ECG Cardiff and Vale ECG Department Electrocardiogram (ECG) Clinical Skills.
AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM...
Transcript of AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM...
![Page 1: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/1.jpg)
09/10/2014
1
ECG Workshop
Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia
1
ECG Workshop
Objectives:
• Uncommon ECG patterns with high mortality implications
• Common ECG underwriting challenges
• Focus on ECG morphology
2
![Page 2: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/2.jpg)
09/10/2014
2
3
55-
45-
35-
25-
15-
5-
-5-
20 30 40 50 60
The Life Insurance Risk Corridor
Deaths per
1000
500%
Standard
50
Age
Mortality Ratio
0 2 4 6 8 10 12 14 16
180
160
140
1 20
100
80
60
40
20
Major abnormality
Men
Women
Major abnormality
Normal
Normal
Mortality per 1000
YearsMajor ECG Abnormalities and Mortality
![Page 3: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/3.jpg)
09/10/2014
3
0 2 4 6 8 10 12 14 16
140
120
100
80
60
40
20
Minor abnormality
Men
Women
Minor abnormality
Normal
Normal
Years
Mortality/1000
Minor ECG Abnormalities and Mortality
39 year old life insurance medical director
![Page 4: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/4.jpg)
09/10/2014
4
7
Asymptomatic 39 year old male
8
Asymptomatic 51 year old male
![Page 5: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/5.jpg)
09/10/2014
5
49 year old asymptomatic male
9
Asymptomatic 40 year old male
10
![Page 6: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/6.jpg)
09/10/2014
6
38-year old stockbroker – ECG for “age and amount”
Courtesy of Dr. M. Clark
12
ECG from 5 years prior to the application
Courtesy of Dr. M. Clark
![Page 7: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/7.jpg)
09/10/2014
7
13
Normal R wave Progression - Horizontal Vector Loop
14
Anteroseptal Infarction
Horizontal Plane
![Page 8: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/8.jpg)
09/10/2014
8
15
Technical errors recording the chest leads - the P wave in V2
16
![Page 9: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/9.jpg)
09/10/2014
9
17
Changing P-Wave Morphology in Lead V2
Ilg KJ, et al, Am J Med 2012; 125:23.
18
Right ventricular hypertrophy and COPD
![Page 10: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/10.jpg)
09/10/2014
10
55 year old asymptomatic woman who is an ex-smoker
19
20
22 year old professional soccer player
![Page 11: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/11.jpg)
09/10/2014
11
21
62 y.o. woman with long history of mild hypertension
22
Left Ventricular Hypertrophy
![Page 12: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/12.jpg)
09/10/2014
12
51 year old male with 10 year history of well-controlled hypertension
23
24
Left Ventricular Hypertrophy
Horizontal Plane
![Page 13: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/13.jpg)
09/10/2014
13
25 year old asymptomatic male
Brugada ECG PatternsBrugada ECG PatternsBrugada ECG PatternsBrugada ECG Patterns
![Page 14: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/14.jpg)
09/10/2014
14
Diagnostic Criteria for Brugada Diagnostic Criteria for Brugada Diagnostic Criteria for Brugada Diagnostic Criteria for Brugada SyndomeSyndomeSyndomeSyndome
Saddleback Pattern Changes When V1 and V2 Are Moved To The Second and Third Intercostal space (V2IC2 and V2IC3) Overlying the Right
Ventricular Outflow Tract
MeregalliMeregalliMeregalliMeregalli P G et al. P G et al. P G et al. P G et al. CardiovascCardiovascCardiovascCardiovasc Res 2005;67:367Res 2005;67:367Res 2005;67:367Res 2005;67:367----378378378378 28
![Page 15: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/15.jpg)
09/10/2014
15
ECG during flecainide provocation test showing marked increase in ST segment elevation in leads V1–V3.
36 year old asymptomatic male college basketball coach
30
![Page 16: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/16.jpg)
09/10/2014
16
26 year old asymptomatic male
31
32
![Page 17: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/17.jpg)
09/10/2014
17
Normal Precordial ST Segment ElevationNormal Precordial ST Segment ElevationNormal Precordial ST Segment ElevationNormal Precordial ST Segment Elevation
33
Is Early Repolarization Still Benign ?Is Early Repolarization Still Benign ?Is Early Repolarization Still Benign ?Is Early Repolarization Still Benign ?
![Page 18: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/18.jpg)
09/10/2014
18
35
51 y.o. asym. male with diabetes
41 year old asymptomatic female
36
![Page 19: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/19.jpg)
09/10/2014
19
21 year old asymptomatic male
37
38
32 year old asymptomatic female
![Page 20: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/20.jpg)
09/10/2014
20
Prevalence of T wave Inversion Beyond V1 and V2
In ages 19-45
< 4% in women
< 1% in men
In middle-aged subjects 36-50
< 0.7%
Marcus F. Am J Cardiol 2005; 95:1070Aro AL. Circulation 2012; 125:1272
39
25 year old asymptomatic male
40
![Page 21: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/21.jpg)
09/10/2014
21
33 year old asymptomatic female
41
42
Complete Heart Block
![Page 22: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/22.jpg)
09/10/2014
22
24 year old female marathon runner
43
44
![Page 23: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/23.jpg)
09/10/2014
23
Isorhythmic AV Dissociation
45
49 year old asym. physically active male college professor
46
![Page 24: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/24.jpg)
09/10/2014
24
47
2:1 AV Block
48
49 year old asym.physically active male college professor
![Page 25: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/25.jpg)
09/10/2014
25
49
Mobitz Type 1 (Wenckebach) Second Degree AV Block
Mobitz Type 2 Second Degree AV Block
![Page 26: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/26.jpg)
09/10/2014
26
21 year old female with history of seizures
51
52
![Page 27: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/27.jpg)
09/10/2014
27
QTcQTcQTcQTc ScaleScaleScaleScale
T Wave Changes in Long QT SyndromeT Wave Changes in Long QT SyndromeT Wave Changes in Long QT SyndromeT Wave Changes in Long QT Syndrome
54
![Page 28: AAIM14 MacKenzie ECG Workshop · 09/10/2014 1 ECG Workshop Dr. Ross MacKenzie FRCPC FACC 2014 AAIM Annual Meeting – Philadelphia 1 ECG Workshop Objectives: • Uncommon ECG patterns](https://reader034.fdocuments.us/reader034/viewer/2022042106/5e847f54b32bfb26870b3fef/html5/thumbnails/28.jpg)
09/10/2014
28
Sudden Death in DalmatiansSudden Death in DalmatiansSudden Death in DalmatiansSudden Death in Dalmatians
Normal QTNormal QTNormal QTNormal QT Long QTLong QTLong QTLong QT
55
56