ECGs by diagnosis: Difference between revisions

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==Arrythmias==
==ACS==
See Cards: Arrythmias (DDX)
''See [[ACS]]''


==MI==
==Aneurysm==
#T wave usu tracks w/ the QRS, thus if QRS primarily negative, twi is not necessarily abnl (nl twi in V1).
''see [[Left ventricular aneurysm]]''
#ST elevation non-specific, also w/ LVH & strain, LBBB, CA spasm, pericarditis, "early repol", hyperK, dig/TCA's, CVA, Vent. aneurysm, hypothermia.
*Suggested by:
#Non-transmural: ST dep at least 1.0mm, twi.
**ST elevation >4wk
#II, II, AVF for inf. MI
**QS wave in setting of ST-segment elevation with out T-wave inversion
#V1-3 for anteroseptal inf.
#I, AVL, V4-6 for lat. wall inf.
#V1 or V2-6 anterolat.
#Large R and ST depression in V1-V2= POST. INFARCT! Post MI usu seen w/ inf MI b/c RCA supplies both in 90% of pts!
#Pts w/ inf. infarction +/or post wall mi often also have RV mi, need R sided leads!!
#STE >/= 1mm in V3R or V4R suggest RV MI!
#STE > 2wks= poss vent aneurysm!
#STE in avR and avL = LMA stenosis
#STE in avR and V1 = LAD or LMA stenosis
#if STE > 1.5 mm in avR pt has 75% mortality from AMI  --> activate cath lab (unless pt is in SVT, then STE is allowed)
 
===Infarct notes===
#inf wall: recip. In 1 and AVl. Downward sloping ST in AVl is often first sign.
#Any ST depression in V1 to V3 in a LBBB is pathological and suggestive of a post. Wall MI.
#Poor r waves progression-no r's by V4
#persistent t-wave elevation 6 wks post mi-vent. Anyeursm.anteroseptal with biphasic/inverted t wave


==Pericarditis==
==Pericarditis==
#Stage I: ST elevated in precordial leads, esp. V5-6 & I-II. Isoelectric or depressed ST in V1. PR depression in II, AVF, V4-6.
''See [[Pericarditis*[[ECG]]|Pericarditis]]''
#Stage II: ST returning to baseline. T wave amplitude decreases.
#Stage III: ST isoelectric. TWI where prior STE.
#Stage IV: Resolution of T wave changes.
#Also ST:T ratio >0.25 in V6
 
(Depressed PR, Diffuse ST elevation, Scooping upwardly concave ST segments, Notching at the end of the QRS)


==Electrolyte Disorders==
==Electrolyte Disorders==
===HyperK===
*[[Hyperkalemia]]
#5.5-6.6 -> tall peaked T, deep S in I and V6, QRS nml
*[[Hypokalemia]]
#7.0-8.0 -> QRS widens, slurred initial and term QRS, ST elevation, low wide P's, AV blocks, SA arrest, bradycardia.
*[[Hypercalcemia]]
#>8.0 -> widened QRS, Vfib, asystole.
*[[Hypocalcemia]]


===HypoK===
==CNS==
#3.0-3.5 no change or flat T' sand U's in V2-3, QT interval and QRS nml.
*[[SAH]], [[IC Bleed]], [[CVA]]
#2.7-3.0 U taller, T smaller, esp. V2-3
**Diffuse wide, deep, blunted, inverted T waves
#<2.6 ECG change includes tall U's, QT and QRS wnl.
**[[QT Prolongation]]


===HyperCa===
==Pacemakers==
#Increased QRS duration (slight)
''see [[Pacemaker complication]]''
#ST short or absent
*Should be in the apex of right ventricle
#Short corrected QT.
*[[ECG]] should mimic LBBB with LAD
#PR long


===HypoCa===
==Pulmonary Embolism==
#slight decrease in QRS.
''see [[Pulmonary embolism]]''
#ST and corrected QT long
*Sinus [[tachycardia]]
#PR short.
*S1Q3T3 (Sp, not Sn)
#T's flat to inverted.
*Right axis deviation
*RBBB
*T wave inversions leads V1-V3


==CNS==
==[[Hypothermia]]==
#SAH, IC bleed, stroke, can see diffuse wide deep, blunted inverted T's. and QT prolonged
[[File:Osborn wave.gif|thumb]]
 
*Osborn wave (J wave) - Positive deflection at the J point
==Pacemakers==
**Height of the J wave correlates to the degree of hypothermia<ref>Vassallo SU, Delaney KA, Hoffman RS, et al. A prospective evaluation of the electrocardiographic manifestations of hypothermia. Acad Emerg Med. 1999; 6(11):1121-1126.</ref>
#Should be in the apex of R vent.
*Bradyarrhythmias, AV blocks
#ECG should mimic LBBB, w/ L axis.
*Prolonged PR, QRS, QT intervals
*Shivering artifact


==PE==
==See Also==
#S1Q3T3
*[[ECG (Main)]]
##(good specificity, poor sensitiviy)
*[[STEMI equivalents]]


==Source==
==References==
DONALDSON 17/09 (Adapted from Niemann/Lampe)
<references/>


[[Category:Cards]]
[[Category:Cardiology]]

Latest revision as of 05:31, 22 March 2026

ACS

See ACS

Aneurysm

see Left ventricular aneurysm

  • Suggested by:
    • ST elevation >4wk
    • QS wave in setting of ST-segment elevation with out T-wave inversion

Pericarditis

See [[Pericarditis*ECG|Pericarditis]]

Electrolyte Disorders

CNS

Pacemakers

see Pacemaker complication

  • Should be in the apex of right ventricle
  • ECG should mimic LBBB with LAD

Pulmonary Embolism

see Pulmonary embolism

  • Sinus tachycardia
  • S1Q3T3 (Sp, not Sn)
  • Right axis deviation
  • RBBB
  • T wave inversions leads V1-V3

Hypothermia

Osborn wave.gif
  • Osborn wave (J wave) - Positive deflection at the J point
    • Height of the J wave correlates to the degree of hypothermia[1]
  • Bradyarrhythmias, AV blocks
  • Prolonged PR, QRS, QT intervals
  • Shivering artifact

See Also

References

  1. ↑ Vassallo SU, Delaney KA, Hoffman RS, et al. A prospective evaluation of the electrocardiographic manifestations of hypothermia. Acad Emerg Med. 1999; 6(11):1121-1126.
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