Ecg Diagnosis

Lists of differential diagnoses of specific ECG findings based on from ECGs for the Emergency Physician 1 and ECGs for the Emergency Physician 2 Atrial fibrillation with slow ventricular response Severe AV nodal disease Hypothermia Medications: Digoxin toxicity, Calcium-channel blocker / beta-blocker toxicity Tachydysrhythmias Narrow-complex regular rhythm: Sinus tachycardia Supraventricular tachycardia Atrial flutter Narrow-complex irregular rhythm: Atrial fibrillation Atrial flutter with variable block Multifocal atrial tachycardia Wide-complex regular rhythm: Ventricular tachycardia Sinus tachycardia with aberrant conduction SVT with aberrant conduction Atrial flutter with aberrant conduction Wide-complex irregular rhythm: Atrial fibrillation with aberrant conduction (for example bundle branch block) Atrial flutter with variable block and aberrant conduction Multifocal atrial tachycardia with aberrant conduction Atrial fibrillation with WPW Polymorphic ventricular tachycardia / Torsades de Pointes Leftward axis Left anterior fascicular block Left bundle branch block Inferior myocardial infarction Left ventricular hypertrophy Ventricular ectopy Paced beats Wolff-Parkinson-White syndrome Low voltage Myxoedema Large pericardial effusion Large pleural effusion End-stage dilated cardiomyopathy Severe chronic obstructive pulmonary disease Severe obesity Infiltrative myocardial diseases (i.e. restrictive cardiomyopathy) Constrictive pericarditis Prior massive MI Low gain settings on ECG machine Increased QRS Duration Hypothermia Hyperkalaemia WPW Aberrant intraventricular conduction (for example bundle branch block) Ventricular ectopy Paced beats Drugs, particularly those with sodium-channel blocking effects Increased QT-interval (and QTc-interval) Hypokalaemia* Hypomagnesaemia Hypocalcaemia Myocardial ischemia Elevated intracranial pressure Sodium-channel blockers Hypothermia Congenital prolonged QT syndrome *Hypokalemia — the actual QT-interval is normal; the QT-interval appears prolonged because of the presence of fusion of the T-wave with a U-wave (a “T-U fusion complex”) ...

Characteristic ECG Abnormalities with Raised Intracranial Pressure Widespread giant T-wave inversions (“cerebral T waves”) QT prolongation Bradycardia (the Cushing reflex – indicates imminent brainstem herniation) Other possible ECG changes that may be seen: ST segment elevation / depression — this may mimic myocardial ischaemia or pericarditis Increased U wave amplitude Other rhythm disturbances: sinus tachycardia, junctional rhythms, premature ventricular contractions, atrial fibrillation In some cases, these ECG abnormalities may be associated with echocardiographic evidence of regional ventricular wall motion abnormality (so-called “neurogenic stunned myocardium”). ...

Left Axis Deviation LAD Left Axis Deviation = QRS axis less than -30°. Normal Axis = QRS axis between -30° and +90° Right Axis Deviation = QRS axis greater than +90° Extreme Axis Deviation = QRS axis between -90° and 180° (AKA “Northwest Axis”) Hexaxial Reference System Hexaxial Reference System – relationship between QRS axis and frontal leads of the ECG. How to recognise left axis deviation Three Lead analysis QRS is POSITIVE (dominant R wave) in Lead I QRS is NEGATIVE (dominant S wave) in leads II, III and aVF ...

Pacemaker Components 1. Pulse generator Power source Battery Control circuitry Transmitter / Receiver Reed Switch (Magnet activated switch) 2. Lead(s) Single or multiple Unipolar or bipolar Pacemaker Classification Pacemakers are classified by the nature of their pacing mode. Classification follows pacemaker code developed by the North American Society of Pacing and Electrophysiology (NASPE) and the British Pacing and Electrophysiology Group (BPEG). The NASPE/BPEG Generic (NBG) Pacemaker Code was last revised in 2002, although many textbooks still use the previous version from 1987. The code is expressed as a series of up to five letters. NBG Pacemaker Code (2002) ...

First reported by Dutch Professor of Cardiology, Robbert J. de Winter in 2008, the de Winter ECG pattern is an anterior STEMI equivalent that presents without obvious ST segment elevation. These patients are suffering occlusion myocardial infarction (OMI) and require immediate reperfusion therapy. ECG Diagnostic Criteria Tall, prominent, symmetrical T waves in the precordial leads Upsloping ST segment depression > 1mm at the J point in the precordial leads Absence of ST elevation in the precordial leads Reciprocal ST segment elevation (0.5mm – 1mm) in aVR Typical STEMI morphology may precede or follow the De Winter pattern ...

Evaluating the Differences in Approach to the ECG Between Experts and Novices We know that emergency medicine attendings are generally faster and more accurate at ECG interpretation than residents and medical students. But how are they able to process this information so much quicker while maintaining accuracy? And can we use these strategies to help learners progress to their own ‘expert-like’ level? Our study combined eye-tracking and interview data to come up with a few ways in which EM attendings look and think about ECGs differently than more novice learners.1 ...