ECG Signs, Scores, Tips, Tricks Flashcards
ECG in Pericarditis
ECG in Pericarditis
= PR depression
= Concave ST elevation global
= PR elevation in aVR/V1
= Sinus tachycardia
= AFib, Flutter, APC’s
= Spodick sign ie downsloping TP
= Late: flat T and then inversion
ECG on paper analysis
The rate of paper (i.e. of recording of the EKG) is 25 mV/s which results in:
1 mm = 0.04 sec (or each individual block)
5 mm = 0.2 sec (or between 2 dark vertical lines)
Distance between Tick marks = 3 seconds (in the rhythm strip)
The voltage recorded from the leads is also standardized on the paper where 1 mm = 1 mV (or between each individual block vertically) This results in:
1 mm = 0.1 mV
5 mm = 0.5 mV (or between 2 dark horizontal lines)
10 mm = 1.0 mV
ECG in pulmonary embolism
Various Presentation
Sinus tachycardia most common
Tall R in V1
RV strain -
= ST down T down in V1V2V3
= ST down T down in II/ III/ aVF
Right BBB
T inversions in V1V2V3
S1S2S3 - deep S in 1/2/3 leads
S1Q3T3 - deep S1, Q in 3, T inv in 3
Inferior STEMI - rarely
ECG in Dextrocardia
= Right axis deviation
= Positive QRS complexes (with upright P + T) in aVR (reversed)
= Lead I: inversion of all complexes, aka ‘global negativity’ (inverted P, negative QRS, inverted T)
= Absent R-wave progression in the chest leads (dominant S waves throughout)
= Normal life exceptancy if no other abnormalities and equal frequency in Male:females
Associations:
= Kartagener syndrome with situs inversus + bronchiectasis + recurrent sinusitis + dextrocardia
STE in lead aVR
STE in aVR - mechanism
STE in aVR - Causes
STE in aVR- Example 2
STE in aVR- Example 3
STE in aVR- Example 4
STE in aVR- Example 5
STE in aVR- Example 6
STE in aVR- Example 7
STE in aVR- Example 8
RBBB pattern wide complex VTach- criteria’s in favor of VTach
Lead V1:
- rSR’ with R’ > r
- RS with R > S
Lead V6:
- if a Q wave is present - it must be 40 ms and < 0.2 mV
Broad complex tachycardia with LBBB criteria’s
Lead V1:
- rS or QS with time to S wave nadir is < 70 ms
Lead V6:
- R wave with no Q wave
Tachyarrhythmia as likely VTach
- broad QRS > 140 ms or 3.5 small squares
- markedly negative LAD
- < 40 ms R-R variation
- QRS concordance in chest leads is mainly positive side
- capture beats, fusion beats
- known CHF or poor LVEF
Irregular Broad Tachycardia Types
- Atrial fibrillation with aberration
- Atrial flutter with aberration
- Multifocal atrial tachycardia with BBB
- Pre-excited AF (WPW)
- Torsade de pointes
Monomorphic Ventricular Tachycardia Rx
Precordial thump
Unsynchronised cardioversion 200 J
If stable -
- IV Amiodarone or
- IV Sotalol or
- IV Procainamide
- Lidocaine or beta blockers 2nd line
- IV Magnesium 8 mmols over 5 min followed by 60 mmols in 50 ml glucose over 24 Hrs if at risk of low Mg (on diuretics, alcoholics)
Think of need for PCI
- correct UE and acidosis
Brugada syndrome
ST coving elevation in V1-V3
ST elevation might need a trigger as fever
Can be induced with Na channel blockers
Risks: Sudden death, Cardiac syncope due to arrhythmia
Autosomal dominant, SCN5a mutation
Diagnostic tests - additional 1mm STE in V1-V3 after iv Flecainide 2mg/kg or Procainamide 10 mg/kg in 10 minutes
Rx - Quinidine, promt fever control, ICD,
Avoid Brugada drugs
Brugada Syndrome Types
Type 1: coved ST elevation in V1V2V3 > 2mm at least 2 leads followed by negative t waves
Type 2: horizontal saddle type ST elevation > 2mm in at least 1 of V1V2V3
Type 3: either type morphology of 1 or 2 types but elevation is < 2mm in V1V2V3
QTc formulas
QTc nomogram
LVH criteria
LVH: Voltage criteria:
- tallest R (v4-v6) + deepest S (v1-v3) > 40
SV1 + RV6 > 35 - tallest R (v4-v6) > 27 mm
- deepest S (v1-v3) > 30 mm
- R in aVL > 13 mm
- QRS > 0.08
- abnormal ST depression or T inversion in V4-V6