ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015
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Transcript of ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015
![Page 1: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/1.jpg)
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/
![Page 2: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/2.jpg)
71 Y/O FEMALE WITH CAD
DIAGNOSIS?
![Page 3: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/3.jpg)
DIAGNOSIS?
Afib with PVC and LBBB
PVC
![Page 4: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/4.jpg)
68 Y/O MALE WITH COPD
DIAGNOSIS?
![Page 5: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/5.jpg)
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
![Page 6: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/6.jpg)
49 Y/O MALE WITH PULMONARY EDEMA
DIAGNOSIS?
![Page 7: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/7.jpg)
DIAGNOSIS?
NSR with LVH (R in Lead I >14, R in aVL > 11)
![Page 8: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/8.jpg)
81 Y/O MALE WITH DYSPNEA ON EXERTION
DIAGNOSIS?
![Page 9: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/9.jpg)
DIAGNOSIS?
Aflutter with variable AV blockLBBB
![Page 10: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/10.jpg)
73 Y/O FEMALE WITH GI BLEED
DIAGNOSIS?
![Page 11: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/11.jpg)
DIAGNOSIS?
Coarse Afib
![Page 12: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/12.jpg)
76 Y/O MALE WITH CAD
DIAGNOSIS?
![Page 13: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/13.jpg)
DIAGNOSIS?
NSR with 1st degree AV blockLeft axis deviation
Old inferior infarct (Q waves in II, III, aVF)Possible LAE
![Page 14: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/14.jpg)
51 Y/O FEMALE WITH CHEST PAIN
DIAGNOSIS?
![Page 15: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/15.jpg)
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
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57 Y/O MALE WITH HX OF MI S/P STENTS
DIAGNOSIS?
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DIAGNOSIS?
Sinus Bradycardia (HR 55)Old posterior infarct = Inferior infarct (Q waves
in II, III, aVF) + Tall R waves in V2Prolonged QTc 500ms
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84 Y/O MALE WITH LIGHTHEADEDNESS
DIAGNOSIS?
![Page 19: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/19.jpg)
DIAGNOSIS?
Afib with idioventricular escape rhythm (LBBB pattern)
HR 35
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41 Y/O FEMALE ON ANTIPSYCHOTICS
DIAGNOSIS?
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DIAGNOSIS?
NSR with nonspecific intraventricular blockT wave inversions in V1-V4
Prolonged QTc 646ms
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67 Y/O MALE WITH CHEST DISCOMFORT
DIAGNOSIS?
![Page 23: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/23.jpg)
DIAGNOSIS?
Ventricular pacemaker
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73 Y/O FEMALE WITH CAD
DIAGNOSIS?
![Page 25: ECG P RACTICE C ASES : P ART 4—M ORE P RACTICE C ASES Megan Chan, PGY-1 UHCMC 2015](https://reader038.fdocuments.us/reader038/viewer/2022103102/5697c0081a28abf838cc6ab7/html5/thumbnails/25.jpg)
DIAGNOSIS?
NSR with low voltage QRSOld inferior infarct (Q waves in II, III, aVF)
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80 Y/O FEMALE WITH CAD
DIAGNOSIS?
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DIAGNOSIS?
NSR with Left axis deviationIncomplete RBBB
Inferior & Anterolateral T wave inversions
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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.