Sharpen Your Calipers and Your ECG Skills - Dr. Littmann

I.      STEMI ECG Pattern in the ICU
        1.     In the ICU setting, 5% of all ECGs show a STEMI pattern
        2.     At least 85% of these patients are found not to have STEMI
        3.     Frequent causes of STEMI ECG in the ICU:
                 a.   Pericardial irritation by chest tube, mediastinal mass, pneumothorax,         
                        hemothorax, hemopericardium
                 b.   Abdominal pathology, acute abdomen, pancreatitis
                 c.   Hyperkalemia, acute renal failure, MSOF, shock
                 d.   Stress-induced cardiomyopathy, septic myocarditis
                 e.   Uncertain
        4.     Evaluation and management:
                 a.   Try to find the underlying cause
                 b.   Stat bedside echocardiogram
                c.   Urgent cardiac catheterization is reasonable in selected cases

II.    The Pacemaker ECG
1.     If the paced QRS is upgoing in lead I: RV apical pacing
         Indication: bradycardia (A-V block or atrial fibrillation with slow ventricular response)

2.     If the paced QRS is downgoing in lead I: biventricular pacing
         Indication: severe systolic heart failure (EF < 35%) and left bundle branch block

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