High Yield EKG Flashcards
Mizenko's EKG and others
Name the condition
Hypothermia,
TCA poisoning,
extreme hypercalcemia
intracranial bleeding.
Name the condition
You have a right axis and look at Lead I and AVR. Lead one has non-existent R wave and huge S wave.
In lead AVR there’s a very tall R wave and non-existent S wave. Also there’s an upright P in AVR and downward P in lead I. These changes would make you think of limb lead reversal.
Look at the R waves. There’s no R wave progression down the precordial leads. Instead the largest voltage is the V1 and it starts to decline and R wave should have the highest in V3 and transition point to V4-V6. So we see have lower voltages the further we go left and so this is dextrocardia.
What is the abnormality in the rhythm
See j point elevation (or notching) in the R wave (looks like it’s part of the QRS complex). Then it goes into the T wave and that’s the Osborne wave.
Seen in hypothermia, TCA poisoning, ICH, and high Ca
Name the condition
Afib with WPW.
NOT VT because H_R rate is 230_ and VT rarely above that; also too much R to R interval variation to be VT.
The underlying A fib is reason for variable R to R intervals and the widened QRS is because of accessory pathway. Also can see almost delta waves
How to treat?
What not to give to the patient?
Give procainmide and if unstable needed synchronized cardioversion.
DON’T give CCB, BB, or adenosine. It can block AV node and force conduction only through the accessory pathway and convert rhythm of 230 down ventricles and cause ventricular fibrillation.
Name the condition
Atrial fibrillation with RVR.
If unstable synchronized cardioversion or BB or CCB. Needs secondary work up for reason. Make sure it’s NOT MAT.
Name the condition
MAT - see three different P morphologies because there are three different foci of the atrial are generating the contraction and MUST have tachycardia. Treat pulmonary condition. Don’t mislabel it as A fib because won’t respond to BB and CCB and commit pt to AC.
If three different P waves and NO tachycardia, it’s wandering atrial pacemaker.
Name the condition
Ventricular tachycardia. the R to R interval is regular. Can see a capture beat noticed.
How to treat this condition?
If pulseless, would do a defibrillation at 100-200J and start ACLS with CPR. Would also give epinephrine 1 mg every 3-5 minutes. If after two rounds of pulse checks and defibrillation that was unsuccessful would administer amiodarone 300 mg IV as a bolus and continue ACLS.
Name the condition
Junctional escape rhythm. See inverted P waves or no P waves because it’s retrograde and hidden in the QRS.
Narrow complex QRS means _it’s above the AV nod_e and not from the ventricles so not complete heart block.
Name the rhythm and when does this happen?
Complete heart block. Needs a permanent pace maker.
Can be transient or permanent post TAVR
Name the condition
Acute anterior MI because of poor R wave progression (deep Q waves meaning this has been happening for a while) or STE in anterior leads.
Name the rhythm
See RBBB.
Unusual to have RBBB to have left axis deviation so may have a conduction block and so start to look for LAFB or LPFB. Look at II III AVF and see R wave is bigger and S wave is prominent in leads I and AVL are suggestive of LAFB.
See RBBB and if you see a right axis deviation WITHOUT LPFB then you need to make sure leads are placed correctly otherwise look into what may be causing that
Name the condition
This is pericarditis because of diffuse STE and PR depression.
NOT STEMI AND DO NOT USE STEROIDS to treat because it can cause refractory pericarditis. Use NSAIDS.
Name the condition
A flutter
Name the condition
Brugada condition - congenital Na channel abnormality. autosomal dominant. Can be transient EKG changes or uncovered by medications, fever, hypo K or hypothermia.
ICD placement is tx
Name the EKG condition
WPW
see shortened PR interval and pre excitation. Most are asymptomatic with WPW and seen on EKG.
Need to get exercise stress test to see if high risk or if low risk.
No amiodarone, CCB, BB, digoxin, or adenosine given risk for afib to degenerate to VF.
what is this and how best to treat this pt?
this patient has biphasic sawtooth flutter waves at the rate of 300/min so this is a flutter with a 2:1 conduction across AV node. Ventricular rate is 150 b/min.
Aflutter has high recurrence rate of 50% in 6 months and so best way to treat is radiofrequency ablation.
Name the condition. Pt is with chest pain.
anterior STEMI.
See the STE elevation with reciprocal ST seg depression in II III AVF and this is associated with a LAD artery occlusion.
What is this?
MAT- Irregular R to R and distinct P waves with THREE different morphologies
-supraventricular tachyarrhythmia that occurs in elderly people with COPD and result of underlying pulmonary dx.
Can be seen with COPD, pneumonia, PE, and heart failure exacerbation. Can be seen with hypokalemia, hypomagnesemia, and non pulmonary conditions that lead to catecholamine surge (sepsis)
EKG will have atrial heart rate >100/min and tachycardia separates this from wandering atrial pacemaker. Irregular R to R and distinct P waves with THREE different morphologies.
Tx by treating underlying pathology.
pt with CHFrEF on aspirin, BB, ACEi, spironolactone, and digoxin has diarrhea after bad food poisoning. Now continuing to have some vomiting and diarrhea and endorses feeling fatigued and confused.
This is her EKG. What is causing her arrhythmia?
This is digoxin toxicity from AKI from her initial gastroenteritis.
Can see parosymal atrial tachycardia, AV block, PVCs, regularized a fib (regular R to R interval) , bidirectional VT (QRS complexes from 2 ectopic foci and bradycardia (due to markedly enhanced vegal effect)
