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Cardiology Wellington > ECG cases > Flashcards

ECG cases Flashcards

1
Q

longstanding progressive SOB with distended neck veins in a smoker

A

RAH - p pulmonale in II,III
RVH - R wave in v1 and S in v5

Likely cor pulminale due to COPD

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2
Q

Chest pain. Territory? What is the ectopic?

A

Anteriolateral infarction (q waves present)

SVE - Has preceeding p wave

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3
Q

74 long term warfarin and worsening of SOBOE. Has loud systolic murmur on exam.
2 things on ECG ?
Diagnosis?

A

AF
LVH with strain

Likely aortic stenosis

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4
Q

chest pain yesterday

A

2:1 AV block
Inferior MI - Q waves

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5
Q

71F Hyperthyroid on carbimazole. AF on digoxin and NOAC. ECG shows?

A

AF
Digitalis effect - with salvador Dali sagging
Downsloping ST depression with a characteristic “reverse tick” or “Salvador Dali sagging” appearance
Flattened, inverted, or biphasic T waves
Shortened QT interval

Here is sagging reverse tick

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6
Q

What drug are they taking

A

Digoxin
Salvador dali ST sagging

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7
Q

Describe the ST segments

A

Reverse tick sign - digoxin

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8
Q

Chest pain yesterday. Now in ED feeling dizzy
Whats on the ECG

A

3rd degree AV block with junctional escape
Inferior infarction- Q Waves and STE as well as reciprocal ST depression v1

[junctional area likely close to bundle of his as QRS complexes normal length]

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9
Q

80F chest pain
Where is lesion? Block?

A

Inferior STEMI
1st degree AV block

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10
Q

56M severe chest pain

A

Anteriolateral ischemia STEMI with reciprocal changes

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11
Q

What type of pacing?
Which type of block do paced rhythms look like?
What if it looked like the other?

A

AV sequential pacing

Look like LBBB
As pacing lead is in Right ventricle -> impulse travels from RV

If looked like RBBB
Concerning as possible pacing lead has eroded through septum and pacing from LV

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12
Q

29m sudden onset Chest pain after cocaine but negative trop. Now entirely resolved

A

Coronary artery vasospasm

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13
Q

Which pacing type? usually due to?

A

Atrial pacing
Sick sinus syndrome

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14
Q

73 SOBOE

A

Atrial Flutter

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15
Q

How fast are most flutter waves?

A

0.2s
300/min usually

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16
Q

25M chest pain with sore throat and pyrexia

A

Pericarditis
Widespread STE saddle

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17
Q

83F collapse. Found at home 11hrs later. What is wrong?

A

Hypothermia
j waves - slight positive delfection of ST segment at j point

AF
Borderline prolonged QT

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18
Q

81F CP

A

Posterior STEMI

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19
Q

24m healthy whats seen

A

Lead misplacement
Appears to show
- RAD
- Upright t waves in aVR
- Negative p and t waves aVL

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20
Q

22m palps prev normal ECG

A

AVNRT
Regular narrow complex rate approx 200

[200 and regular unusual if flutter]

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21
Q

79 SOB which pacing?

A

ventricular

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22
Q

86F SOB dizzy and syncope
MI 2/12 and t2dm

A

3rd degree HB

23
Q

77f presyncope for 1 month

A

2:1 second degree block

24
Q

72f SOBOE and orthopnea
Prev MI with impaired LVEF + essential tremor

A

NSM with tremor in limb leads

25
Q

73M SOB and oedmea
HTN and COPD

A

LVH and RVH

RVH - Dominant R wave v1 and >7mm

26
Q

28m palps

A

Artefact

27
Q

Which operation

A

Heterotopic heart transplant
New heart from donor

[orthotopic - own heard removed
heterotopic - own heart left when donor heart transplanted]

28
Q

83m VVI pacemaker presents with dizziness

A

Pacemaker failing to capture

5 pacing spikes
2 paced QRS (in blue)
3 failed (yellow)

29
Q

What is this ectopic

A

R on T ventricular ectopic

29
Q

63 D&V and abnormal electrolytes.
Now syncope

A

Polymorphic VT

likely secondary to prolonged QT

30
Q

77f haematemesis and melena
What rhythm?

A

Sinus tachy with aberrant conduction

p waves visible in v1/2
LBBB pattern - creates the wide QRS

31
Q

73m syncope

A

SA block

In block the area where the p p interval is constant with 1 or 2 missed beats

In SA arrest the interval will not match a predicted P P interval

Looking at just p waves
Top - Sinus Rythm
Middle - SA block
Bottom Sinus arrest

32
Q

57f SOB following hip operation

A

Sinus tachy

RSR in III and v1.
negative T waves in R sided precordial leads
-> RV strain

= PE

33
Q

57F sudden onset palps

A

AF with ventricular prexcitation

Irregular rythm

34
Q

78m why are the T waves negative

A

NSR
Wide QRS LBBB and notched R in 1

Note LBBB resolves after 1st half ECG

-> Expect TWI following LBBB dissolution

35
Q

56M palps

A

mobitz type 1 with atrial ectopics

[dont mix up the p and the t waves]

36
Q

46F anxious and presyncopal episodes

A

AV dissocation

37
Q

34M routine check up for insurance

A

Short PR
Big R waves v1 and throughout
[no deep S waves in v5/6 so not RBH]

d waves
= WPW

38
Q

77F syncopal episodes

A

RBBB RSR v1
LAD
1st degree AV block

= trifasicular block (but not complete heart block)

39
Q

74F on digoxin nausea and vomiting

A

Atrial tachy (rate approx 190) with a 2::1 AV block

40
Q

76F IHD CP and SOB
ECG demonstrates?

How can you be sure its not SVT with aberrant conduction ?

A

monomorphic VT

Very broad QRS >160ms
Positive complexes V1-6
No LBBB/RBBB
History suggestive
independent p wave activity

41
Q

52m anteriolateral STEMI thrombolysed
Now

A

First half
Idioventricular rhythm
[Often seen post reperfusion]

Then SR

[Idioventricular rhythm starts in your ventricles or lower chambers.
Junctional rhythm begins at the junction of your upper and lower heart chambers.]

42
Q

80m SOB
which rhythm?
Which medication would you be suspicious of?

A

Atrial tachy with variable block

Note inverted p waves in eg v2-v3 and inferior leads
Upright p waves in v1
[Indicates an ectopic focus in the atria (travelling away from inferior leads)]

Digoxin - reverse tick sign in inferiolateral leads.
Atrial tachy with variable block is also a side effect of toxicity

43
Q

58M smoker
Palps and dizziness -> given adenosine

A

Atrial flutter

44
Q

71m asymptomatic

A

p waves precede each QRS (circled blue)

Additonal p waves (circled red) which have no relationship to QRS
-> Ectopic focus firing at different rate to SA node

=Atrial parasystole
[Generally benign condition]

45
Q

24m Dizzy and chest pressure for 6 months ?
What test to identify?

A

RSR and TWI in v1/2

?Brugada / other Sodium chanelopathy
Ajmalin test

-See unmasking of STE in v1-3
Widening of QRS
Note R on T ectopic at start of tracing (worry as may progress to VT)

46
Q

Whats this ectopic

A

AF with Ashman phenomenon

Ashman - aberrant conduction of QRS complex when you have a short RR interval following a long RR interval
-Usually RBBB appearance
-Comes from supraventricular focus

Due to a variability in the refratory period in the ventricular (right bundle) conduction system (following the long RR interval)

47
Q

29m collapse at home

A

Brugada - Type 1

R sided leads
-RBBB morphology
-STE +/-TWI

48
Q

How can you increase sensitivity of brugada ECG? What causes it?
Test if your unsure ?

A

Leads v1/v2 in 2nd rather than 4th intercostal space

Caused by mutation Na channel (SCN5a)
-Autosomal dominant

ajmaline / flecainide challenge - unmasks appearance

49
Q

3 types of brugada on ECG?

A

type 1
-Coved STE with inverted T waves

Type 2
-Saddle shaped STE with positive / biphasic t waves
-Terminal portion of ST segment >1mm raised

type 3
-Saddle shaped STE with positive T waves
-Terminal portion ST segment <1mm raised

50
Q

29m Collapse at home

A

Brugada Type 2
[has >2mm of saddleback shaped ST elevation]

51
Q

29m collapse at home

A

Brugada type 1
-Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave.

52
Q
A
53
Q

Chest pain

A

ST elevation is present throughout the precordial and inferior leads
There are hyperacute T waves, most prominent in V1-3
Q waves are forming in V1-3, as well as leads III and aVF
This pattern is suggestive of occlusion occurring in “type III” or “wraparound” LAD (i.e. one that wraps around the cardiac apex to supply the inferior wall

Cardiology Wellington (9 decks)

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