ECG quiz ECG Session (JMA)

Dr K Ranjadayalan

Consultant Cardiologist

Newham

04/04/2018

Question No: 1 37 year old male with left sided chest pain. What is the cause of his chest pain ?

Acute Chest pain and ECG:

Clue will be on ST segment /T waves

• ACUTE MI - • ST elevation or ST depression

• T wave inversion (L1, L2, V3 – V6)

Answer No: 1 Acute Pericarditis

“ Saddleback” ST segment elevation in most leads except aVR & V1

Question No: 2 55 year old lady admitted with epigastric pain What is the cause of her epigastric pain ?

Answer No: 2 Inferoposterior MI with Mobitz 1

Question No : 3 2 causes for this patient’s Low BP ?

Answer No :3 1. Inferior STEMI 2. Fast Atrial fibrillation

Question No: 4 This patient developed heart burn while visiting his relative in the hospital What is the cause of his chest pain ?

Answer No: 4 De Winter’s T waves –STEMI

- Is specific for left anterior descending artery (LAD) occlusion

Question No:5 Describe the abnormality

Question No: 6 65 yr old diabetic with LVF What is the likely cause of LVF

Question No : 7 18 year old male with fever, cough, Right sided pleuritic chest pain What is the cause of his chest pain? What is the abnormality on his ECG ?

Answer No : 7 Right sided pleurisy secondary to Pneumonia ECG shows Type 2 Brugada pattern

Type 1 Brugada ECG

Brugada syndrome

Question No : 8 What is the diagnosis ?

Two investigations ?

Question No : 8 NSTEACS Troponin and angiogram

Question No : 9 60 year old male with recurrent chest pain relieved by morphine. Describe the ECG changes? What is the definitive treatment?

Answer No :9 1.In a patient presenting with chest pain, the combination of- Widespread ST depression, ST elevation in aVR ≥ 1mm ST elevation in aVR ≥ V1 is strongly suggestive of left main stem(LMS) occlusion or severe multi-vessel disease. 2. Angiogram with a view to CABG/PCI

Question No : 10 ECG recording (Lead 11 ) of a 75 year old patient with recurrent falls What are the two abnormalities on this rhythm strip ? Diagnosis and treatment ?

Answer No : 10 Paroxysms of junctional tachycardia at around 140 /m Runs of tachycardia interspersed with long sinus pauses (up to 6 seconds) This is a classic example of Sick sinus with the “Tachy-brady” syndrome This patient needs a Pacemaker

SA block

Complete Heart Block

Question No : 11 33 year old lady with chest pain and dizziness What is the cause of chest pain ?

Answer No : 11 SVT (Re-entrant tachycardia -AVNRT)

Question No : 12 65 year old lady with Syncope. What is the cause of her syncope?

Atrial flutter -Typical

Question No : 13 17 year old male with exertional Syncope. What is the cause of his syncope?

Answer No : 13 VT with LBBB morphology – RV origin

Arrhythmogenic right ventricular dysplasia (ARVD) is a rare type

of cardiomyopathy.

It occurs if the muscle tissue in the right ventricle dies and is

replaced with scar tissue.

This disrupts the heart's electrical signals and

causes arrhythmias.

Symptoms include palpitations and fainting after physical activity.

ARVD usually affects teens or young adults. It can cause

sudden cardiac arrest (SCA) in young athletes.

Arrhythmogenic right ventricular dysplasia (ARVD)

Question No : 14 32 year male with recurrent palpitations. What is the underlying cause of his palpitations ?

Answer No : 14 WPW syndrome - 1930 – Louis Wolff, Sir John Parkinson, and Paul Dudley White

Question No: 15 18 year old female with recurrent palpitations Strong F/H of PAF, and Sudden cardiac death. Describe the ECG? Diagnosis ?

Answer No: 15 An extremely short QT interval (QTc -250ms), virtually absent ST segments (the end of the QRS complex merges with the start of the T wave) Very tall, narrow, symmetrically peaked T waves in the precordial leads. Diagnosis - Congenital short QT syndrome (SQTS) --associated with paroxysmal atrial and ventricular fibrillation, syncope and SCD

SQTS - The most common initial presenting symptom is cardiac arrest or fast AF

Question No: 16 30 year old with recurrent syncope. What is the cause of his syncope?

Answer No: 16 Long QT Syndrome

Question No 17 : 56 year old male, H/T with SOB

Answer No 17 ; LVH causing Heart failure - HFPEF

Patient with acute breathlessness Question No : 18 What are the two abnormalities on this ECG ?

Patient with acute breathlessness Answer No : 18 1. RVH with strain 2. Right axis deviation

Question No : 19 A 78 year old man is brought to your emergency department after being found on the floor of his home. His only past medical history is of congestive cardiac failure, and he is unable to remember his medications. Management ?

Answer No : 19 Mobitz Type 2 block – 2:1 Check electrolytes, Troponin PPM

Question No: 20 75 year old male on digoxin for AF, P/C Palpitations. What is the diagnosis?

Digoxin toxicity

Both increased cardiac Automaticity and AV block: Atrial tachycardia Bidirectional VT AF with CHB and AJER

Question No : 21 Bilateral leg swelling Cause ?

Question No : 22 74 yr male.H/o collapse