Download Definition:

PRESENTED BY:
Dr. Areej Al-jabaly
A: Drugs Effects
B: ELECTROLYTE
C : DISEASES
D: NORMAL VARIANTS
Digoxin :
Therapeutic Effect
* ST segment depression
( reversed tick )
* Shortening of the QT interval T
wave inversion
Toxic Effect :
Any type of arrhythmia especiall
ventricular octopi
Quinidine:
and related drugs like ( procinamide ,
Disopyramide , phenothiazine, Tricyclic,
Antidepressant, Amiodarone
)
* P wave widening
* QRS widening
* Prolonged QT interval ( longer
than half of the RR interval)
•
* Increase U wav amplitude
* ST segment depression
* Increase U wav amplitude
Hyperkalemia :
1- Mild to moderate hyperkalemia
(5 -7 mEq/L )
* Tall symmetrical peaked ( (
tents T waves with narrow bas
.
2- More severe hyperkalemia
(8 - 11 mEq/L )
* widening of QRS
* PR interval prolonged
3- Severe case > 11
* ECG resemble a sine
wave
* P wave disappearance
(atrial arrest)
Hypokalemia :
Mild( 3-3.5) to moderate ( 2.5 –
3) mEq /L
* Progressive ST segment
depression
* Progressive decrease in T
wave amplitude
* increase U wave amplitude
Severe (< 2.5 mEq /L(
* Fusion of T and U wave
* Increase QRS duration and
amplitude
* Increase P wave duration
and amplitude
* QT interval usually slightly
prolonged
Hypercalcaemia:
Marked shortening of the QT
interval due to shortening of
the ST segment
Hypocalcaemia:
Prolong the ST segment without
affecting the T wave
Renal failure :
Triad of
* LVH (HTN)
* Peaked T wave
(Hyperkalemia)
* Prolong of the QT interval
(Hypocalcemia)
Pericardial Effusion:
Triad of
* Low voltage QRS complexes
(0.5mv or less)
* low to inverted T waves in
most leads
* Total electrical alternans
Thyroid disease :
A: Hypothyroidism:
* Low voltage ECG
* Sinus bradycardia
* Inverted T waves without ST
segment deviation in many or all
leads ( slow and low ECG )
B:Thyrotoxicosis:
* Unexplained AF ( sinus
tachycardia at rest)
* High voltage ECG
* Decrease of QT interval
* Prominent U wave in
association with tachycardia
Acute Pericarditis :
* Diffuse ,Upward concave ST
elevation
* PR depression (specific but
less sensitive )
* Almost associated with sinus
tachycardia
Acute Myocarditis :
* Non specific T wave change.
* Depression or elevation of
ST segments .
* Prolonged QT interval .
CVA:
* Abnormal & widened T waves
that may be deeply inverted or
tall & peaked .
* Prominent U waves.
* Prolonged QT interval .
These changes are termed CVA
pattern & usually resolved with
time .
COPD :
* RAD
* Absent R wave in
precordial leads.
* Prominent R wave in Rt
precordial leads & ST
segment depression when
there is RVH
* Prominent P wave in
leads (P inferior
pulmonale ) resulting from Rt
atrial abnormality .
* Occasionally SI , SII , SIII
syndrome .
* Rarely in 10 % of patients LAD
Pulmonary embolism :
* Sinus tachycardia.
* Rt ventricular strain
, appearance of ST-T changes
in VI ,VII.
* SI QIII TIII more specific but
less sensitive ( due to acute Rt
ventricular dilatation )
* ST depression .
* Acute RBBB ( rSR' in
result from Rt
VI)
ventricular dilatation
Amyloidosis :
* Low voltage of all wave in limb
leads
* Marked LAD
* QS or minimal R wave in V1V3 or V4
Early repolarization syndrom:
* ST elevation :
1- may raised to 2 mm above
the baseline .
2- It always follow the S wave
.
* Tall R & ST-T change in the Lt
precordial leads .
* Relatively tall &
frequently
symmetrical T wave , rarely
T wave inversion.
* No reciprocal changes except
ST segment depression in
aVR .
Hypothermia :
* J wave or ( Osborn wave ) it is
localized to the junction of the
end of QRS complex and
beginning of the end of ST
segment
* Prolongation of QRS
complexes
* Depression of ST segment
* T wave depression
* Prolongation of QT interval
* Sinus bradycardia
* First and second - degree heart
block
* Ectopic rhythm
Obesity :
* Displacement of heart by
elevated diaphragm to the left
but within normal range QRS
axis
* Increasing the distance
between the heart and the
recording electrodes although
the true low voltage QRS
amplitude is rarely appears
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