Non Cardiac Causes Of Nasty Looking ECG

Question 1

What causes the ‘spiked helmet sign’

Answer 1

Anything that raises abdo pressure - ARDS, SAH, acute abdo, pneumothorax, metabolic derangement, gut ischaemia, pneumomediastinum, sepsis

Question 2

Spiked helmet sign

Answer 2

Baseline upstroke, QRS on top of T wave
Easy to mistake for ST elevation
Caused by incr abdo pressure

Question 3

SAH ECG

Answer 3

Raised baseline
Inverted T waves in praecordial and limb leads.- cerebral T waves
Long QT

Question 4

Potential cause of ST elevation with no reciprocal changes

Answer 4

Raised ICP

Question 5

Neuro changes in ECG

Answer 5

Prolonged QTc
ST elevation with

Question 6

Why can Neurological problems cause ECG changes

Answer 6

Altered autonomic function
Vagal stimulation
Sympathetic overload - effects electrical function and causes myocardial damage

Question 7

ECG when limb lead placed over fistula (or radial art)

Answer 7

Abnormal tall fin-like T waves in limb leads, V1, V2
V4 5 6 normal

Question 8

Sodium channel blocker OD ECG

Answer 8

Extreme axis deviation
Long PR
broad QRS
Long QT
T wave broadening
prominente R wave aVF
Tachy
Can mimic VT but slower

Question 9

Sodium channel blocker OD tx

Answer 9

Sodium bicarbonate bolus if QRS >100
Fluids
Benzos for seizures
Ionotropes
Vasopressors
Intubate
ECMO

Question 10

Is it more dangerous to by tachy or Grady with long QT

Answer 10

tachy more dangerous

Question 11

Normal QT length in men and women

Answer 11

Men 440
Women 460
Significant >500

Question 12

What arrhythmia is assoc with long QT

Answer 12

Torsades

Question 13

Causes of long QT

Answer 13

Overdose
Hypothermia
Hypokalaemia
Hypocalcemia
Hypothyroidism
Raised ICP
Congenital long QT
Antiarrhythmic
Antivirals
Antiemetics
Antihistamines
Anti fungals
Antidepressants

Question 14

What substance in yew trees is cardiotoxic and how does it effect the heart

Answer 14

Taxane alkaloids
If ingested in large amounts become calcium channel blocker

Question 15

Cardiac effects of beta blocker and CCB OD

Answer 15

Heart blocks
Bradycardia
Arrythmia

Question 16

How to differentiate a Beta blocker and CCB overdose

Answer 16

CCB causes Hypercalcaemia
Beta causes hypocalcaemia
(Calcium needed to release insulin)

Question 17

CCB OD

Answer 17

Different types have different effects - pump or electrical impacts
Non dihydropyridine (verapamil, diltiazem) - pump problem
Dihydropyridine (amlodipine, felodipine, nifedipine) - pipe problem
Can cause Cardiogenic or vasoplegic shock

Question 18

CCB OD Tx

Answer 18

Fluids
Calcium
Atropine
Pacing
Inotropes
Vasopressors
High dose insulin (in hospital, works as inotrope allowing heart to uptake glucose)
Methylene blue if refractory

Question 19

Hyperkalaemia ECG

Answer 19

Broad and bizarre
Peaked T
Brady or Tachy arrhythmia

Question 20

Hyperkalaemia tx

Answer 20

Fluids
Salbutamol
Calcium
Insulin
Glucose

Question 21

First ECG sign of DKA

Answer 21

peaked T waves

Question 22

How does DKA lead to hyperkalaemia

Answer 22

Hydrogen ions enter myocytes -> K+ leaves myocytes -> Hyperkalaemia

Question 23

What part of the cardiac cycle should a shock be delivered on

Answer 23

R wave

Question 24

What could happen if a shock is delivered on the T wave

Answer 24

R on T leading to AF or VF

Question 25

What does an Osborn/Jay wave suggest

Answer 25

Hypothermia

Question 26

Epsilon wave

Answer 26

Sign of arrhythmia in young people

Question 27

Signs of hypothermia on ECG

Answer 27

Tremor artefact until <30* Bradycardia T waves inversion Osborn/jay waves Prolonged intervals PR QRS QTc AF <32* VF <28* Hypokalaemia

Question 28

Signs of hypothermia on ECG

Answer 28

○ Tremor artefact until <30degreed ○ Bradycardia ○ T wave inversion ○ Osborne waves - Jay waves ○ Prolonged intervals ○ VF below 30 degrees, ○ Decreases potassium

Question 29

Signs of hypothermia on ECG

Answer 29

Tremor artefact until <30degreed Bradycardia T wave inversion Osborne waves - Jay waves Prolonged intervals VF below 30 degrees Decreases potassium

Question 30

What environment makes myocytes more attracted to sodium channel blockers than sodium

Answer 30

Acidic

Question 31

OD of what medication can cause a brugada pattern

Answer 31

Sodium channel blocker

Question 32

Causes of long ST segment with normal T wave (long QT but not due to prolonged T)

Answer 32

Hypocalcaemia Hypothermia Long QT3 syndrome

Question 33

Causes of long ST segment with normal T wave (long QT but not due to prolonged T)

Answer 33

Hypocalcaemia Hypothermia Long QT3 syndrome

Question 34

Hope does hypothermia lead to arrythmia

Answer 34

Hypothermia -> decr K and Mg -> prolong QT -> incr arrythmia risk