theecginthebroaderpicture - cape town (af) centre · 2015-08-06 · hypokalaemia! •...
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![Page 1: TheECGinthebroaderpicture - Cape Town (AF) Centre · 2015-08-06 · Hypokalaemia! • The$characteris+c$abnormali+es$associated$ with$alow$potassium$are:$ • Flaened$T$waves$ •](https://reader033.vdocuments.net/reader033/viewer/2022041600/5e30643a4caa365d4a2136db/html5/thumbnails/1.jpg)
The ECG in the broader picture
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Hypokalaemia
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Hypokalaemia
• The characteris+c abnormali+es associated with a low potassium are:
• Fla7ened T waves • U waves • ST depression • Peaked p waves (p pulmonale like)
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Hypokalaemia
• Treatment is dependent on the presence or absence of arrhythmia
• VT/VF is possible with very low levels but rare • Ideally should be brought up gradually with causal correc+on
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Hyperkalaemia
• Progressive ECG changes usually related to level of K and danger of arrythmia
• Ini+al peaking of T waves • Then broadening of QRS un+l bundle branch block sort of picture
• Finally sinusoidal looking ECG that is a peri-‐arrest phenomenon
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Sinus tachy with Potassium 9.1 This, for once, was not VT. CaCl caused the complex to
narrow immediately, showing sinus rhythm
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Hyperkalaemia – what it usually looks like
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Hyperkalaemia
• Treatment is to initally give CaCl 10mls of 10% • Acts as myocardial membrane stabilising agent to reduce risk of arrythmia
• Then goal is to move potassium into cells • Dextrose/insulin • Salbutamol • Then to remove potassium • Stop drugs/calcium resonium/renal replacement
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Hypocalcaemia
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Hypocalcaemia
• Prolonged QTc with u waves • Flat T waves • Can also cause coronary spasm and ST eleva+on
• Unusual cause of symptoms or arrythmia
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Digoxin
• Normal levels of digoxin can produce ECG changes
• Changes can become more marked during toxicity
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Digoxin
• Can induce brady or tachycardia • Even mildly elevated levels can be dangerous in presence of addi+ve factor:
• Hypokalaemia • Drugs – erythromycin, ibuprofen, quinindine • Can induce heart block
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Pericardial Effusion
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Pericardial effusion • The characteris+c ECG findings are those of small
complexes
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PericardiGs
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PericardiGs
• Saddle-‐shaped ST eleva+on • PR depression • Usually see abnormali+es in most if not all leads
• Can be difficult to dis+nguish from benign early repolarisa+on (history)
• Prone to accumula+ng pericardial fluid • Can rarely cause tamponade
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PericardiGs
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Amyloid • Amyloid is an infiltra+ve
disorder which can involve the heart
• ECG changes are similar to those seen with pericardial effusion
• Le\ axis devia+on may also be seen in heavily hypertrophied hearts
• Atrial arrythmia is common due to the high atrial filling pressures caused by the s+ff ventricle
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Pulmonary Embolus
• The most common ECG in PE is sinus tachycardia
• The fabled ‘S1Q3T3’ simply represents right axis devia+on
• Caused by strain on the right ventricle from the clot
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Massive Pulmonary Embolus can rarely cause the anterior T waves to flip
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Hypothermia
• Causes bradycardia and J point eleva+on 33o
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Hypothermia – during warming the ‘Osbourne wave’ gradually disappears
35o
38o