ECG, ACS, Endocrine and Diabetic Emergencies: Clinical Assessment

What does a 12-lead ECG assess?

Electrical activity from multiple anatomical views of the heart.

What is the systematic rhythm approach?

Rate, rhythm, P waves, PR interval, QRS duration, ST segment and T waves.

Which leads view the inferior wall?

II, III and aVF.

Which leads view the lateral wall?

I, aVL, V5 and V6.

Which leads view the septum?

V1 and V2.

Which leads view the anterior wall?

V3 and V4.

What does the PR interval represent?

Conduction from atria through AV node to ventricles.

What does QRS represent?

Ventricular depolarisation.

What does the T wave represent?

Ventricular repolarisation.

What is Einthoven's triangle?

The relationship of limb leads I, II and III.

Why check lead placement?

Misplacement can distort waveforms and mimic pathology.

What are V7-V9 used for?

Additional posterior chest views.

What is V4R used for?

Assessing possible right ventricular involvement.

What are reciprocal changes?

ST depression in leads electrically opposite an area of ST elevation.

What causes most acute coronary syndromes?

Acute reduction in coronary blood flow, often due to plaque disruption and thrombosis.

What is STEMI?

Acute myocardial infarction with a characteristic ST-elevation ECG pattern.

What is NSTEMI?

Myocardial infarction without diagnostic ST elevation; diagnosis requires evidence of myocardial injury.

What is unstable angina?

Myocardial ischaemia without myocardial necrosis.

What does ST elevation in II, III, aVF suggest?

Inferior myocardial injury.

What does ST elevation in V1-V4 suggest?

Septal/anterior myocardial injury, depending on the leads involved.

What does ST elevation in I, aVL, V5-V6 suggest?

Lateral myocardial injury.

What can posterior MI look like in V1-V3?

ST depression with possible tall R waves; posterior leads help assess.

Why assess V4R in inferior STEMI?

To look for right ventricular involvement.

What is PCI?

Percutaneous coronary intervention to restore coronary blood flow.

What is fibrinolysis?

Drug-mediated breakdown of fibrin in a thrombus.

Name ACS mimics from the course.

Pericarditis, pulmonary embolism and electrolyte-related ECG abnormalities; also consider other life-threatening chest pain causes.

How can pericarditis appear on ECG?

Often widespread ST elevation and PR depression; interpret with clinical context.

What is a major concern with pulmonary embolism?

Obstructed pulmonary circulation causing right ventricular strain and possible shock.

What should be prioritised in suspected ACS?

Primary survey, vital signs, 12-lead ECG, serial reassessment and timely appropriate destination/notification; follow current local protocols.

What is hyperthyroidism?

Excess thyroid hormone activity producing an increased metabolic state.

What is thyroid storm?

Life-threatening decompensated thyrotoxicosis with severe systemic manifestations.

What clinical features suggest thyroid storm?

Fever, marked tachycardia, agitation or altered consciousness and possible cardiac failure.

What is hypothyroidism?

Deficiency of thyroid hormone activity with slowed metabolism.

What is myxoedema coma?

Severe decompensated hypothyroidism, often with altered consciousness, hypothermia and bradycardia.

What is adrenal insufficiency?

Inadequate adrenal corticosteroid production or availability.

What is adrenal crisis?

Acute severe cortisol deficiency that may cause hypotension/shock, vomiting, weakness and altered consciousness.

What is a key endocrine assessment principle?

Consider endocrine disease in unexplained abnormal temperature, heart rate, blood pressure, BGL or mental status.

What is type 1 diabetes?

Autoimmune destruction of pancreatic beta cells causing absolute insulin deficiency.

What is type 2 diabetes?

Insulin resistance with progressive relative insulin deficiency.

What is DKA?

Diabetic ketoacidosis: insulin deficiency causing hyperglycaemia, ketone production and metabolic acidosis.

What features suggest DKA?

Dehydration, nausea/vomiting, abdominal pain, Kussmaul breathing and possible fruity breath.

What is HHS?

Hyperosmolar hyperglycaemic state: profound hyperglycaemia and hyperosmolality with severe dehydration and little significant ketoacidosis.

What distinguishes HHS from DKA?

HHS generally has more profound hyperosmolality/dehydration; DKA has significant ketosis and acidosis.

What is Kussmaul breathing?

Deep, laboured breathing compensating for metabolic acidosis.

What is hypoglycaemia?

Abnormally low blood glucose that can cause autonomic and neuroglycopenic symptoms.

What symptoms suggest hypoglycaemia?

Sweating, tremor, confusion, behavioural change, seizures or reduced consciousness.

Why check BGL in altered consciousness?

Hypoglycaemia is an important reversible cause of neurological impairment.

What is alcoholic ketoacidosis?

Ketosis and metabolic acidosis associated with heavy alcohol use and poor intake.

What are major diabetic emergency priorities?

Airway/ventilation, circulation, BGL, hydration assessment, mental status and appropriate escalation according to protocol.

What are key kidney functions?

Fluid and electrolyte balance, acid-base regulation, waste excretion, blood pressure regulation and endocrine functions.

What is GFR?

Glomerular filtration rate: an estimate of kidney filtration function.

What is AKI?

Abrupt reduction in kidney function with accumulation of wastes and disturbances of fluid/electrolyte balance.

What is CKD?

Persistent kidney damage or reduced kidney function over time.

What are prerenal causes of AKI?

Reduced renal perfusion, such as dehydration or shock.

What are postrenal causes of AKI?

Urinary outflow obstruction.

What is renal colic?

Severe intermittent pain associated with movement or obstruction by urinary calculi.

What can suggest pyelonephritis?

Urinary symptoms plus systemic illness, fever and flank pain.

What is acute urinary retention?

Inability to empty the bladder, often due to obstruction or neurological dysfunction.

Why is hyperkalaemia dangerous?

It can impair cardiac conduction and cause life-threatening dysrhythmias.

What ECG changes may occur with hyperkalaemia?

Peaked T waves, PR prolongation, QRS widening and severe conduction abnormalities.

What ECG findings may occur with hypokalaemia?

Flattened T waves, ST depression and prominent U waves.

What are the classic orthostatic hypotension thresholds?

A systolic drop ≥20 mmHg or diastolic drop ≥10 mmHg within 3 minutes of standing.

Why assess fluid status in renal illness?

Both fluid depletion and overload can cause deterioration.

What are the liver's three major functional categories in the lecture?

Synthesis, breakdown and storage.

What blood vessels supply the liver?

Hepatic artery and hepatic portal vein; blood drains via hepatic veins.

What are Kupffer cells?

Resident liver macrophages that clear material from portal blood.

What does the liver store?

Glycogen, certain vitamins and minerals including iron.

Why can liver disease cause bleeding?

Impaired production of clotting factors and other haemostatic disturbances.

What is bilirubin?

A haemoglobin breakdown product processed and excreted through bile.

What is jaundice?

Yellow discolouration associated with elevated bilirubin.

What is cirrhosis?

Advanced chronic hepatic fibrosis with architectural distortion and scarring.

What is portal hypertension?

Elevated pressure in the portal venous system, which can cause varices and ascites.

What is ascites?

Accumulation of fluid in the peritoneal cavity.

What are oesophageal varices?

Dilated veins associated with portal hypertension that may bleed severely.

What is hepatic encephalopathy?

Brain dysfunction associated with liver failure or portosystemic shunting.

What is asterixis?

A flapping tremor associated with metabolic encephalopathy, including hepatic encephalopathy.

What is acute liver failure?

Severe acute liver injury with impaired synthesis and encephalopathy in a patient without established cirrhosis.

What is cholecystitis?

Inflammation of the gallbladder, often associated with gallstones.

What is a major toxin causing liver injury in the lecture?

Paracetamol overdose.

What does RUQ pain suggest in a hepatobiliary context?

Possible liver or gallbladder pathology; correlate with associated symptoms and examination.

What signs suggest chronic liver disease?

Jaundice, ascites, spider naevi, varices, bruising and encephalopathy.

What are the key neurological assessment elements?

Conscious state, GCS, pupils, speech, cranial nerve findings, limb strength/sensation, coordination and BGL.

What is GCS?

Glasgow Coma Scale: eye, verbal and motor responses.

Why is last-known-well time important?

It helps determine time-sensitive stroke assessment and treatment eligibility.

Name reversible AMS causes to consider.

Hypoglycaemia, hypoxia, intoxication, seizures, infection and metabolic derangement.

What is syncope?

Transient loss of consciousness due to temporary global cerebral hypoperfusion with spontaneous recovery.

What is vasovagal syncope?

Reflex-mediated bradycardia and/or vasodilation leading to transient hypotension.

What is cardiac syncope?

Transient cerebral hypoperfusion caused by arrhythmia or structural cardiac disease.

What is orthostatic syncope?

Syncope caused by a fall in blood pressure after standing.

What is POTS?

Postural orthostatic tachycardia syndrome: excessive heart-rate rise on standing with orthostatic symptoms.

Why perform a 12-lead ECG after syncope?

To investigate potentially dangerous cardiac causes.

What is ischaemic stroke?

Sudden focal neurological injury due to interruption of cerebral blood supply.

What is haemorrhagic stroke?

Neurological injury due to bleeding within or around the brain.

What is a TIA?

Transient neurological dysfunction due to focal ischaemia without established acute infarction.

What does FAST assess?

Face droop, Arm weakness, Speech disturbance and Time to act.

What is a posterior circulation stroke concern?

Dizziness, ataxia, visual disturbance and other brainstem/cerebellar signs may occur.

Name common stroke mimics.

Hypoglycaemia, seizures/postictal state, migraine and other neurological/metabolic conditions.

What is a seizure?

A transient event caused by abnormal excessive or synchronous neuronal activity.

What is a focal seizure?

Seizure activity originating within one cerebral hemisphere/network.

What is a generalised tonic-clonic seizure?

Seizure involving bilateral networks with tonic stiffening and clonic jerking.