Rarely: SI QIII TIII Metabolic/drug Hyperkalaemia:
tall tented T wave, wide QRS, P wave flattening
later, 'sine wave' appearance
eventually VT Hypokalaemia: small T waves, prominent U waves
Hypercalcaemia: short QT interval
Hypocalcaemia: long QT interval

Digoxin: ST depression and inverted T ('reverse tick') Pericarditis Widespread saddle-shaped ST elevation
Other features: PR depression, sinus tachycardia WPW Wolff-Parkinson-White syndrome
due to presence of accessory pathway
features: short PR interval, slurred upstroke to QRS

patients present with SVT (AVRT), pre-excited AF, or pre-excited atrial flutter Example 1 A 62 year old man presents with chest pain

What does the ECG show?
What is your most likely diagnosis?
What would you do next? What would you do next? Which investigations would be useful?

How would you manage a STEMI? ABC, then M(O)NABASH + PCI
Morphine
(Oxygen)
Nitrates
Aspirin + Clopidogrel
Beta blocker
ACE inhibitor
Statin
Heparin (LMWH) Common ECG abnormalities - Examples Example 2 A 62 year old man presents with chest pain

What does the ECG show?
What is your most likely diagnosis?
What would you do next? What would you do next? Which investigations would be useful?

How would you manage a PE? ABC - oxygen and IV access
Morphine

If stable --> heparin + warfarin

If unstable/massive PE --> involve seniors, support circulation and consider thrombolysis Common ECG abnormalities - Examples Example 3 A 62 year old long-standing diabetic receives an ECG following an abnormal set of blood results

What does the ECG show?
What is your most likely diagnosis?
What would you do next? What would you do next? Which investigations would be useful?

How would you manage his potassium? 1) Review the patient immediately (ABC)
2) Perform an ECG
3) Only if 1+2 are normal, repeat K

Managing hyperkalaemia:
Calcium gluconate
Insulin/dextrose
Salbutamol
Calcium resonium
Dialysis Common ECG abnormalities - Examples Example 4 A 45 year old woman presents with chest pain

What does the ECG show?
What is your most likely diagnosis?
What would you do next? What would you do next? Which investigations would be useful?

What are the causes of acute pericarditis? May be idiopathic or secondary to:
viruses (coxsackie, flu, EBV, etc)
bacteria (streps, staphs, TB, etc)
fungi
MI/Dressler's
drugs (procainamide, hydralazine, isoniazid, etc)
others: uraemia, autoimmune (RA, SLE), malignancy, radiotherapy, trauma/surgery Common ECG abnormalities - Examples Example 5 A 28 year old man presents after repeated palpitations

What does the ECG show?
What is your most likely diagnosis?
What would you do next? Heart block Heart block:
1st degree - increased P-R interval
2nd degree
Mobitz I - gradual increase in P-R, then drop a beat
Mobitz 2 - P-R constant, but occasional dropped beat
Fixed block - 2:1, 3:1, 4:1 block
3rd degree - no relationship between P and QRS Common ECG abnormalities - Examples Example 6 A 62 year old man is admitted complaining of dizziness
Past history includes several MIs

What does the ECG show?
What is your most likely diagnosis?
What would you do next? How is 3rd degree heart block managed? Pacemaker Atrial fibrillation Features:
No P waves (erratic baseline)
Irregular ventricular rhythm Causes? Common ECG abnormalities - Examples Example 7 A 70 year old woman with a history of a MI presents with a recent onset of palpitations

What does the ECG show?
What is your most likely diagnosis?
What would you do next? What would you do next? CVS: Hypertension, MI/ischaemia, heart failure, mitral valve disease
Resp: PE, pneumonia
Endocrine/metabolic: alcohol, caffeine, hyperthyroidism, hypokalaemia
Other: Post-op Acute AF:
Unstable --> ABC + emergency cardioversion
Stable --> rate control, LMWH, treat cause --> consider cardioversion

Chronic AF:
1) Rate control
2) Rhythm control
Must ensure no clot is present

3) Anticoagulation
CHADSVASc vs HASBLED
Supraventricular tachycardia (SVT) Common ECG abnormalities - Examples Example 8 A 48 year old man with palpitations

What does the ECG show?
What is your most likely diagnosis?
What would you do next? Ventricular rhythms VT VF
Full transcript