ECG PRACTICE CASES:PART 4—MORE PRACTICE CASES

Megan Chan, PGY-1

UHCMC 2015

http://thepracticalpsychosomaticist.com/2013/04/01/qtc-interval-prolongation-and-antipsychotics-by-elysha-elson-pharm-d-mph/

71 Y/O FEMALE WITH CAD

DIAGNOSIS?

DIAGNOSIS?

Afib with PVC and LBBB

PVC

68 Y/O MALE WITH COPD

DIAGNOSIS?

DIAGNOSIS?

Multifocal atrial tachycardia(Irregular rhythm w/ varying P wave morphology & PR

intervals)Right axis deviation

RSR’ in V1 suggests RV conduction delayPoor R wave progression

49 Y/O MALE WITH PULMONARY EDEMA

DIAGNOSIS?

DIAGNOSIS?

NSR with LVH (R in Lead I >14, R in aVL > 11)

81 Y/O MALE WITH DYSPNEA ON EXERTION

DIAGNOSIS?

DIAGNOSIS?

Aflutter with variable AV blockLBBB

73 Y/O FEMALE WITH GI BLEED

DIAGNOSIS?

DIAGNOSIS?

Coarse Afib

76 Y/O MALE WITH CAD

DIAGNOSIS?

DIAGNOSIS?

NSR with 1st degree AV blockLeft axis deviation

Old inferior infarct (Q waves in II, III, aVF)Possible LAE

51 Y/O FEMALE WITH CHEST PAIN

DIAGNOSIS?

DIAGNOSIS?

NSR with LVH (R in V6 + S in V2 > 35, R in lead I >14 )

J point elevations in V1 & V2ST depressions in lateral leads aVL, V5, V6

T wave inversions in I & aVLPossible atrial enlargement

57 Y/O MALE WITH HX OF MI S/P STENTS

DIAGNOSIS?

DIAGNOSIS?

Sinus Bradycardia (HR 55)Old posterior infarct = Inferior infarct (Q waves

in II, III, aVF) + Tall R waves in V2Prolonged QTc 500ms

84 Y/O MALE WITH LIGHTHEADEDNESS

DIAGNOSIS?

DIAGNOSIS?

Afib with idioventricular escape rhythm (LBBB pattern)

HR 35

41 Y/O FEMALE ON ANTIPSYCHOTICS

DIAGNOSIS?

DIAGNOSIS?

NSR with nonspecific intraventricular blockT wave inversions in V1-V4

Prolonged QTc 646ms

67 Y/O MALE WITH CHEST DISCOMFORT

DIAGNOSIS?

DIAGNOSIS?

Ventricular pacemaker

73 Y/O FEMALE WITH CAD

DIAGNOSIS?

DIAGNOSIS?

NSR with low voltage QRSOld inferior infarct (Q waves in II, III, aVF)

80 Y/O FEMALE WITH CAD

DIAGNOSIS?

DIAGNOSIS?

NSR with Left axis deviationIncomplete RBBB

Inferior & Anterolateral T wave inversions

REFERNCES

Agabegi SS, Agabegi ED. Step up to Medicine, 3rd ed. 2013. Lippincott Williams & Wilkins. Philadelphia, PA.

Gomella LG, Haist SA. Basic EKG reading. In: Clinician’s Pocket Reference. McGraw-Hill; 2007. http://flylib.com/books/en/2.569.1.27/1/. Accessed Nov 18, 2014.

Longo DL, Fauci AS, Kasper DL, et al. Electrocardiography. In: Harrison’s Principles of Internal Medicine, 18th ed. 2012. McGraw Hill. New York, NY.

University of Illinois at Chicago. Online ICU Guidebook. 2013. http://chicago.medicine.uic.edu/UserFiles/Servers/Server_442934/Image/1.1/residentguides/final/icuguidebook.pdf. Accessed December 1, 2014.