differentiele diagnose ekg patronen
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Differentiele Diagnose EKG patronen. Supraventriculaire t achycardie Linker k amer h ypertrofie Subendocardiale ischemie ( fietsproef ) Ischemie “ type ” hoofdstamischemie Subepicardiale ischemie in reciproke afleiding ( bij STEMI) Hypokaliëmie - PowerPoint PPT PresentationTRANSCRIPT
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Differentiele Diagnose EKG patronen
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• Supraventriculaire tachycardie• Linker kamerhypertrofie • Subendocardiale ischemie (fietsproef)• Ischemie “type” hoofdstamischemie• Subepicardiale ischemie in reciproke afleiding
(bij STEMI)• Hypokaliëmie• ST depressie bij inname digitalis
K74 - ST decallage
Subendocardiale ischemie
Aspecifiek, belang van kliniek
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K75 - ST elevatie in afl. V1-V2
• Variant van het normale (ORBTB, jongere)• Linker kamerhypertrofie • Wellens syndroom • Acuut anteriorinfarct• Aneurysma na doorgemaakt anteriorinfarct• Pericarditis • Brugada syndroom• Hyperkaliëmie
Bij twijfel acuut anteriorinfarct
Acuut anteriorinfarct
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• Linker kamerhypertrofie • Acuut inferiorinfarct• Acuut anteriorinfarct • Aneurysma na doorgemaakt inferiorinfarct• Pericarditis (concaaf)• Hyperkaliëmie
K76 - ST elevatie in afl. II,III & aVF
Bij twijfel acuut inferiorinfarct
Acuut inferiorinfarct
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K77 - Hoge R golf in afl. V1,V2
• Normale variant (juveniel)• RBTB• WPW • Rechter kamerhypertrofie• Oud posteriorinfarct
V1
V2
V3
V4
V5
V6
Rechter bundeltakblok
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• Normale variant• Te hoge plaatsing elektrode• LBTB• WPW• Oud anteriorinfarct• RV apex pacing
K78 – QS golf in afl. V1,V2
Oud anteriorinfarct
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• Normale variant (positionele Q in III)• LPHB• WPW• Oud inferiorinfarct• Acuut longembool (niet in II)• HCMP • RV apex pacing
K79 - QS in afl. II,III & aVF
Oud inferiorinfarct
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• Supraventriculaire tachycardie met functioneel BTB (aberrantie)• Supraventriculaire tachycardie met voorafbestaand BTB • Antidrome AVRT (WPW)• Gepre-exciteerde AT (WPW)• Monomorfe kamertachycardie
K82 - Breed QRS (> 120 ms): regelmatig
Monomorfe kamertachycardie met fusie slag
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• Atriale fibrillatie met voorafbestaand BTB• Atriale fibrillatie met functioneel BTB (aberrantie)• Atriale fibrillatie met pre-excitatie (FBI)• Niet onderhouden of polymorfe kamertachycardie
K83 - Breed QRS (> 120 ms): onregelmatig
Bij structureel hartlijden: kamertachycardie
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• Gekenmerkt door diepe S in III & aVF• Linker anterior hemiblok• Congenitaal hartlijden
K84 – Linker as
• Gekenmerkt door diepe S in afl. I & aVL• Rechter kamerhypertrofie • Linker posterior hemiblok• Acuut longembool
K84 – Rechter as
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• Variant van het normale (jongere, vrouw)• Tijdens of na BTB, WPW, pacing, ectopisch ritme (escape, tachycardie,...)• Linker kamerhypertrofie (zeker als apicale hypertrofie) • Subendocardiale ischemie (tijdens pijn)• Ischemie “type” Wellens Syndroom (kritische stenose prox LAD)• Na subepicardiale ischemie• Aspecifieke repolarisatiestoornissen (na oud infarct)• Acuut longembool• ARVC• Intracraniële drukverhoging
K85 - Negatieve T toppen
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• BTB (functioneel of structureel)
• Pre-excitatie (WPW)
• Hyperkaliëmie
• Klasse I anti-aritmica
• Ventriculair ritme
K87 - Breed QRS complex tijdens sinusritme
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Atriale fibrillatie met WPWAcuut myocardinfarct
Totaal AV blokHoofdstamlestel
Lang QT syndroomBrugada syndroom
HyperkaliëmieDigitalisintoxicatie
K86 - Niet te missen ECGs
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ECG interpretation for beginners – 2
Axel en Luc De Wolf
RZ Tienen UZ Leuven
DANK U voor de aandacht
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For more presentations www.medicalppt.blogspot.com
Left Ventricular Hypertrophy
Why is left ventricular hypertrophy characterized by tall QRS complexes?
LVH ECHOcardiogramIncreased QRS voltage
As the heart muscle wall thickens there is an increase in electrical forces moving through the myocardium resulting in increased QRS voltage.
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For more presentations www.medicalppt.blogspot.com
Left Ventricular Hypertrophy
• Criteria exists to diagnose LVH using a 12-lead ECG. – For example:
• The R wave in V5 or V6 plus the S wave in V1 or V2 exceeds 35 mm.
• However, for now, all you need to know is that the QRS voltage increases with LVH.
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Type I- Diagnostic• V1-V3 (as least two leads) ST
segment elevation >2mm, “coved” shape, inverted T-wave.
• Coupled with – Documented VFib– Polymorphic VT– FH of sudden cardiac death
<45 yo– Type I EKG in family members– VT inducable in EP lab– Syncope– Nocturnal agonal respiration
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Types II and III- Suggestive• II: V1-V3 ST segment
elevation >2mm, “saddleback” shape, pos or biphasic T.
• III: <1 mm elevation, either coved or saddleback.
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Cardiomyopathy
• dilated cardiomyopathy• hypertrophic cardiomyopathy• arrythmogenic right ventricular
cardiomyopathy• left ventricular non-compaction• restrictive cardiomyopathy
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ECG Variants • Coronary Spasm:
“Printzmetals angina”Injury pattern that resolves w/ rest, NTG,O2 etc.
• Early Repolarization: elevated “J” point seen best in V3,4. Key to Dx pt’s are usually young & asymptomatic
• Pericarditis: ST elevation usually global associated w/ fever, pleuritic c/p.
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ECG Variants due to Drugs or Electrolytes Imbalances
• Hypokalemia: lg U waves ( usually taller than T) seen best in precordial leads. <2.7
• Hyperkalemia:– Tall peaked T waves > 6.0– PR prolongs, QRS widens– P waves disappear > 8.0
• Hypocalcemia:– Prolonged QT interval
• Hypercalcemia:– Shortened QT interval
• Digitalis effect:– ST depression- downsloping,
curved ST segments.– “scooping”, “sagging”, flat or
inverted T’s in lateral leads– PR prolonged– QT shortened
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ECG PERICARDITIS
• PR depression• ST elevation
– concave up, ST/T V6 >.25, no reciprocal• DDx:
– Acute MI– Early Repolarization– Myocarditis– Aneurysm– other: Brugada, BBB
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• Stage Ieverything is UP (i.e., ST elevation in almost all leads - see below)
• Stage IITransition ( i.e., "pseudonormalization").
• Stage IIIEverything is DOWN (inverted T waves).
• Stage IV Normalization
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Pericarditis