Electrocardiography and rhythm disorders - Group Teaching

Question 1

On your PCH hospital placement in the you meet Mr A, who has been experiencing “a severe deep burning sensation in his chest on and off. The pain is associated with sweating and is worse when he walks upstairs”.

Mr A has a twelve lead electrocardiogram.

What are the key findings of his ECG shown below (4)?

Answer 1

• Regularly Irregular P waves and QRS Complex - 3rd Degree heart blockage
• Elevated ST Segment (Inferior MI - RCoronary Artery)
• Bradycartic (300/big squares - 8): 37.5 bpm
• Cardiac Axis: 80 degrees

Question 2

On your PCH hospital placement in the you meet Mr A, who has been experiencing “a severe deep burning sensation in his chest on and off. The pain is associated with sweating and is worse when he walks upstairs”.

Mr A has a twelve lead electrocardiogram.

What is the most likely diagnosis?

Answer 2

STEMI caused by obstruction of RCA

Question 3

On your PCH hospital placement in the you meet Mr A, who has been experiencing “a severe deep burning sensation in his chest on and off. The pain is associated with sweating and is worse when he walks upstairs”.

Mr A has a twelve lead electrocardiogram.

The registrar tells you Mr A is being referred for a coronary angiogram.

What findings would you expect to see?

Answer 3

• RCA obstruction (>90%)
• LAD / LCx small obstruction

Question 4

There is another patient in the adjacent bed with chest discomfort. She is called Mrs D. You introduce yourself as a second year medical student. She tells you she has already had an ECG (shown below) and has been told she has heart block. You ask if you can have a look at the ECG because you’re excited to be able to apply some of the wonderful ECG interpretation skills that you’ve developed in Bioregulatory Systems. You go to her notes at the nurses’ station and find the trace.

The registrar comes over and asks you what you think?

Answer 4

2nd degree heart block (Mobitz II)

Question 5

Estimate the cardiac axis (+/- 10^o)

Answer 5

78^o

Question 6

Estimate the cardiac axis (+/- 10^o)

Answer 6

92^o

Question 7

Estimate the cardiac axis (+/- 10^o)

Answer 7

-1^o

Question 8

Estimate the cardiac axis (+/- 10^o)

Answer 8

42^o

Question 9

Estimate the cardiac axis (+/- 10^o)

Answer 9

-2^o

Question 10

Estimate the cardiac axis (+/- 10^o)

Answer 10

5^o

Question 11

Estimate the cardiac axis (+/- 10^o)

Answer 11

-79^o

Question 12

Estimate the cardiac axis (+/- 10^o)

Answer 12

-23^o

Question 13

Estimate the cardiac axis (+/- 10^o)

Answer 13

-24^o

Question 14

Estimate the cardiac axis (+/- 10^o)

Answer 14

-174^o