ECGs by diagnosis: Difference between revisions

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==Cardiac Ischemia==
==ACS==
===T Wave===
''See [[ACS]]''
*Distribution
**T wave is normally inverted in aVR; sometimes inverted in III, aVF, aVL, V1
*T-wave inversions in V2-V6 are pathologic
*Morphology
**Inverted, symmetric,
**Transient changes suggests ischemia without infarction
**Persistent changes suggests infarction (troponin elevation usually seen)
*Pseudonormalization
**In presence of baseline TWI (within 1 month), reocclusion causes normalization of TWI
**Should be interpreted as evidence of ischemia
 
===Q Wave===
*Q waves do not always indicate infarction (see DDX below)
*Must distinguish normal septal q waves from pathologic Q waves:
**Normal septal q wave: <0.04s, low amplitude
**Abnormal septal q wave: >0.04s in I OR in II, III, AND aVF OR V3, V4, V5, AND V6
*Q-wave equivalents in the precordial leads:
**R-wave diminution or poor R-wave progression
**Reverse R-wave progression (R waves increase then decrease in amplitude)
***Must distinguish from lead misplacement
**Tall R waves in V1, V2 (representing "Q waves" from posterior infarction)
 
====Q Wave (Pathologic) DDX====
*Ischemic Q waves
*LBBB
*LVH
*Chronic lung disease
*Hypertrophic cardiomyopathy
*Dilated cardiomyopathy
 
===ST Segment Depression===
*Assume posterior STEMI or reciprocal changes to STEMI until proven otherwise
*Indicators of ischemia:
**>0.5mm depression from baseline (especially >1mm) in two or more contiguous leads
**Transient depression
**Morphology that is flat or downsloping
 
===ST Segment Elevation===
*Stage 1
**Timing: 30min - hours
**Finding: hyperacute T waves
***>6mm limb leads
***>10mm precordial leads
**Duration: normalizes in days, weeks, or months
*Stage 2
**Timing: minutes - hours
**Finding: ST segment elevation
***≥0.1mV in two or more contiguous leads
**Duration: ST segment resolution occurs over 72hrs; completely resolves w/in 2-3wks
*Stage 3
**Timing: within 1hr; completed within 8-12hr
**Finding: Q waves
**Duration: persist indefinitely in 70% of cases
 
===Reciprocal Changes===
#Anterior STEMI
##Reciprocal ST-segment depression in at least one of leads II, III, aVF
##Occurs in 40-70% of cases
#Inferior STEMI
##Reciprocal ST-segment depression usually present in I, aVL; often in V1-V3
##Occurs in 56% of cases
#Posterior STEMI
##Reciprocal ST-segment depression in V1-V4
###Differentiate from inf STEMI reciprocal depression based on upright T waves, posterior leads showing STEMI
##Often associated w/ ST-segment elevation in II, III, aVF (inferior involvement)
 
==Anatomical Correlation==
#Posterior
##ST depression in V1-V2
##R-S ratio of >1 in V1 or V2
##ST elevation >1 in V7-9
##Often accompanied by inferior ST changes
##Often accompanied by RV MI
#Anterior
##ST depression in II, III, aVF usually due to high lateral ST elevation (I, aVL)
#Inferior
##Look at I, aVL for reciprocal changes (ST depression or TWI)
###If no changes pt probably not having an inf STEMI


==Aneurysm==
==Aneurysm==
#ST elevation > 2wk
''see [[Left ventricular aneurysm]]''
*Suggested by:
**ST elevation >4wk
**QS wave in setting of ST-segment elevation with out T-wave inversion


==Pericarditis==
==Pericarditis==
*See [[Pericarditis#ECG|Pericarditis]]
''See [[Pericarditis*[[ECG]]|Pericarditis]]''


==Electrolyte Disorders==
==Electrolyte Disorders==
===Hyperkalemia===
*[[Hyperkalemia]]
*See [[Hyperkalemia#ECG|Hyperkalemia]]
*[[Hypokalemia]]
 
*[[Hypercalcemia]]
===Hypokalemia===
*[[Hypocalcemia]]
*See [[Hypokalemia#Diagnosis|Hypokalemia]]
 
===Hypercalcemia===
*See [[Hypercalcemia#Diagnosis|Hypercalcemia]]
 
===Hypocalcemia===
*See [[Hypocalcemia#Diagnosis|Hypocalcemia]]


==CNS==
==CNS==
#SAH, IC bleed, CVA
*[[SAH]], [[IC Bleed]], [[CVA]]
##Diffuse wide, deep, blunted, inverted T waves
**Diffuse wide, deep, blunted, inverted T waves
##QT prolongation
**[[QT Prolongation]]


==Pacemakers==
==Pacemakers==
#Should be in the apex of R ventricle
''see [[Pacemaker complication]]''
#ECG should mimic LBBB w/ LAD
*Should be in the apex of right ventricle
*[[ECG]] should mimic LBBB with LAD


==Pulmonary Embolism==
==Pulmonary Embolism==
#S1Q3T3 (Sp, not Sn)
''see [[Pulmonary embolism]]''
*Sinus [[tachycardia]]
*S1Q3T3 (Sp, not Sn)
*Right axis deviation
*RBBB
*T wave inversions leads V1-V3
 
==[[Hypothermia]]==
[[File:Osborn wave.gif|thumb]]
*Osborn wave (J wave) - Positive deflection at the J point
**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>
*Bradyarrhythmias, AV blocks
*Prolonged PR, QRS, QT intervals
*Shivering artifact


==See Also==
==See Also==
*[[ST Segment Elevation]]
*[[ECG (Main)]]
*[[ST Segment Depression]]
*[[STEMI equivalents]]


==Source==
==References==
*Electrocardiography in Emergency Medicine. ACEP Textbook.
<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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