Hatim Al Lawati. MD, FRCPC, DABIM(CV), FACC
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1 Hatim Al Lawati. MD, FRCPC, DABIM(CV), FACC Consultant Interventional Cardiology & Structural Heart Disease Department of Medicine Sultan Qaboos University Hospital April 2017
2 Preoperative Assessment Anesthesia is worried about a previous MI! Are you? A. Enter Answer Text
3 Preoperative Assessment Anesthesia is worried about a previous MI! Are you?
4 1. Right ventricular hypertrophy The main abnormality shown on this ECG is 2. Left posterior fascicular block 3. An old (remote) lateral wall infarct 4. Limb lead misplacement 5. Acute pulmonary embolism
5 Einthoven s Triangle
6 I = LA - RA II = LL - RA III = LL - LA
7 Interesting! I just got a pacemaker implanted this past month, but I m still dizzy and keep fainting! I wonder why?
8 The main abnormality shown on this ECG is 1. 3 rd degree atrio-ventricular block 2. Intermittent demand v-pacing with normal pacer function 3. V-paced rhythm with failure to capture 4. V-paced rhythm with failure to sense 5. V-paced rhythm with failure to both capture and sense
9 Pacer spikes seen on the surface ECG, but there is no capture intermittent failure to capture Pacemaker fails to sense (undersenses) and as a result fails to pace when required
10 Preoperative Assessment This time it s a young man admitted for hernia repair. Anesthesia is very worried. What is your next step?
11 1. Dextrocardia The main abnormality shown on this ECG is 2. Left posterior fascicular block 3. An old (remote) lateral wall infarct 4. Limb lead misplacement 5. Acute pulmonary embolism
12 This pattern is consistent with the previous ECG seen showing lead placement error There is R wave regression with nearly absent R wave in V 5 -V 6. This is consistent with dextrocardia.
13 A middle-aged man with heart failure was admitted with nausea, vomiting and seeing yellow halos. He was recently started on a new medication 6 months
14 1. Atrial fibrillation The main abnormality shown on this ECG is 2. Paroxysmal supraventricular tachycardia 3. Atrial tachycardia with 2:1 block 4. Atrial flutter 5. Sinus tachycardia
15
16 Young lady! Anxious, diaphoretic and very dizzy. According to spouse, she fainted earlier at home? Are you worried?
17 1. Polymorphic ventricular tachycardia The main abnormality shown on this ECG is 2. Atrial fibrillation with right bundle branch aberrancy 3. Pacemaker-mediate tachycardia 4. Pre-excited atrial fibrillation 5. Ventricular flutter
18 Highly irregular R-R interval characteristic of AF Wide-QRS complex with a slurred upstroke and a sharp down stroke. The wide upstroke is due to a δ wave Ultra-short R-R cycle length (physiologically impossible to sustain through the AV node and native conduction system)
19 Another dizzy patient who just fainted at home! This time, he s a 89-year-old man. Send him home?
20 1. Right ventricular hypertrophy The main abnormality shown on this ECG is 2. An old (remote) posterior infarct 3. Right bundle branch block 4. Trifascicular block 5. Bifascicular block
21 It must be an epidemic! Another fainter, but this time, she s a middle-aged lady on dialysis who was started recently on Sotalol for symptomatic atrial fibrillation.
22 1. Intermittent sinus pause with ventricular escape rhythm The main abnormality shown on this ECG is 2. Torsades de pointes 3. 3 rd degree atrio-ventricular block with ventricular ectopics 4. Aberrantly conducted nonsustained atrial tachycardia 5. Pre-excited atrial fibrillation
23 markedly prolonged QT interval with an R-on-T phenomenon Long-Short initiation sequence A self-terminating run of polymorphic VT with twisting QRS axis
24 Elderly lady in the emergency room with nausea, vomiting and abdominal pain. The emergency physician was worried about this ECG. Are you worried too?
25 1. Sinus arrest with ventricular escape rhythm The main abnormality shown on this ECG is 2. Atrial fibrillation with complete atrioventricular block 3. Atrial fibrillation with a v-paced rhythm with normal sensing and capture 4. Atrial fibrillation with non-specific intraventricular conduction delay
26 Erratic atrial activity consistent with atrial fibrillation V-paced rhythm at a preset rate of 60/min with normal sensing and capture
27 Elderly lady weak and breathless for days was brought in by son because today she was very dizzy and!!
28 1. 2:1 atrioventricular block The main abnormality shown on this ECG is 2. Sinus bradycardia 3. Intermittent pauses due to nonconducted APB (s) 4. Sinus arrest with intermittent ventricular pacing 5. Sinus rhythm with aberrantly conducted APB (S)
29 Wide complex escape rhythm suggesting a distal (infrahisian) site of block
30 Young man with a strong family history of sudden death presented to the hospital with palpitations and severe fatigue while jogging on the treadmill. What do you see?
31 1. Ventricular bigemini The main abnormality shown on this ECG is 2. Aberrantly conducted atrial bigemini 3. Bi-directional ventricular tachycardia 4. Polymorphic ventricular tachycardia 5. WPW-alternans
32 P-waves marching through independently from the ventricular activity (AV dissociation) Two alternating QRS morphologies, both of ventricular origin
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