Clinical Anesthesia > ECGs > Flashcards

ECGs Flashcards

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1
Q

A wider P wave indicates what?

A

LA enlargement

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2
Q

A higher P wave amplitude indicates what?

A

RA enlargement

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3
Q

Increased amplitude of the R wave indicates what?

A

LV enlargement

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4
Q

A deep and wide S wave indicates what?

A

RV enlargement

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5
Q

What electrolyte abnormality would you suspect with increased amplitude of T waves?

A

Hyperkalemia

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6
Q

What electrolyte abnormality would you suspect with decreased T wave amplitudes that were biphasic?

A

Hypokalemia

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7
Q

What are some reasons you might see a depressed ST segment?

A
  • Ischemia
  • Electrolye abnormalities
  • Digitalis toxicity
  • Myocardial trauma
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8
Q

What might you suspect if you saw elevated ST segments?

A

ischemia

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9
Q

You should anticipate an increased risk of arrythmias in which patients?

A
  • GDVs
  • Pheos
  • Hypovolemic
  • GI FB
  • DCM
  • ARVC (Boxers)
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10
Q

What does this ECG indicate?

A

Sinus bradycardia (HR <60 in dogs or <100 in cats)

  • note the consistent P and QRS complexes that are always related
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11
Q

What are some causes of sinus bradycardia?

A
  • Opioids/alpha 2s
  • Vagal reflex
  • Hypertension (+++ sudden onset, due to baroreceptor reflex)
  • Hypothermia
  • Cushing’s response
  • Hypoglycemia
  • Hypoxia
  • Hypothyroidism
  • Hyperkalemia
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12
Q

What does this ECG indicate?

A

Sinus tachycardia

  • HR >160 bpm in dogs, >240 bpm in cats
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13
Q

What are some causes of sinus tachycardia?

A
  • Increased adrenergic tone (exercise, fear, anxiety, insufficient analgesia, “light” anesthetic plane)
  • Hypovolemia
  • Accidental bolus of beta agonist
  • Anticholinergic
  • Hyperthyroidism
  • Pheo
  • Hyperthermia
  • Anemia
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14
Q

What are the hemodynamics consequences of sinus tachycardia?

A
  • Hypertension
  • Hypotension (decreased diastole—> reduced end-diastolic volume)
  • Increased myocardial oxygen consumption = myocardial ischemia = arrhythmias
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15
Q

How do you treat sinus tachycardia?

A

Depends on the cause!

  • analgesics, sedatives
  • hypnotics
  • discontinue beta agonist administration
  • beta blocker (esmolol)
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16
Q

What does this ECG indicate?

A

Respiratory sinus arrhythmia

  • patterned irregularity to QRS complexes
    • Regularly irregular
    • Shortening of the RR interval during inspiration and lengthening during expiration
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17
Q

What are some causes for respiratory sinus arrhythmias?

A
  • May be associated with high vagal tone or opioid administration
  • Normal at low HR in dogs
  • Uncommon in cats - often associated with upper resp tract obstruction
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18
Q

What does this ECG indicate?

A

Wandering pacemaker

  • variable P wave morphology
  • Often seen alongside respiratory sinus arrhythmia
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19
Q

When should you treat wandering pacemakers or respiratory sinus arrhythmias?

A

If hypotension is present, then anitcholinergics should be used

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20
Q

What does this ECG indicate?

A

Atrial premature complexes

  • P wave can be biphasic
  • Common with LA enlargement
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21
Q

What is a hemodynamic consequence of APCs?

A

Smaller pulse wave due to insufficient fill time

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22
Q

What drug might you consider avoiding if your patient’s ECG is demonstrating APCs?

A

Opioids, since high doses of them may increase the frequency of APCs

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23
Q

What does this ECG indicate?

A

1st degree AV block

  • prolonged PQ interval
  • normal QRS
  • caused by high vagal tone
  • Treatment = none vs. anticholinergics
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24
Q

What does this ECG indicate?

A

2nd degree AV block Mobitz type I (Wenkenbach)

  • progressively prolonged PQ followed by a non conducted P wave
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25
What are the causes of a 2nd degree AV block Mobitz type I?
* High vagal tone * opioids * alpha 2s * Cushing’s response
26
How do you treat a Mobitz I 2nd degree AV block?
* None if occasional and in absence of hemodynamic consequences * anticholinergics can be administered if BP is low * mannitol or HSS to decrease ICP if Cushing’s response suspected
27
What does this ECG indicate?
**2nd degree AV block Mobitz type II** * _PQ_ _is_ *constant* before P is not conducted
28
What are the causes of Mobitz type II 2nd degree AV blocks?
* Fibrosis * Cardiomyopathy * Trauma * Infections (ie. Lyme) * Alpha 2’s _Less likely to be vagally mediated_ **May progress into 3rd degree AV block!!**
29
What does this ECG indicate?
**2nd degree AV block Mobitz type II - High grade** * 2 consecutive P waves *are never conducted one after the other* (always one blocked P wave in between them) * NOT drug induced —\> typically unresponsive to anticholinergics and require pacemaker implantation!
30
What does this ECG indicate?
**Junctional escape rhythm - 3rd degree AV block** * ​complete dissociation b/t atria and ventricles (two independent rates) * Narrow QRS complex, higher rate (40-60 bpm) than ventricular escape rhythm * *severe hemodynamic consequences*
31
What does this ECG indicate?
**Ventricular escape rhythm - 3rd degree AV block** * wide QRS complex, lower rate than junctional escape rhythm (20-40 bpm) * *severe hemodynamic consequences*
32
What are the causes of 3rd degree AV blocks?
* Usually due to a damaged AV node * **Idiopathic** (most frequent) * Neoplastic * Infiltrative * Inflammatory * Drug toxicity (Digitalis) * Hyperkalemia Very rarely vagally mediated
33
How do you treat a 3rd degree AV block?
* **Pacemaker** * May or may not respond to anticholinergics * Isoproterenol (beta agonist)
34
What does this ECG indicate?
**Sick sinus syndrome** * idiopathic disease of the sinus node, most commonly seen in older female WHWT, Schnauzers, Cockers, Dachshunds * Periods of **extreme tachycardia and bradycardia, long pauses in sinus rhythm (sinus arrest) often followed by escape rhythm**
35
What drugs should be used with care when anesthetizing a risk breed for SSS?
High doses of opioids and alpha 2’s
36
How do you treat sick sinus syndrome?
* Pacemaker implantation * May or may not respond to anticholinergics * **When anesthetized, pauses may become severely prolonged!** * **​**When undergoing pacemaker implantation, a temporary pacemaker or external patches should be placed while animal is awake or under light sedation
37
Describe the 2 types of temporary pacemakers you can place
* **External (trans-thoracic) patches:** positioned in awake animals, pain is elicited during stimulation * **Trans-venous temporary pacemaker:** * **​**inserted in lateral saphenous or femoral vein and advanced into RV * fluoroscopic guidance * usually done under sedation or local anesthesia * risk of vascular or cardiac perforation * _No pain during stimulation_
38
Describe permanent pacemaker implantation
* Usually done under GA * Protocols aimed at maintaining the intrinsic HR until pacemaker can be activated * Inserted thru jugular and advanced in the RV * Pulse generator fits in a pocket in the neck * Minimally painful
39
Describe pericardial pacemaker implantation
* **Cats, very small dogs** * In case of pacemaker revision * Transdiaphragmatic approach * Added difficulty: laparotomy! * Analgesia must be provided
40
What does this ECG indicate?
These are the characteristic pacemaker spikes
41
Why do bundle branch blocks occur?
occur when electrical activity within the myocardium is re-routed from the rapid-conducting fibers of the bundle branches and travels more slowly thru the myocardial cells * may be intermittent or persistent * wide QRS complexes * P wave is present and associated with the wide QRS complex
42
What does this ECG indicate?
**Left BBB** * Positive QRS in lead II * **Associated** **with** **severe** **myocardial** **disease** (left BB is thicker than R, so damage to this branch reflects more severe dz) * Dogs = DCM; Cats = HCM * May be associated with impaired systolic and diastolic function
43
What does this ECG indicate?
**Right BBB** * Deep S wave in lead I, II (negative QRS) * May be incidental * **R sided heart disease** * **​**Fibrosis * Heartworm infection * After balloon valvuloplasty for pulmonic stenosis (usually transient) * Often no hemodynamic consequences
44
What does this ECG indicate?
**Atrial fibrillation** * discernible P waves are absent * +/- **F waves** = oscillation of the isoelectric line of varying amplitude (low HR) * ventricular rate is **usually rapid** and **irregularly irregular** commonly seen in giant dogs, horses seen in small dogs and cats ONLY with atrial enlargement
45
What is the hemodynamic consequence of atrial fibrillation?
The atrial kick is lost, therefore stroke volume is reduced by 20-30%
46
What does this ECG indicate?
**Atrial flutter** ‘saw tooth pattern’ * similar hemodynamic consequences as Afib * commonly seen in giant dogs, horses * seen in small dogs and cats ONLY with atrial enlargement
47
What does the term supra-ventricular tachycardia mean?
Tachycardia that originates above the ventricle (atria or AV node), characterized by elevated heart rate and _narrow_ QRS complex
48
Describe ventricular arrhythmias
* QRS is wide and bizare * No P wave * T is opposite polarity to the QRS complex f * can occur before the next sinus complex - **VPC** or after a pause **ventricular escape**
49
What does this ECG indicate?
**Ventricular premature complexes** * may be isolated or couplets, triplets * 4 or more = run of Vtach * may be associated with cardiac or non-cardiac dz (cats = almost always cardiomyopathy) * treatment is rarely necessary, unless they become frequent —\> **Lidocaine**
50
What does this ECG indicate?
**Bigeminy =** one VPC every other sinus beat
51
What does this ECG indicate?
**Trigeminy** = one VPC every third sinus beat
52
What are some causes of VPCs?
* Primary cardiac dz * Trauma * Shock * Hypoxemia/ischemia * Electrolyte/acid-base imbalance * GDV * HSA * Major abdominal surgery
53
When should you consider treating VPCs?
* Frequent * Multifocal (they are present in different shapes) * Impact on cardiac output * Frequent runs * R on T phenomenon - R wave is very close to previous beat T wave
54
What is a ventricular escape rhythm?
* The ventricle compensates for a pause = **this is a compensatory rhythm** * **​**the pause in anesthetized animals may be induced by anesthetic drugs that incr PS tone * *Lidocaine administration could suppress this compensatory rhythm!!!* * May be treated with **atropine**
55
What does this ECG indicate?
**Ventricular escape rhythm**
56
What does this ECG indicate?
**Idioventricular rhythm** * looks the same as accelerated idioventricular rhythm and Vtach, only difference is **rate!** * HR \< 100 bpm * Acclerated: HR \> 100 bpm * Vtac: HR \>180 bpm
57
What are the causes of idioventricular rhythms?
* GI FB, sepsis, GDV, hemoabdomen * Hypovolemia * Hypoxia * Alterations of ANS during anesthesia
58
When should you consider treating idioventricular rhythms?
* Idioventricular (accelerated) rhythms **should not** be treated with lidocaine —\> both are compensatory rhythms, lidocaine may cause asystole! * may consider using atropine if there’s a low HR * Vtach may be treated with lidocaine if it is sustained or polymorphine or if causes hemodynamic stability
59
What does this ECG indicate?
**Monomorphic ventricular tachycardia** * All complexes look the same * Often minimal hemodynamic impact
60
What does this ECG indicate?
**Polymorphism ventricular tachycardia** * complexes look different from one another * may become torsade de pointes or Vfib * call for help! * get a defibrillator
61
What electrolyte abnormalities may cause Vtach?
hypokalemia or hypomagnesemia
62
What does this ECG indicate?
**Ventricular fibrillation** * **Shockable rhythm**
63
What two rhythms are considered a defibrillation success?
sinus rhythm or asystole
64
What does this ECG indicate?
**Asystole** * **Non-shockable rhythm**
65
What does this ECG indicate?
**Pulseless electrical activity** * **non-shockable rhythm** * may look very similar to a normal sinus complex or be associated to a wide and bizarre complex
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