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Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Other Cardiac Conditions and the ECG Fast & Easy ECGs, 2nd E – A Self-

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Presentation on theme: "Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Other Cardiac Conditions and the ECG Fast & Easy ECGs, 2nd E – A Self-"— Presentation transcript:

1 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Other Cardiac Conditions and the ECG Fast & Easy ECGs, 2nd E – A Self- Paced Learning Program

2 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Other Cardiac Conditions Many conditions cause changes to the ECG – Electrolyte abnormality – Ischemia – Infarction – Inflammation – Medications 2

3 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Pericarditis Inflammation of the pericardium Produces sharp, substernal chest pain I I 3

4 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Pericarditis Pain has an abrupt onset that worsens on inspiration or by movement, particularly when the individual is lying down The pain lessens when sitting up and leaning forward 4

5 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Causes of Pericarditis Most common causes are viral and bacterial infections Other causes include uremia, renal failure, rheumatic fever, connective tissue disease, and cancer Sometimes pericarditis can accompany an MI 5 I I

6 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Characteristics of Pericarditis 6

7 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. ECG Changes in Pericarditis T wave initially upright and elevated but then during recovery phase it inverts ST segment elevated and usually flat or concave 7

8 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Pericardial Effusion Can occur with pericarditis Can cause low- voltage QRS complexes in all leads and electrical alternans 8

9 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Electrical Alternans QRS complexes change in height with each successive beat 9

10 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Pulmonary Embolism Acute blockage of one of the pulmonary arteries Leads to obstruction of blood flow to the lung segment supplied by the artery Produces large S wave in lead I, deep Q wave in lead III, inverted T wave in lead III – Called the S1 Q3 T3 pattern 10

11 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Characteristics of Pulmonary Embolism 11

12 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Effects of Pulmonary Embolism The larger the artery occluded, the more massive the pulmonary embolus and therefore the larger the effect the embolus has on the lungs and heart Due to the increased pressure in the pulmonary artery caused by the embolus, the right atrium and ventricle become distended and unable to function properly, leading to right heart failure – This condition is referred to as acute cor pulmonale 12

13 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Effects of Pulmonary Embolism Massive pulmonary embolism impairs oxygenation of the blood, and death may result The most common source of the clot is in one of the large pelvic or leg veins The pain that accompanies a pulmonary embolus is pleuritic, and shortness of breath is often present 13

14 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Pulmonary Embolism A number of dysrhythmias may be seen with massive pulmonary embolism, most commonly sinus tachycardia and atrial fibrillation 14

15 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Electrolyte Imbalances Increases or decreases in potassium and calcium serum levels can have a profound effect on the ECG 15

16 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Hyperkalemia Is an abnormally elevated level of potassium in the blood – Levels between 5.1 mEq/L and 6.0 mEq/L reflect mild hyperkalemia – Levels of 6.1 mEq/L to 7.0 mEq/L reflect moderate hyperkalemia – Levels above 7 mEq/L reflect severe hyperkalemia Signs and symptoms of hyperkalemia include weakness, paralysis, and respiratory failure 16

17 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Hyperkalemia Key characteristics include: – T wave peaking – Flattened P waves – 1st-degree AV heart block – Widened QRS complexes – Deepened S waves – Merging of S and T waves 17

18 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Hypokalemia Is a lower-than-normal amount of potassium in the blood Symptoms of hypokalemia include weakness, fatigue, paralysis, respiratory difficulty, constipation, and leg cramps Severe hypokalemia can lead to dysrhythmias and pulseless electrical activity (PEA) or asystole 18

19 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Hypokalemia Key ECG characteristics include: – ST segment depression – Flattening of the T wave – Appearance of U waves 19

20 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. QT Interval Changes In hyperkalemia the QT interval is shortened In hypokalemia the QT interval is prolonged 20

21 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Digoxin Slows influx of sodium while allowing a greater influx of calcium Increases myocardial contractility and improves the heart’s pumping ability Slows heart rate and AV conduction Useful in the treatment of fast atrial dysrhythmias 21

22 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. ECG Changes Seen with Digoxin At therapeutic levels: – Produces a characteristic gradual downward curve of the ST segment – R wave slurs into the ST segment 22

23 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Digoxin Very narrow therapeutic margin Excreted from the body slowly Excessive levels can cause slower heart rates, faster heart rates and PVCs 23

24 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Practice Makes Perfect Identify if pulmonary embolism, low- amplitude waveforms, electrical alternans, electrolyte imbalance or digitalis use are present I I 24

25 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Practice Makes Perfect Identify if pulmonary embolism, low- amplitude waveforms, electrical alternans, electrolyte imbalance or digitalis use are present I I 25

26 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Practice Makes Perfect Identify if pulmonary embolism, low- amplitude waveforms, electrical alternans, electrolyte imbalance or digitalis use are present I I 26

27 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Summary Pericarditis is an inflammation of the pericardium In pericarditis the T wave is initially upright and elevated but then during the recovery phase it inverts. The ST segment is elevated and usually flat or concave Substantial pericardial effusion can occur with pericarditis and produce ECG changes which include low voltage QRS complexes in all leads and electrical alternans 27

28 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Summary A pulmonary embolism is an acute blockage of one of the pulmonary arteries Characteristic ECG changes seen with massive pulmonary embolus include a large S wave in lead I, a deep Q wave in lead III and an inverted T wave in lead III 28

29 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Summary Increases or decreases in the potassium and calcium serum levels can have a profound effect on the ECG Key characteristics of hyperkalemia include T wave peaking, flattened P waves, 1st-degree AV heart block, widened QRS complexes, deepened S waves and merging of S and T waves 29

30 Fast & Easy ECGs, 2E © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Summary Key ECG characteristics of hypokalemia include ST segment depression, flattening of the T wave and appearance of U waves In hypercalcemia the QT interval is shortened while in hypocalcemia the QT interval is prolonged Digoxin slows the influx of sodium while allowing a greater influx of calcium A characteristic gradual downward curve of the ST segment is seen with digoxin 30


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