An elderly lady is brought in by EMS minimally responsive. The only VS that you have are a blood pressure of 80/60, HR of 36, and a oxygen saturation of 100% on NRB. She received atropine 0.5 mg x 3 in the field with no effect. You obtain the EKG above. Interpret the EKG. What are your diagnostic considerations? What other information do you want? What are you doing to stabilize the patient?
EKG shows bradycardia and J waves in most leads, most prominent in anterior leads. Concerned about hypothermia, brugada syndrome, hypercalcemia, ACS, head bleed. Other info: past medical history, recent HPI, medications. Plan: IV, O2, monitor, temp, head CT, labs, place pacer pads +/- dopamine infusion for bradycardia, review with cardiology
Can anyone help me spot the difference between the scoop seen in this ECG and the scoop seen in digitalis toxicity? They can get bradycardic and hypotensive too figured a temp would be helpful to distinguish them in real life, but without that...
Yes, I looked into this the other day, and uptodate has a good example of the digitalis effect. The dig effect causes the st segment to be depressed, so the "dip" goes below the baseline. J waves like we see here are either at baseline or are associated with some st elevation. --Phil C
It is indeed classically a dip below baseline. To speak for the old guard - and I hope this is not proprietary in any way - the comparison has been made to Salvador Dali's moustache. Look it up, unlikely you'll forget.
EKG shows bradycardia and J waves in most leads, most prominent in anterior leads. Concerned about hypothermia, brugada syndrome, hypercalcemia, ACS, head bleed. Other info: past medical history, recent HPI, medications. Plan: IV, O2, monitor, temp, head CT, labs, place pacer pads +/- dopamine infusion for bradycardia, review with cardiology
ReplyDeleteCan anyone help me spot the difference between the scoop seen in this ECG and the scoop seen in digitalis toxicity? They can get bradycardic and hypotensive too figured a temp would be helpful to distinguish them in real life, but without that...
ReplyDeletehttp://en.ecgpedia.org/wiki/File:Med_digitalis.png
It has always looked pretty similar to me.
My understanding is that J waves are usually associated with ST elevation where as the digoxin dip is associated with ST depression?
ReplyDeleteYes, I looked into this the other day, and uptodate has a good example of the digitalis effect. The dig effect causes the st segment to be depressed, so the "dip" goes below the baseline. J waves like we see here are either at baseline or are associated with some st elevation. --Phil C
DeleteIt is indeed classically a dip below baseline. To speak for the old guard - and I hope this is not proprietary in any way - the comparison has been made to Salvador Dali's moustache. Look it up, unlikely you'll forget.
Delete