09. AKT: ECG/CKD Flashcards
(40 cards)
What is a precordial thump and when is it indicated?
- A precordial thump is a single, sharp blow delivered by the rescuer’s fist to the mid sternum of the victims chest
- It may be considered for patients with monitored, pulseless ventricular tachycardia if a defibrillator is not immediately available
What is preferred for defibrillation, monophasic or biphasic?
Biphasic
ECG Localisation - if these leads are affected, 1) what myocardial area is affected and 2) what coronary artery is affected?
V1-V2
- Septal
- Proximal LAD
ECG Localisation - if these leads are affected, 1) what myocardial area is affected and 2) what coronary artery is affected?
V3-V4
- Anterior
- LAD
ECG Localisation - if these leads are affected, 1) what myocardial area is affected and 2) what coronary artery is affected?
V5-V6
- Apical
- Distal LAD, LCx or RCA
ECG Localisation - if these leads are affected, 1) what myocardial area is affected and 2) what coronary artery is affected?
I, AVL
- Lateral
- LCx
ECG Localisation - if these leads are affected, 1) what myocardial area is affected and 2) what coronary artery is affected?
II, III, aVF
- Inferior
- 90% RCA. 10% LCx
ECG Localisation - if these leads are affected, 1) what myocardial area is affected and 2) what coronary artery is affected?
V7, V8, V9 (reciprocal ST depressions are frequently evident in V1-V3)
- Posterolaeral (AKA inferobasal or posterior)
- RCA or LCx
What is benign early repolarisation?
- Benign early repolarization is a usually benign ECG pattern producing widespread ST segment elevation that is commonly seen in young, healthy patients less than 50 years old
- J point morphology/fish hook pattern with a high take off
- ST elevation is limited to the precordial leads
Differentials for chest pain?
Isolated musculoskeletal chest wall pain
* Costochondritis
* Low rib pain syndrome
* Sternalist syndrome
* Thoracic costovertebral joint dysfunction
Rhuematic causes
* Fibromyalgia
* Rheumatoid arthritis
* Axial spondyloarthropathy (including anklyosing spondylitis)
* Psoriatic arthritis
Non-rheumatic systemic Causes
* Osteoporotic fracture
* Neoplasm with pathological fracture or bone pain
Pharmacotherapy for haemodynamically stable patient with sustained ventricular tachycardia (lasting more than 30 seconds)?
Amiodarone300mg IV infusion over 30 minutes, followed by 900mg IV infusion over 24 hours if required
Management for haemodynamically stable patient with narrow complex tachycardia?
- Vagal manoeuvres
- Adenosine 6mg rapid IV bolus; if unsuccessful, give 12mg; if unsuccessful, give further 12mg
- Continuous ECG monitoring
What must you always consider with a ventricular rate of 150bpm (range 130-170) with narrow QRS complexes?
Atrial flutter with 2:1 block (might be hard to see the sawtooth pattern)
How can you differentiate between atrial flutter with 2:1 block and AVNRT/AVRT?
Give a test dose of adenosine
* Atrial flutter: slowing of the ventricular rate shows the sawtooth pattern
* AVNRT/AVRT: will often revert to sinus rhythm
What are delta waves and what are they associated with?
- Slurred upstroke of QRS
- Associated with pre-excitation syndromes
What are characteristics ECG findings for Wolff-Parkinson-White syndrome?
- Short PR interval (<120ms)
- Broad QRS complex (>100ms)
- Slurred upstroke of QRS (delta wave)
What are the ECG definitions for a ST elevation myocardial infarction?
- ST elevation (length varies depending on the patient demographic) in 2 or more contiguous leads
- Development of new onset left bundle-branch block (use Sgarbossa criteria)
Contraindications for the use of GTN in the acute management of suspected cardiac related chest pain?
- Suspected right ventricular myocardial infartion (pre-load sensitive)
- Recent phoshodiesterase type 5 inhibitor use -> severe hypotension
What medications should be given in out of hospital suspected cardiac chest pain?
- GTN if blood pressure is good (0.3-0.6mg tablet OR 0.4-0.8mg spray sublingually every 5 minutes for 3 doses)
- Aspirin 300mg PO STAT
- IV opioids if pain is not responsive to GTN (fentanyl preferred as morphine may reduce absorption of oral antiplatelets)
ECG characteristics for a posterior myocardial infarction?
- ST depression in V1-3 (usually horizontal)
- Tall, broad R waves (>30ms) in V1-3
- Dominant R wave (R/S ratio > 1) in V2
- Upright terminal portions of the T waves in V1-3
Note: in patients presenting with ischaemic symptoms, horizontal ST depression in the anteroseptal leads (V1-3) should raise the suspicion of posterior MI
What should you consider if a patient presents with cardiac ischaemic symptoms and has an ECG with horizontal ST depression in the anteroseptal leads (V1-3)?
Posterior myocardial infarction
ECG changes in pericarditis?
- Widespread concave ST elevation and PR depression throughout most of the limb leads and precordial leads
- Reciprocal ST depression and PR elevation in lead aVR (+/- V1)
- Sinus tachycardia is also common in acute pericarditis due to pain and/or pericardial effusion
What is Beck’s triad?
- Hypotension
- Elevated JVP
- Muffled heart sounds
NB: indicates cardiac tamponade
Clinical features of cardiac tamponade?
Beck’s triad:
* Hypotension
* Elevated JVP
* Muffled heart sounds
- Tachypnoea
- Tachycardia
- Atrial arrhythmias - e.g. atrial fibrillation
- Kussmaul sign (paradoxical rise in JVP on inspiration)
- Positive hepatojugular reflux
- Weakened peripheral pulses
- Peripheral oedema
- Cyanosis
- Pulsus paradoxus
- ECG: electrical alternans (alteration in the amplitude of QRS complexes thought to be due to the swinging movement of the heart within the pericardial cavity)
