Cardiology
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Cardiology
“Dig Effect” EKG Changes in Hypokalemia
EKG Changes in Hyperkalemia
© Andrea Cormier
Delta wave (blurring of the R wave)
Delta wave of WPW syndrome
Jugular Venous Pulsations Right Ventricular Hypertrophy (RVH) Bundle Branch Blocks • QRS < 0.12 seconds, R/S ratio > 1 in V1, R/S ratio < 1 in V5 and V2 V1 V6, R > 7 mm in V1 • right axis deviation (RAD) (> 90º) • asymmetric ST segment depression and T wave inversion in V1 and V2 (RV strain pattern) RBBB Left Ventricular Hypertrophy (LVH) • S in V1 or V2 + R in V5 or V6 > 35 mm V6 • S in V1 or V2 or R in V5 or V6 > 25 mm • R in aVL > 11 mm (most sensitive criterion) V1 • R in I + S in III > 25 mm • left axis deviation (LAD) (> –30º) with slightly widened QRS • asymmetric ST segment depression and T wave inversion (LV strain) leads I, aVL, V4-6 • left atrial enlargement (LAE) Right Atrial Enlargement(RAE) (P Pulmonale) • P wave > 2.5 mm (in height) in leads II, III or aVF Left Atrial Enlargement (LAE) (P Mitrale) • P wave duration > 0.11s best seen in leads I, II, aVL, V4-V6 LBBB • large, biphasic P wave in V1 with deep terminal component that is at least one square wide (0.04 sec) and one square deep (1 mm) • notched P with interpeak interval > 0.04 seconds in I, II or aVL
Clinical Approach to Arrhythmias Mobitz Type I
Atrial Flutter
Usual Involved Vessel
Infarct Area
Leads
left anterior descending (LAD)
anteroseptal anterior anterolateral extensive anterior
V1, V2 V3, V4 I, aVL, V3-V6 I, aVL, V1 - V6
inferior right ventricle posterior in the company of inf. MI
II, III, aVF V4R (V5R and V6R) (right sided chest leads) V1 and V2 (prominent R waves)
right coronary artery (RCA)
circumflex
lateral* I, aVL, V5, V6 Isolated posterior MI *often no ECG changes because small infarcts and lateral wall is late in the depolarization (QRS complex)
Acute days (avg. 3-5) ST segment elevation
ECG changes with Infarction
Recent Old weeks-months (avg. 2-6 months) months-years (avg. > 6 months) T wave inversion Just significant Qs
Toronto Notes 2006 – Editors: Carolyn Shiau and Andrew Toren
Areas of Infarction/Ischemia (right dominant anatomy)
Paroxysmal Supraventricular Tachycardia Ventricular Tachycardia
Ventricular Fibrillation
Torsades de Pointes
Toronto Notes 2006 – Editors: Carolyn Shiau and Andrew Toren
Atrial Fibrillation
“Dig Effect” EKG Changes in Hypokalemia
EKG Changes in Hyperkalemia
© Andrea Cormier
Delta wave (blurring of the R wave)
Delta wave of WPW syndrome
Jugular Venous Pulsations Right Ventricular Hypertrophy (RVH) Bundle Branch Blocks • QRS < 0.12 seconds, R/S ratio > 1 in V1, R/S ratio < 1 in V5 and V2 V1 V6, R > 7 mm in V1 • right axis deviation (RAD) (> 90º) • asymmetric ST segment depression and T wave inversion in V1 and V2 (RV strain pattern) RBBB Left Ventricular Hypertrophy (LVH) • S in V1 or V2 + R in V5 or V6 > 35 mm V6 • S in V1 or V2 or R in V5 or V6 > 25 mm • R in aVL > 11 mm (most sensitive criterion) V1 • R in I + S in III > 25 mm • left axis deviation (LAD) (> –30º) with slightly widened QRS • asymmetric ST segment depression and T wave inversion (LV strain) leads I, aVL, V4-6 • left atrial enlargement (LAE) Right Atrial Enlargement(RAE) (P Pulmonale) • P wave > 2.5 mm (in height) in leads II, III or aVF Left Atrial Enlargement (LAE) (P Mitrale) • P wave duration > 0.11s best seen in leads I, II, aVL, V4-V6 LBBB • large, biphasic P wave in V1 with deep terminal component that is at least one square wide (0.04 sec) and one square deep (1 mm) • notched P with interpeak interval > 0.04 seconds in I, II or aVL
Clinical Approach to Arrhythmias Mobitz Type I
Atrial Flutter
Usual Involved Vessel
Infarct Area
Leads
left anterior descending (LAD)
anteroseptal anterior anterolateral extensive anterior
V1, V2 V3, V4 I, aVL, V3-V6 I, aVL, V1 - V6
inferior right ventricle posterior in the company of inf. MI
II, III, aVF V4R (V5R and V6R) (right sided chest leads) V1 and V2 (prominent R waves)
right coronary artery (RCA)
circumflex
lateral* I, aVL, V5, V6 Isolated posterior MI *often no ECG changes because small infarcts and lateral wall is late in the depolarization (QRS complex)
Acute days (avg. 3-5) ST segment elevation
ECG changes with Infarction
Recent Old weeks-months (avg. 2-6 months) months-years (avg. > 6 months) T wave inversion Just significant Qs
Toronto Notes 2006 – Editors: Carolyn Shiau and Andrew Toren
Areas of Infarction/Ischemia (right dominant anatomy)
Paroxysmal Supraventricular Tachycardia Ventricular Tachycardia
Ventricular Fibrillation
Torsades de Pointes
Toronto Notes 2006 – Editors: Carolyn Shiau and Andrew Toren
Atrial Fibrillation
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