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