Drug And Electrolyte Effects, Other Conditions (Lauren đźŚ) Flashcards
What will you see in the ECG if someone has pericarditis?
DIFFUSE ST elevation
Depressed PR interval
Later on, ST segments normalize, and T waves invert
What do you think it is:
ST segments elevated in every single lead
ST segment is usually flat or concave (not a tombstone)
Pericarditis
What would you see if a patient had benign early repolarization?
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
How would someone’s ECG change if they developed a pericardial effusion?
Low voltage would be seen in every lead (water is surrounding heart, it’s gonna be a weak signal)
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?
Electrical alternans
QRS amplitude changes from beat to beat
What is the most common ECG change if there is a pulmonary embolism?
Sinus tachycardia
What is the name of the ECG pattern that is associated with massive Pulmonary Embolism that they loooove to test on?
S1-Q3-T3
S1- large S wave in lead I
Q3- deep Q wave in lead III
T3- inverted T wave in lead III
What are some other changes that may be on an ECG if someone has a pulmonary embolism?
Tachyarrhythmias!
Right Atrial Enlargement (tall peaked P waves)
Right axis deviation
New RBBB
Inverted T waves in V1-V4
How do you get Long QT syndrome or Short QT syndrome
You are born with them
Long QT syndrome puts you at risk of developing ________ and ________
Torsades de Pointes
V Fib
What is the QTc interval?
It is the “Corrected” QT interval that corrects for heart rate
What is the HALLMARK ECG finding of Hyperkalemia
Tall Peaked T Waves
What happens to your ECG when you are SUPER hyperkalmemic?
K over 7.0
S and T waves merge to form a sine-wave pattern
What is the progression of ECG changes as your Potassium gets higher and higher?
- Peaked T waves (all leads)
- T wave peaks increase, P waves flatten and QRS complexes widen
- Widened QRS and peaked T waves become indistinguishable forming a Sine Wave pattern
What is the HALLMARK ECG finding of hypokalemia?
U waves
**
Flat T waves
ST depression
In hypokalemia, can the U wave be taller than the T wave?
Yes
What is the HALLMARK finding of Hypercalcemia?
Shorter QT interval
Hypercalcemia= ______QT interval
Hypocalcemia= _______QT interval
Hypercalcemia= shorter QT interval
Hypocalcemia= longer QT interval
Hypokalemia, Hypocalcemia and hypomagnesemia make the QT interval (longer/shorter)
LONGER
*****
If you are low in K+, Ca++, or Mg++, you have a a long QT interval!
Long QT interval puts you at risk for _______
TORSADS DE POINTES
*****
What are the 2 main effects of digoxin on the heart?
Increased contractility
Slows heart rate
Who is at a higher risk of developing digoxin toxicity?
Hypokalemia**
Kidney problems
Old people
What will the ECG look like when someone is on digoxin? (At therapeutic levels, not even toxic levels)
Short QT
ST segment slopes DOWN
Flat/inverted T waves
How is digoxin excreted?
RENAL
USE CAUTION IN OLD PEOPLE AND PEOPLE WITH CKD
The therapeutic margin of digoxin is (narrow/wide)
Narrow
Digoxin (slows/speeds up) conduction through the AV and SA nodes
Digoxin (slows/speeds up) conduction everywhere else
slows
Speeds up
Can digoxin toxicities cause AV block?
Yes
What is the most common rhythm disturbance of digoxin?
PAT with 2ndËš AV block (2:1)
She never talked about this but she had it bolded in her slide
Have a look at some drugs that can cause a prolonged QT and increase risk for V Tach and Torsades
Anti-arrhythmics- quinidine, procainamide, amiodarone, Sotalol
TCAs
Phenothiazines
Macrolides- Azithromycin, clarithromycin, erythromycin
You need to take your patient off a QT prolonging drug if their QT interval increases by ______%
25%
When are Osborn waves seen?
Hypothermia
What do Osborn waves look like?
ST segment elevation with an abrupt ascent at the J point then a plunge back to the baseline
What is one reason ECGs of hypothermic patients are often misinterpreted?
Muscle artifact due to shivering can look like other arrhythmias
In hypothermia, every interval will be (shorter/longer)
Longer
What is this:
Autosomal dominant disorder that causes variable ST segment abnormalities. Can cause sudden death.
Brugada Syndrome
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
Brugada syndrome
How is Brugada syndrome treated?
ICD (Implantable Cardioverter-defibrillator)
Hypercalcemia and Digoxin will (increase/decrease) QT interval
Decrease
Hypocalcemia, Antiarrhythmics, TCAs, Phenothiazines, and Macrolides will (increase/decrease) QT interval
Increase
QTc is considered prolonged if it is longer than:
_______in men
_______in women
.44 in men
.46 in women