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12.12.18 ECG teaching

The key thing
  • ECGs are useless without a good HISTORY
    • TAKE A HISTORY!!
    • Make sure you don't thrombolyse someone with pericarditis

Regular rhythm
  • R-R constant
  • P waves before each QRS
  • P-R constant

Atrial flutter types
  • Regular
  • Variable block

P wave abnormalities
  • Should be 3 x 2.5 squares
  • P pulmonale
    • From pulmonary HTN
  • P mitrale
    • From mitral stenosis
    • Can flip into AF and therefore won't be seen!

Medications
  • Most common cause of 1st degree block
    • Beta blockers, CCBs
  • Most common cause of long QT

Aortic stenosis
  • Bulky ventricles, long systole => Ischaemia 
  • Gradually decreasing exercise tolerance

Locations + vessels
  • LAD
    • Septal - V1, V2
    • Anterior - V3, V4
  • Circumflex
    • Lateral - V5, V6, I, AVL
  • Right
    • Inferior - II, III, AVF

Pericarditis
  • Diffuse saddle-shaped ST elevation
    • Pattern does not sensibly correspond to arteries
  • PR depression
  • Pain relieved by leaning forwards
  • History of viral illness
  • They'll tamponade if you thrombolyse them!
    • Give NSAIDs

Notes
  • V4R sometimes useful for right heart stuff
  • Physiological sinus arrhythmia from deep breathing
  • WPW is not dangerous in itself - only when palpitations occur for some other reason
    • As they all get transmitted
  • New-onset BBB is a criteria for MI
  • Look at the vessels affected and see if it can possibly be an MI, or is it more likely pericarditis
  • Pathological Q is >2 mm
  • Posterior MI => Big R waves in V1, V2 due to unopposed vector
  • QT should be approximately less than 2 large squares
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