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100 cases ECG Amal Mattu > First 50 points > Flashcards

First 50 points Flashcards

1
Q

The differential diagnosis for a regular narrow-complex tachycardia includes:

A

Atrial flutter Atrial tachycardia AV nodal reentrant tachycardia AVRT (ie, WPW) with orthodromic conduction Junctional tachycardia Narrow complex VT Sinus tachycardia

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2
Q

in the context of regular narrow-complex tachycardia , the absence of p waves rules out

A

atrial tachycardia and sinus tachycardia;
if the rate is too fast, wil exclude also junctional tachycardial

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3
Q

in the context of regular narrow-complex tachycardia The QRS complex duration is ~80 msec,

Berberian, Jeremy; Mattu, Amal; Brady, William J.. Emergency ECGs: Case-Based Review and Interpretations (p. 28). EMRA. Kindle Edition.

A

so narrow complex VT is unlikely.

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4
Q

The AV node’s intrinsic refractory period prevents ventricular rates from exceeding

Berberian, Jeremy; Mattu, Amal; Brady, William J.. Emergency ECGs: Case-Based Review and Interpretations (p. 28). EMRA. Kindle Edition.

A

220-240 bpm in the absence of any extrinsic factors that increase conduction velocity

this makes regular narrow-complex tachycardia very rare in adult population

Berberian, Jeremy; Mattu, Amal; Brady, William J.. Emergency ECGs: Case-Based Review and Interpretations (p. 28). EMRA. Kindle Edition.

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5
Q

The differential diagnosis for causes of supraventricular tachycardias with rates > 220-240 bpm includes:

Berberian, Jeremy; Mattu, Amal; Brady, William J.. Emergency ECGs: Case-Based Review and Interpretations (p. 28). EMRA. Kindle Edition.

A

Catecholamine surge Sympathomimetic toxicity Hyperthyroidism/thyroid storm

Berberian, Jeremy; Mattu, Amal; Brady, William J.. Emergency ECGs: Case-Based Review and Interpretations (p. 28). EMRA. Kindle Edition.

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6
Q

The differential diagnosis for the pattern of STE in lead aVR +/- lead V1 with diffuse STD includes both ACS and non-ACS etiologies:

Berberian, Jeremy; Mattu, Amal; Brady, William J.. Emergency ECGs: Case-Based Review and Interpretations (p. 29). EMRA. Kindle Edition.

A

in this regurd keep this in mind
The2018Fourth Universal Definition of MIstates“ST-segment depression≥ 1 mm in 6 or more leads, which may be associated with STsegmentelevation in leads aVR and/or V1 and hemodynamiccompromise, is suggestive of multivesseldisease or left main disease” but does notprovide specific management recommendations.

Berberian, Jeremy; Mattu, Amal; Brady, William J.. Emergency ECGs: Case-Based Review and Interpretations (pp. 29-30). EMRA. Kindle Edition.

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7
Q

is commonly seen with thyroid storm and will often be refractory to rate control or cardioversion until the elevated thyroid hormones are treated.

Berberian, Jeremy; Mattu, Amal; Brady, William J.. Emergency ECGs: Case-Based Review and Interpretations (p. 30). EMRA. Kindle Edition.

A

af

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8
Q

AVNRT VS AVRT

A
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9
Q

explain how Dual chamber pacing works

Berberian, Jeremy; Mattu, Amal; Brady, William J.. Emergency ECGs: Case-Based Review and Interpretations (p. 336). EMRA. Kindle Edition.

A

Dual chamber pacing, also called A-V sequential pacing, involves pacing of both the right atria and right ventricle. There is one atrial lead and one ventricular lead: The right atrial lead paces the right atrial appendage The RV lead paces the RV apex The atrial lead is programmed to sense for native atrial activity and act accordingly: The pacemaker senses native atrial activity, waits a programmed amount of time, then paces the ventricles (ie, atrial-sensed, ventricular-paced rhythm) The pacemaker paces the atria if no native atrial activity is detected during a programmed amount of time, waits another programmed amount of time, then paces the ventricles (ie, A-V sequential pacing)

Berberian, Jeremy; Mattu, Amal; Brady, William J.. Emergency ECGs: Case-Based Review and Interpretations (pp. 336-337). EMRA. Kindle Edition.

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10
Q

explain Pacemaker-mediated tachycardia,

Berberian, Jeremy; Mattu, Amal; Brady, William J.. Emergency ECGs: Case-Based Review and Interpretations (p. 337). EMRA. Kindle Edition.

A

also called endless-loop tachycardia, is a re-entry tachycardia seen with dual chamber pacemakers that have atrial sensing. After it triggers an atrial depolarization, the atrial lead is programmed to have a refractory period to prevent it from being retriggered by the ventricular depolarization or retrograde P-waves. This is called the post-ventricular atrial refractory period (PVARP) and pacemaker-mediated tachycardia can occur if it is too brief. The typical trigger is a PVC that causes a retrograde P-wave that is sensed by the atrial lead which then triggers ventricular depolarization which leads to a retrograde P-wave, etc. The antegrade impulse is via the pacemaker with retrograde conduction through the AV node. This is very similar to antidromic AVRT except that the pacemaker replaces the accessory pathway.

Berberian, Jeremy; Mattu, Amal; Brady, William J.. Emergency ECGs: Case-Based Review and Interpretations (p. 337). EMRA. Kindle Edition.

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11
Q

expain in short Pacemaker-mediated tachycardia

A

Pacemaker-Mediated Tachycardia Re-entry tachycardia with antegrade conduction through the pacemaker and retrograde conduction through the AV node
ECG shows paced wide complex tachycardia (may see retrograde P-waves)
Treat with a magnet (will cause pacemaker to pace at a default rate) or as AVRT (eg, adenosine or nodal blockers)

Berberian, Jeremy; Mattu, Amal; Brady, William J.. Emergency ECGs: Case-Based Review and Interpretations (pp. 337-338). EMRA. Kindle Edition.

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12
Q

dd regular wide complex tachycardia

A
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13
Q

some signs that suggest vt

A

QRS duration > 200msec
extreme as
brugada’s sign best seen in V2
Josephson’s sign best seen in V3

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14
Q

think about the figure and keep it in mind, where is the R where is the T

A
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15
Q

in which patients should you avoid procainamide?

A

those with long QTc interval or reduced EF

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16
Q

define vt

A
17
Q

in wide complex tachycardia and the rate is lower than 120 bpm, what should you consider?

A
18
Q

ecg features that increase the likelhoood of Vt in a regular WCT?

A
19
Q

dd verlengde QTc interval

A
20
Q

define prolonged QTc interval

A
21
Q

long QT syndrome subtypes?

A
22
Q

an important pattern that is associated with prolonged QTc interval is

A
23
Q

name 3 findings associated with ventricular pre excitation

A

shortened pr interval, prolonged qrs complex duration, and delta wave

24
Q

true or false; the delta wave in wpw can sometimes only in selected leads

A

true

25
Q

in wpw, you can have shortend pr interval and delta wave but normal qrs complex duration

A

true

26
Q

why should you think about AP in AF with intermittent conduction if the rte faster than 220-240?

A
27
Q

treatment of af with wpw? and what should you avoid?

A
28
Q

what do you know about wpw?

A
29
Q

what do you know about af with wpw?

A
30
Q

what do you know abut hyperacute t waves?

A
31
Q

what do you know about posterior mi

A
32
Q

what do you know about right ventricular mi

A

In patients with inferior STEMI, right ventricular infarction is suggested by:

ST elevation in V1
ST elevation in V1 and ST depression in V2 (highly specific for RV infarction)
Isoelectric ST segment in V1 with marked ST depression in V2
ST elevation in III > II
Diagnosis is confirmed by the presence of ST elevation in the right-sided leads (V3R-V6R)

33
Q

what are your takes about the criteria to diagnose stemi?

A
34
Q

what do you know about the J point and stable baseline st segment

A
35
Q

what do you know about the J point and stable baseline st segment in pictures

A
36
Q

af with slow ventricular response, what should you think about?

A

digoxin toxicity and aother antidysrhythmic medication toxicity like CCB or beta blockers, as well as electrolyte abnormalties

37
Q
A

note digoxin could also be consider as syphilis of electrocardiography

100 cases ECG Amal Mattu (3 decks)

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