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.

ECG MNEUMONICS - rule of 3............

P wave - Maximum ht<= 3 small squares,maximum width <=3 small squares ( lead 2)
PR segment -max 3 small squares
QRS duration- max 3 small squares
QT interval (corrected )- usually < 12 small squares ( multiple of 3)
T wave width - usually less than 3 small squares
T wave ht- usually less than 1/3 - 1/4th QRS voltage
p.s - small square = 40 milliseconds

Implications

p wave - ht > 3 small squares - right atrial enlargement
p wave - width > 3 small squares- left atrial enlargement

PR segment > 3 small squares - AV nodal conduction disturbance - first degree heart block

QRS duration > 3 small squares - intraventicular conduction delay

QT interval (corrected ) - 12 or more small squares - Long QT syndrome

T wave width > 3 small squares..... broad based t waves seen in hypokalemia

Tall T wave - hyperkalemia