Wednesday, 11 November 2009

ECG Case study - 009




A 74-Year-old male post MI.

PMH: CABG 10 years ago, TIA 8 years ago, femoral aneurysm and narrowing of vessels both legs.

PLEASE DISCUSS THIS ECG.

This p/t had been c/o of central chest pain for 5 days, then decided to visit is GP, who then immediately called for an ambulance, the p/t was bradycardic, short of breath on excertion, pale/clammy, NO nausea or vomiting, BP 90/46.

ECG Case study - 008



78 year old male, who has been unwell for past few days, seen by his own doctor and prescribed Amoxicillin for a chest infection. Patient was found to be in severe respiratory distress:

Ob's:

HR:144
BP: 94/50
RR: 40, with accessory muscle use.
BM: 6.6
Sp02 80 air 99: after 20 mins 02
GCS: 6

ECG Case study - 007



52 YEAR-OLD MALE WITH CENTRAL CHEST PAIN, NON-RADIATING, EPISODES OF SHORTNESS OF BREATH, NAUSEA, NO VOMITING. PT HAS ATTENDED THE EMERGENCY DEPARTMENT ON NUMEROUS OCCASIONS WITH THE SAME PROBLEM, BUT NOTHING CARDIAC RELATED HAS BEEN FOUND. THE PATIENT ON SCENE WAS TREATED WITH 100% O2 VIA NON REBREATHING MASK, GTN SPRAY, 300MG OF ASPRIN AND ALERTED TO THE EMERGENCY DEPARTMENT.

HEART RATE: 67
BP 137/56
SPO2 100% O2
RR: 18



AMI OR "HIGH TAKE OFF" WHAT DO YOU THINK?

ECG Case study - 006



23 year female presenting with palpitations since age of 20 years, no Hxsyncope.

ECG Case study - 005



What type of AMI are we looking at here ?

ECG Case study - 004





(What type of AMI is this ECG showing)?

ECG Case study - 65 yr old female feeling lightheaded, N & V, Generally unwell for past 2 week




65 yr old female... c/o feeling lightheaded, N & V, Generally unwell for past 2 weeks...

HR: 65
TEMP: 36.7
BP 105/68
SKIN: PALE
BM 15:8
SPO2: 95 (AIR)

Ventricular rate: 65
PR Interval: 225 ms
QRS Duration: 106 ms
QT/QTc 372/450
P-R-T axes 87 - 101 - 65

Please try to interpret this ECG, with possible causes and differential diagnosis...GOOD LUCK!

ECG Case study - 68 year old female




68 year old female... No history is given for this patient, this is just a case of analysis and interpretation exercise of this ECG, build up some clues first and I will add to the interpretation to stay on the right track to examine possible causes.

Please add clues by examining the Rate, Rhythm, complexes and intervals, Axis, Hypertrophy, Ischemia, other possible effects of this ECG???


58 year old female with type1 diabetes


58 year old female with type1 diabetes... Patient has been unwell for 3/7... c/o > S.O.B, also nausea & vomiting.

Resps-22
HR-45
BP-92/49
BM-19.1 (mmol/l)
Skin-Pale/Clammy
SP02-92% (Air)
TEMP: 36.1

PMH: None relevant, ex-smoker 40 per day over 30 year span.

MEDS: Ramipril, Insulin and Asprin 75mg daily. no other meds noted.

*PLEASE GIVE ANALYSIS FOR THIS ECG AND YOUR INTERPRETATION... MANY THANKS!

ECG FEATURES:

Atrial Rate: 100 bpm
Ventricular Rate: 45 bpm

AXIS:

Quadrant: Normal
Degrees: +70 (aVL most isoelectric, slightly negative)

ECG MNEUMONICS.

> ST elevation ELEVATION
Electrolytes, LBBB, Early Repolarization, Ventricular hypertrophy,Aneurysm, Treatment (eg
pericardiocentesis),
 Injury (AMI, contusion), Osborne waves (hypothermia), Non-occlusive
vasospasm (prinzmetal’s)

> Exercise ramp ECG: contraindications RAMP:
Recent MI
Aortic stenosis
MI in the last 7 days
Pulmonary hypertension


  > ECG: T wave inversion causes INVERT:
Ischemia
Normality [esp. young, black]
Ventricular hypertrophy
Ectopic foci [eg calcified plaques]
RBBB, LBBB
Treatments [digoxin]

> EKG: 12 lead EKG quick interpretation of V1-V6 SSAALL:
· Elevations matched with their classic location of MI:
V1 Septal
V2 Septal
V3 Anterior
V4 Anterior
V5 Lateral
V6 Lateral

 > Pericarditis: EKG "PericarditiS":
PR depression in precordial leads.
ST elevation.

> Depressed ST-segment: causes DEPRESSED ST:
Drooping valve (MVP)
Enlargement of LV with strain
Potassium loss (hypokalemia)
Reciprocal ST- depression (in I/W AMI)
Embolism in lungs (pulmonary embolism)
Subendocardial ischemia
Subendocardial infarct
Encephalon haemorrhage (intracranial haemorrhage)
Dilated cardiomyopathy
Shock
Toxicity of digitalis, quinidine

> ECG: left vs. right bundle block "WiLLiaM MaRRoW":
W pattern in V1-V2 and M pattern in V3-V6 is Left bundle block.
M pattern in V1-V2 and W in V3-V6 is Right bundle block.
· Note: consider bundle branch blocks when QRS complex is wide.

 > ST elevation causes in ECG ELEVATION:
Electrolytes
LBBB
Early repolarization
Ventricular hypertrophy
Aneurysm
Treatment (eg pericardiocentesis)
Injury (AMI, contusion)
Osborne waves (hypothermia)
Non-occlusive vasospasm

> Einthoven's Triangle: organization Corners are at RA (right arm),LA (left arm), LL (left leg).
Number of L's at a corner tell how many + signs are at that corner [egLL is ++].
Sum of number of L's of any 2 corners tells the name of the lead [egLL-LA is lead III].
For reference axes, the negative angle hemisphere is on the half of the triangle drawing that has all the negative signspositive anglehemisphere contains only positive signs.

> Dominant R wave in V1 WORD
WPW, Old MI, RBBB, Dextrocardia