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===Digoxin=== | ===Digoxin=== | ||
[[Image:med_digitalis.png|thumb|300px|Typical for digoxin intoxication is the oddly shaped ST-depression]] | [[Image:med_digitalis.png|thumb|300px|Typical for digoxin intoxication is the oddly shaped ST-depression]] | ||
ECG changes typical for digoxin | ECG changes typical for digoxin '''use''' (digoxin = Lanoxin) are: | ||
*Oddly shaped ST-depression | *Oddly shaped ST-depression with 'scooped out' appearance of the ST segment (see figure) | ||
* | *Flat, negative or biphasic T wave | ||
*Short QT interval | *Short QT interval | ||
*Increased u-wave amplitude | *Increased u-wave amplitude | ||
*Prolonged PR-interval | *Prolonged PR-interval | ||
*Sinus bradycardia | |||
ECG changes typical for digoxin '''intoxication''' are: | |||
*Bradyarrhythmias: | *Bradyarrhythmias: | ||
**AV block. Including complete AV block and Wenkebach. | **AV block. Including complete AV block and Wenkebach. | ||
*Tachyarrhythmias: | *Tachyarrhythmias: | ||
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Intoxication can lead to an SA-block or AV-block, sometimes in combination with tachycardia. '''NB''' these effects are increased by hypokalemia. In extreme high concentrations rhythm disturbances (''ventricular tachycardia, ventricular fibrillation, atrial fibrillation'') may develop. | Intoxication can lead to an SA-block or AV-block, sometimes in combination with tachycardia. '''NB''' these effects are increased by hypokalemia. In extreme high concentrations rhythm disturbances (''ventricular tachycardia, ventricular fibrillation, atrial fibrillation'') may develop. | ||
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===Antiarrhythmics=== | ===Antiarrhythmics=== | ||
* '''Anti-arrhythmics:''' These may lead to several ECG-changes; | * '''Anti-arrhythmics:''' These may lead to several ECG-changes; | ||
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Additionally, several arrhthytmias can be seen. | Additionally, several arrhthytmias can be seen. | ||
===Beta blockers=== | ===Beta blockers=== | ||
Beta blocker intoxication can result in bradycardia, hypotension, QRS widening and seizures. In a series of 260 patients with beta blocker intoxication, 41 (15%) developed cardiovascular morbidity and 4 (1.4%) died. Cardioactive coingestant (e.g. calcium channel blockers) was the only factor significantly associated with the development of cardiovascular morbidity. <cite>bb</cite> | [[File:E000542.jpg|thumb|right|ECG of a patient with atenolol intoxication]]Beta blocker intoxication can result in bradycardia, hypotension, QRS widening and seizures. In a series of 260 patients with beta blocker intoxication, 41 (15%) developed cardiovascular morbidity and 4 (1.4%) died. Cardioactive coingestant (e.g. calcium channel blockers) was the only factor significantly associated with the development of cardiovascular morbidity. <cite>bb</cite> | ||
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=== Nortriptyline Intoxication === | === Nortriptyline Intoxication === | ||
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==Hypothermia== | ==Hypothermia== | ||
[[Image:osborne.png|thumb|left|250px| An | [[Image:osborne.png|thumb|left|250px| An Osborn J wave]] | ||
[[Image:Osborn-wave.gif|thumb|left|250px|Osborn wave. 81-year-old black male with BP 80/62 and temperature 89.5 degrees F (31.94 C).]] | |||
<div style="float:right"> | <div style="float:right"> | ||
<gallery> | <gallery> | ||
Image:osborne_ecg.jpg|A 12 lead ECG of a patient with a body temperature of 32 degrees Celsius. Note the sinus bradycardia, the prolonged QT interval (QTc is not prolonged) and the | Image:osborne_ecg.jpg|A 12 lead ECG of a patient with a body temperature of 32 degrees Celsius. Note the sinus bradycardia, the prolonged QT interval (QTc is not prolonged) and the Osborn J wave, most prominently in leads V2-V5 | ||
Image:JJ0001.jpg|An ECG of a patient with a body temperature of 28 degrees Celsius. | Image:JJ0001.jpg|An ECG of a patient with a body temperature of 28 degrees Celsius. | ||
</gallery> | </gallery> | ||
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* Prolonged QTc-interval | * Prolonged QTc-interval | ||
* ST segment elevation (inferior and left precordial leads) | * ST segment elevation (inferior and left precordial leads) | ||
* | * Osborn-waves (slow deflections at the end of the QRS-complex) | ||
{{clr}} | {{clr}} |
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