Transcript Document 7202614

ECG Review
James T. DeVries, MD
6 December 2004
45 yo female 1 week post-op with shortness of breath
The most likely diagnosis is:
1) ST elevation MI
2) Digitalis toxicity
3) Pulmonary embolism
4) Ventricular tachycardia
Findings
• Accelerated junctional
rhythm
• Right axis deviation
• “S1Q3T3” pattern
• Clinical history and
EKG most consistent
with acute PE
67 yo dialysis patient without symptoms
The most likely diagnosis is:
1) Pacemaker malfunction
2) Hyperkalemia
3) Normal EKG for dialysis patient
4) Intermittent LBBB
Findings
• NSR with 1rst degree
AVB
• injury current V1-V2
• Peaked t waves
• Leftward axis
• Findings most c/w
hyperkalemia
49 yo male with chest pain
This EKG demonstrates
1) acute anterior infarction
2) acute inferior/posterior injury without RV involvement
3) acute inferior/posterior injury with RV involvement
4) acute pericarditis
Findings
•
•
•
•
Sinus brady
inferior STEMI
posterior STEMI
V1 ST elevation
• Most consistent with
inferior/posterior STEMI
with RV involvement
77 yo woman with hypertension
This EKG demonstrates
1) atrial flutter with 3:1 conduction
2) left ventricular hypertrophy
3) no abnormalities
4) left anterior fascicular block
Findings
•NSR with 1°AVB
•LVH
•Best answer is LVH
Criteria for LVH
• Sokolow-Lyon
• Sv1+Rv5/v6>3.5mm
• RI+SIII>2.5mm
• Ravl>11mm
• Cornell
• Sv3+Ravl >2.8 (men)
>2.0 (women)
• Romhilt-Estes
• LV strain
3
• LAE
3
• LAD
2
• QRS duration
1
• R v5/v6>3
3
• Sv1/v2>3
3
• Largest R or S>2
3
5 or more points suggests LVH
54 yo female with lung disease and shortness of breath
The rhythm in this EKG is:
1) Ectopic atrial rhythm
2) NSR
3) Atrial bigeminy
4) Atrial flutter with block
Findings
• Ectopic rhythm
• Note PR>110ms
• Inverted p waves
• Best answer: Ectopic
atrial rhythm
22 yo male with lightheadedness and palpitation
In addition to an echocardiogram, this patient will likely require:
1) A permanent pacemaker
2) A heart transplantation
3) A coronary angiogram
4) An ICD
Findings
• NSR with PAC’s
• LVH with repole
• Hypertrophic cardiomyopathy- altered myocyte shape, size,
and alignment, leading to LVH, diastolic dysfunction, and
syncope/sudden death. Frequently require prophylactic ICD
placement when identified.
57 yo female with exercise-induced palpitations
This patient presents to your ER with a BP of 100/60. She recently had a
normal coronary angiogram and echo. The most likely diagnosis is:
1) Aberrant SVT
2) VT
3) Sinus tach with LBBB
4) Artifact
Findings
•
•
•
•
A/V dissociation
LBBB
Rightward axis
Positive QRS
axis inferiorly
• RV outflow tract ventricular tachycardia: typically catacholamine
induced (post-exercise), have characteristic LBBB morphology
with rightward axis and positive QRS vector inferiorly.
25 yo male with systolic murmur
The most likely diagnosis is:
1) Congenital bicuspid aortic valve
2) Severe mitral stenosis
3) Pulmonic stenosis
4) Ebstein’s anomaly
Findings
• RVH
• Rightward axis
• The constellation of right
ventricular enlargement
with rightward axis in a
young patient with a
systolic murmur is most
suggestive of pulmonic
stenosis.
Quick Review
• Right axis deviation
•
•
•
•
•
RVH
COPD
Lateral MI
LPFB
Secundum ASD
• RVH
• R>7mm in V1 or R>10
with RBBB
• Right axis
• S<2 in V1
• qR pattern in V1
32 yo male with palpitations
This ECG demonstrates:
1) Wandering atrial pacemaker
2) Junctional rhythm
3) Delta waves
4) Subtle Epsilon waves
Findings
• NSR with
short PR
• Delta waves
• WPW
45 yo male with palpitations
The LEAST likely rhythm is:
1) AVNRT
2) Atrial flutter with 2:1
3) Multifocal atrial tachycardia
4) Orthodromic atrioventicular tachycardia
Findings
• Narrow complex, regular tachycardia
• No visible p waves
• Multifocal atrial tachycardia requires >3 p wave
morphologies and is slightly irregular
The End