Samir Morcos Rafla, FESC, FACC
Professor of Cardiology
These ECGs are from Saudi Arabia Conference
2004, I was speaker and chairperson
33 yr old female pregnant 12 weeks not responding to
medications. What to do?
Case 5: 33 yr old female pregnant 12
weeks not responding to medications.
Incessant atrial tachycardia, EF 35%, HR
during sleep 110, awake 150. Given
Flecainide gradually in ICU with BBlockers. Delivered at 29 weeks. The baby
was put in incubator, developed normally
thereafter. Ablation was done, LA focus.
VT 205/min, LBBB with right axis
Remember right ventricular dysplasia
6 months old infant presenting with dilated
cardiomyopathy. The following 15 leads electrogram was
obtained during the evaluation. What is your diagnosis?
Sinus tachycardia, rate 154/min.
Cath. was done
Anomalous left coronary artery
10 year old girl who is asymptomatic and found to have this
Q: What are the ECG findings?
Prolonged QT, 0.50 sec
Note T wave changing morphology
Management: maximum tolerated dose of
beta blockers, stop any causative drugs if
Brugada syndrome. Brother died
ICD is indicated.
Case 32: 14 yr old male, healthy,
complains of tachycardia.
Wide QRS tachycardia with retrograde P,
Junctional ectopic tachycardia, HR 102.
Case 33: DDD pacemaker, biventricular,
34: DDD, bipolar, LV off, atrium and RV
35: RV off.
ECG recordings from leads II, aVF, and V5 in three
patients from families with long QT syndrome
linked to genetic markers on chromosomes 3,7,
and 11. None of the patients were receiving adrenergic blocking medication at the time the
ECGs were obtained. Chromosome 3, 15-year-old
boy (family 1) with a mutation in the cardiac
sodium channel gene SCN5A; the heart rate is 42
beats per minute (bpm), and the QTc in lead II is
570 ms with late-onset T waves of normal duration
Chromosome 7, 21-year-old woman (family 3); the
heart rate is 57 bpm, and the QTc in lead II is 583
ms with low-amplitude T waves.
Chromosome 11, 31-year-old woman (family 6); the
heart rate is 79 bpm, and the QTc in lead II is 573
ms with early onset of broad-based T waves
Case 38: Inf. MI. Bradycardia dependent
block. No pacemaker or EPS are needed.
Case-1 : 14 years old boy, asymptomatic
1- Describe the rhythm 2- What is the treatment?
Case 39: 14 years old boy, asymptomatic.
Accelerated idioventricular rhythm, fusion
beats, focus in RV.
40: Same patient Holter
Note at fast HR, sinus rhythm. At slower
HR, ventricular rhythm.
Management: nothing, benign rhythm.
Same patient Holter - Note at fast HR, sinus rhythm.
At slower HR, ventricular rhythm.
Case 43 : 1 year old girl with cardiomyopathy
What is the most likely diagnosis?
Case 43: 1 year old girl with
SVT 170, AVNRT or atrial tachycardia or
44: Holter same patient: At slower rate, p
waves. Atrial tachycardia leading to
Holter same pt.
At slower rate,
p waves seen.
8 years old boy
Case 46: Neonate with frequent
2:1 conduction. Normal AV node,
isoprenaline was given by mistake,
leading to 1:1 conduction.
Neonate with bradycardia
What is the diagnosis?
What is the underlying etiology?
Case 47: QT 0.6 sec. 2:1. Holter: repeated
Torsades de Pointes.
Management: Pacemaker + B-Blockers.
Case-7 : Neonate with bradycardia
What is the diagnosis? What is the treatment?
Case 48: Neonate with Complete Heart
Block. Narrow QRS, HR 75. Mother has
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