Drug And Electrolyte Effects, Other Conditions (Lauren 🌭)

Question 1

What will you see in the ECG if someone has pericarditis?

Answer 1

DIFFUSE ST elevation

Depressed PR interval

Later on, ST segments normalize, and T waves invert

Question 2

What do you think it is:

ST segments elevated in every single lead

ST segment is usually flat or concave (not a tombstone)

Answer 2

Pericarditis

Question 3

What would you see if a patient had benign early repolarization?

Answer 3

MINIMAL ST elevation (<1/4 the height of the T wave)

J point notching

Upsloping ST segment

T wave asymmetry

No reciprocal findings in other leads

Question 4

How would someone’s ECG change if they developed a pericardial effusion?

Answer 4

Low voltage would be seen in every lead (water is surrounding heart, it’s gonna be a weak signal)

Question 5

What change might happen to someone’s ECG if they got a pericardial effusion that was SO BIG that the heart was swinging freely from side to side?

Answer 5

Electrical alternans

QRS amplitude changes from beat to beat

Question 6

What is the most common ECG change if there is a pulmonary embolism?

Answer 6

Sinus tachycardia

Question 7

What is the name of the ECG pattern that is associated with massive Pulmonary Embolism that they loooove to test on?

Answer 7

S1-Q3-T3

S1- large S wave in lead I

Q3- deep Q wave in lead III

T3- inverted T wave in lead III

Question 8

What are some other changes that may be on an ECG if someone has a pulmonary embolism?

Answer 8

Tachyarrhythmias!

Right Atrial Enlargement (tall peaked P waves)

Right axis deviation

New RBBB

Inverted T waves in V1-V4

Question 9

How do you get Long QT syndrome or Short QT syndrome

Answer 9

You are born with them

Question 10

Long QT syndrome puts you at risk of developing ________ and ________

Answer 10

Torsades de Pointes

V Fib

Question 11

What is the QTc interval?

Answer 11

It is the “Corrected” QT interval that corrects for heart rate

Question 12

What is the HALLMARK ECG finding of Hyperkalemia

Answer 12

Tall Peaked T Waves

Question 13

What happens to your ECG when you are SUPER hyperkalmemic?

K over 7.0

Answer 13

S and T waves merge to form a sine-wave pattern

Question 14

What is the progression of ECG changes as your Potassium gets higher and higher?

Answer 14

1. Peaked T waves (all leads)
2. T wave peaks increase, P waves flatten and QRS complexes widen
3. Widened QRS and peaked T waves become indistinguishable forming a Sine Wave pattern

Question 15

What is the HALLMARK ECG finding of hypokalemia?

Answer 15

U waves
**

Flat T waves

ST depression

Question 16

In hypokalemia, can the U wave be taller than the T wave?

Answer 16

Yes

Question 17

What is the HALLMARK finding of Hypercalcemia?

Answer 17

Shorter QT interval

Question 18

Hypercalcemia= ______QT interval

Hypocalcemia= _______QT interval

Answer 18

Hypercalcemia= shorter QT interval

Hypocalcemia= longer QT interval

Question 19

Hypokalemia, Hypocalcemia and hypomagnesemia make the QT interval (longer/shorter)

Answer 19

LONGER
*****

If you are low in K+, Ca++, or Mg++, you have a a long QT interval!

Question 20

Long QT interval puts you at risk for _______

Answer 20

TORSADS DE POINTES

*****

Question 21

What are the 2 main effects of digoxin on the heart?

Answer 21

Increased contractility

Slows heart rate

Question 22

Who is at a higher risk of developing digoxin toxicity?

Answer 22

Hypokalemia**

Kidney problems

Old people

Question 23

What will the ECG look like when someone is on digoxin? (At therapeutic levels, not even toxic levels)

Answer 23

Short QT

ST segment slopes DOWN

Flat/inverted T waves

Question 24

How is digoxin excreted?

Answer 24

RENAL

USE CAUTION IN OLD PEOPLE AND PEOPLE WITH CKD

Question 25

The therapeutic margin of digoxin is (narrow/wide)

Answer 25

Narrow

Question 26

Digoxin (slows/speeds up) conduction through the AV and SA nodes

Digoxin (slows/speeds up) conduction everywhere else

Answer 26

slows

Speeds up

Question 27

Can digoxin toxicities cause AV block?

Answer 27

Yes

Question 28

What is the most common rhythm disturbance of digoxin?

Answer 28

PAT with 2nd˚ AV block (2:1)

She never talked about this but she had it bolded in her slide

Question 29

Have a look at some drugs that can cause a prolonged QT and increase risk for V Tach and Torsades

Answer 29

Anti-arrhythmics- quinidine, procainamide, amiodarone, Sotalol

TCAs

Phenothiazines

Macrolides- Azithromycin, clarithromycin, erythromycin

Question 30

You need to take your patient off a QT prolonging drug if their QT interval increases by ______%

Answer 30

25%

Question 31

When are Osborn waves seen?

Answer 31

Hypothermia

Question 32

What do Osborn waves look like?

Answer 32

ST segment elevation with an abrupt ascent at the J point then a plunge back to the baseline

Question 33

What is one reason ECGs of hypothermic patients are often misinterpreted?

Answer 33

Muscle artifact due to shivering can look like other arrhythmias

Question 34

In hypothermia, every interval will be (shorter/longer)

Answer 34

Longer

Question 35

What is this:

Autosomal dominant disorder that causes variable ST segment abnormalities. Can cause sudden death.

Answer 35

Brugada Syndrome

Question 36

A 30 year old Asian man walks into the ER saying he is having fainting spells. On ECG, you see weird ST segment elevation abnormalities. He has a family history of sudden cardiac death.
What do you think he has

Answer 36

Brugada syndrome

Question 37

How is Brugada syndrome treated?

Answer 37

ICD (Implantable Cardioverter-defibrillator)

Question 38

Hypercalcemia and Digoxin will (increase/decrease) QT interval

Answer 38

Decrease

Question 39

Hypocalcemia, Antiarrhythmics, TCAs, Phenothiazines, and Macrolides will (increase/decrease) QT interval

Answer 39

Increase

Question 40

QTc is considered prolonged if it is longer than:

_______in men

_______in women

Answer 40

.44 in men

.46 in women