ECG: Drugs effects Flashcards

1
Q

Digoxin can cause many different ECG abnormalities when supratherapeutic levels occur which are called the digoxin effect

A) The classic digoxin effect appears as:

A

A) Appears as a:

  • down-sloping ST segment depression
  • also known as the “reverse tick” or “reverse check” sign.
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2
Q

Digoxin toxicity can induce literally every arrhythmia except for rapidly conducted atrial arrhythmias (atrial fibrillation and atrial flutter).

The classic arrhythmias seen during digoxin toxicity include:

A
  • Atrial tachycardia with a 2:1 conduction,
  • Bidirectional ventricular tachycardia and,
  • Atrial fibrillation with a slow ventricular response.
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3
Q

The ECG findings of hyperkalemia change as the potassium level increases. From slightly high levels to very high levels, ECG findings include:

A) Peaked T waves best seen in which leads¿
B) What are 3 other changes can often be seen¿

A

The ECG findings of hyperkalemia change as the potassium level increases. From slightly high levels to very high levels, ECG findings

A: The precordial leads.

B)

  • shortened QT interval, and
  • sometimes ST segment depression
  • Widening of the QRS complex (usually potassium level is 6.5 or greater).
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4
Q

Widening of the QRS complex from elevated potassium (usually in level is 6.5 or greater).
This frequently appears as in:

A

Widening of the QRS complex (usually potassium level is 6.5 or greater).
“non-specific intraventricular conduction delay” or IVCD
-which is characterized by a widened QRS complex of > 120 ms
that does not meet the criteria for a left or right bundle branch block.

Frequently an IVCD will look like a left bundle branch block in lead V1 with a rS complex or monomorphic S wave and it appears like a right bundle branch block in leads I and V6 with a broad, slurred S wave.

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5
Q

CLINICAL PEARL: If you see an IVCD, think of which drug¿

A

Hyperkalemia

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6
Q

What ECG changes can be seen with potassium level in excess of 7.0¿

A

Decreased amplitude of the P waves, an increase in the PR interval, and bradycardia in the form of AV blocks.

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7
Q

Absence of the P waves and eventually a “sine wave” pattern, which is frequently a fatal rhythm, is usually associated with which drug in high levels¿

A

Excessive Potassium

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8
Q

In the setting of hyperkalemia does giving intravenous calcium decrease the potassium levels¿

A

Although it is “cardioprotective” in the setting of hyperkalemia. And you will frequently see instant reversal of all hyperkalemic ECG changes within seconds of administration, Calcium does not decrease the potassium levels.

So other therapy like bicarbonate or insulin is needed to do this.

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