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location of injury?
[image] |
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ANTEROLATERAL INJURY
WITH RECIPROCAL ST CHANGES
note ST elevation in V1-V6 (LAD territory) |
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FIRST DEGREE AV BLOCK
note long PQ interval |
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FIRST DEGREE AV BLOCK
note long/absent PQ interval |
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INFERIOR INFARCT (II, III, AVF)
WITH RECIPROCAL ST CHANGE (V1-V3)
(possible posterior involvement) |
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normal or abnormal?
[image] |
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INFEROLATERAL INJURY
RECIPROCAL ST CHANGE
note ST elevation in leads II, III, aVF (inferior) and V4-6 (lateral) |
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SECOND DEGREE BLOCK - MOBITZ TYPE I
Look for narrow QRS with QRS complexes dropped in a repeating pattern |
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| SECOND DEGREE BLOCK - MOBITZ TYPE II |
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VENTRICULAR TACHYCARDIA
MONOMORPHIC |
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VENTRICULAR TACHYCARDIA
POLYMORPHIC
(TORSADES DE POINTES) |
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location of infarct?
[image] |
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Definition
ANTERIOR INFARCT (V3, V4)
WITH RECIPROCAL ST CHANGE |
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II, III, aVF
[image][image] |
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impulse travels through AV node → bundle of His → bundle branches
proportional to the velocity of conduction |
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ventricular depolarization
should be skinny in normal ventricular conduction and myocardium
wide QRS signifies loss of conduction apparatus and spread of electrical impulse through myocardial cells via gap junctions |
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ventricular repolarization
T wave is generally in the same direction as QRS complex
ST depression = ischemia
ST elevation = injury/infarct |
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| The systematic approach to EKG |
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Definition
Determine the rhythm:
- find P waves (II, V1) - P waves are upright in leads I, II, aVF
- are P waves similar and at regular intervals?
- is every P associated with a QRS
- if yes = sinus rhythm
Determine the rate
- divide number of big boxes between QRS complexes into 300
Waves and intervals
- normal QRS is skinny (<100 msec)
- septal Q waves = not pathologic
- T wave = ventricular repol
- T wave should be same direction as QRS
Determine the axis
- normal = R up in Leads I and II
- left axis deviation = R up in Lead I, down in Lead II
- right axis deviation = R down in Lead I, up in Lead II
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Definition
asynchronous activation of ventricles or delay in intraventricular conduction:
- bundle branch blocks
- myopathies
- non-specific intraventricular conduction delay
- pacemakers
- Wolf Parkinson White syndrome
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Definition
- QT interval is dependent on age, sex, HR
- QT should be <1/2 of the RR interval
- Prolonged QT predisposes to ventricular arrhythmias
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Definition
- Determined largely by transit time through AV node
- Should be .12-.2 seconds (3-5 small boxes)
- Prolonged PR = first degree AV block
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| Describe congenital long QT syndrome (LQTS) |
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Definition
- Ion channelopathies (sodium & potassium)
- Can lead to recurrent palpitations and syncope
- At risk for sudden cardiac death
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| Describe acquired long QT syndrome |
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- Electrolyte abnormalities (K, Mg)
- DRUGS (antiarrhythmics, antibiotics, etc)
- Ischemia, cardiomyopathies
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| ST segment depression can be caused by? |
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- ischemia
- drugs
- electrolyte disorders
- hyperventilation
- LVH
- BBB
- stroke
Often impossible to determine cause of ST depression from ECG alone (non-specific ST change)
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| ST segment elevation can be caused by? |
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- Injury (STEMI)
- pericarditis
- hyperkalemia
- LV aneurysm
- hypothermia (Osborne waves)
- early repolarization (normal variant)
ST segment elevation is NOT non-specific! (compare to ST depression)
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| What EKG findings may indicate posterior injury/involvement? |
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| Inferior injury (II,III,aVF) + reciprocal ST change in V1-V3 (anteroseptal) |
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| Describe the pathophysiology behind reciprocal ST segment depression/changes |
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Definition
| Infarct → pumps stop working → K+ builds up inside muscle cells → increased positivity in infarcted cells → increased relative negativity in healthy cells → electrical impulse repelled away from negative healthy cells → ST segment depression |
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| What are pathologic Q waves? |
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- Evidence of prior transmural infarct
- >40msec wide
- >1/4 of R wave height
- often accompanying T wave inversion
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| T wave inversion means what? |
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Definition
- ischemia
- drugs
- electrolyte disorders
- hyperventilation
- LVH
- BBB
- stroke
often impossible to determine cause of T wave inversion from EKG alone (nonspecific T wave change) |
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| What is an atrial premature complex (APC)? |
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Definition
- Originates from atrial focus outside sinus node, occurs before next "scheduled" sinus P wave
- Has different P wave morphology than sinus P wave, different PR interval than sinus P wave, followed by non-compensatory pause
- NORMAL occurence
- Frequent cause of palpitations
- May become more frequent in a number of disorders (pregnancy, thyroid)
- Benign prognosis
- May occur in pairs, every other beat (bigeminy)
- May trigger sustained atrial arrhythmias
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| What is a premature ventricular complex (PVC)? |
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- Premature QRS complex (different in timing, usually different in shape not caused by P wave, may be conducted back to atria but not usually, sinus node is not affected therefore compensatory pause)
- Very common NORMAL occurrence
- May be single, bigeminy, or couplets (2 in a row)
- Frequent cause of palpitations
- Generally benign; sx may require tx
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