Med A - ECG interpretation

Question 1

68 y/o male

pc: light headedness, palpitations

Obs: bradycardic

pmh: MI 1 year ago

Dx: beta blocker

what investigations would you do immediately and why?

Answer 1

1. ECG, Obs
2. IV access
   a) FBC - anaemia/haemolysis
   b) U+E - renal failure/sepsis
   c) CRP - infection
   d) glucose - DKA
   e) TFTs - hypothyroid/ myxoedma
   f) LFTs - congestive hepatopathy, obstruction, biliary sepsis
   g) VBG
3. CXR - assessment of pleural / pericardial effusion

Question 2

in presence of haemodynamic compromise, what should be done?

Answer 2

1. ABCDE
2. to increase heart rate: atropine (muscarinic antagonist) blocks parasympathetic output
3. second line

Question 3

what type of drug is atropine and why is it used?

Answer 3

• to increase heart rate
• short acting
• poorly tolerated
• blurred vision, nausea, feeling of impending doom

Question 4

What is Ashman phenomenon?

Answer 4

• change in QRS cycle length
• can be seen in supraventricular arrhythmia
• wide QRS complex that follows a short R-R interval preceded by a long R-R interval