ECG Cases and Questions. Ashish Sadhu, MD, FHRS, FACC Electrophysiology/Cardiology

Transcription

1 ECG Cases and Questions Ashish Sadhu, MD, FHRS, FACC Electrophysiology/Cardiology

2 32 yo female Life Insurance Physical

3 56 yo male with chest pain

4 Terminology Injury ST elevation Ischemia T wave inversion Infarct Q waves

5 54 yo smoker with new onset CP

6 Wellen s Criteria Progressive symmetrical deep T wave inversion in leads V2 and V3 Slope of inverted T wave generally degrees Little or no cardiac biomarker elevation Discrete or no ST segment elevation No loss of precordial R waves

7 82 yo male with chest pain

8 69 yo male s/p single chamber ICD

9 79 yo diabetic male with sudden onset shortness of breath

10 22 yo female with palpitations

11 Same patient in office during treadmill testing

12 34 yo female with palpitations

13 24 yo with palpitations and near syncope

14 19 yo male from Thailand

15 Brugada Syndrome Commonly associated with loss of function of sodium channel gene SCN5A (Chromosome 3p21) Loss of function mutations lead to loss of AP dome of epicardial areas of RV changes in epicardial/endocardial repolarization increased risk of VT/VF Three different ECG patterns Type I (example ECG on previous page) coved ST elevation with at least 2mm J point elevation with gradually descending ST segment followed by negative T wave Common cause of SCD in young males in southeast asia

16 45 yo female with complaints of cold intolerance and constipation

17 43 yo male preop ECG for hernia surgery

18 Is this an indication for a pacemaker?

19 64 yo male found unconscious Osborne wave (or J wave)

20 Osborn Wave (J wave) Extra positive deflection between terminal portion of the QRS complex and beginning of ST segment Usually positive in the left precordial leads and has an amplitude that is inversely proportional to the body temperature Hypothermia can cause junctional rhythm, AF with slow ventricular response, pround bradycardia, T wave inversions

21 40 yo female with chest pain

22 Question: ST elevation can be seen in pericarditis in all leads except: avf III avr V1

23 81 yo male with complaints of generalized weakness and malaise

24 Questions: CHA2DSVASC criteria? HAS BLED criteria?

25 36 yo female with generalized parasthesias

26 RBBB characteristics

27 73 yo male with pedal edema, DOE, orthopnea

28 LBBB Characteristics

29 68 yo male with COPD

30 Question: Atrial flutter with 2:1 AV block usually results in a ventricular rate of approximately beats per minute

31 65 yo female with hx of ESRD

32 Question: Peaked T waves can occur with: Intracranial bleeding Acute myocardial infarction Left ventricular hypertrophy Early repolarization abnormality Hyperkalemia Left bundle branch block All of above

33 Question: Hyperkalemia can cause all of the following ECG changes except: QRS widening PR prolongation Prominent U wave Left anterior fascicular block

34 Question: Hyperkalemia is associated with all of the following ECG findings except: First degree AVB Left anterior fascicular block Prolonged QT interval Sinus arrest Tall peaked T waves Intraventricular conduction delay (IVCD)

35 73 yo male, SBP 70, diaphoretic

36 True or False: Ventricular tachycardia always manifests a QRS duration > or equal True False to 120ms (0.12 sec)

37 In Setting of Wide QRS Tachycardia, decide whether ECG findings favor VT or SVT ECG Feature QRS morphology similar to PVCs Tachycardia initiated by PACs AV dissociation absent Capture beats present Fusion beats present QRS deflection in precordial leads all positive or negative (concordance) QRS duration during tachycardia > 0.14 with RBBB or > 0.16 with LBBB (assuming QRS narrow in SR) VT or SVT with Aberrancy VT SVT SVT VT VT VT VT

38 89 yo in ambulance with sudden LOC

39 Question: Two most frequent causes of ventricular fibrillation are: Severe aortic stenosis Cardiomyopathy Pulmonary embolism Coronary artery disease Drug induced or congenital long QT

40 21 yo female syncope with loud sounds

41 Question: QT prolongation can be seen in all except: CNS injury Class III AADs Hypercalcemia Myocardial ischemia or injury Tricyclic antidepressants Phenothiazines

42 Question: Drugs commonly associated with proarrhythmia include: Sotalol Flecainide Quinidine Propafenone All of the above

43 Thank You