DRUG and ELECTROLYTE EFFCET on ECG • Many drug effect and electrolyte disturbances may be diagnosed initially and monitored from an ECG. • The diagnosis should be confirmed by assessing the clinical features, drug history, levels of potassium and calcium and finding the underlying cause, before treatment is initiated. List of Drug Digitalis Antiarrthymic drugs : CLASS IA , CLASS IB & CLASS IC Electrolyte abnormalities : Potassium & Calcium

1. DRUG and ELECTROLYTE
EFFCET
NAME : YUKTA S WANKHEDE
PRN : 17040121108
Programme: BSc. Medical Technology Cardiac Care Technology

2. DRUGS AND ELECTROLYTES EFFECT
• Many drug effect and electrolyte disturbances may be diagnosed initially and
monitored from an ECG.
• The diagnosis should be confirmed by assessing the clinical features, drug history,
levels of potassium and calcium and finding the underlying cause, before
treatment is initiated.

3. List of drug
• Digitalis
• Antiarrthymic drugs
• Electrolyte abnormalities
Potassium
Calcium

4. DIGITALIS
• Digitalis is used to treat congestive heart disease (CHF) and heart rhythm
problems (atrial arrhythmias).
• Digitalis increase blood flow throughout your body and reduce swelling in hands
and ankles.
• Normal serum level of digitalis 2ng/mL , if level of digitalis increases lead to
alternative effect on ECG cause Digitalis Toxicity.

5. ECG CRITERIA
• RATE : Greater than 75bpm
• RHYTHM : Irregular
• AXIS : NAD
• WAVE MORPHOLOGY :
P WAVE : Not clinically significant
QRS COMPLEX: No effect
T WAVE : The amplitude of T wave is diminishes. The initial portion of T wave
is negative but latter portion is mostly positive (thus T wave may appear
biphasic).

6. • SEGMENTS AND INTERVALS ;
1. Depressed ST segment gradually slope downward and look like
‘scooped out’ in leads where the main QRS deflection is positive (in inferior
and lateral leads).
2. Elevated ST segment in leads (V1) where the QRS deflection is negative.
3. Shortened QT interval and flattened inverted T waves.
4. Prolongation of PR interval compared with a per-treatment baseline; the
duration of PR interval often lengthens by 0.04-0.08 sec.

7. Sagging ST segment are the most evident in the lateral leads V4 – V6 and Lead I
and aVL

8. TREATMENT
• Withhold further digoxin
• Potassium replacement therapy (carefully avoid hyperkalaemia)
• Digoxin antibody fragments (digoxin immune Fab )
• Temporary pacing.
• Dipehnylhydantion (for treatment of digitalis- include ventricular dysrhythmias)

9. ANTIARRTHYMIC DRUG
• CLASS IA
• CLASS IB
• CLASS IC

10. CLASS I A DRUGS : QUNIDINE , PROCINAMIDE and DISOPYRADE .
• INDICATION : Supraventricular and ventricular dysrhythmias.
• ECG CRITERIA
RATE : Greater than 150bpm
RHYTHM : Irregular
WAVE MORPHOLOGY : T wave Inversion
U wave Prominence
SEGMENTS AND INTERVALS
Prolongation QT interval (may lead to torsade de pointes)
Widening of QRS complex (associated with toxic drug levels)
ST segment depression

12. CLASS I C DRUGS : PROPAFENONE, ENCAINIDE and FLECAINIDE.
INDICATION : Supraventricular and ventricular dysrhythmias.
• ECG CRITERIA
RATE : Greater than 150bpm
RHYTHM : Irregular
SEGMENTS AND INTERVALS
Prolongation PR interval (may lead to torsade de pointes)
Prolongation of QRS complex and QT interval (associated with toxic drug
levels)
ST segment depression

14. ELECTROLYTE ABNORMILITIES
(POTASSIUM)
• HYPOKALEMIA
Hypokalemia refers to a serum potassium (K+) level less than 3.5mEq/liter.
Etiology :
Alkalosis
Renal tubular acidosis
Insulin effect
Diuretics
Vomiting or nasogastric suction
Burns
Diarrhoea

15. ECG CRITERIA
RATE : 75 – 80 bpm
RHYTHM : Regular
WAVE MORPHOLOGY : Prominent P wave
Decreased amplitude(flattening) of the T wave.
T wave inversion
Prominent U wave (best seen in V1 to V4)
SEGMENT and INTERVALS: Prolonged PR interval
ST segment depression

17. • HYPERKALEMIA
Hyperkalaemia refers to a serum potassium (K+) level greater than 5.1 mEq/liter.
Etiology :
Renal failure
Adrenal insufficiency
Acidosis
Trauma or Ischemia (Myocardial Infraction, Burns, Hemolysis of RBCs)
Potassium Sparing Diuretics

18. ECG CRITERIA
RHYTHM : Irregular
WAVE MORPHOLOGY : 1. Wide and flat P wave
2. Tall symmetrical peaked T wave (V2 – V4)
3. Widening of QRS complex.
4. QRS-T fusion (a sinusoidal waveform is obersved
when elevation of K+ in serum)
5. Prominent U wave (best seen in V1 to V4)
SEGMENT and INTERVALS: Prolonged PR interval
ST segment depression

20. ELECTROLYTE ABNORMILITIES (CALCIUM)
• HYPOCALCAEMIA
Hypocalcaemia refers to ionized calcium (Ca++) level less than 4.5 mEq/liter.
Etiology :
Alkalosis
Hypo-parathyroidism
Renal failure
Acute pericarditis
Malabsorbtion

21. ECG CRITERIA
RATE : Regular
RHYTHM : 75bpm
SEGMENT and INTERVALS: Lengthening of ST segment
Lengthening QT interval

23. • HYPERCALCEMIA
Hypercalcemia refers to a total ionized calcium (Ca++) level greater than
5.3mEq/liter.
Etiology:
Hypo-parathyroidism (especially in the presence of renal failure)
Immobility
Vitamin D intoxication.

24. ECG CRITERIA
RATE : 75-80bpm
RHYTHM : Regular
WAVE MORPHOLOGY : J wave
SEGMENT and INTERVALS: Shortening of ST segment
Shortening of QT interval
The end of the QRS complex from beginning of T wave .

26. HYPOTHERMIA
• Hypothermia is medical condition which occurs when our body loses heat fater
than the normal, causes dangerously low body temperature.
• Hypothermia occurs as the body temperature falls below 30℃ (95℉).
Indications
Shivering
Slurred speech
LOC
Clod skin
Slow and Shallow breathing

27. ECG CRITERIA
RATE : 75-80bpm
RHYTHM : Regular
WAVE MORPHOLOGY : J wave (Osborne Wave )
SEGMENT and INTERVALS: Prolongation of PR,QRS and QT interval
There can be Shivering Artefacts.

29. CASE STUDY
History of present illness:
• A 46-year-old male was brought in by emergency medical services (EMS) after
being found unconscious outside.
• The patient was known to have a history of alcohol abuse and seizure disorder.
• The patient’s vital signs included a rectal Temperature of 26° C, Heart Rate of
108, Blood Pressure of 124/95, Respiratory Rate of 14, and an Oxygen Saturation
of 99% on a non-rebreather mask.
• He was unresponsive to verbal or tactile stimuli.
• The decision was made to intubate the patient and begin active rewarming
measures. As part of his diagnostic evaluation, an EKG was obtained.

30. Osborn waves are usually seen in leads II, III, aVF, and V3 – V6.

31. BIBLIOGRAPHY
• ECG Assessment and Interpretation. – Bandford C. Lipman
• https://liftl.com