ECG in

Cardiovascular
Emergencies
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12 – Lead Strips
Remember: Every lead is like a “camera angle”
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ECG 1
Presentation
88 y.o. woman came to emergency
Not responsive, was said to be ill and weak since the last 4 days then
suddenly worsen
Was complaining breathless and chest pain
Not much known about previous history
In shock, cold extremities, BP 80/palpable, HR 100 bpm
The Classical Presentation
ECG 2
Presentation
54 y.o. male come to clinic
Shortness of breath worsen since 2 hours
Known uncontrolled HT
BP 186/102 mmHg; HR 120 bpm irregular; RR 28x;
Sat 89% on room air
Physical: diaphoretic, rales on both lung fields,
pedal edema
Principles of Management
Relieve oxygen deprivation ASAP
Lower cardiac workload
Reduce fluid overload
Shift fluids away from the lung
Nitrates
Forrester Classification of AHF
ECG 3
Presentation
62 y.o. male with dyspnea on effort
No known previous disease
Sudden onset of symptom, limiting activity.
BP 140/90 mmHg, HR 42 bpm regular.
Heart Blocks
Especially common in the elderly population
Commonly dismissed as ‘getting old’
ECG 4
Presentation
48 y.o. female with history of breast cancer
Complained breathlessness on activity.
BP: 90/50 mmHg, HR: 120 bpm.
“Swinging Heart”
ECG 5
Presentation
38 y.o. male with history of syncope
Older brother died suddenly from unknown cause
BP: 120/80 mmHg, HR: 56 bpm, Saturation 100%
Long QT Syndrome
Uncommon but frequent cause of Sudden Cardiac Death
Family history is very important
Subtle ECG changes often missed
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ST elevation in V2 – V5
(Anterior wall)
No ST elevation but peaked T waves
(Hyperkalemia)
Hyperkalemia
Can be caused by
◦ Over medication of potassium supplement (ex. K-dur)
◦ Excessive intake of foods (bananas are high in potassium)
◦ Crush syndrome
◦ After pressure/crush is released, the heart is hit with the potassium that
built-up in the poorly perfused crushed area

Too much potassium can lead to critical heart

dysrhythmias; difficult to treat
Other populations at risk
Dialysis patient
Patient in diabetic ketoacidosis
ST elevation in II, III & aVF
(Inferior wall with LBBB)
Watch for hypotension
ST elevation V1-V5, I, aVL (Ant. Extensive)
Watch for heart block