Static Cardiology Lecture Notes

Introduction

• Focus: ECG rhythm and scenario analysis in the context of a National Registry exam.
• Timer set to 1 minute and 30 seconds to mimic exam conditions.

ECG Analysis

Steps to Analyze an ECG

1. Calculate Heart Rate:
   • Use a 6-second strip for accuracy.
   • Count R-waves, excluding PVCs (Premature Ventricular Contractions).
   • Example rate calculation: Approximately 60 BPM.
2. Identify Rhythm:
   • Presence of narrow QRS complex and consistent R-to-R intervals.
   • Example diagnosis: Normal sinus rhythm with unifocal PVCs.
3. Evaluate Each Lead Grouping:
   • Anterior Leads (V1-V4): Look for ST elevation/depression.
   • Criteria: ST elevation of at least 2mm.
   • ST Elevation: Detected in V1, V2, V3, V4 (5mm elevation observed).
   • Inferior Leads (II, III, AVF): Observation of segment depression and reciprocal change indicative of lateral MI.
   • Lateral Leads (I, AVL, V5, V6): ST elevation in leads I and AVL (potential anterolateral MI).

Scenario Analysis

• Patient Details: 44-year-old male with chest pain and dizziness.
• Vital Signs:
  • BP: 172/94
  • Pulse: 70
  • Respiratory Rate: 18
  • SpO2: 98%
  • Blood Sugar: 166
• Stability Assessment:
  • Use CHAD Criteria (Cardiac insufficiency, Hypotension, Altered mental status, Dyspnea).
  • Patient does not meet the instability criteria.

Diagnosis

• ECG Finding: Normal sinus rhythm with unifocal PVCs and an acute anterolateral MI.

Treatment Plan

• Initial Steps: Scene safety, BSI (Body Substance Isolation), IVO2 monitor.
• ACS Pathway:
  • Nitroglycerin: 0.4 mg sublingual every 5 minutes, up to 3 doses.
  • Aspirin: 324 mg orally.
  • Morphine/Fentanyl: Morphine 2-4mg or Fentanyl 50mcg IV push.
  • Fluids: Keep vein open (KVO) or to keep open (TKO).
  • Transport: Rapid transport to a PCI-capable facility.
• Additional Considerations:
  • Attaching pads for potential ventricular dysrhythmias (e.g., V-fib or pulseless VTAC).

Conclusion

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• End note: Encouragement to subscribe and utilize resources.