Deadly, can’t miss ECG!
Episode 61
October 31, 2012

Wide DDx for this deadly ECG…but simple if you break it down. Learn 3 DDx’s you must know!

5 Step Approach to ECG Interpretation
  1. Rate and rhythm
  2. Axis
  3. Intervals
  4. Enlargement
  5. Ischemia and Infarction (Q-waves, ST-segment changes, T-wave inversions)
R AXIS Deviation Differential
  • LPFB
  • Lateral MI (from Q-waves)
  • RVH
  • Acute (PE) and chronic (COPD) lung disease
  • Ventricular ectopy
  • Hyperkalemia
  • Na-channel blocking drugs (TCA)
  • Normal thin adults with horizontally positioned hearts
  • Lead misplacement
Causes of QRS prolongation
  • BBB (LBBB or RBBB) or paced rhythm
  • Pre-excitation (WPW)
  • Ventricular ectopy
  • Metabolic/Electrolytes (acidosis, hyperkalemia)
  • Medications - Na2+ channel blocking drug toxicity (TCA’s, Quinidine & Anti-arrhythmics)
  • Nonspecific intraventricular conduction delay (ex. from LVH) or congenital
Causes of QT-interval prolongation
  • Hypothermia
  • HypoK+(due to U-wave), HypoMg2+, HypoCa2+
  • Cardiac Ischemia
  • Increased ICP
  • Na-channel blocking drugs (TCA’s, Quinidine & Anti-arrhythmics)
  • Congenital
Na-channel blocker toxicity can mimic STEMI and Brugada syndrome!
 
Deadly, can’t miss ECG!
Episode 61
October 31, 2012

Wide DDx for this deadly ECG…but simple if you break it down. Learn 3 DDx’s you must know!

5 Step Approach to ECG Interpretation
  1. Rate and rhythm
  2. Axis
  3. Intervals
  4. Enlargement
  5. Ischemia and Infarction (Q-waves, ST-segment changes, T-wave inversions)
R AXIS Deviation Differential
  • LPFB
  • Lateral MI (from Q-waves)
  • RVH
  • Acute (PE) and chronic (COPD) lung disease
  • Ventricular ectopy
  • Hyperkalemia
  • Na-channel blocking drugs (TCA)
  • Normal thin adults with horizontally positioned hearts
  • Lead misplacement
Causes of QRS prolongation
  • BBB (LBBB or RBBB) or paced rhythm
  • Pre-excitation (WPW)
  • Ventricular ectopy
  • Metabolic/Electrolytes (acidosis, hyperkalemia)
  • Medications - Na2+ channel blocking drug toxicity (TCA’s, Quinidine & Anti-arrhythmics)
  • Nonspecific intraventricular conduction delay (ex. from LVH) or congenital
Causes of QT-interval prolongation
  • Hypothermia
  • HypoK+(due to U-wave), HypoMg2+, HypoCa2+
  • Cardiac Ischemia
  • Increased ICP
  • Na-channel blocking drugs (TCA’s, Quinidine & Anti-arrhythmics)
  • Congenital
Na-channel blocker toxicity can mimic STEMI and Brugada syndrome!
 
 

Approach each ECG systematically so that you don’t miss things. Watch last week’s video for more on this…

  1. ekgumem posted this
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