# ECG Analysis and Patient Management



## nakor (Oct 7, 2017)

Call to: 76 yr old male lying in bed. Pt feeling heart is jumping out of his chest and describes his heart feels like it is all over the place. No current chest pain but states something isnt right and every now and then he cant catch his breath. Denies nausea and has no other pain.
PMHx: unknown but regular blood tests
Current meds: Aspirin, Warfarin, Digoxin






https://imgur.com/a/n6ELC

Im learning my ECG rhythms and was hoping to get some help with this example, im thinking SVT or Sinus arrhythmia but have no idea what my treatment would be? Done a bit of research am i looking at amiodarone and magnesium sulphate?


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## StCEMT (Oct 7, 2017)

Your picture isn't showing up for me.


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## nakor (Oct 7, 2017)

StCEMT said:


> Your picture isn't showing up for me.


Sorry just provided the link is that working?


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## StCEMT (Oct 7, 2017)

It's neither of those rhythms. Break down the basic rules of determining a rhythm and lay them out for us.


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## VentMonkey (Oct 7, 2017)

StCEMT said:


> It's neither of those rhythms. Break down the basic rules of determining a rhythm and lay them out for us.


This^^^. Another hint would be it's the single most common arrhythmia we see. Not to mention your first paragraph gave it away even before your rhythm strip was available.


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## nakor (Oct 7, 2017)

Ok so P wave is the first short upward movement of the ECG and it indicates that the atria are contracting

The QRS complex is next normally beginning with a downward bit with the first Q is going upwards and a peak which is the R then a downwards S wave. The QRS complex is the ventricles depolarization and contraction.

The PR interval is the transit time for the electrical signal  from the sinus node to the ventricles

T wave is normally upwards wave representing ventricular repolarization

In this example we have no P wave before the QRS and theres a T wave after it


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## nakor (Oct 7, 2017)

Im looking for a good online source to learn from the book we have been given is really limited.


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## VentMonkey (Oct 7, 2017)

nakor said:


> In this example *we have no P wave before the QRS* and theres a T wave after it


Right, so you're way overthinking this one. Treat the patient from the monitor, i.e., rhythm strip presented + scenario and complaint(s).

What does the PMH tell you about the patients complaint and current ECG tracing?


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## nakor (Oct 7, 2017)

VentMonkey said:


> Right, so you're way overthinking this one. Treat the patient from the monitor, i.e., rhythm strip presented + scenario and complaint(s).
> 
> What does the PMH tell you about the patients complaint and current ECG tracing?



From his meds i know he has heart issues and Digoxin is used to control atrial fibrillation and atrial flutter. And from lookin at arial fibrillation examples of ECG tracings they look similar to this one.


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## StCEMT (Oct 7, 2017)

nakor said:


> In this example we have no P wave before the QRS and theres a T wave after it


Edit because you answered correctly as I posted


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## VentMonkey (Oct 7, 2017)

https://lifeinthefastlane.com/ecg-library/atrial-fibrillation/


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## nakor (Oct 7, 2017)

VentMonkey said:


> https://lifeinthefastlane.com/ecg-library/atrial-fibrillation/


Thank you for the link!!


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## nakor (Oct 7, 2017)

Trying to find management guidelines the links for management in https://lifeinthefastlane.com/ecg-library/atrial-fibrillation/ touch on self management and mangement of risk factors. Im only a first year student so im trying to get a basic view, like give this to manage this and this to manage that if you know what i mean.


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## nakor (Oct 7, 2017)

Theres lots of information on long term management... Found some info saying IV heparin and Warfarin to prevent thromboembolism and then transport


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## StCEMT (Oct 8, 2017)

I would suggest focusing on learning to identify the rhythms before you learn managment. You have to know what you're treating to treat it.


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## nakor (Oct 8, 2017)

StCEMT said:


> I would suggest focusing on learning to identify the rhythms before you learn managment. You have to know what you're treating to treat it.



I have this OCD systematic approach to everything I normally write up a few pages of epidemiology/ aetiology/ pathophysiology then management of condition and move onto the next haha


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## Gurby (Oct 9, 2017)

nakor said:


> im thinking SVT or Sinus arrhythmia but have no idea what my treatment would be? Done a bit of research am i looking at amiodarone and magnesium sulphate?


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## Chris07 (Oct 10, 2017)

nakor said:


> I have this OCD systematic approach to everything I normally write up a few pages of epidemiology/ aetiology/ pathophysiology then management of condition and move onto the next haha



Okay I'll bite. Why would you put someone with A.Fib on an anticoagulant? For bonus points....why are they on Digoxin to manage their (presumably) atrial fibrillation and/or heart failure?


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## phideux (Oct 11, 2017)

Get Dubins "Rapid interpretation" of EKGs, it's like EKGs for dummies. Great book.


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## HH1251 (Jan 26, 2018)

Chris07 said:


> Okay I'll bite. Why would you put someone with A.Fib on an anticoagulant? For bonus points....why are they on Digoxin to manage their (presumably) atrial fibrillation and/or heart failure?



They are on an anticoagulant because people with history of AFib are at an increased risk of developing/throwing clots. They are on dig because it's a positive inotropic drug.  Therefore is increases the strength of myocardial contractions.


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