More ECGS

Question 1

Chest pain

51yo

Answer 1

Inferior STEMI (early, acute)

Hyperacute (peaked) T waves in II, III and aVF with relative loss of R wave height.

Early ST elevation and Q-wave formation in lead III.

Reciprocal ST depression and T wave inversion in aVL.

ST elevation in lead III > lead II suggests an RCA occlusion; the subtle ST elevation in V4R would be consistent with this.

Question 2

68 yo

heart failure and CRF

on ramipril and spironolactone

Answer 2

Hyperkalaemia

Suspect hyperkalaemia in any patient with a new bradyarrhythmia or AV block, especially patients with renal failure, on haemodialysis or taking any combination of ACE inhibitors, potassium-sparing diuretics and potassium supplements.

Question 3

50 yo. Fatigue, dyspnoea, muscle weakness, constipation, bony pain.

What does the ECG show?

Further tests also show renal impairment, normocytic anaemia and xray shows wedge compression fractures.

Dx?

Answer 3

Hypercalcaemia

Multiple myeloma:

CRAB:

hypreCalcaemia - 13%

Renal impairment 20-40%

Anaemia - 70%

Bony lesions 80% (bone pain 58%)

• Need monoclonal paraprotein in serum

xray shows multiple wedge compression insufficiency fractures