ecg made easy part 2 ecg quiz...ecg made easy part 2 –ecg quiz 1 •presented by: •dr randall...
Post on 25-Jun-2020
44 Views
Preview:
TRANSCRIPT
ECG made easyPart 2 – ECG Quiz
1
• Presented by:• Dr Randall Hendriks, Interventional Cardiologist – Western Australia
1. Left2. Right3. Indeterminate
? Axis
1. Left2. Right3. Indeterminate
? Axis
1. Left2. Right3. Indeterminate
Page 4
? Axis
1. Left2. Right3. Indeterminate
Page 5
? Axis
1. Left2. Right3. Indeterminate
Page 6
? Axis
1. Left2. Right3. Indeterminate
Page 7
? Axis
Standard limb lead reversal!
1. Atrial fibrillation2. Atrial flutter3. SVT4. Sinus tachycardia5. Junctional
Page 8
Tachycardia
1. Atrial fibrillation2. Atrial flutter3. SVT4. Sinus tachycardia5. Junctional
Page 9
Tachycardia
1. Atrial fibrillation2. Atrial flutter3. SVT4. Sinus tachycardia5. Junctional
Page 10
Tachycardia
1. Atrial fibrillation2. Atrial flutter3. SVT4. Sinus tachycardia5. Junctional
Page 11
Tachycardia
1. Atrial fibrillation2. Atrial flutter3. SVT4. Sinus tachycardia5. Junctional
Page 12
Tachycardia
1. Atrial fibrillation2. Atrial flutter3. SVT4. Sinus tachycardia5. Junctional
Page 13
Tachycardia
1. Atrial fibrillation2. Atrial flutter3. SVT4. Sinus tachycardia5. Junctional
Page 14
Tachycardia
1. Atrial fibrillation2. Atrial flutter3. SVT4. Sinus tachycardia5. Junctional
Page 15
Tachycardia
1. Atrial flutter2. Atrial fibrillation3. SVT4. Sinus tachycardia5. Junctional
Page 16
Tachycardia
1. Atrial flutter2. Atrial fibrillation3. SVT4. Sinus tachycardia5. Junctional
Page 17
Tachycardia
1. Sinus bradycardia2. First degree AV block3. Mobitz Type I
(Wenckebach)4. Mobitz Type 25. Complete heart block
Page 18
Bradycardia
1. Sinus bradycardia2. First degree AV block3. Mobitz Type I
(Wenckebach)4. Mobitz Type 25. Complete heart block
Page 19
Bradycardia
1. Inferior2. Anterior3. Lateral4. Posterior5. IPL
Page 20
ST elevation MI
1. Inferior2. Anterior3. Lateral4. Posterior5. IPL
Page 21
ST elevation MI
1. Inferior2. Anterior3. Lateral4. Posterior5. IPL
Page 22
ST elevation MI
1. Inferior2. Anterior3. Lateral4. Posterior5. IPL
Page 23
ST elevation MI
1. Inferior2. Anterior3. Lateral4. Posterior5. IPL
Page 24
ST elevation MI
1. Inferior2. Anterior3. Lateral4. Posterior5. IPL
Page 25
ST elevation MI
1. Anterior MI2. Normal repolarisation3. LV aneurysm4. Pericarditis5. Brugada syndrome
Page 26
ST elevation – 30 year old Thai man with syncope
1. Anterior MI2. Normal repolarisation3. LV aneurysm4. Pericarditis5. Brugada syndrome
Page 27
ST elevation – 30 year old Thai man with syncope
1. Anterior MI2. Normal repolarisation3. LV aneurysm4. Pericarditis5. Brugada syndrome
Page 28
ST elevation – young adult patient with pleuritic chest pain
1. Anterior MI2. Normal repolarisation3. LV aneurysm4. Pericarditis5. Brugada syndrome
Page 29
ST elevation – young adult patient with pleuritic chest pain
1. VT2. SVT with aberrancy
Page 30
Palpitations
1. Anterior MI2. Normal repolarisation3. LV aneurysm4. Pericarditis5. Brugada syndrome
Page 31
ST elevation – young adult patient with pleuritic chest pain
1. Anterior MI2. Normal repolarisation3. LV aneurysm4. Pericarditis5. Brugada syndrome
Page 32
ST elevation – young adult patient with pleuritic chest pain
1. Absence of RS?2. No – next question
Page 33
Palpitations
1. R/S interval > 100msec?2. Yes - VT
Page 34
Palpitations
Can’t miss-life threatening ECGs
35
Page 36
Bradycardia and hypotensive in ED
Page 37
Bradycardia and hypotensive in ED
Complete heart block
Wolff-Parkinson-White syndrome
Page 40
Palpitations: 20 year old female with presyncope
Page 41
Palpitations: 20 year old female with presyncope
Pre-excited AF
Page 42
Hypokalaemia
Page 43
Broad complex tachycardia – diagnosis?
Page 44
Broad complex tachycardia – diagnosis?
Torsades de Pointes – QT prolongation
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 flattensPR prolongationP wave disappears
• Conduction abnormality and bradycardia:QRS prolongs / bizarreHigh grade AV block, junctional and ventricular escape rhythmsSinus brady or slow AFSine wave (pre terminal)
• Cardiac arrest:AsystoleVFPEA with bizarre wide QRS
Page 48
Hyperkalaemia
Page 49
Digoxin toxicity – PAT with block and VPBs
Page 50
Bidirectional VT – digoxin toxicity
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)
Page 52
Intracranial haemorrhage
Page 53
Intracranial haemorrhage
• Widespread giant T inversion• QT prolongation• Bradycardia (Cushing reflex – brain stem herniation)• ST elevation or depression• Increased U wave amplitude• ST, junctional, VPBs, AF• (? Hypothalamic stimulation / autonomic dysregulation)
Page 54
Massive pulmonary embolism
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
Page 56
Pacemaker malfunction
Page 57
70 year old, chest pain and diaphoresis
Page 58
70 year old, chest pain and diaphoresis
Extensive anterior MI (‘tombstoning” pattern)
Page 59
Ischaemic sounding chest pain
Page 60
Ischaemic sounding chest pain
Wellens’ Syndrome – proximal LAD stenosis
Page 61
LMCA occlusion
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 occlusionsevere triple vessel diseasediffuse subendocardial ischaemia (ie. post resuscitation)
• aVR records electrical activity right upper portion of heart, including RVOT and basal IV septum
Anterior STEMI equivalentST depression and peaked T waves in precordial leadsSeen in ~ 2% acute LAD occlusionsYounger / male / hypercholesterolaemia
Code STEMI
Page 64
De Winter’s T wave
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
Page 67
Ventricular flutter
Ventricular flutter
•Continuous monomorphic sine wave•No identifiable P, QRS or T wave•Rate >200•Extreme form of VT•Rapid degeneration into VF
Page 68
Bradyarrhythmias (any)Osborn waves (= J waves = positive deflection at J point)Prolonged PR, QRS and QTShivering artefactVPBsCardiac arrest due to VT, VF or asystole
Page 69
Hypothermia
BradycardiaLow QRS voltageWidespread T wave inversionQT prolongationFirst degree AV blockIVCDs
Myxoedematous deposits in myocardiumDecreased SNS activityLess thyroxine – decreased inotropy / chronotropy
Page 70
Hypothyroidism
The End
71
top related