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A - ECG Weekly > Pearls From Cases > Flashcards

Pearls From Cases Flashcards

1
Q

What must you consider in a pt with sob, Dyspnea and syncope? What additionally?

A

PE Pericardial effusion

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2
Q

What defines low voltage? Low voltage (especially if new) + tachycardia think what?

A

QRS complexes < 15mm in leads I, II, III combined Or QRS amplitudes in V1+V2+V3 < 30mm Pericardial effusion

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3
Q

AHA circulation 2004 chemo drugs and SEs, author is Yeh (cardiovascular complications) What drug causes cardiac vasospasm?

A

5-FU

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4
Q

What are the 5 things that can cause diffuse STE?

A

Large acute MI —> Reciprocal depression Pericarditis Vasospasm Ventricular aneurysm —> Q waves from old MI Early Repol —> dx of exclusion, look for fishhooks (looks like J wave)

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5
Q

Pt that has AFib that presents with bradycardia and appears regular, what must you think of?

A

Digoxin toxicity —> look for Salvador Dali sloping ST segment

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6
Q

How does Digoxin make the rhythm regular in AFib?

A

Blocks AV node, it becomes a Junctional escape rhythm (40-60)

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7
Q

What is Contraindicated in Digoxin toxicity with hyperkalemia? What is this called?

A

Calcium —> Stone Heart

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8
Q

LBBB what is present in leads V1-V3? What about in lead I, V5, V6?

A

Deep wide S, absent R wave No Q wave

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9
Q

What is appropriate discordance in LBBB (Also in pacemakers)? Where QRS goes down what should you see?

A

QRS goes up should see ST depression ST elevation

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10
Q

What is excessive discordant ST elevation in LBBB for MI?

A

Discordance ST elevation >/= 5mm I.e. if QRS goes down and you have > 5mm of ST elevation This is Sgarbossa criteria C —> Not validated

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11
Q

What is Sgarbossa Criteria A? B?

A

Concordant ST elevation >/= 1mm in any lead Concordant ST depression >/= 1mm in V1, V2, V3 ONLY

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12
Q

What is the Revised Sgarbossa C?

A

ST elevation > 25% than the S wave in their discordance

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13
Q

What is the 1st marker on EKG in someone with active Chest Pain that could be having acute inferior wall STEMI? Then what?

A

Inverted T wave in aVL ST depression

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14
Q

T wave height greater than ENTIRE height of QRS could mean what? Do what?

A

Early cardiac ischemia Get a REPEAT EKG This is a called a type 2 hyperacute T wave

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15
Q

DDx long QTc (> 500ms)?

A

HypoK HypoMg HypoCa Hypothermia Na blocking drugs Elevated ICP

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16
Q

What are the only 2 etiologies that prolong the QT d/t via prolonged ST?

A

Hypothermia HypoCalcemia

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17
Q

What is intermittent WPW?

A

Sinus rhythm with a normal beat then a WPW beat (short PR with delta Wave and subsequent long QRS) Can cause flipped T waves in general

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18
Q

How to diagnose Right axis Deviation? What are the main ddx for RAD + STE?

A

Large S wave in lead I PE, HyperK and Na channel blocking drugs

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19
Q

PE can produce STE in what leads?

A

Rightward leads —> aVR, V1, V2, III

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20
Q

Signs of right heart strain?

A

Tall RV1 RAD T wave inversions (anteroseptal and inferior leads) ST changes in V1, V2, aVR, III

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21
Q

Patient with NEW weakness think about what? Can cause what?

A

HyperK and Rhabdo —> get a CK STE

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22
Q

STE + RAD think about what?

A

1 —> HyperK Na Channel blocking drugs Acute Pulm HTN (PE)

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23
Q

STE in lead V1, V2, aVR with a RAD think immediately of what?

A

HyperK

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24
Q

What is the treatment for symptomatic PVCs?

A

Beta-Blockers (IV metoprolol)

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25
Q

What factors strongly suggest STEMI over Pericarditis?

A

STD in any leads except V1 or aVR STE in III > II Horizontal or convex upwards of STE

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26
Q

What is Spodick’s Sign? Indicates what?

A

Downsloping of the TP segment Pericarditis

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27
Q

Sgarbossa Criteria?

A
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28
Q

How to tell STEMI vs Pericarditis?

A
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29
Q
A
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30
Q

Pt that has lead V1, V2 concerning for Brugada but not 100% clear picture, what can you do to confirm?

A

Move leads 1-2 interspaces higher

31
Q

What are signs of early cardiac ischemia?

A

T wave inversion in aVL

Hyperacute T waves - T wave height > qrs height or straightening of T wave

32
Q

When deciding if a pt has AFib, where to check P waves first?

why?

A

Lead V1

Sitting right over the RA

33
Q

What is most commonly misdiagnosed as AFib?

A

Mobitz Type 1

34
Q

Whenever you have grouped or clumped beats (regularly irregular) in the rhythm strip it is indicating what?

A

Mobitz type 1 or PAC

35
Q

T wave alternas with long QT can lead to what?

QTc > what level?

A

Torsades or sudden cardiac arrest

> 500

36
Q

Patient with deep T Wave inversions and prolonged QT interval has what?

A

Inc ICP

37
Q

Patient with RBBB, what should you NEVER see?

where to look?

A

STE, you should see ST depression

V1, V2

38
Q

What rate is VTach is usually seen?

If it is kinda slow what can kill the pt?

A

Needs to be GREATER than 130 (maybe 120)

Na channel blocker like amio, procainamide, lidocaine if the underlying problem is hyperK

39
Q

What can you do to helpdiagnose if you suspect HyperK mimicking VTach on EKG?

A

give 1 amp NaHCO and the rhythm will change

40
Q

what is the DDx for STE in V1, V2, aVR?

A

STEMI

But also: HyperK and PE

41
Q

How to tell if a pt with a Pacemaker is having a STEMI?

A

Sgarbossa A - Concordant STE in ANY lead

B - Concordant STD in V1-V3

C - Discordant STE > 5mm in ANY lead

42
Q

How to Dx LBBB on ekg?

A

look at V1, usually no Q wave, Very small r wave, then deep S wave that is negatively deflected

QRS > 120

lead V5-V6 has RsR’ and no Q wave

43
Q

What is BRASH syndrome?

A

Bradycardia

Renal Failure

AV nodal blockers (BB or CCB)

Shock

HyperKalemia (mild)

44
Q

how to treat BRASH?

A

treat the hyperKalemia with 2g Calcium gluconate even if K is mild (5-6.5)

45
Q

RAD (or big S wave in lead I) with STE in leads aVR, V1, V2 what must you strongly consider?

A

PE

46
Q

TCA overdose EKG findings?

A

tachycardia

tall R wave in aVR

RAD

long QT

Wide QRS

47
Q

DDx long QT?

A
48
Q

DDx wide QRS?

A
49
Q

DDx Right Axis Deviation?

What degrees is RAD?

A

90-180

50
Q

EKS and ACS chart indicating when to go to CATH lab

A
51
Q

What are the only 2 things that cause a prolonged QT because of a prolonged ST segment?

A

Hypocalcium

Hypothermia

52
Q

What must you check before you call an EKG a STEMI?

when does this commonly occur?

A

Check the QRS length, it may just be part of QRS and not STEMI

RBBB patterns

53
Q

Narrow complex regular tachycardia, what are the possibilities?

A

Sinus tachy

SVT

Atrial flutter 2:1 (rate of 150 +/- 20)

54
Q

What is the Bix Rule?

A

T wave that is poky/sharp (P wave buried in T wave) exactly bw 2 QRS complexes means you probably have atrial flutter

55
Q

What leads to look for in Benign Early Repol?

What is a characteristic pattern?

what makes you think it is more likely a STEMI?

A

V1 - V4 Only

Fishhook

Shark takeoff from J point

56
Q

What does LV aneurysm look like?

A

STE lead V1, V2

Q waves leads V1-V4

NO recipricol changes

57
Q

How do you determine if it is a junctional rhythm?

A

rate is around 40 with narrow QRS

No P waves OR short PR

58
Q

How to tell if it is Mobitz I, Mobitz II, or 3rd degree heart block?

A

If PR interval is changing then it is 3rd degree

59
Q

Large T wave inversions (MC in anterolateral leads) + QT prolongation think what?

what else may they have?

A

ICH

STE

60
Q

Pt with atypical chest pain/ongoing chest pain with most unremarkable EKG, what lead may show T Wave changes that are concerning?

A

New upright T wave V1

61
Q

Describe VTach rate

If not VTach bc of rate, what is it?

due to what?

A

> 120

AIVR

Usually reperfusion

62
Q

What are the Lewis leads for?

Place where?

A
63
Q

Give the DDx of RAD

A
64
Q

Pt with wide complex tachycardia with a rate below 120, what is it?

Means what?

Treat how?

A

Accelerated Idioventricular rhythm

Reperfusion rhythm (usually after giving lytics)

Observe!

65
Q

How to treat stable pt with nonsustained VTach?

A

Treat underlying cause

Beta Blockers

Amiodarone

66
Q

How to calculate ventricular rate if the machine is not giving it to you?

A

count up all the QRS complexes and multiply by 6

each ekg is 10 seconds (10x6 is 60 seconds so 1 minute)

67
Q

What leads mimic STEMI in massive PE?

A

V1, V2

then aVR

then finally lead III

68
Q

Treatment of sustained VTach that is stable?

A

Class I recomendation: Shock Cardioversion 250 or 360J

Class IIa - Procainamide

Class IIb - Amio

69
Q

Difference bw “generic” Polymorphic VTach vs Torsades?

A

Generic has Normal QT

70
Q

where to look for STD in inferior MI?

A

aVL

71
Q

Inverted U wave in lateral leads (V4-V6) indicates what?

A

LAD occlusion - ischemic heart disease

93% specific

72
Q

What is required to Dx BER?

If it does not, called what?

A

S wave or J wave in BOTH leads V2 and V3

Terminal QRS distortion - means STEMI

73
Q
A

A - ECG Weekly (1 decks)

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