ECG made easy Part 2 – ECG Quiz, Summaries of Cardiology

Download ECG made easy Part 2 – ECG Quiz and more Summaries Cardiology in PDF only on Docsity! ECG made easy Part 2 – ECG Quiz 1 • Presented by: • Dr Randall Hendriks, Interventional Cardiologist – Western Australia ? Axis 1. Left 2. Right 3. Indeterminate | GenesisCare 1. Left 2. Right 3. Indeterminate Page 5 ? Axis 1. Left 2. Right 3. Indeterminate Page 6 ? Axis 1. Left 2. Right 3. Indeterminate Page 7 ? Axis Standard limb lead reversal! 1. Atrial fibrillation 2. Atrial flutter 3. SVT 4. Sinus tachycardia 5. Junctional Page 10 Tachycardia 1. Atrial fibrillation 2. Atrial flutter 3. SVT 4. Sinus tachycardia 5. Junctional Page 11 Tachycardia 1. Atrial fibrillation 2. Atrial flutter 3. SVT 4. Sinus tachycardia 5. Junctional Page 12 Tachycardia 1. Atrial fibrillation 2. Atrial flutter 3. SVT 4. Sinus tachycardia 5. Junctional Page 15 Tachycardia 1. Atrial flutter 2. Atrial fibrillation 3. SVT 4. Sinus tachycardia 5. Junctional Page 16 Tachycardia 1. Atrial flutter 2. Atrial fibrillation 3. SVT 4. Sinus tachycardia 5. Junctional Page 17 Tachycardia 1. Inferior 2. Anterior 3. Lateral 4. Posterior 5. IPL Page 20 ST elevation MI 1. Inferior 2. Anterior 3. Lateral 4. Posterior 5. IPL Page 21 ST elevation MI 1. Inferior 2. Anterior 3. Lateral 4. Posterior 5. IPL Page 22 ST elevation MI 1. Inferior 2. Anterior 3. Lateral 4. Posterior 5. IPL Page 25 ST elevation MI 1. Anterior MI 2. Normal repolarisation 3. LV aneurysm 4. Pericarditis 5. Brugada syndrome Page 26 ST elevation – 30 year old Thai man with syncope 1. Anterior MI 2. Normal repolarisation 3. LV aneurysm 4. Pericarditis 5. Brugada syndrome Page 27 ST elevation – 30 year old Thai man with syncope  Palpitations 1. VT ' 2. SVT with aberrancy GenesisCare Page 30 1. Anterior MI 2. Normal repolarisation 3. LV aneurysm 4. Pericarditis 5. Brugada syndrome Page 31 ST elevation – young adult patient with pleuritic chest pain 1. Anterior MI 2. Normal repolarisation 3. LV aneurysm 4. Pericarditis 5. Brugada syndrome Page 32 ST elevation – young adult patient with pleuritic chest pain Can’t miss-life threatening ECGs 35 Bradycardia and hypotensive in ED 2 big GenesisCare Page 36 Page 37 Bradycardia and hypotensive in ED Complete heart block Palpitations: 20 year old female with presyncope GenesisCare Page 40 Page 41 Palpitations: 20 year old female with presyncope Pre-excited AF alaemia Hypok ~ GenesisCare Page 45 Hypokalaemia • Decreased extracellular K – hyperexcitability: re-entrant arrhythmias • Increase amplitude and width of P wave • Prolonged PR interval • T flattening / inversion • ST depression • Prominent U waves • Apparent long QT (QTU fusion) • SVEs, VPBs • SVT (AF, atrial flutter, atrial tachy) • VT, VF and Torsades de Pointes Page 46 Hyperkalaemia Page 47 Hyperkalaemia • Increased extracellular K – reduces myocardial excitability • Repolarisation changes: Peaked T waves • Atrial paralysis: P wave widens and flattens PR prolongation P wave disappears • Conduction abnormality and bradycardia: QRS prolongs / bizarre High grade AV block, junctional and ventricular escape rhythms Sinus brady or slow AF Sine wave (pre terminal) • Cardiac arrest: Asystole VF PEA with bizarre wide QRS Bidirectional VT - digoxin toxicity ime eae ay ht spe ereer tye “orl sari ere el GenesisCare Page 51 Digoxin toxicity • Increased automaticity / decreased AV conduction: SVT with slow ventricular response • PVC’s, sinus brady, AF • Any type of AV block • Regularised AF (AF with CHB) • VT (polymorphic or bidirectional) Intracranial haemorrhage pt tet ~ GenesisCare Page 55 Massive pulmonary embolism • Sinus tachycardia • Complete or incomplete RBBB • RV strain T inversion V1-4, II,III,aVF • Right axis deviation • Dominant R V1 • P pulmonale • SI, QIII, TIII in 20% only • Clockwise rotation • Atrial arrhythmias • Non specific ST/T changes Pacemaker malfunction ~ppb a aeeat “Cay ae ee cv GenesisCare 70 year old, chest pain and diaphoresis GenesisCare Page 57 Page 60 Ischaemic sounding chest pain Wellens’ Syndrome – proximal LAD stenosis LMCA occlusion Sone een n tia fm tay ler dl y s~ vy | aa LENE III GenesisCare Page 61 Page 62 LMCA occlusion • Widespread ST depression (leads I, II, V4 – 6) • ST elevation aVR ≥ 1mm • ST elevation aVR ≥ V1 • Can also see in: prox LAD occlusion severe triple vessel disease diffuse subendocardial ischaemia (ie. post resuscitation) • aVR records electrical activity right upper portion of heart, including RVOT and basal IV septum Middle aged female presents with dyspnoea, prior mastectomy for breast cancer. Page 65 Middle aged female presents with dyspnoea, prior mastectomy for breast cancer. Page 66 QRS alternans – pericardial effusion Ventricular flutter GenesisCare Page 67 Bradycardia Low QRS voltage Widespread T wave inversion QT prolongation First degree AV block IVCDs Myxoedematous deposits in myocardium Decreased SNS activity Less thyroxine – decreased inotropy / chronotropy Page 70 Hypothyroidism The End 71