E2: Drugs And Electrolyte Flashcards
(22 cards)
What are the EKG findings of benign early repolarization?
- J point notching
- T wave asymmetry, concordance with QRS
- upsloping ST segment
What is electrical alternans and when do you see it?
- Changing amplitude of the QRS complex
- Seen with large pericardial effusion and the heart may rotate freely
What EKG findings can you see with a pulmonary embolism?
- Sinus tachycardia if the embolism is small
- if passive PE, may see S1 Q3 T3
What is S1Q3T3?
-Large S wave in lead 1, deep Q wave in lead III, and inverted T wave in lead 3
What is Long QT syndrome?
A rare congenital condition that results in delayed repolarization following depolarization, which is associated with ventricular dysrhythmias including V fib and Torsades
What is the QTc interval?
- The “corrected Qt interval”
- represents depolarization and repolarization but is corrected for HR
What QTc interval should make you concerned about your patient developing Torsades?
Men: >0.44
Women: >0.46
What is the visual tip to determine if the QT interval is normal?
Normal QT is less than half the R-R interval
What EKG characteristics does Hyperkalemia cause?
- Tall peaked T waves
- Flattened P waves
- 1st degree AV heart block
- Widened QRS complex
- Merging of S and T wave forming a “sine wave” pattern
What are the EKG findings of Hypokalemia?
- Flattening of the T waves
- Appearance of U waves
- ST segment depression
What are the EKG findings with Hypercalcemia?
- Increased PR interval and QRS interval
- Short ST and QT interval
What are the EKG findings with Hypokalemia, hypocalcemia, and hypomagnesemia?
-Prolonged QT
What are the general effects of Digoxin?
- Affects the movement of sodium and calcium during depolarization and repolarization (slows sodium movement into the cell and facilitation’s movement of calcium out of the cell )
- Increases myocardial contractility and improves the hearts pumping ability
- Slows heart rate and AV conduction
What happens in toxic levels of Digoxin?
- Will see conduction blocks and/or tachy-dysrhythmias which are increases with renal disease, hypokalemia, and aging
What are the EKG changes you will see with therapeutic levels of Digoxin?
- Shortened QT interval
- flattened T waves
- Asymmetric ST depression and T wave inversion in leads with tall R waves
What EKG findings might you see with toxic levels of Digoxin?
- Since it slows conduction through the AV node, may see 1st, 2nd, or third degree AV block
- can cause virtually any tachy-dysrhythmia
- PAT with second degree AV block is the most characteristic rhythm disturbance
What are the types of drugs that can prolong the QT interval?
- Anti-arrhythmics
- TCAs
- Phenothiazines
- Macrolides
When monitoring QT interval when a patient is on Digoxin, at what point should you discontinue the Digoxin?
If >25^ prolongation develops, or QTc exceeds 0.5 seconds
What are the EKG findings in TCA overdose?
- Prolonged QT
- Narrow QR portion, widened RS portion
- Often long PR interval
What are the EKG findings in Hypothermia?
- All intervals are prolonged
- Distinctive type of ST segment elevation with an abrupt ascent at the J point, and then plunge back to baseline (Osborn waves)
- Sinus brady and slow a fib are common
- muscle artifact due to shivering
What is Brugada syndrome?
-A rare clinical syndrome due to an inherited autosomal dominant genetic defect that results in EKG abnormalities which cause sudden death due to V fib.
What is the treatment of Brugada syndrome?
Implantable cardioverter-defibrillator (ICD)
