ECG2 in afya

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Acute MI - ST elevation (may occur with complete block)
Hyperkalaemia - T waves abN (tall tented) then BBB, wide QRS and loss of p
Myocarditis - sinus tachy, prolonged QT, ST up or down, T inversion
Non ST elevation acute coronary syndrome - deep arrow T inversion (left ant descending artery), ST depression, vent arrhythmias,
Pericarditis - ST elevation (saddle shape), PR depression (pathognomic) - often lots of ECG changes
 
Acute coronary syndrome - 2-3hrs chest pain - self limiting, smoking, HT, exam normal
antiplatelet (aspirin and ticagrelor), anticoag (unfractionated heparin) angiography to PCI
Mx aggressively if marked Twave change / ST depression
 
Thrombolysis - BBB, ST elevation, or MI
 
Acute MI (may occur with AF / shock)
Mx aspirin, urgent angioplasty (or thrombolysis)
 
SVT - looks like BBB - will get broad complex if aberrant conduction - treat as ventricular if in doubt, If SVT can give Adenosine
Torsades de pointes - rare VT, secondary to prolonged QT (amiodarone or electrolyte imbalance)
VT (Hx severe coronary disease with chest pain) - regular broad complex tachy ?with capture / fusion beats
 
VT Mx - resolve arrythmia and hemodynamic compromise before tackling underlying cause (usually infarction or ischaemia, may be drugs or electrolytes)
sedate (midazolam) and synchronised shock
 
Remember gastro-oesophageal reflux - pain nausea vomiting
definitive test for ischaemia - exercise test, stress echo, myocardial perfusion scan
 
Pericarditis causes - MI, post infarct (Dressler), uraemia, autoimmune, bacterial infection
usually self limits - give Colchicine
look out for tamponade, T>38, immunosuppressed, trauma, myopericarditis
 
Heart block Mx - if <40 needs pacemaker
no p waves - broad complex escape rhythm
check electrolytes (esp hyperkalaemia)
 
MI without ongoing Sx - needs assessment - including troponin, angiography and echo, secondary prevention and cardiac rehab

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