Arjun Khadilkar, MD Profile picture
May 3 11 tweets 6 min read Twitter logo Read on Twitter
One of the most important diagnostic tests in Cardiology to interpret is the EKG. Here are my thoughts and notes.

Let me know what you think!

Thread #18: Electrolyte Abnormalities #arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG
Hyperkalemia:
- Distinctive sequence of ECG changes affecting both depolarization (QRS) and repolarization (ST-T)
- First change: Narrowing and peaking of T-waves ('tented' or 'pinched' shape) and can become tall Image
Hyperkalemia:
- Further elevation: PR intervals become prolonged, P-waves may disappear. Will have intra-ventricular conduction delay, with widening of QRS complexes.
- Can lead to large, undulating (sine wave) pattern with asystole and cardiac death Image
Hyperkalemia ECG:
- Nice example from Life in the Fast Lane (litfl.com/hyperkalaemia-…)
- Can see: prolonged PR interval, broad QRS, and peaked T-waves Image
Hypokalemia:
- Produces distinctive changes in the ST-T complex; most common with ST-depressions with prominent U-waves and prolong repolarization
- U-waves may even exceed the height of the T-waves
- Can be challenging to measure the QT intervals Image
Hypokalemia EKG:
- Nice EKG from Life in the Fast Lane (litfl.com/hypokalaemia-e…)
- Note: Widespread ST depression and T wave inversion, Prominent U waves, Long QU interval
- Reported K~1.7 Image
Hypercalcemia:
- Shortened QT interval is due to shortening of ST-segment.
- T-waves may appear to take off from the end of the QRS complex
- High Calcium can lead to coma/ death Image
Hypercalcemia EKG:
- Nice EKG from Life in the Fast Lane (litfl.com/hypercalcaemia…)
- Note hypercalcemia causing marked shortening of the QT interval (260ms) Image
Hypocalcemia:
- Lengthens or prolongs the QT intervals
- Example of a patient with prolonged QTc in the setting of hypoparathyoidism Image
Hypomagnesemia:
- Can be attributed to GI or renal losses (diuretic)
- Implicated in ventricular arrhythmias with acute MI and Torsade de Points
- Should have aggressive IV Magnesium replacement if needed
- EKG (litfl.com/hypomagnesaemi…) with an example of NSVT Image
***Not to use for clinical care, just educational material**

Thanks to these websites for the amazing graphics!

litfl.com/hyperkalaemia-…
litfl.com/hypokalaemia-e…
litfl.com/hypocalcaemia-…
litfl.com/hypercalcaemia…
litfl.com/hypomagnesaemi…

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More from @akhadilkarMD

Mar 21
One of the most important diagnostic tests in Cardiology to interpret is the EKG.

Here are my thoughts and notes. Will continue to this thread. Let me know what you think!

Thread #13: Inferior, Posterior, RV Infarction

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG
Inferior Wall Infarction:
- Diaphragmatic portion of the LV
- Will see changes in leads II, III, and aVF
- May produce abnormal Q-waves in these leads
- Generally caused by occlusion of the RCA; less commonly can occur with a left circumflex coronary obstruction
Posterior Infarction:
- Occurs on the posterior (back) surface of the LV
- May be difficult to diagnose because characteristic abnormal ST elevations may no appear in any of the 12 conventional leads
- Tall R-waves and ST depressions can occur in V1 and V2
Read 7 tweets
Mar 20
One of the most important diagnostic tests in Cardiology to interpret is the EKG.

Here are my thoughts and notes. Will continue to this thread. Let me know what you think!

Thread #12: Q-waves

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG
Q-wave:
- Can occur in any lead; indicates that the electrical voltages are directed away from that particular lead
- With a transmural infarction, necrosis of heart muscle occurs in a localized area of the ventricle
- New Q-waves usually appear within first day of MI
Anterior Wall MI:
- Can see loss of normal R-wave progression in the chest leads (normally should have a progression of height of R-waves from V1-V6)
- In antero-septal infarct, will lose small r waves in V1-V2 (septal depolarization from left to right) and have QS in V1-V2
Read 7 tweets
Mar 19
One of the most important diagnostic tests in Cardiology to interpret is the EKG.

Here are my thoughts and notes. Will continue to this thread. Let me know what you think!

Thread #11: Myocardial Ischemia

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG
Myocardial Ischemia:
- One of the most important things to evaluate on EKG
- If severe narrowing/complete blockage of a coronary artery causes blood flow to become adequate, ischemia of the heart muscle develops
- Can be transient (angina pectoris) or more severe (necrosis & MI)
Myocardial Ischemia
- LV consists of an outer layer (epicardium/sub-epicardium) and inner layer (sub-endocardium)
- Can have limit of ischemia to the inner layer or can affect the entire thickness of the ventricular wall (transmural ischemia)
Read 8 tweets
Mar 17
One of the most important diagnostic tests in Cardiology to interpret is the EKG.

Here are my thoughts and notes. Will continue to this thread. Let me know what you think!

Thread #10: Fascicular Blocks

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG
Fascicular Blocks:
- Left bundle branch system: sub-divided into an anterior & posterior fascicle.

- Hemi-block does not widen the QRS complex markedly (compared to a RBBB or LBBB)
Left Anterior Fascicular Block (LAFB):
- Diagnosed by finding of a left axis deviation (-45 degrees or more negative)
- Delayed activation of more superior & leftward position of the LV
- Isolated finding is non-specific; can be seen w/ HTN, AV disease, CAD, and aging
Read 9 tweets
Mar 16
One of the most important diagnostic tests in Cardiology to interpret is the EKG.

Here are my thoughts and notes. Will continue to this thread. Let me know what you think!

Thread #9: Left Bundle Branch Block (LBBB)

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG
LBBB:
- Similar to a RBBB, produces a wide QRS and affects the early phase of depolarization
- Septum will depolarize from (right to left; instead of normal left to right).
- Will see the loss of septal r-wave in V1 and septal q-wave in V6
LBBB:
- V1: Negative QRS complex b/c the LV is still electrically predominant (initial depolarization is negative and remains negative in the right-sided chest lead) (W-shape)
- V6: Entirely positive R-wave ('M'- Pattern)
Read 6 tweets
Mar 15
One of the most important diagnostic tests in Cardiology to interpret is the EKG.

Here are my thoughts and notes. Will continue to this thread. Let me know what you think!

Thread #8: Right Bundle Branch Block (RBBB)

#arjuncardiology #medtwitter #CardioTwitter #MedEd #IMG
Ventricular Conduction:
- Normal electrical stimulus reaches ventricles from the atria through the AV node & His-Purkinje systems
- First part of heart to be depolarized is the left-side of the septum; then spreads to RV and LV by right & left bundles
- Normal QRS < 0.10 sec
RBBB:
- 1st phase of depolarization: Left side of septum is stimulated first (branch of left bundle); on a normal ECG produces a septal r-wave in V1 and small septal q-wave in V6. No impact with RBBB.

- 2nd phase: Simultaneous depolarization of LV and RV. No impact with RBBB.
Read 7 tweets

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