ECG

Question 1

ECG?

Answer 1

Wellens
Tight, critical stenosis of prox LAD
symmetrical deep TWI in anterior precordial leads +/- biphasic TWI

Question 2

ECG? - PP

Answer 2

BRUGADA - look for ugly non convincing STE & TWI in V1-3

Downsloping STE (V1-V3, almost looks like MI) (coved STE w/ **TWI**) 
QRS can be wide like RBBB (M pattern in V1)

SCN5A gene

PP = Avoid Na channel blockers & CCB
Na channel blockers: Lidocaine, Phenytoin, Flecainide (amiodarone, propranolol)

Question 3

ECG?

Answer 3

AVRT (WPW if tachy)

• Accessory pathway present/pre-excitation without WPW
• Delta wave (short PR interval)
• Manifest (can see delta wave) vs concealed (retrograde)
  HR 200-300
• Rx: Flecainide (or DCCV if unstable)

Question 4

ECG?

Answer 4

K channels (type 1 & 2)
Type 1: life threatening arrhythmia while **swimming** (pathognomic) 50%
Type 2: other **exercise / emotion** 40% (QT prolonging drugs)
Na channel (type 3)
SCN5A (type 3): death during sleep/at rest (10%)

AD: 80% +ve genetic test - Types correspond to mutations: LQT1, LQT2, LQT3

ECG: QTc >500 = greatest risk of sx arrythmias
Cross over w/ normal popn (in 450-500 range) - 12 sml squares (>2 lrg)

LQT1 - normal T wave but lengthened
LQT2 - biphasic
LQT3 - late peaking (short)

Question 5

ECG findings of inferior MI & clinical presentation & Rx

Answer 5

• Inferior (II, III) STEMI - RCA (occ LCx) supplies
• Consider: RVMI (50% of inf STEMI)
• MI w/ hypoTN, JVPE w/ CLEAR LUNGS
  (+ bradycardia - S.A node/can be tachy, Kussmauls, TR, N+V)
• Check V1 (partial RV view) ?STE, Reciprocal STD in I + AVL
• R) side (mirrored) ECG - STE in V4R (q waves V3-6R)
• RVMI = preload SENSITIVE
• avoid morphine, GTN, diuretics, Bblockers, ACE
• IVH if no APO
• Dec RV afterload: inotropes, pulm vasodil (Nitric oxide, Prostacycline)
• May need dual chamber temp pacing, do TTE/cMRI etc