ECG

Question 1

A nurse presents an ECG to you showing inferior ischaemia. What additional bedside investigation should you ask them for?

Answer 1

Right sided ECG

At minimum get a V4R lead

Question 2

What % of new or possible new LBBB actually have ACS?

Answer 2

< 10%

Question 3

STE in III >II suggest what?

Answer 3

right sided infarction

Look for STE in V1. Is specific to proximal right coronary artery occlusion

Question 4

Posterior infarction may be isolated or in association with what other areas of infarction?

Answer 4

lateral or
inferior

Question 5

STE in aVR and V1 suggest ischaemia in what coronar vessel?

Answer 5

LAD

Question 6

What is the modified sgarbossa criteria?

Answer 6

• > 1mm concordant STE
• > 1mm concordant ST depression
• > 5mm or > 25% discordant STE

Used for those with LBBB or paced ECG
Excessive concordant STE is the weakest predictor of infarction

Question 7

What are the two types of wellen’s t waves and where do you see them?

Answer 7

• biphasic
• deeply inverted
• anterior leads

Usualy V2, V3. May be seen in V4, occassionaly V5, V6
75% of pts with this finding have critical LAD stenosis

Question 8

Why is it important to capture an ECG with a pt in pain and when pain resolves?

Answer 8

Show if ECG is dynamic

Question 9

A pt has an inferior STEMI and also ST depression in V1 and V2. Is this reciprocal changes?

Answer 9

Get a posterior ECG to ensure STEMI not extending posteriorly

Question 10

Are wellen T waves present during pain or when pain free

Answer 10

When pain free
Pain can actually makes them resolve

Question 11

What is Wellen’s syndrome

Answer 11

• episode of angina
• typical T wave changes that come and go depending on pain state
• no pathological Q waves
• no loss of R waves
• none or minimal STE
• none or minimal troponin elevation

Without angina ECG may have Wellen’s sign but pt does not have Wellen’s syndrome

Question 12

What are you looking for on a syncope ECG?

Answer 12

**The obvious **
- Ischaemia
- dysrythmia
- AV blocks
Intervalopathies
– Short PR (WPW)
– Long QTc
Genetic
–HCM
–Brugada
–ARVC (ACM)

Question 13

What are the DDx of TWIs?

Answer 13

• CAD (ischaemia, Wellens, reperfusion)
• elevated ICP
• Pulmonary (PE, PTx, Pulm HTN, pneumonia, hyperventilation)
• ARVC (V1-V3), Brugada (V1-V2)
• wide QRS (BBB, PVC, paced, WPW)
• LVH, RVH with “strain”
• pericarditis, myocarditis
• hyperkalaemia, hypokalaemia
• mitraval valve prolapse
• normal in V1, aVR & IIII