Meds and metabolic derangements (EKG effects)

Question 1

digitalis/digoxin in therapeutic doses cause what on EKG?

Answer 1

causes scooped ST depression in therapeutic doses

Question 2

Sxs of digoxin toxicity?

Answer 2

• GI: N/V, anorexia, diarrhea
• visual: blurred vision, yellow/green discoloration, haloes
• CVS: palpitations, syncope, dyspnea
• CNS: confusion, dizziness, fatigue

Question 3

What kind of arryhthmias does digitalis toxicity cause?

Answer 3

• increased automaticity (increased intracellular ca), and decreased AV conduction (increased vagal effects at the AV node)
• Classic dysrythmia assoc with digoxin toxicity is combo of SVT (due to increased automaticity) with slow ventricular response (due to decreased AV conduction) - atrial tachy with block

Question 4

What will you see on EKG of digoxin overload, toxicity?

Answer 4

• atrial and junctional premature beats
• PAT with block
• sinus blocks
• AV blocks

toxicity:

• atrial and junctional tachyarrhythmias
• PVCs
• VT
• VF

Question 5

What changes will you see on EKG of hyperkalemia?

Answer 5

• classic change: peaked T waves
• P wave can flatten and widen
• QRS complex can widen (ventricles are taking over)

Question 6

Hypokalemia on EKG?

Answer 6

• classic: U waves
• T waves can flatten out and possible invert
• causes irritation of ventricular foci which can lead to torsades, VT and VF

Question 7

EKG findings of hypercalcemia?

Answer 7

• short QT interval

- j waves

Question 8

EKG findings of hypocalcemia?

Answer 8

• prolonged QT waves

Question 9

EKG findings of hypomagnesemia?

Answer 9

• prolonged QT
• torsades
• frequent PVCs, PACs
• ventricular and supraventricular tachyarrhythmias

Question 10

Hypothermia on EKG?

Answer 10

• osborn wave ( J wave) positive deflection at J pt (neg in AVR and VI)
• usually most prominent in precordial leads
• hypothermia: less than 30 celsius
• likely to see bradycardia

Question 11

Other casuses of J waves on EKG?

Answer 11

• normal
• hypercalcemia
• meds
• neuro insults: intracranial HTN, severe head injury, and subarachnoid hemorrhage
• idiopathic VF

Question 12

PE findings on EKG?

Answer 12

• most common: sinus tach (responding to hypoxemia)
• S1Q3T3
• RAD
• transient RBBB
• T wave inversions in V1-V4