ECG anomalies. Dr David Gray Consultant Physician and Cardiologist (recently retired) Cardiovascular Medicine University Hospital Nottingham
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1 ECG anomalies Dr David Gray Consultant Physician and Cardiologist (recently retired) Cardiovascular Medicine University Hospital Nottingham
2 What is the ECG? Just a delicate voltmeter Measures millivolts Clever bit filters out a lot of skeletal muscle interference
3 Normal ECG Bigger wave = more muscle Longer wave = longer duration
4 Cardiac conduction system
5 Normal ECG 1
6 Normal ECG
7 Normal ECG
8 Normal ECG
9 Normal ECG
10 Slow rhythms ECG anomalies in cardiology practice Fast rhythms Anxiety due to automatic interpretation package
11 Fast heart rates: a general rule narrow QRS complexes usually benign easily treated broad QRS complexes usually malignant complex to treat
12 ECG anomalies in cardiology practice Resting heart rate ~ 60-70bpm Heart block- Bradycardia- vascular disease atropine beta blockers calcium channel blockers digoxin cholinesterase inhibitors
13 ECG anomalies in cardiology practice: slow heart rates Resting heart rate below 60 bpm Heart block Drugs vascular disease beta blockers calcium channel blockers digoxin anti-arrhythmics cholinesterase inhibitors
14 Sinus bradycardia
15 Sinus bradycardia
16 Sinus bradycardia Tiredness Dizziness Collapse Breathlessness and consequences
17 Sick sinus syndrome
18 If it goes on for long enough, it can cause symptoms
19 If it goes on for long enough, it can cause symptoms Dizziness Collapse Breathlessness and consequences
20 Complete heart block
21 Complete heart block Dizziness Collapse Breathlessness and consequences
22 Left bundle branch block
23 Left bundle branch block Often asymptomatic Several causes But best to assume ischaemic heart disease
24 Sinus tachycardia
25 Sinus tachycardia
26 Sinus tachycardia Often asymptomatic Several causes Including anxiety
27 Bypass tract= extra wire
28 Bypass tract= extra wire
29 Bypass tract= extra wire Tendency to go very fast Dizziness Collapse Breathlessness and consequences
30 Narrow complex tachycardia
31 Narrow complex tachycardia
32 Narrow complex tachycardia Dizziness Collapse Breathlessness and consequences
33 Narrow complex tachycardia self-terminating
34 Atrial fibrillation
35 Atrial fibrillation
36 Atrial fibrillation Dizziness Collapse Breathlessness and consequences
37 Long QT syndrome
38 Long QT syndrome
39 Long QT syndrome Normal male = <430 msec Normal female = <460 msec >500 msec Risk of very fast heart rate Risk of sudden death
40 Brugada syndrome
41 Brugada syndrome
42 Brugada syndrome Risk of sudden death
43 Ventricular tachycardia Broad complex tachycardia
44 Ventricular tachycardia Broad complex tachycardia
45 Ventricular tachycardia Broad complex tachycardia Dizziness Collapse Breathlessness and consequences
46 Ventricular tachycardia Can be intermittent
47 Ventricular fibrillation
48 Ventricular fibrillation
49 Ventricular fibrillation Death unless rapid defibrillation
50 ST elevation
51 ST depression
52 ECG abnormalities in psychiatric practice
53 Psychiatric illness Does not protect from common health problems Cardiovascular disease Cerebrovascular disease Exposes individuals to increased risk of sudden death esp schizophrenia psychiatric medication
54 Risk factors at Rampton Hospital Blood pressure Cholesterol Diabetes mellitus Cigarette smoking Advancing age Obesity Lack of exercise Family history of premature heart disease Risk factors for vascular disease Blood pressure Cholesterol Diabetes mellitus Cigarette smoking Advancing age Obesity Lack of exercise Family history of premature heart disease
55 Psychiatric illness Does not protect from common problems Cardiovascular disease Cerebrovascular disease Exposes individuals to increased risk of sudden death esp schizophrenia psychiatric medication
56 Slow rhythms ECG anomalies in psychiatric practice Fast rhythms Anxiety due to automatic interpretation package
57 ECG anomalies and psychiatric practice: slow heart rates Resting heart rate below 60 bpm vascular disease beta blockers calcium channel blockers digoxin anti-arrhythmics cholinesterase inhibitors
58 ECG anomalies and psychiatric practice: fast heart rates Heart rate above 100 bpm anti-psychotic drugs Usually through QT prolongation
59 A few oddities
60 Reminder - Normal ECG
61 Sometimes drugs cause harm Reverse tick from digoxin toxicity
62 And some are downright dangerous Torsade de pointes: drug-induced RISK OF DEATH
63 AV pacing
64 Severe left ventricular hypertrophy
65 Hyperkalaemia Loss of P wave, wide QRS complex RISK OF DEATH
66 Hypokalaemia First degree heart block, ST depression, prominent U waves
67 Questions?
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