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Clinical Anesthesia > ECGs > Flashcards

ECGs Flashcards

1
Q

A wider P wave indicates what?

A

LA enlargement

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2
Q

A higher P wave amplitude indicates what?

A

RA enlargement

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3
Q

Increased amplitude of the R wave indicates what?

A

LV enlargement

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4
Q

A deep and wide S wave indicates what?

A

RV enlargement

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5
Q

What electrolyte abnormality would you suspect with increased amplitude of T waves?

A

Hyperkalemia

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6
Q

What electrolyte abnormality would you suspect with decreased T wave amplitudes that were biphasic?

A

Hypokalemia

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7
Q

What are some reasons you might see a depressed ST segment?

A
  • Ischemia
  • Electrolye abnormalities
  • Digitalis toxicity
  • Myocardial trauma
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8
Q

What might you suspect if you saw elevated ST segments?

A

ischemia

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9
Q

You should anticipate an increased risk of arrythmias in which patients?

A
  • GDVs
  • Pheos
  • Hypovolemic
  • GI FB
  • DCM
  • ARVC (Boxers)
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10
Q

What does this ECG indicate?

A

Sinus bradycardia (HR <60 in dogs or <100 in cats)

  • note the consistent P and QRS complexes that are always related
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11
Q

What are some causes of sinus bradycardia?

A
  • Opioids/alpha 2s
  • Vagal reflex
  • Hypertension (+++ sudden onset, due to baroreceptor reflex)
  • Hypothermia
  • Cushing’s response
  • Hypoglycemia
  • Hypoxia
  • Hypothyroidism
  • Hyperkalemia
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12
Q

What does this ECG indicate?

A

Sinus tachycardia

  • HR >160 bpm in dogs, >240 bpm in cats
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13
Q

What are some causes of sinus tachycardia?

A
  • Increased adrenergic tone (exercise, fear, anxiety, insufficient analgesia, “light” anesthetic plane)
  • Hypovolemia
  • Accidental bolus of beta agonist
  • Anticholinergic
  • Hyperthyroidism
  • Pheo
  • Hyperthermia
  • Anemia
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14
Q

What are the hemodynamics consequences of sinus tachycardia?

A
  • Hypertension
  • Hypotension (decreased diastole—> reduced end-diastolic volume)
  • Increased myocardial oxygen consumption = myocardial ischemia = arrhythmias
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15
Q

How do you treat sinus tachycardia?

A

Depends on the cause!

  • analgesics, sedatives
  • hypnotics
  • discontinue beta agonist administration
  • beta blocker (esmolol)
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16
Q

What does this ECG indicate?

A

Respiratory sinus arrhythmia

  • patterned irregularity to QRS complexes
    • Regularly irregular
    • Shortening of the RR interval during inspiration and lengthening during expiration
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17
Q

What are some causes for respiratory sinus arrhythmias?

A
  • May be associated with high vagal tone or opioid administration
  • Normal at low HR in dogs
  • Uncommon in cats - often associated with upper resp tract obstruction
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18
Q

What does this ECG indicate?

A

Wandering pacemaker

  • variable P wave morphology
  • Often seen alongside respiratory sinus arrhythmia
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19
Q

When should you treat wandering pacemakers or respiratory sinus arrhythmias?

A

If hypotension is present, then anitcholinergics should be used

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20
Q

What does this ECG indicate?

A

Atrial premature complexes

  • P wave can be biphasic
  • Common with LA enlargement
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21
Q

What is a hemodynamic consequence of APCs?

A

Smaller pulse wave due to insufficient fill time

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22
Q

What drug might you consider avoiding if your patient’s ECG is demonstrating APCs?

A

Opioids, since high doses of them may increase the frequency of APCs

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23
Q

What does this ECG indicate?

A

1st degree AV block

  • prolonged PQ interval
  • normal QRS
  • caused by high vagal tone
  • Treatment = none vs. anticholinergics
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24
Q

What does this ECG indicate?

A

2nd degree AV block Mobitz type I (Wenkenbach)

  • progressively prolonged PQ followed by a non conducted P wave
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25
Q

What are the causes of a 2nd degree AV block Mobitz type I?

A
  • High vagal tone
    • opioids
    • alpha 2s
  • Cushing’s response
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26
Q

How do you treat a Mobitz I 2nd degree AV block?

A
  • None if occasional and in absence of hemodynamic consequences
  • anticholinergics can be administered if BP is low
  • mannitol or HSS to decrease ICP if Cushing’s response suspected
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27
Q

What does this ECG indicate?

A

2nd degree AV block Mobitz type II

  • PQ is constant before P is not conducted
28
Q

What are the causes of Mobitz type II 2nd degree AV blocks?

A
  • Fibrosis
  • Cardiomyopathy
  • Trauma
  • Infections (ie. Lyme)
  • Alpha 2’s

Less likely to be vagally mediated

May progress into 3rd degree AV block!!

29
Q

What does this ECG indicate?

A

2nd degree AV block Mobitz type II - High grade

  • 2 consecutive P waves are never conducted one after the other (always one blocked P wave in between them)
  • NOT drug induced —> typically unresponsive to anticholinergics and require pacemaker implantation!
30
Q

What does this ECG indicate?

A

Junctional escape rhythm - 3rd degree AV block

  • ​complete dissociation b/t atria and ventricles (two independent rates)
  • Narrow QRS complex, higher rate (40-60 bpm) than ventricular escape rhythm
  • severe hemodynamic consequences
31
Q

What does this ECG indicate?

A

Ventricular escape rhythm - 3rd degree AV block

  • wide QRS complex, lower rate than junctional escape rhythm (20-40 bpm)
  • severe hemodynamic consequences
32
Q

What are the causes of 3rd degree AV blocks?

A
  • Usually due to a damaged AV node
    • Idiopathic (most frequent)
    • Neoplastic
    • Infiltrative
    • Inflammatory
    • Drug toxicity (Digitalis)
    • Hyperkalemia

Very rarely vagally mediated

33
Q

How do you treat a 3rd degree AV block?

A
  • Pacemaker
  • May or may not respond to anticholinergics
  • Isoproterenol (beta agonist)
34
Q

What does this ECG indicate?

A

Sick sinus syndrome

  • idiopathic disease of the sinus node, most commonly seen in older female WHWT, Schnauzers, Cockers, Dachshunds
  • Periods of extreme tachycardia and bradycardia, long pauses in sinus rhythm (sinus arrest) often followed by escape rhythm
35
Q

What drugs should be used with care when anesthetizing a risk breed for SSS?

A

High doses of opioids and alpha 2’s

36
Q

How do you treat sick sinus syndrome?

A
  • Pacemaker implantation
  • May or may not respond to anticholinergics
  • When anesthetized, pauses may become severely prolonged!
    • ​When undergoing pacemaker implantation, a temporary pacemaker or external patches should be placed while animal is awake or under light sedation
37
Q

Describe the 2 types of temporary pacemakers you can place

A
  • External (trans-thoracic) patches: positioned in awake animals, pain is elicited during stimulation
  • Trans-venous temporary pacemaker:
    • ​inserted in lateral saphenous or femoral vein and advanced into RV
    • fluoroscopic guidance
    • usually done under sedation or local anesthesia
    • risk of vascular or cardiac perforation
    • No pain during stimulation
38
Q

Describe permanent pacemaker implantation

A
  • Usually done under GA
  • Protocols aimed at maintaining the intrinsic HR until pacemaker can be activated
  • Inserted thru jugular and advanced in the RV
  • Pulse generator fits in a pocket in the neck
  • Minimally painful
39
Q

Describe pericardial pacemaker implantation

A
  • Cats, very small dogs
  • In case of pacemaker revision
  • Transdiaphragmatic approach
  • Added difficulty: laparotomy!
    • Analgesia must be provided
40
Q

What does this ECG indicate?

A

These are the characteristic pacemaker spikes

41
Q

Why do bundle branch blocks occur?

A

occur when electrical activity within the myocardium is re-routed from the rapid-conducting fibers of the bundle branches and travels more slowly thru the myocardial cells

  • may be intermittent or persistent
  • wide QRS complexes
  • P wave is present and associated with the wide QRS complex
42
Q

What does this ECG indicate?

A

Left BBB

  • Positive QRS in lead II
  • Associated with severe myocardial disease (left BB is thicker than R, so damage to this branch reflects more severe dz)
    • Dogs = DCM; Cats = HCM
  • May be associated with impaired systolic and diastolic function
43
Q

What does this ECG indicate?

A

Right BBB

  • Deep S wave in lead I, II (negative QRS)
  • May be incidental
  • R sided heart disease
    • ​Fibrosis
    • Heartworm infection
    • After balloon valvuloplasty for pulmonic stenosis (usually transient)
  • Often no hemodynamic consequences
44
Q

What does this ECG indicate?

A

Atrial fibrillation

  • discernible P waves are absent
  • +/- F waves = oscillation of the isoelectric line of varying amplitude (low HR)
  • ventricular rate is usually rapid and irregularly irregular

commonly seen in giant dogs, horses

seen in small dogs and cats ONLY with atrial enlargement

45
Q

What is the hemodynamic consequence of atrial fibrillation?

A

The atrial kick is lost, therefore stroke volume is reduced by 20-30%

46
Q

What does this ECG indicate?

A

Atrial flutter ‘saw tooth pattern’

  • similar hemodynamic consequences as Afib
  • commonly seen in giant dogs, horses
  • seen in small dogs and cats ONLY with atrial enlargement
47
Q

What does the term supra-ventricular tachycardia mean?

A

Tachycardia that originates above the ventricle (atria or AV node), characterized by elevated heart rate and narrow QRS complex

48
Q

Describe ventricular arrhythmias

A
  • QRS is wide and bizare
  • No P wave
  • T is opposite polarity to the QRS complex f
  • can occur before the next sinus complex - VPC or after a pause ventricular escape
49
Q

What does this ECG indicate?

A

Ventricular premature complexes

  • may be isolated or couplets, triplets
  • 4 or more = run of Vtach
  • may be associated with cardiac or non-cardiac dz (cats = almost always cardiomyopathy)
  • treatment is rarely necessary, unless they become frequent —> Lidocaine
50
Q

What does this ECG indicate?

A

Bigeminy = one VPC every other sinus beat

51
Q

What does this ECG indicate?

A

Trigeminy = one VPC every third sinus beat

52
Q

What are some causes of VPCs?

A
  • Primary cardiac dz
  • Trauma
  • Shock
  • Hypoxemia/ischemia
  • Electrolyte/acid-base imbalance
  • GDV
  • HSA
  • Major abdominal surgery
53
Q

When should you consider treating VPCs?

A
  • Frequent
  • Multifocal (they are present in different shapes)
  • Impact on cardiac output
  • Frequent runs
  • R on T phenomenon - R wave is very close to previous beat T wave
54
Q

What is a ventricular escape rhythm?

A
  • The ventricle compensates for a pause = this is a compensatory rhythm
    • ​the pause in anesthetized animals may be induced by anesthetic drugs that incr PS tone
    • Lidocaine administration could suppress this compensatory rhythm!!!
  • May be treated with atropine
55
Q

What does this ECG indicate?

A

Ventricular escape rhythm

56
Q

What does this ECG indicate?

A

Idioventricular rhythm

  • looks the same as accelerated idioventricular rhythm and Vtach, only difference is rate!
    • HR < 100 bpm
  • Acclerated: HR > 100 bpm
  • Vtac: HR >180 bpm
57
Q

What are the causes of idioventricular rhythms?

A
  • GI FB, sepsis, GDV, hemoabdomen
  • Hypovolemia
  • Hypoxia
  • Alterations of ANS during anesthesia
58
Q

When should you consider treating idioventricular rhythms?

A
  • Idioventricular (accelerated) rhythms should not be treated with lidocaine —> both are compensatory rhythms, lidocaine may cause asystole!
  • may consider using atropine if there’s a low HR
  • Vtach may be treated with lidocaine if it is sustained or polymorphine or if causes hemodynamic stability
59
Q

What does this ECG indicate?

A

Monomorphic ventricular tachycardia

  • All complexes look the same
  • Often minimal hemodynamic impact
60
Q

What does this ECG indicate?

A

Polymorphism ventricular tachycardia

  • complexes look different from one another
  • may become torsade de pointes or Vfib
  • call for help!
  • get a defibrillator
61
Q

What electrolyte abnormalities may cause Vtach?

A

hypokalemia or hypomagnesemia

62
Q

What does this ECG indicate?

A

Ventricular fibrillation

  • Shockable rhythm
63
Q

What two rhythms are considered a defibrillation success?

A

sinus rhythm or asystole

64
Q

What does this ECG indicate?

A

Asystole

  • Non-shockable rhythm
65
Q

What does this ECG indicate?

A

Pulseless electrical activity

  • non-shockable rhythm
  • may look very similar to a normal sinus complex or be associated to a wide and bizarre complex

Clinical Anesthesia (15 decks)

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