EKG Meds and Metabolic Derangements

Question 1

Digitalis/Digoxin

• EKG findings
• Sx of digoxin toxicity
• what rhythm is common with toxic levels of digoxin

Answer 1

EKG findings: scooped ST depression (slows down repolarization)
-should see this in ALL of the leads, if only in V5 V6 you are maybe worried about ischemia.

Toxicity sx:

• N/V, anorexia, diarrhea
• blurred vision, yellow/green discoloration halos
• palpitations, syncope, dyspnea
• confusion, delirium, fatigue
• increased automaticity and decreased AV conduction
• Atrial tachycardia with block is a common rhythm of digoxin toxicity.* (supraventricular tachycardia with a slow ventricular response) AND everything bad that can happen on ekg…
• PAT w/ block
• Sinus Block
• AV blocks
• VT/VF
• PVC

Question 2

Hyperkalemia

-ekg findings

Answer 2

EKG:

• peaked T waves* (eiffel tower) (may be as high as 15mm in precordial leads)
• Pwave flattening, widening, or no p waves.
• QRS widening

Question 3

Hypokalemia

-ekg findings

Answer 3

• U waves*
• T wave flattening or possibly inverted
• irritation of ventricular foci which can lead to Torsades, VT, VF

Question 4

Hypercalcemia
-ekg findings

Hypocalcemia
-ekg findings

Answer 4

-short QT interval & J waves

Hypocalcemia:
-prolonged QT interval

Question 5

Hypomagnesemia

-ekg findings

Answer 5

• prolonged QT
• torsades
• frequenct PVC and PACs
• ventricular and supraventricular tachyarrythmias

Question 6

Hypothermia

-ekg findings

Answer 6

-osborne wave (Jwave) is a positive deflection at the Jpoint most commonly seen in precordial leads

Question 7

J waves may be seen in a number of other conditions…list some :)

Answer 7

• hypercalcemia
• medications
• neurological insults such as intracranial HTN, severe head injury and subarachnoid hemorrhage

Question 8

Pulmonary Embolus

-ekg findings

Answer 8

• sinus tachycardia** (first change you will see)
• S1Q3T3
• RAD
• Transient RBBB
• Twave inversion V1-V4