ECG IN MISCELLANEOUS CONDITIONS

PRESENTED BY: Dr. Areej Al-jabaly

A: Drugs Effects

B: ELECTROLYTE

C : DISEASES

D: NORMAL VARIANTS

A: DRUGS EFFECTS Digoxin :

Therapeutic Effect *ST segment depression

( reversed tick )

* Shortening of the QT interval T wave inversion

Toxic Effect :

Any type of arrhythmia especiallventricular octopi

Quinidine: and related drugs like ( procinamide , Disopyramide , phenothiazine, Tricyclic, Antidepressant, Amiodarone )

* P wave widening * QRS widening

* Prolonged QT interval ( longer than half of the RR interval)

• 

* Increase U wav amplitude *ST segment depression

* Increase U wav amplitude

B: ELECTROLYTE:

Hyperkalemia:

1 -Mild to moderate hyperkalemia (5 -7 mEq/L )

)* Tall symmetrical peaked ( tents T waves with narrow bas.

2 -More severe hyperkalemia (8 - 11 mEq/L )

* widening of QRS * PR interval prolonged

3 -Severe case > 11 * ECG resemble a sine wave * P wave disappearance

(atrial arrest)

Hypokalemia :

Mild( 3-3.5) to moderate ( 2.5 – 3) mEq /L

* Progressive ST segment depression

* Progressive decrease in T wave amplitude

* increase U wave amplitude

)Severe (< 2.5 mEq /L * Fusion of T and U wave

* Increase QRS duration and amplitude

* Increase P wave duration and amplitude

* QT interval usually slightly prolonged

Hypercalcaemia:

Marked shortening of the QT interval due to shortening of the ST segment

Hypocalcaemia:

Prolong the ST segment without affecting the T wave

C : DISEASES Renal failure :

Triad of *LVH (HTN) 

* Peaked T wave (Hyperkalemia)

*Prolong of the QT interval (Hypocalcemia)

Pericardial Effusion: Triad of

* Low voltage QRS complexes (0.5mv or less)

* low to inverted T waves in most leads

* Total electrical alternans

:Thyroid disease

 A: Hypothyroidism: * Low voltage ECG * Sinus bradycardia

* Inverted T waves without ST segment deviation in many or all leads ( slow and low ECG )

B:Thyrotoxicosis:

  *Unexplained AF ( sinus tachycardia at rest)

* High voltage ECG * Decrease of QT interval

* Prominent U wave in association with tachycardia

Acute Pericarditis:  * Diffuse ,Upward concave ST

elevation * PR depression (specific but

less sensitive ) *Almost associated with sinus

tachycardia

 Acute Myocarditis :

 * Non specific T wave change. * Depression or elevation of

ST segments . * Prolonged QT interval.

: CVA* Abnormal & widened T waves

that may be deeply inverted or tall & peaked.

* Prominent U waves.* Prolonged QT interval.

These changes are termed CVA pattern & usually resolved with

time .

:COPD  * RAD

* Absent R wave in precordial leads.

* Prominent R wave in Rt precordial leads & ST segment depression when

there is RVH

* Prominent P wave in inferior leads (P pulmonale ) resulting

from Rt atrial abnormality .* Occasionally SI , SII , SIII

syndrome. * Rarely in 10 % of patients LAD

:Pulmonary embolism * Sinus tachycardia.

* Rt ventricular strain , appearance of ST-T changes

in VI ,VII. * SI QIII TIII more specific but

less sensitive ( due to acute Rt ventricular dilatation )

* ST depression. * Acute RBBB ( rSR' in VI)

result from Rt ventricular dilatation

:Amyloidosis  * Low voltage of all wave in limb

leads * Marked LAD

* QS or minimal R wave in V1- V3 or V4

D: NORMAL VARIANTS

: Early repolarization syndrom * ST elevation:

1 -may raised to 2 mm above the baseline.

2 -It always follow the S wave .

 * Tall R & ST-T change in the Lt

precordial leads. * Relatively tall & frequently

symmetrical T wave , rarely T wave inversion.

* No reciprocal changes except ST segment depression in

aVR.

Hypothermia : * J wave or ( Osborn wave ) it is

localized to the junction of the end of QRS complex and beginning of the end of ST segment

* Prolongation of QRS complexes

* Depression of ST segment* T wave depression

* Prolongation of QT interval* Sinus bradycardia

* First and second - degree heart block

* Ectopic rhythm

Obesity: * Displacement of heart by

elevated diaphragm to the left but within normal range QRS axis

* Increasing the distance between the heart and the recording electrodes although the true low voltage QRS amplitude is rarely appears 

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