Meds and Metabolic Derangements

Question 1

Digitalis/Digoxin

Answer 1

causes a scooped ST depression in therapeutic doses

normal finding if on digoxin

Question 2

Symptoms of digoxin toxicity

Answer 2

GI: Nausea, vomiting, anorexia, diarrhea
Visual: Blurred vision, yellow/green discoloration, halos
CVS: Palpitations, syncope, dyspnea
CNS: Confusion, dizziness, delirium, fatigue

Question 3

Hyperkalemia

Answer 3

Classic change is that of peaked T waves
P wave can also flatten and widen
QRS complex can widen

Question 4

Hypokalemia

Answer 4

Classic changes are the presence of U waves
T waves can flatten out and possibly invert
Causes irritation of ventricular foci which can lead to Torsades, VT, VF

Question 5

Hypercalcemia

Answer 5

Short QT interval

can cause J waves

Question 6

Hypocalcemia

Answer 6

Prolonged QT interval

Question 7

Hypomagnesemia

Answer 7

Prolonged QT
Torsades
Frequent PVCs, PACs
Ventricular and supraventricular tachyarrhythmias

Question 8

Hypothermia

Answer 8

J waves aka Osborn waves
The Osborn wave (J wave) is a positive deflection at the J point (negative in aVR and V1)
It is usually most prominent in the precordial leads

Question 9

J waves may be seen in a number of other conditions:

Answer 9

Normal variant
Hypercalcemia
Medications
Neurological insults such as intracranial hypertension, severe head injury and subarachnoid hemorrhage
(idiopathic VF)

Question 10

Pulmonary embolus

Answer 10

Most common finding is sinus tachycardia
Ekg changes may include S1Q3T3
Right axis deviation
Transient RBBB
T wave inversions in V1-V4