ECG etc…(Miscellaneous ECGs)

Rey Vivo, MDAssistant Professor of Medicine

Texas Tech University Health Sciences Center

Objectives

• Describe the following miscellaneous ECGs:– Lead reversal– Dextrocardia– Hypothermia– Pericarditis– Cardiac Tamponade– Wolff-Parkinson-White– Pulmonary embolism

• Practice, practice, practice!!!

Limb lead reversal

Inverted P and QRS in lead I

Chest lead reversal

Tall precordial R waves

Normal ECG

Dextrocardia

Negative P and QRS in lead I and aVLReverse R wave progression(differential: lead reversal)

Hypothermia

Osborn or “J” waves (arrows)Baseline interference from shivering

(others: sinus brady, QT prolongation, junctional rhythm,ventricular fibrillation, asystole)

Hypothermia

Pericarditis

Diffuse ST elevationsTypically, no reciprocal changes

PR displacement

Pericarditis

Cardiac Tamponade

Tamponade Triad (specific, not sensitive):1. Sinus tachycardia2. Low voltage QRS

3. Electrical alternans

Wolff-Parkinson-White

WPW Triad:1. Short PR interval

2. Wide QRS3. Delta wave

A. Fib with WPW

Pulmonary Embolism

Clues:Sinus tachycardiaS1Q3T3 pattern

Incomplete RBBB with R precordial T wave inversions

PE

Lets’ practice!

EKG 1

EKG 2

EKG 3

EKG 4

EKG 5

EKG 6

EKG 7

EKG 8

Brugada syndrome• Defined in 1992 by brothers Pedro and Josep

Brugada in J Am Coll Cardiol• Rare condition associated with sudden cardiac death (SCD) or ventricular

fibrillation/polymorphic VT in structurally normal hearts• Mean age of presentation: 35-40 years; male predominance (notably in SE

Asia where it is endemic)• Familial with autosomal dominant inheritance• Clinical presentation: syncope or SCD is most common initial event;

typically occurs in sleep or in early morning• ECG criteria: ST segment elevation in V1-V3 with characteristic RBBB

pattern• Defect in sodium channel gene (SCN5A) on chromosome 3• Lifetime risk of SCD• Consider ICDs; refer for genetic counseling

The End