[EKG] Arrhythmogenic D/Dx for Syncope

1. Dysrhythmia

2. Ischemia

3. WPW

4. Long-QT

5. Brugada

6. HoCM

7. (Arrhythmic right ventricular displacement)

[EKG] Electrolytes

Hypokalemia

Prolonged QT (Due to U waves)

ST-segment Depression 

Biphasic T-waves (Down then up, unike Wellen’s waves)

PVC’s, ventricular arrhythmias


Hyperkalemia
Tall T-wave
Prolonged PR
P-wave flattening
QRS widening
Sine wave
VF

Hypercalcemia

Short QT

ST-Elevation

STEMI Definition

1. New ST-elevation at the J point in at least 2 contiguous leads of：
(a)  2 mm (0.2 mV) in men in leads V2 –V3 ,or  
(b) 1.5 mm (0.15 mV) in women in leads V2 –V3 ,and/or
(c) 1 mm (0.1mV) in other contiguous chest leads or the limb leads.

2. ST- depression in 2 precordial leads (V1 ~ V4 )

3. Multilead ST-depression with coexistent ST-elevation in lead aVR

4. Hyperacute T-wave changes (? 包含 de-Winter T-wave)

5. LBBB 要用Sgarbossa Criteria來定義 (new-LBBB但不符Sgarbossa Criteria不算)
(a) CONcordance STE > 1 mm            5-points
(b) STD > 1 mm in V1~V3                  3-points
(c) DISCONcordance STE > 5 mm      2-points                > 3-points的Sensitivity有98%


2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction
DOI: 10.1161/CIR.0b013e3182742cf6

常用(被考)又容易忘記的Parameters

1. Blood sugar:
(a) ROSC: 144~180
(b) tPA/stroke: 50~185
(c) Sepsis: < 180

2. Blood pressure:
(a) Ischemic stroke
    (i)   tPA (+): < 185/110
    (ii)  tPA (-):  < 220/120
(b) Hemorrhagic stroke (ICH): < 180/105
(c) SAH: SBP < 160, MAP < 130
(d) Septic shock
    (i)   Sepsis-induced hypotension: SBP < 90 or decrease > 40 or < 2 SD below normal for age, or                                                     MAP < 70
    (ii)   With vasopressor: MAP > 65

3. NIHSS:
美國版 (11項，0~42分，不打tPA：< 4 or > 22)

台灣版，改成：
(a) 13項：[第 5項(左、右手臂之運動)，與第 6 項(左、右腿部之運動)，分別被獨立列為單題所致)]
(b) 0~38分：[第 9 項與第 13 項；英文版之第 7 項 limb ataxia 與第 11 項 extinction and inattention [formerly neglect]) 無反應的病人不評分 (以 0 分計)]
(c)  不打tPA：< 6 or > 25