Term
| monophasic action potential of a cardiac muscle cell and electrolytes |
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Definition
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Term
| electrolytes and drug to worry about |
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Definition
• Potassium
• Calcium
• And then there are drugs: • Digoxin |
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Definition
- The typical ECG findings of hypokalemia (low potassium level) include:
• A U wave, which occurs just after the T wave and is usually of smaller amplitude than the T wave
• Flattening of the T wave
• ST depression on occasion, which can mimic ischemia |
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Definition
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Definition
• Hyperkalemia can cause life-threatening arrhythmia, so recognizing hyperkalemia on the ECG is crucial
• The ECG findings of hyperkalemia change as the potassium level increases
• From slightly high levels to very high levels, ECG findings include:
- Peaked T waves best seen in the precordial leads, shortened QT interval, and sometimes ST segment depression
- Widening of the QRS complex (usually potassium level is 6.5 or greater)
•*This frequently appears as in “nonspecific intraventricular conduction delay”or IVCD which is characterized by a widened QRS complex of > 120 ms that does not meet the criteria for a left or right bundle branch block
•*Frequently an IVCD will look like a left bundle branch block in lead V1 with a rS complex or monomorphic S wave and it appears like a right bundle branch block in leads I and V6 with a broad, slurred S wave |
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Term
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Definition
hyperkalemia
• Decreased amplitude of the P waves, an increase in the PR interval, and bradycardia in the form of AV blocks occur as the potassium level exceeds 7.0
• Absence of the P waves and eventually a “sine wave” pattern (see below), which is frequently a fatal rhythm |
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Definition
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Definition
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Definition
hypercalcemia
• The ECG findings include:
• A shortened QT interval
• A shortened ST segment
• Osborne waves |
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Term
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Definition
hypocalcemia
- The ECG findings include: • A prolonged QT interval
• A lengthened ST segment |
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Term
| other things that can cause QT prolongation |
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Definition
- Drugs
• Type IA antiarrhythmics
• Quinidine, procainamide, disopyramide • Type III antiarrhythmics
• Sotalol, defetilide, amiodarone • Tricyclic antidepressants
• Phenothiazines
- Electrolytes
• Hypokalemia, hypomagnesemia, hypocalcemia
- CNS catastrophes
• Stroke, seizure, coma, intracerebral or brainstem bleeding |
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Term
| drugs to avoid in patients with long QT syndrome |
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Definition
cardiac- Sotalol, Quinidine, amiodarone
Psychiatric- Haloperidol, fluocetine, sertraline
Antibiotics- azithromycin, clarithromycin, ciprofloxacin
Narcotics- methadone |
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Term
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Definition
| • Influence Na and Ca ion flow in cardiac muscle, increasing contraction of atrial and ventricular myocardium and EF (+ inotropic effect) |
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Term
• Used in treatment of left-sided heart failure • Not indicated in right-sided HF
• Used in patients with HF and A fib
• Side effects: arrhythmia (slowing AV conduction), anorexia, N/V, headache, alteration in color perception
• Increased toxicity noted with hypokalemia, quinidine, verapamil, amiodarone, hypothyroidism, and renal failure |
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Definition
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Term
| what causes the digoxin effect? |
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Definition
• The ECG features of digoxin effect are seen with therapeutic doses of digoxin and are due to:
• Shortening of the atrial and ventricular refractory periods—producing a short QT interval with secondary repolarization abnormalities affecting the ST segments, T waves, and U waves
• Increased vagal effects at the AV node—causing a prolonged PR interval |
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Term
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Definition
digoxin effect
• Down-sloping ST depression with a characteristic “sagging” appearance
• Flattened, inverted, or biphasic T waves
• Shortened QT interval
• Mild PR interval prolongation (up to 240 ms due to increased vagal
tone)
• Prominent U waves |
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Term
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Definition
• Due to inflammation of the pericardial lining of the heart
• Characterized by chest pain, a pericardial friction rub,
and serial electrocardiographic abnormalities |
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Term
| acute pericarditis etiologies |
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Definition
• Idiopathic
• Viral pericarditis: Coxsackie B virus
• Malignancy: lung, breast CA, and lymphoma are most common • Metabolic: uremia
• Infection: TB, SBE, fungal
• Drug induced: procainamide, hydralazine
• Idiopathic inflammatory disease: SLE, RA
• Post-myocardial injury s/p AMI (1–3 weeks post) |
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Term
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Definition
pericarditis EKG
• Diffuse ST segment elevation with upright T wave
• PR interval depression
• Low voltage
• A-fib/flutter |
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Term
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Definition
- Right ventricular hypertrophy and failure due to pulmonary disease/hypoxia
- Clinical
• Both from pulmonary disease and heart effects
• Chronic productive cough, exertional dyspnea, wheezing, weakness
• JVD, edema, hepatomegaly, ascites |
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Term
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Definition
• COPD (most common for chronic presentation, think PE for acute presentation)
• Pneumoconiosis
• Pulmonary fibrosis |
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Term
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Definition
Cor Pulmonale ekg findings
• Rightward shift of the P wave axis with prominent P waves in the inferior leads and flattened or inverted P waves in leads I and aVL
• Right axis deviation towards +90 degrees (vertical axis)
• Exaggerated atrial depolarization causing PR and ST segments
that “sag” below the TP baseline
• Low-voltage QRS complexes
• May be complete absence of R waves in leads V1–3 (the “SV1-
SV2-SV3” pattern)
• With development of cor pulmonale, the following changes are
seen:
- Right atrial enlargement (P pulmonale) • Right ventricular hypertrophy
- Right axis deviation, deep S waves in V6 |
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Term
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Definition
• Due to thrombi in the venous circulation or right side of heart
• 80–90% originate in deep veins of lower extremities |
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Term
| pulmonary embolism risk factors |
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Definition
• Hypercoagulable states: malignancy, thrombophilia • Pregnancy/BCP
• Surgical procedures: orthopedic surgery
• Atrial fibrillation
• Major trauma |
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Term
| pulmonary embolism clinical findings and physical exam |
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Definition
- Clinical
• Pleuritic chest pain (74%)
• Dyspnea (85%), cough (53%), hemoptysis (30%)
- Physical examination
• Tachypnea (92%), tachycardia (45%), fever (45%), thrombophlebitis |
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Term
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Definition
pulmonary embolism ekg
• Sinus tachycardia (S1Q3T3)
- EKG changes (S1Q3T3) due to right heart strain (cor pulmonale) |
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Term
| Paroxysmal Supraventricular Tachycardia (PSVT) |
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Definition
• Reentry AV tachycardia
• Common in the elderly with underlying heart disease
• Symptoms: palpitations, anxiety |
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Term
| Paroxysmal Supraventricular Tachycardia (PSVT) treatment |
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Definition
• Vagal maneuver, carotid massage • Drugs
- Adenosine (drug of choice) or verapamil (or dilitizem)
- Beta blockers
-increased AV node ERP breaks the reentrant cycle and restores sinus rhythm
-if the effective refractory period is increased beyond the conduction time around a reentrant circuit, reentry can no longer occur |
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Term
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Definition
Paroxysmal Supraventricular Tachycardia (PSVT)
Regular rate 150–180 beats/minute Atrial activity typically not noted
A sinus tachycardia should not be faster than 220-age; if faster, think SVT |
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