DfDx AV nodal reentrant tachycardia. In yellow, is evidenced the P wave that falls after the QRS complex.
LBBB: QRS >0,12 sec, Biphasic R peaks R and R' in leads II and V6, large late negative deflections in V1 Broad monomorphic R waves in I and V6 with no Q waves Broad monomorphic S waves in V1, may have a small r wave conduction in the left bundle is slow delayed depolarization of the LV, especially the left lateral wall.
The late electrical activity in the left lateral wall is unopposed by the usual right ventricular electrical activity. the last activity on the ECG goes to the left or away from V1
RBBB: QRS >0,12 sec, Slurred S wave in lead I and V6, Watch V1: RSR'-pattern where R' > R conduction in the right bundle is slow. As the RV depolarizes, the LV is often halfway finished and little counteracting electrical activity is left.
In RBBB the QRS complex in V1 is always markedly positive. RBBB is a common (13.5% of healthy individuals) The last electrical activity is thus to the right, or towards lead V1.
Hypercalcemia: High blood calcium, speeds repolarization, short QT interval widened T wave suggest hypercalcaemia.
Mild: broad based tall peaking T waves Severe: extremely wide QRS, low R wave, disappearance of p waves, tall peaking T waves. Causes: Primary hyperparathyroidism and malignancy account for about 90% of cases
Significant hypercalcaemia can mimic an acute myocardial infarction. Hypocalcemia: Narrow QRS, Reduced PR interval, T wave flattening and inversion, Prolongation of the QT-interval, Prominent U-wave, Prolonged ST and ST-depression
Hyperkalemia: wide, low amplitude P-waves, slowing of conduction QRS: widening, fusion of QRS-T, loss of the ST segment, Tall tented T waves Causes: acidosis and during Class IC anti-arrhythmic intoxication.
At concentrations > 7.5 mmol/L atrial and ventricular fibrillation can occur Hypokalemia: ST depression and flattening of the T wave, Negative T waves, A U-wave may be visible
Hypothyroidism: characterized by low voltages, ST deviation or T wave inversions across most or all leads,
+sinus bradycardia. presented with profound fatigue Hyperthyroidism: Can be characterized by a sinus tachycardia.
Also in new onset atrial fibrillation, a TSH should be checked as part of the routine workup
Pericarditis: ST elevation in all leads important to distinguish pericarditis from MI
Pericarditis: ST elevation in all leads. PTa depression, inverted T-waves (in early pericarditis STE in all leads except rightward leads (aVR, V1 and III))
MI: has more acute complaints and ST-elevations are limited to the infarct area.
Pericardial Effusion/ Tamponade: Low Amplitude Sinus Tach with Electrical Alterans
= QRS of erratic morphology due to changing fluid impedance
Ischemia: lack of oxygenation, ST depression or T wave inversion (lead specifc)
Injury: prolonged ischemia, ST segment elevation (lead specific)
Infarct: death of tissue, STE + Pathological Q wave
1. Any Q wave (downward deflection) in leads V2V3 0.02 s
2. A Q-wave lasting longer than 0.03 s and > 0.1 mV deep in leads I, II, aVL, aVF, or V4V6
3. R-wave (upward deflection) lasting longer than 0.04 s in V1V2
Quick Diagnostic Findings
Inverted P-Waves: Ectopic Atrial Rhythm
Shortened QT interval: Hypercalcemia, some drugs, certain genetic abnormalities, hyperkalemia Prolonged QT interval: Hypocalcemia, some drugs, certain genetic abnormalities Flattened or inverted T waves: Coronary ischemia, hypokalemia, left ventricular hypertrophy, digoxin effect, some drugs
Hyperacute T waves:1st manifestation of aMI, where T waves become more prominent, symmetrical, and pointed Peaked T wave, QRS wide, prolonged PR, QT short Hyperkalemia, treat with calcium chloride, glucose and insulin or dialysis T-Wave Inversion: coronary ischemia, left ventricular hypertrophy, or CNS disorder, hypothyroidism
Prominent U waves: Hypokalemia Wave Definations Q wave is any downward deflection after the P wave. R wave follows as an upward deflection S wave is any downward deflection after the R wave T-Wave is concordant with QRS (AUC QRS is AUC under T-wave is
U wave is typically small, follows the T wave, repolarization of the papillary muscles or Purkinje fibers
Hypokalemia, Hypercalcemia, Hyperthyroidism
Drugs: Digitalis, Epinephrine, Class 1A & 3 Antiarrhythmics
Congenital Long Qt Syndrome, Intracranial Hemorrhage.
Myocardial ischemia or LV overload.
Acute CNS Event
Ectopic Atrial Rhythm
Severe Hyperkalemia
Mild Hyperkalemia
Pericarditis
II AVB type 2
Non-Sustained VT
LBBB
Ischemia with lead specific T-wave inversion
Hypothyroidism
V5 AVNRT
II AVB type 1
Idioventricular Rhythm
Prolonged QT
Junctional Brady
No Q Waves
Acute Inferior Wall Injury and Infarct
Paced Atrial
III AV Block
Fisrt Degree AV Block
Paced Ventricular
V1 --> looks like letter M Right bundle branch block
Hypothyroidism --> Mild hyperkalemia --> big T waves Severe hyperkalemia --> tall R waves??
Hypercalcemia --> shortened QT interval
T waves are almost as tall as R waves Diagnosis: mild hyperkalemia
R waves are less than 10 small boxes tallRate is fast >120bpmDiagnosis: Pericardial eusionLung cancer in males and breast cancer in females with pericardial eusion until proven otherwise
PVC --> no P wave before that, wide QRS PAC --> narrow QRS following P waveIf rate is slow or ST elevations w smily faces --> early repolarization
Diagnosis: left bundle branch blockV6 --> monophasic predominantly upright Discordant T wave changesV1 --> QS pattern w no R wave
Hypothyroidism and pericardal effusion have same EKG
but hypothyroid is NSR and effusion is tachy
More than 3 in a row and less than 10sec --> nonsustained tachy
Idioventricular rhythm --> typically slower than junctional (can't tell by rate alone)Junctional --> would have narrow QRSRate is slow, QRS is not wide (Ventricular escape rhythm and idioventricular would have wide QRS)
ischemia: T wave inversions (not lead specic) ST elevation
Mobitz 1 Txt --> give atropine
Early activation in WPW --> preexcitationWidened QRS with short PR intervalOriginates in atria and conducted through bypass tract which is why they are wide NOT PVCs
CNS event Prolonged QT with negative T waves
Narrow QRS complexes2 large box btwn R waves --> rate = 150 P waves are after QRSAtrial b --> RR would change Ventricular tachy --> QRS would be wide ANSWER: AV nodal reentrant tachy
AMC ECGs