16 ECGs importantes Flashcards
O que é o padrao de De Winter?
- Anterior STEMI equivalent that presents without obvious ST segment elevation.
- Key diagnostic features include ST depression and peaked T waves in the precordial leads
These patients are suffering occlusion myocardial infarction (OMI) and require immediate reperfusion therapy.
- https://litfl.com/de-winter-t-wave/
Como calcular o QT corrigido?
- Formula de Bazett
- D2 ou V5
QTC = QT / √ RR
- QTc is prolonged if > 440ms in men or > 460ms in women
- QTc > 500 is associated with an increased risk of torsades de pointes
Principais causas de QT longo:
- geneticas
- eletrolitos
- drogas anestesicas
- outras situacoes
- outras drogas
- doencas cardiacas
- mutacoes canais ionicos (Na, K)
- hipo-Ca, hipo-K, hipo-Mg
- sevoflurano, sulfentanyl, atropina, metadona, ondansetron, haloperidol
- manobras de intubacao e extubacao.
- antidepressivos, antiarritmicos, cocaina, antibioticos…
- IAM, BAVT, Cardiomiopatia
Manejo para QT Longo (5)
- BBQ
- evitar aumento tonus simpatico
- Marcapasso
- Tratar causa
- CDI
Caracteristicas e significado da Sindrome de Wellens
Wellens Syndrome = high grade LAD or LM coronary lesion
- Clinical syndrome characterised by biphasic or deeply inverted T waves in V2-3, plus a history of recent chest pain now resolved. It is highly specific for critical stenosis of the left anterior descending artery (LAD)
- The pattern is usually present in the pain free state — it may be obscured during episodes of ischaemic chest pain, when there is “pseudonormalisation” of T waves in V2-3
There are two patterns of T-wave abnormality in Wellens syndrome:
- Type A – Biphasic, with initial positivity and terminal negativity (25% of cases)
- Type B – Deeply and symmetrically inverted (75% of cases)
Qual a etiologia da Sindrome de Brugada?
Mutation in the cardiac sodium channel gene.
Tratamento da Sindrome de Brugada
CDI
A 21 year old male of Asian descent has presented to your ED following a brief episode of syncope. He feels fine now and wants to go home. His ECG looks like this:
Sindrome de Brugada
- Type 1 (Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave) is the only ECG abnormality that is potentially diagnostic. This has been referred to as Brugada sign.
This ECG abnormality must be associated with one of the following clinical criteria to make the diagnosis:
- Documented ventricular fibrillation (VF) or polymorphic ventricular tachycardia (VT).
- Family history of sudden cardiac death at <45 years old .
- Coved-type ECGs in family members.
- Inducibility of VT with programmed electrical stimulation
- Syncope.
- Nocturnal agonal respiration.
O que é o Sinal de Brugada?
Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave
- It is the only ECG abnormality that is potentially diagnostic. Diagnosis depends on a characteristic ECG finding AND clinical criteria.:
- Documented ventricular fibrillation (VF) or polymorphic ventricular tachycardia (VT).
- Family history of sudden cardiac death at <45 years old .
- Coved-type ECGs in family members.
- Inducibility of VT with programmed electrical stimulation
- Syncope.
- Nocturnal agonal respiration.
O que é Brugada Tipo 2?
Brugada Type 2 has >2mm of saddleback shaped ST elevation.
- Type 2 and 3 Brugada are non-diagnostic but possibly warrant further investigation (see discussion below).
O que é Brugada Tipo 3?
Brugada type 3: can be the morphology of either type 1 or type 2, but with <2mm of ST segment elevation.
- Type 2 and 3 Brugada are non-diagnostic but possibly warrant further investigation (see discussion below).
