Week 7: The Electrocardiogram Flashcards
ECG shows - ST elevation and Q wave formation in V2-5, ST elevation in I and aVL and reciprocal ST depression in lead III.
What is the diagnosis?
acute anterior STEMI.
ECG shows - ST elevation and Q wave formation in V2-5, ST elevation in I and aVL and reciprocal ST depression in lead III.
Where the pathology and what is the treatment?
acute anterior STEMI.
Pathology - occlusion of the LAD.
Treatment - urgent reperfusion (PCI).
ECG shows abnormalities - marked ST elevation in II, III and aVF and reciprocal changes in aVL.
What is the diagnosis?
Diagnosis – acute inferior STEMI.
ECG shows abnormalities - marked ST elevation in II, III and aVF and reciprocal changes in aVL.
Where is the likely pathology?
Vast majority are RCA occlusions (80%).
(Inferior MIs can result from left circumflex artery (18%) and occasionally left anterior descending artery (LAD- produces the pattern of inferior and anterior ST elevation).
65-year-old lady developed a sudden onset of central chest pain associated with palpitations, sweating and breathlessness. She has a history of Coronary Heart Disease.
ECG Approximately 135 bpm. Irregular narrow-complex tachycardia. V1 coarse fibrillatory waves. What is the diagnosis?
Fast Atrial fibrillation.
An 80-year-old man attends the Emergency Department following a collapse.
ECG: Atrial rate is approximately 60 bpm.
Ventricular rate is approximately 27 bpm
What is the diagnosis and why?
What is the management?
Third degree heart block. None of the atrial impulses appear to be conducted to the ventricles. There is a slow ventricular escape rhythm.
Management
Patients with third degree heart block are at high risk of ventricular standstill and sudden cardiac death. They require urgent admission for cardiac monitoring, backup temporary pacing and usually insertion of a permanent pacemaker.
A 47-year-old lady with chronic renal failure has a routine ECG performed. The most striking abnormality is Symmetrical tall peaked T waves. What is the likely cause?
What blood test would you perform?
Hyperkalaemia.
Check Serum potassium.
A 47-year-old lady with chronic renal failure has a routine ECG performed. The most striking abnormality is Symmetrical tall peaked T waves. You believe the most likely cause is hyperkalaemia.
Outline the management?
- calcium gluconate - Give 10% calcium gluconate IV over 5-10 minutes (protect the heart)
- Insulin - Give 10 units of Actrapid in 50mls of 50% dextrose IV over 15 minutes
- Give nebulised salbutamol 10mg to 20mg.
A 47-year-old lady with chronic renal failure has a routine ECG performed. The most striking abnormality is Symmetrical tall peaked T waves. You believe the most likely cause is hyperkalaemia. What other ECG changes might you see in this condition?
Typical ECG changes include peaked T waves, prolonged PR interval, absent or flattened P waves, bradycardia, broad QRS, VT, sine wave morphology
A 60-year-old man presents with hypotension, chest pain, and decreased conscious level. His ECG shows Broad complex tachycardia probably ventricular tachycardia.
In view of his clinical presentation what is the treatment?
Cardioversion.
A 70-year-old man has a systolic murmur in the aortic region that radiates
into the neck.
His ECG shows:
Left axis deviation.
Increased LV voltages: huge precordial R and S waves that overlap with the
adjacent leads (SV2 + RV6»_space; 35 mm).
LV strain pattern with ST depression and T-wave inversions in I, aVL and V5-6.
ST elevation in V1-3.
What is the diagnosis?
Left ventricular hypertrophy.
relate his ECG to the findings on auscultation - Aortic stenosis leading to LVH.
