Week 12: Key Medical Terms and Definitions for Understanding Prinzmetal Angina and Related Cardiac Conditions

ST/T wave

- ventricular repolarization

- crucial in identifying warning signs of ischemia and infarction (not the only conditions that cause changes in ST/T)

normal ST

typically isoelectric

normal T wave

upright in all leads except aVR and V1

left bundle branch block

- QRS abnormally wide

- QRS in V1

- appropriate discordance (ST elevation in leads with negative QRS complexes)

left ventricular hypertrophy

- sokolow-lyon criteria

- R wave taller than 11 mm in aVL

- appropriate discordance (ST elevation in V2-V3 most common)

pericarditis

inflammation of the pericardial sac

S/S of pericarditis

pleuritic chest pain, patient sitting up and leaning forward, may have friction rub

characteristics of pericarditis

- widespread concave ST elevation

- ST/T ratio >0.25

- widespread PR depression

- sinus tachycardia

benign early repolarization

- normal EKG variant

- young men, typically under age 50

characteristics of benign early repolarization

- widespread concave ST elevation

- notching or slurring a J point "fishhook"

- tall asymmetric T waves

- no reciprocal ST depression

- ST changes remain constant (STEMIs evolve)

brugada syndrome

- autosomal-dominant sodium channelopathy

- can cause ventricular arrhythmias and sudden cardiac death (estimated 40-60% idiopathic V. fib)

characteristics of brugada syndrome

may be intermittent and revealed by conditions (i.e., fever, ischemia, medications, hypokalemia)

- pseudo RBBB

- coved ST segment elevation >2 mm in right chest leads

- T-wave inversion in right chest leads

diagnosis of brugada syndrome

characteristic EKG changes plus one of the following

- documented V. fib or polymorphic V. tach

- family history of sudden cardiac death under the age of 45 years

- same coved ST morphology in family members

- VT can be induced by electrical stimulation

- syncope

- nocturnal agonal respiration

prinzmetal angina

vasospastic angina caused by coronary artery vasospasm

S/S of prinzmetal angina

- chest pain at rest (often occurs between midnight-early morning and lasts 5-15 minutes)

- drugs and alcohol

- male smokers

characteristics of prinzmetal angina

- widespread ST elevation

- quick resolution of ST elevation

takotsubo

aka "broken heart syndrome;" ballooning shape of the left ventricle due to emotional stress

characteristics of takotsubo

- widespread ST elevation with no reciprocal depression

- reversible Q waves indicative of Purkinje cell death (usually disappear within 30 days)

- T wave inversion

- QT prolongation

hyperkalemia

potassium level >5.5

characteristics of hyperkalemia

- can lead to ST elevation that mimics STEMI

- usually in right chest leads (V1-V3) with tall, pointed T waves

right bundle branch block

- wide QRS

- rSR' morphology in right chest leads (V1-V2)

- ST/T wave discordance (T wave inversion in right chest leads)

right ventricular hypertrophy

- tall R waves followed by ST depression and T wave inversion in V1-V3

- formerly called "strain pattern"

arrhythmogenic right ventricular cardiomyopathy (ARVC)

- fibrotic tissue that can result in ventricular arrhythmias

- 3x more common in men than in women (Greek or Italian)

characteristics of ARVC

- prolonged S-wave upstroke

- epsilon wave: small positive deflection at end of QRS that is similar to a "fishhook"

- inversion of T waves in right chest leads

what is the most specific finding for ARVC?

epsilon wave

elevated ICP

can caused by tumors, infections, intracranial bleeds, etc.

characteristics of elevated ICP

- widespread giant T wave inversions known as "cerebral T waves"

- prolonged QT interval

- bradycardia

Cushing's triad seen in elevated ICP

bradycardia, respiratory depression, and hypertension

what is the most common EKG finding with a pulmonary embolism?

right ventricular strain can cause T wave inversions in right chest leads

digitalis effect

slight sagging/swooping of ST

hypokalemia

potassium level <2.7

characteristics of hypokalemia

- ST depression

- flattened T waves

arrhythmias causing ST depression

- WPW

- SVT

persistent juvenile T waves

- children have asymmetric T wave inversions through right chest leads

- can persist in adults, particularly African-American women under the age of 30