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ΩΩ 3b Bateman - Clinical Scans etc > ECG Examples > Flashcards

ECG Examples Flashcards

1
Q

What does this show?

What is the treatment?

A

Ventricular tachycardia

  1. If the patient has adverse signs (systolic BP < 90 mmHg, chest pain, heart failure) then immediate cardioversion is indicated. In the absence of such signs antiarrhythmics may be used. If these fail, then electrical cardioversion may be needed with synchronised DC shocks
  2. Drug therapy
    • amiodarone: ideally administered through a central line
    • lidocaine: use with caution in severe left ventricular impairment
    • procainamide
  3. Verapamil should NOT be used in VT
  4. If drug therapy fails
    • electrophysiological study (EPS)
    • implant able cardioverter-defibrillator (ICD) - this is particularly indicated in patients with significantly impaired LV function
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2
Q

What does this show?

What is the treatment?

A

Supraventricular tachycardia

Acute management

  1. Vagal manoeuvres:
    • FIRST LINE - Valsalva manoeuvre: e.g. trying to blow into an empty plastic syringe
    • carotid sinus massage
  2. Intravenous adenosine - only lasts 10 seconds
    • Rapid IV bolus of 6mg → if unsuccessful give 12 mg → if unsuccessful give further 18 mg
    • Contraindicated in asthmatics - verapamil is a preferable option
  3. Electrical cardioversion
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3
Q

How is supraventricular tachycardia normally characterised?

A

Episodes are characterised by the sudden onset of a narrow complex tachycardia, typically an atrioventricular nodal re-entry tachycardia (AVNRT)

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4
Q

What does this show?

What is the treatment?

A

Atrial flutter with variable block (a form of supraventricular tachycarida)

  1. I similar to that of atrial fibrillation although medication may be less effective
  2. Atrial flutter is more sensitive to cardioversion however so lower energy levels may be used
  3. Radiofrequency ablation of the tricuspid valve isthmus is curative for most patients
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5
Q

What does this show?

What causes it?

What is the management?

A

Torsades de pointes (polymorphic tachycarida)

  1. Congenital
  2. Jervell-Lange-Nielsen syndrome
  3. Romano-Ward syndrome
  4. Antiarrhythmics: amiodarone, sotalol, class 1a antiarrhythmic drugs
  5. Tricyclic antidepressants
  6. Antipsychotics
  7. Chloroquine
  8. Terfenadine
  9. Erythromycin
  10. Electrolyte: hypocalcaemia, hypokalaemia, hypomagnesaemia
  11. Myocarditis
  12. Hypothermia
  13. Subarachnoid haemorrhage

IV magnesium sulphate

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6
Q

What does this show?

What is the treatment?

A

Mobitz type 2

  1. Atropine, up to maximum of 3mg
  2. Transcutaneous pacing
  3. Isoprenaline/adrenaline infusion titrated to response

Pacemaker for long term

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7
Q

What does this show?

A

Hypertrophic obstructive cardiomyopathy

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8
Q

What does this show?

A

Normal ECG

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9
Q

What does this show?

What is the treatment?

A

Wolff-Parkinson White

  1. short PR interval
  2. wide QRS complexes with a slurred upstroke - ‘delta wave’
  3. left axis deviation if right-sided accessory pathway*
  4. right axis deviation if left-sided accessory pathway*
  5. Definitive treatment - radiofrequency ablation of the accessory pathway
  6. Medical therapy: sotalol***, amiodarone, flecainide
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10
Q

What does this show?

What is the management?

A

Pericarditis

  1. Treat the underlying cause
  2. a combination of NSAIDs and colchicine is now generally used for first-line for patients with acute idiopathic or viral pericarditis
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11
Q

What does this show?

A

AF

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12
Q

What does this show?

A

PE

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13
Q

What does this show?

A

ECG features

down-sloping ST depression (‘reverse tick’, ‘scooped out’)

flattened/inverted T waves

short QT interval

arrhythmias e.g. AV block, bradycardia

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14
Q

What does this show?

A

Bifascicular block

combination of RBBB with left anterior or posterior hemiblock

e.g. RBBB with left axis deviation

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15
Q

What would a posterior MI show?

A

This patient has most likely experienced a posterior STEMI. On a 12-lead ECG ST-elevation would not be noticeable and so only reciprocal changes are visible in leads V1-V3. The changes associated with these leads include:

  1. ST depression
  2. Tall, broad R-waves
  3. Upright T-waves
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16
Q

What does this show?

A

ECG features of hypokalaemia

  1. U waves
  2. small or absent T waves (occasionally inversion)
  3. prolong PR interval
  4. ST depression
  5. long QT

The ECG below shows typical U waves. Note also the borderline PR interval. This also has long QT

17
Q

What leads show an inferior MI, what coronary artery is affected?

A

II, III, aVF

Right coronary

ΩΩ 3b Bateman - Clinical Scans etc (6 decks)

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