ECG syndromes

Question 1

Wellen’s syndrome - ECG findings (2)

Answer 1

Prominent/deep TWI anterior leads (V1-4)

Twave flattening inferior leads (II, III, aVF)

Question 2

WPW syndrome - ECG findings (2)

Answer 2

short PR interval (<3 small squares)

Delta wave - slurring upstroke of QRS (seen best in rhythm strip)

Question 3

WPW syndrome - Immediate mx

Answer 3

urgent ambo transfer to hospital ED

arrange urgent cardiology review

Question 4

Brugada syndrome - dx criteria
ECG criteria (2 parts)
clinical criteria (5)

Answer 4

coved ST elevation, followed by TWI in leads V1-3
a/w ≥1 of:
documented VF or VT
Syncope
Nocturnal agonal respiration
FHx - SCD <45yrs 
FHx - Coved ST elevation on ECG

Question 5

Brugada syndrome - Mx

Answer 5

urgent t/f via ambulance to ED

10% mortality rate, requires implanted cardio defib device

Question 6

Pericarditis - ECG findings (3)

Answer 6

widespread PR depression (I, II,III, aVF, aVL, V2-V6)
widespread concave ST elevation
reciprocal ST depression - aVR +/-V1

Question 7

Pulmonary embolism - ECG findings

Answer 7

simultaneous TWI inferior and anterior leads (II, III, aVF, V1-4)
(in 99% of cases)

sinus tachycardia (45% cases)

+/- nonspecific ST and T wave changes elevation or depression (50% of cases)

+/- RBBB (‘M’ + ‘W’ = RSR V1-2, wide slurred S wave V6)

SI, QIII, TIII (20% of cases):
Lead I - deep S wave
Lead III - Q wave
Lead III - TWI