Cardiology Flashcards
Wat zijn de Sgarbossa criteria in LBTB
Modified Sgarbossa Criteria:
A. ≥ 1 lead with ≥1 mm of concordant ST elevation
B. ≥ 1 lead of V1-V3 with ≥ 1 mm of concordant ST depression
C. ≥ 1 lead anywhere with ≥ 1 mm STE and proportionally excessive discordant STE, as defined by ≥ 25% of the depth of the preceding S-wave.
Crevised: STE > 25% van QRS complex
ECG criteria LAFB
ECG Criteria for Left Anterior Fascicular Block (LAFB)
· Left axis deviation (usually between -45 and -90 degrees)
· Small Q waves with tall R waves (= ‘qR complexes’) in leads I and aVL
· Small R waves with deep S waves (= ‘rS complexes’) in leads II, III, aVF
· QRS duration normal or slightly prolonged (80-110 ms)
· Prolonged R wave peak time in aVL > 45 ms
· Increased QRS voltage in the limb leads
Contra indicaties nitroglycerine
- Hypotensie
- RV infarct
- Viagra gebruik
Indicaties vroege ischemie:
- Hyperacute T-golven: Indien T > QRS complex.
2. Nieuwe negatieve T in aVL
ECG aanwijzingen pericarditis
- Concave ST elevatie
- PR depressie
- Spodick’s sign (downsloaping TP segment)
DD Bradycardia
HEDIES H - Hyperthyroidism E - Elevated ICP D - Drugs (Ca en B-blokkers, clonidine, digoxine) I - Ischemia E - Electrolyte abnormalities S - Sick sinus syndrome
ECG afwijkingen digoxine intoxicatie
“Salvador Dali snor”
Afwijkingen op het ecg die passen bij digitalisintoxicatie (digitalis = Lanoxin) zijn:
komvormige ST-depressie. T-top vlak, negatief of bifasisch QT is verkort Verhoogde U-golfamplitude Verlengd PR-interval Brady-aritmiën: Sinusbradycardie AV-blok, inclusief compleet AV-blok en Wenckebach. Tachy-aritmiën: Junctionale tachycardie Boezemtachycardie Ventriculaire ectopie, bigemini, monomorfe ventriculaire tachycardie, bidirectionele ventriculaire tachycardie Intoxicatie kan leiden tot een SA-blok of AV-blok eventueel in combinatie met een tachycardie. NB de effecten hiervan worden versterkt door hypokaliëmie. In extreem hoge concentraties kunnen ritmestoornissen (ventriculaire tachycardie, ventrikelfibrilleren, atriumfibrilleren) ontstaan. Als oorzaak wordt vaak het prikkelen van ectopische foci aangewezen.
Wat is Wellen’s syndroom
Wellens’ syndrome is an electrocardiographic manifestation of critical proximal left anterior descending (LAD) coronary artery stenosis in patients with unstable angina. Originally thought of as two separate presentations, A and B, it is now considered an evolving wave form, initially of biphasic T wave inversions and later becoming symmetrical, often deep (>2 mm), T wave inversions in the anterior precordial leads.
Wellens’ sign has also been seen as a rare presentation of Takotsubo cardiomyopathy or stress cardiomyopathy.
ECG afwijkingen bij Wellen’s syndroom
- Progressive symmetrical deep T wave inversion in leads V2 and V3
- Slope of inverted T waves generally at 60°-90°
- Little or no cardiac marker elevation
- Discrete or no ST segment elevation
- No loss of precordial R waves.
ECG afwijkingen longembolie
EKG: No findings are highly sensitive or specific;
- sinus tachycardia,
- historically S1Q3T3 pattern,
- precordial T wave inversions (V1 – V4),
- New (complete or incomplete) right bundle branch block
- STE + nieuwe rechter as: denk aan LE
Diagnostische criteria Tako Tsubo
- Nieuwe ST-elevaties / T-top inversies, of matige stijging van troponine
- Voorbijgaande dys- of akinesie van de linkerventrikel (apicale of midventriculaire
segmenten) met regionale wandafwijkingen die niet bij één bepaald stroomgebied
passen - Afwezigheid van coronairstenose > 50% of “culprit lesion”
ECG Criteria for Left Posterior Fascicular Block (LPFB)
ECG Criteria for Left Posterior Fascicular Block (LPFB)
· Right axis deviation (RAD) (> +90 degrees)
· Small R waves with deep S waves (= ‘rS complexes‘) in leads I and aVL
· Small Q waves with tall R waves (= ‘qR complexes‘) in leads II, III and aVF
· QRS duration normal or slightly prolonged (80-110ms)
· Prolonged R wave peak time in aVF
· Increased QRS voltage in the limb leads
· No evidence of right ventricular hypertrophy
· No evidence of any other cause for right axis deviation
Handy Tips
· LPFB is much less common than LAFB, as the broad bundle of fibres that comprise the left posterior fascicle are relatively resistant to damage when compared with the slim single tract that makes up the left anterior fascicle.
· It is extremely rare to see LPFB in isolation. It usually occurs along with RBBB in the context of a bifascicular block.
· Do not be tempted to diagnose LPFB until you have ruled out more significant causes of right axis deviation: Example: acute pulmonary embolus; tricyclic overdose; lateral STEMI; and right ventricular hypertrophy.
Bifasciculair block
Bifascicular block is the combination of RBBB with either LAFB or LPFB.
· Conduction to the ventricles is via the single remaining fascicle.
· The ECG will show typical features of RBBB plus either left or right axis deviation.
· RBBB + LAFB is the most common of the two patterns.
· Bifascicular block is a sign of extensive conducting system disease, although the risk of progressing to complete heart block is thought to be relatively low (1% per year in one cohort study of 554 patients).
NB. Some authors also consider LBBB to be a ‘bifascicular block’, because both fascicles of the left bundle branch are blocked
Trifasciculair block
Definition of Trifascicular Block
The most common pattern referred to as “trifascicular block” is the combination of bifascicular block with 1st degree AV block.
Incomplete trifascicular block
· Bifascicular block + 1st degree AV block (most common)
· Bifascicular block + 2nd degree AV block
· RBBB + alternating LAFB / LPFB
Complete trifascicular block
· Bifascicular block + 3rd degree AV block
Main Causes
· Ischaemic heart disease
· Hypertension
· Aortic stenosis
· Anterior MI
· Primary degenerative disease of the conducting system (Lenègre-Lev disease)
· Congenital heart disease
· Hyperkalaemia (resolves with treatment)
· Digoxin toxicity
DD thoracale pijn
- ACS
- Thoracale dissectie
- Longembolie
- Pneumothorax
- Oesofagusruptuur
- Musculoskeletaal
- Pericarditis
- Myocarditis
- Tamponade
