EKG CHANGES IN PULMONARY DISEASE
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- Andrew Goodman
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1 EKG CHANGES IN PULMONARY DISEASE Derrick Sorweide, DO FACOFP Assistant Professor- COMP-NW Director- Cardiovascular Course Major- United States Army Reserve
2 What: 1. Review and reinforce what you already know. 2. Build a strategy and confidence in how to approach an abnormal EKG 3. Review some aspects of EKG that are troubling to some in the field. 5. Learn from a couple of unique situations. What NOT: 1. A comprehensive review of all aspects of EKG. This would take more than our allotted time. Legal/ Financial: I am here for the satisfaction of knowing I made you better doctors, and the pure joy of being here today. I have nothing to sell you.
3 The air goes in, The air comes out, The blood goes round and round
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7 1. Rate 2. Rhythm (diagnostic) 3. Axis 4. Pathology 1.Rate 2.Rhythm (Regular/ Irregular ) 3.Origin of the Beat 4.Location of Pathology (P, PR, QRS, ST, ) 5.Axis
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9 Garage (SA Node) Yield Sign at on-ramp (AV Node) Beach Work
10 P= Atria PR= AV Junction Q= Septum QRS= Ventricles (depolarization/down) ST= Ventricular Latency (mm contraction) T= Ventricles (repolarization/up)
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12 1. Look at the computer read! 2. avf/avl Thumbs Up! 3. Isoelectric- Perpendicular 4. Most + Lead
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14 What is the most common diagnostic rhythm seen on EKG in a patient with pulmonary disease? What is the most common diagnostic rhythm seen in ANY patient? Normal Sinus Rhythm!
15 NORMAL SINUS RHYTHM (SA NODE) Normal Rate! P for every QRS, QRS for every P Proves Atrial Identical P waves Normal and consistent PR intervals Proves same spot on Atria P waves upright in leads II, III, and avf
16 P P P P Box count method- large boxes 300, 150, 100, 75, 60, 50 Rate= Normal, 64 P for every QRS, QRS for every P Normal and consistent P s and PR s Normal Sinus Rhythm
17 Rate: Rhythm: Origin of the beat: So, What is this? Fast- Just under 150 Regular Sinus (atrial) Sinus Tachycardia
18 HR= 120 O2 CO2
19 When you see sinus tachycardia, Do not think of a sick heart, think of a healthy heart working in a sick body. Fear Pain Volume depletion Stimulants Sepsis Hypoxemia/ Hypercapnia Acidosis
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21 Low Voltage: COPD/Emphysema Morbid Obesity Myocardial Injury Hypothyroid Pericardial/ Pleural Effusion Hypothyroid The Rules: QRS complexes (top of R to bottom of S) Less than 5 mm (1 lg box) in all the limb leads And/ or less than 10 mm (2 lg boxes)in all the precordial leads.
22 Hypoxia, Hypercapnia, Pulm. HTN, Vent overload, Atrial stretch, Inflammation, Pulmonary Rx
23 Hyper expansion of the lungs: Diastolic dysfunction Hypoxic pulmonary vasoconstriction: Vessels near hypoventilated alveoli constrict Scarring and arteriosclerosis of the lungs: Increased work of breathing Pulmonary hypertension: Increased pressure in R atria and ventricle Changes in R heart lead to arrhythmia
24 Lungs-> R Atria Atrial changes- Think P waves!
25 Rate: Rhythm: Origin: So, what is this? 9 beats in 6 seconds= 90 Irregularly Irregular! What is that P ish stuff? A-fib!
26 >90% Irreg/ Irreg= A-Fib Other 2 Multi Focal Atrial Tachycardia (MAT) Wandering Atrial Pacemaker (WAP)
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33 Causes: RVH/Cor pulmonale Pulmonary embolus R ischemic changes Myocarditis Rheumatoid heart Congenital Can be a normal variant
34 Normal EKG- Should NOT see prominent S waves in I, II, AND III S1S2S3 Pattern= RVH
35 RVH: R axis: Prominent S waves in leads I,II,III (S1S2S3) Can also see prominent S waves in V1V2V3: (SV1SV2SV3)
36 RBBB S1S2S3 1 st Deg AVB
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38 EMS/ED- Mistaken as SVT (Rapid/Narrow QRS)
39 Irregularly Irregular! A-fib! MAT WAP
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41 PE! Sudden increase in pulmonary vascular resistance. Acute R Heart Strain- R heart/ inf. heart ST/T changes S1Q3T3 Hypoxemia Endorphins
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43 Most common EKG change with PE= Sinus Tachycardia. RBBB (complete or incomplete) common R ventricular strain= T wave inversions R chest (V1-4) and inferior leads (II,III, avf) Most sensitive= up to 99% Classic Change= McGinn-White Change (S1Q3T3) (only 10-20% of PE s)
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45 Low Voltage P pulmonale SV1-SV2-SV3
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47 Normal Heart/ Sick Body Normal Sinus Rythym Sinus Tachycardia Sick Chest Low Voltage Sick Heart/ COPD A-fib P-pulmonale R axis deviation/ R Vent Hypertrophy AV block/ RBBB S1S2S3/ SV1-SV2-SV3 Multifocal Atrial Tachycardia PE Sinus Tach/R strain/ S1Q3T3
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